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Stabilizing, what does that mean? How long does it take after reinstating or updosing?


John
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I know the difference between Wd symptoms and bad reaction. It is very clear to me since I know my body and they are very different kind of symtoms. Also the bad reaction is immediate akathisia after 1 or 2 hours after the dose of SSRI. I never have had akahisia as WD symptom.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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I understand. It can also be a side effect of the med, which would show at higher doses. I'm not saying it was not a reaction to updosing. I just thought it could be other things too.

 

When that happened to you, I assume you decreased and the reaction resolved. But what about the withdrawal symptoms that you were trying to address with the updose? What happened to those symptoms when you updosed and then decreased again?

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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I didn't have much other WD symptoms than extreme muscle weakness. At one point I couldn't get out house because of the muscle weakness. Mentally I was very emotional and crying and laughing a lot and it felt good to feel again so much. There were some minor other physical symptoms but nothing bigger except that weakness. I was sleeping a lot like 14 hours a day and i was very relaxed, but due to weakness i wanted to try updosing...

 

Updosing made me extremely agitated added insomnia alkathisia and anhedonia and didn't help with muscle weakness at all. It helped when I reduced my dose to previous and akathisia lifted but anhedonia is still there and my sleep is still lighter that before updosing. 

 

Very very slowly muscle weakness has alleviated a lot and now i can walk 1 hour a day.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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I see. So for you updosing led to bad results and some of those bad symptoms have not resolved completely even months later. That scares me :(

 

Was the weakness there at all before you started tapering (and got worse when tapering)?

 

The times when I updosed I had unbearable symptoms like bad anxiety that lasted months, and the updosing helped. But right now the situation is more uncertain.

 

Thanks for sharing your experiences. I appreciate it :)

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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No, before tapering I was in very good shape physically, athletic swimming and jogging.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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  • Moderator

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Final Dose 0.016mg.     Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

 

Brass,

 

If you were stable after a several month hold, can you still benefit from updosing, or is it a bad idea?

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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  • Moderator

If you're stable then why would you want to be updosing?

 

"My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues."

 

If your symptoms are starting to kick up after several months of stability, that would indicate the beginnings of a tolerance issue and the best thing to do would be starting a slow gentle taper. Up dosing would just add fuel to the tolerance issue.  It's counter intuitive but the best way out of tolerance is to decrease.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Final Dose 0.016mg.     Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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If you're stable then why would you want to be updosing?

 

"My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues."

 

If your symptoms are starting to kick up after several months of stability, that would indicate the beginnings of a tolerance issue and the best thing to do would be starting a slow gentle taper. Up dosing would just add fuel to the tolerance issue.  It's counter intuitive but the best way out of tolerance is to decrease.

 

I thought about that, but some of the other moderators don't believe in "tolerance withdrawal". They believe if this is withdrawal, then cutting more will cause more instability.

 

If I don't stabilize within a week or two, I'll try cutting a little. If I get worse then will take it from there.

 

Thanks for the advise!

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

"Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.[67] The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels."

 

So the intensity of serotonin syndrome can vary. I also read that it is impossible to test serotonin syndrome anyway(like take labs) so it only can be pointed out from symptoms(agitation, akathasia, imsomnia ect.). If I understood correctly it all depend from receptors and how sensitive they are. When we start to taper it is impossible to know what kind of changes is happening to our receptors. If we start getting more and more emotions it sounds to me like receptors are waking up and becoming more sensitive  so if you in that condition updose the stimulus can be so much bigger than in previous state where the receptors have been more numbed and you end up on toxic levels of serotonin. 

 

This is what mm100 wrote in an other thread:

 

"it seems to me that the problems may start due to the UPREGULATION of the serotonin receptors after discontinuing the drug, and this is also why taking the drug again will not help as the serotonin system is far too sensitized (upregulated)"

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

"Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.[67] The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels."

 

So the intensity of serotonin syndrome can vary. I also read that it is impossible to test serotonin syndrome anyway(like take labs) so it only can be pointed out from symptoms(agitation, akathasia, imsomnia ect.). If I understood correctly it all depend from receptors and how sensitive they are. When we start to taper it is impossible to know what kind of changes is happening to our receptors. If we start getting more and more emotions it sounds to me like receptors are waking up and becoming more sensitive  so if you in that condition updose the stimulus can be so much bigger than in previous state where the receptors have been more numbed and you end up on toxic levels of serotonin. 

 

This is what mm100 wrote in an other thread:

 

"it seems to me that the problems may start due to the UPREGULATION of the serotonin receptors after discontinuing the drug, and this is also why taking the drug again will not help as the serotonin system is far too sensitized (upregula

 

I didn't know there were different degrees of Serotonin Syndrome. Since Serotonin can't be measured reliably, it is virtually impossible to differentiate an adverse reaction to an updose/reinstatement from mild Serotonin Syndrome, if the symptoms of the reaction mimic Serotonin Syndrome.

 

I don't think one can get Serotonin Syndrome at the low doses we are on when tapering. Even if the receptors are upregulating, if you didn't get Serotonin Syndrome on the full dose before any of your receptors were downregulated, you shouldn't get it at lower doses or with half of your receptors upregulated again.

