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After reinstating or updosing, how long to stabilize?


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HardTimes

@Oriyah4: I'm not a moderator and don't think I'm really equipped to be giving proper advice. Hopefully you've done an "intro page" and some moderator has sent you links to various important things you should read to start (looks like it, since you have a proper signature thing). So again, I'm not a medical doctor, this is just my opinion...

 

But to me you should very likely NOT make any changes so quickly. That much I've learned. Two days of reinstatement isn't even enough time for the drug to really get into your system (5-10 days?). If I'm reading you right 0.6 was actually what you were at several weeks ago, a few steps higher from when you finally went off, but lower than the 2mg you were stable with in October? I think it is good that you are thinking about a reinstatement now (I waited way too long b/c I didn't know what was happening to me), as you don't want to wait too long, but figuring out what dose to go with is challenging. I think you've likely picked the right neighbourhood. Avoid picking too high (as you've read) - you should pick low and then increase (slowly, not after two days) if necessary. The main thing (I think) is to pick and then hold for decent periods (like two weeks or more) and then assess. Rigorously journal if you can. 

 

Also, not to be discouraging at all, but just prepare yourself for some more bad nights and try to accept that if you can. Insomnia is by far my most stubborn symptom, and is shared by almost everybody on this site. I've had some nights of just zero sleep, and my moderator has it even worse than me. I used to complain about waking up at 5 - now I'd give my teeth to be able to sleep unbroken till 5! On the plus side your sleep WILL settle down, but I really don't think it is going to change immediately and forever based on a small change you make today. Read the various insomnia pages and try some of it out (breathing, music, melatonin, masks, etc. etc.) and hopefully a few good nights will come to you. Your body will eventually conk you out to sleep when it really needs to. 

 

Wishing you a better night tonight, and calm acceptance if it doesn't happen - it will eventually. You're on the right track. Hang in there!

15+ years Citalopram 10mg (sometimes 20?)

2019 Citalopram 5mg. No problem reduction.

2020 Citalopram 5mg to zero. (Feb)

2020 (Feb - mid Oct): Very rare use of 0.125 or .25mg Xanax for really bad symptoms

2020 (Feb - Nov): Occasional use of "Nytol" sleep aid (an antihistamine). 

2020 Failed reinstatement: Escitalopram by accident (not Citalopram).  

 -- using a scale, started July 27 0.5mg, doubled every week or so to reach 5mg by Aug 30. Too fast - terrible depression, quit.

2020 (Oct-current): Supplements:

 -- Morning: Magnesium 300mg, Omega 3(483 EPA, 360 DHA +Vit E) Night: Liquid Valerian/Passiflore/Escholtzia - French organic herbal sleep aid, 1.9mg LD Melatonin 

2020 Current - new Citalopram reinstatement. (Accidentally started with Escitalopram before realizing and switching to Citalopram Oct. 30)

 -- using pipette method: Oct 30, 0.25mg; Nov. 4th, 0.375; Dec. 1st 0.5mg, Dec. 21st 0.75mg Jan 19: Decide reinstatement fail: Jan 21 0.625mg, Jan 28: 0.5mg Feb 8 0mg

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Now that its been 19 months since my cold turkey from Effexor, Im about 85% recovered. As you know im now tapering slowly off of Effexor from when I reinstated in my 3rd month of the cold turkey. Ho

The autonomic dysregulation caused by the first withdrawal was only partly corrected by medication. Going back on medication does not guarantee that withdrawal damage will be "fixed."

I think Rhi's answer pretty much nailed it. I've been at this game for years now, and had a range of experiences reinstating/updosing, in the past I've been able to reinstate to full dose after months

@HardTimes: thank you so much for your response and support. I’m on Day 5 of the reinstatement at .6 mg and, as you suggested, it’s hardly helping. With the help of melatonin, I think I’m getting about 4 hours of broken sleep a night. When and how will I know that reinstatement either is or isn’t working? And if it isn’t working, do I just go back to 0 mg and tough it out b/c I have no other choice, or do I increase my dose again, at which point I potentially will still have the same withdrawal symptoms but then will have set myself up for an even LONGER taper for no reason???

  • 7.5 mg Remeron about a year ago (I think February 2020) 
  • Stopped CT in August 2020, I think?
  • Reinstated at about 2.5 mg in September 2020 (liquid taper)
  • Started Buspirone (5 mg 3x day) in November 2020
  • Tapered to 2 mg for October, then dropped to 1.05 for November, and then down by .15 mg once/week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021
  • Stopped in second week of January 2021 and am seeking support -- experiencing extreme insomnia
  • Supplements: 200 mg magnesium, .5 mg melatonin, 2000 mg Vitamin D, Omega 3 (kelp-based)
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HardTimes

Hi @Oriyah4

I'm so sorry you are going through this. It really stinks. I am too - and it is likely as hard as it has ever been for me right now! 

 

I'm really not a moderator here, and I think you can get better advice from others with more experience, if anybody is out there. I don't really know anybody except for @DataGuy, so I'm tagging him here. DataGuy - I have no idea what the moderator protocol is (and I'm sorry to call on you like this), but you're in a better position to know than I am? And also, this should likely all be moved to your Introduction post. 

 

Best advice I can give you (and again, listen to a moderator or someone else too!!!): The goal should be reduction of symptoms, even if it takes longer. You do not want these symptoms growing and ruining your life as they have ruined mine. The mantra of this whole site is very much STABILIZE, then slowly reduce. But determining whether or not a reinstatement is working can be difficult for some (it was extremely difficult for me). IF you are certain that the current dose isn't making things worse, then it might be safe to go UP a bit and see if that helps once you're sure this dose is in your system (maybe 1 more day?). If you have immediate bad symptoms, stop! But you have to give each up-dose time to sink in, as in 4 days to get into your bloodstream properly and maybe a few more to see results (1 week). These drugs are NOT like Tylenol for a headache! The worst thing you can do is go up and down and on and off every few days - insomnia will be the least of your worries!

 

You should likely take the time to read that whole main thread on reinstatement as well if you haven't already done so - the more you know the better your decisions will be. I'm attaching a chart that some kind person took the trouble to make that shows different users' experiences with reinstatement. You'll see that lots of people have had successful reinstatements that helped quite quickly, and maybe you'll see something about your drug and/or timeframe specifically. That's why I wanted to reinstate, as it seems like the fastest path to health, but in my case it doesn't seem to have worked. 

 

Finally: is insomnia your only major symptom right now? I totally sympathize, as it is a real struggle for me (and for almost everybody here). Still, just FYI, while it might really seem like only getting 4 hours is a really bad situation, that is still a very livable amount for a short period (like a month or two). It stinks, for sure, and it might feel pretty grim, but it really won't cause any major long term harm. 

 

Good luck! Courage! Positive attitude! Hang in there!

SADrugReinstatement.xlsx

15+ years Citalopram 10mg (sometimes 20?)

2019 Citalopram 5mg. No problem reduction.

2020 Citalopram 5mg to zero. (Feb)

2020 (Feb - mid Oct): Very rare use of 0.125 or .25mg Xanax for really bad symptoms

2020 (Feb - Nov): Occasional use of "Nytol" sleep aid (an antihistamine). 

2020 Failed reinstatement: Escitalopram by accident (not Citalopram).  

 -- using a scale, started July 27 0.5mg, doubled every week or so to reach 5mg by Aug 30. Too fast - terrible depression, quit.

2020 (Oct-current): Supplements:

 -- Morning: Magnesium 300mg, Omega 3(483 EPA, 360 DHA +Vit E) Night: Liquid Valerian/Passiflore/Escholtzia - French organic herbal sleep aid, 1.9mg LD Melatonin 

2020 Current - new Citalopram reinstatement. (Accidentally started with Escitalopram before realizing and switching to Citalopram Oct. 30)

 -- using pipette method: Oct 30, 0.25mg; Nov. 4th, 0.375; Dec. 1st 0.5mg, Dec. 21st 0.75mg Jan 19: Decide reinstatement fail: Jan 21 0.625mg, Jan 28: 0.5mg Feb 8 0mg

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