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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I know that my conclusions are only speculations since no one knows what really is happening in our brains and to our receptors during taper and during withdrawal. I believe that my receptors have changed so much from what they used to be before ten years on SSRI that it is now possible for me to get serotonin toxicity on lower doses. For example in insulin resistance it doesn't matter are the insulin levels normal it only matters are the insulin receptors sensitive enough to insulin. But if the insulin receptors are sensitive then you can get easily poisoning even from a little too high level of insulin. So in a way I think that SSRI can make serotonin resistant (serotonin) receptors and nothing happens even on high doses (except treatment resistant depression eventually).

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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I agree with RFTS from first hand experience about how the body reacts to these drugs after a bad reaction, even I don't know much about the science behind it. I never had problems taking lexapro at high doses until lately My body feels the poison effects of even a tiny drop. The whole situation changed completely. It doesn't matter what we call it, it's very true indeed.

Drug free Sep. 23 2017

2009 Mar.: lexapro 10mg for headache for 2 weeks.

2009-2012: on and off 1/4 to 1/3 of 10mg

2012 June--2013 Jan,: 1/4-1/3 of 10mg generic, bad jaw pain

2013 Jan-Mar: 10 mg generic. severe jaw and head pain;

2013 Mar--Aug. started tapering (liquid ever since) from 10 to 5 (one step) then gradually down to 2.25 mg by July. first ever panic attack, severe head/jaw pain

2013 Aug.: back to 2.75 mg; Nov: back to Brand Lex. 2.75mg -- 3mg,

2014 June: stopped PPI, head pressure/numbness. up-dosed 4.5mg, severe reaction mental symptoms added on

2014 Aug--2015 Aug: Micro taper down to 3.2mg, .025mg (<1%) cut holding 2-3 weeks.

2015 Aug 15th, Accidental one dose of 4.2mg. worsening brain non-functional, swollen head, body, coma like, DR

2016 Feb., started dosing 10am through 11 pm everyday 2/13--3.2mg, 3/15-- 2.9mg, 4/19-- 2.6mg, 6/26--2.2mg, 7/22 --1.9mg, 8/16--1.8mg,8/31--1.7m g, 9/13--1.6mg, 9/27--1.5mg, 10/8--1.4mg, 10/14--1.3mg, 11/1--1.2mg, 11/29--1.1mg, 12/12--1mg, 12/22--0.9mg

2017: 1/7--0.8mg, 1/15--0.7mg, 1/17--0.6mg, 1/20--0.52, 1/21--0.4mg, 1/22--0.26, 1/23--0.2, 2/13--0.13mg, 2/20--0.06mg, 3/18--0.13mg, 6/1--0.12mg, 7/6--0.1mg, 7/14--0.08mg, 8/17--0.04mg, 8/20--0.03mg, 8/28--0.02mg, 9/6--0.0205mg, 9/8--0.02mg, 9/17--0.015mg, 9/20--0.01mg, 9/21--0.0048mg, 9/22--0.0001mg,

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  • 3 weeks later...

You need to let your nervous system stabilize after reinstating. How long this might take depends on how long you've been off the drug and other factors. If you were off only a couple of days, you might stabilize for a month before trying to taper. If you've been off longer, to be safe, you should give your nervous system longer to stabilize, even if symptoms go away right away. If you've been off months, it might take months before you stabilize. Do not attempt to taper again until you feel symptom-free. (Cold turkey off another psych drug simultaneously compounds the situation.)

Hello Alto,

 

Thank you so very much for creating this site.  BTW, I actually grew up in SF and went to Woodrow Wilson High on Mansell, but I think it's closed now.

 

This statement above is such a great and very important piece of information. 

 

I was wondering if you think this post or something paraphrasing it may be appropriate to add to the first page of the Forum on tapering, where reinstatement is discussed in some detail.

 

I personally was pretty frantic when I first got to SA and didn't know my way around and has so much vital information, so I initially just read the Forums and did not see the post above until a few weeks ago.

 

Just my 2 cents,

You all are the best,

 

Most Respectfully and most Sincerely,

Woof

If on a Benzo for a relatively short period of time, such as less than 6-12 months, one may want to consider tapering off their Benzo first (please see Will Hall's book on Harm Reduction)

 

Prior to commencing with an AD taper please consider what problems the AD is causing, as tapering is an extremely serious endeavor.   

If one has been on an AD for more than 10 yrs. please consider the potential long term negative consequences of AD withdrawal prior to tapering. (please see Drs. Healy, Glenmullen and Shipko) 

Prior to re-starting an AD taper, please do not resume tapering until all w/d sx's from any prior taper, especially CT, have resolved. 

 

2004 - Dec. 2015,  Cymbalta 20mg/d  for neck pain - Never had problems with Cymbalta.   Dec 2015, CT 20mg/d Cymbalta.  5 weeks later reinstated 20mg/d Cymbalta - without increase in CT sx's.   

Feb 2016 STARTED VALIUM 25mg/d for CT Cymbalta wd sxs.    Jan-April 2016 Held Cymbalta 20mg/d - doing pretty well (AM 3/10 anxiety and 3/10 tinnitus)

April 2016, CT Cymbalta sx's had not yet resolved and I prematurely tapered 10% q 4 wks x 3 mos.  After 3rd cut developed 10/10 wd sx's of Anxiety, Anhedonia, Anorexia, Panic attacks, dark, incresaed Valium to 28mg/d. 

November 2016, after 3 cuts, UP-DOSED all (41 beads) back up to 20mg (193 beads total) Cymbalta - from , dark to light.

VALIUM TAPER: Jan 2017 28mg to March 2019 Zero   Cymbalta has partially stabilized and helped with the Valium taper.  The only sx I have now is 3/10 Tinnitus, which I only notice when it is quiet.

http://survivingantidepressants.org/index.php?/topic/11900-woof-cymbalta-re-stabilization-after-cold-turkey-withdrawal/  Benzo Posts http://survivingantidepressants.org/index.php?/topic/11951-woof-valium-scheduling-and-dosage-with-cymbalta-wd-symptoms/

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  • 2 months later...

You need to let your nervous system stabilize after reinstating. How long this might take depends on how long you've been off the drug and other factors. If you were off only a couple of days, you might stabilize for a month before trying to taper. If you've been off longer, to be safe, you should give your nervous system longer to stabilize, even if symptoms go away right away. If you've been off months, it might take months before you stabilize. Do not attempt to taper again until you feel symptom-free. (Cold turkey off another psych drug simultaneously compounds the situation.)

If one did not have problems with the AD in the first place.  Tapering off them may not be the best choice for that person.  My situation is admittedly a bit odd in that I just wanted off of all meds, because I thought it was a good thing.

 

Please see my intro below.  Hopefully this can be of some help to someone in a situation like myself. 

 

For over 10 years I never experienced any problems with 20mg/d Cymbalta, It actually helped my sleep.  I wish I never started it for my neck pain, but that is way in the past.  I arrogantly just wanted to get off of all meds.

 

It's been 4 weeks now since I fully updosed to 20mg/d Cymbalta, after 3, 10% cuts.  The first cut was good as my AM anxiety immediately went away, so I thought that tapering was right for me.

 

Now I believe Alto's words above are extremely wise and that the anxiety and insomnia would have resolved, given a few more months at my reinstated dose of 20mg/d; as is empirically evidenced by my current state.

 

I was so scared to updose by 41 beads, but I did have confidence in the 4 doctors I consulted with and they all independently concurred with the action I should take - take the full 20mg pill.

 

One of these MDs is one of the 3 most cited MD's on this site, as well as within the healthcare community. 

 

While 41 beads sounds like a lot, if you look at the exponential activity curve (which these MDs were all well aware of) in combination with my dose and the fact that I had had no problems with Cymbalta in the first place,  I took their advice.

 

With the exception of my 1-3/10 tinnitus all of my sxs have resolved at this point. 

 

All of my sx's just got better and better after I updosed to my original 20mg/d level.

 

After a full year my sleep finally has come back, anxiety is gone, appetite is great, BM's are normal, I can watch sports or anything I want on TV again and Anhedonia is gone :)

 

Unfortunately, now I have to taper off of 25mg/d of Valium which I was maintaining as I was tapering, but at least my mind seems quite a bit more stabilized.

 

I will be tapering slowly off of the Valium after about another month or so of stabilization.

 

Everyone on this site has been wonderful to me and I have learned so very much from all of you, this is without question the best online site. 

 

I just hope that this post may help others. 

 

Warmest Regards,

Woof :)  

If on a Benzo for a relatively short period of time, such as less than 6-12 months, one may want to consider tapering off their Benzo first (please see Will Hall's book on Harm Reduction)

 

Prior to commencing with an AD taper please consider what problems the AD is causing, as tapering is an extremely serious endeavor.   

If one has been on an AD for more than 10 yrs. please consider the potential long term negative consequences of AD withdrawal prior to tapering. (please see Drs. Healy, Glenmullen and Shipko) 

Prior to re-starting an AD taper, please do not resume tapering until all w/d sx's from any prior taper, especially CT, have resolved. 

 

2004 - Dec. 2015,  Cymbalta 20mg/d  for neck pain - Never had problems with Cymbalta.   Dec 2015, CT 20mg/d Cymbalta.  5 weeks later reinstated 20mg/d Cymbalta - without increase in CT sx's.   

Feb 2016 STARTED VALIUM 25mg/d for CT Cymbalta wd sxs.    Jan-April 2016 Held Cymbalta 20mg/d - doing pretty well (AM 3/10 anxiety and 3/10 tinnitus)

April 2016, CT Cymbalta sx's had not yet resolved and I prematurely tapered 10% q 4 wks x 3 mos.  After 3rd cut developed 10/10 wd sx's of Anxiety, Anhedonia, Anorexia, Panic attacks, dark, incresaed Valium to 28mg/d. 

November 2016, after 3 cuts, UP-DOSED all (41 beads) back up to 20mg (193 beads total) Cymbalta - from , dark to light.

VALIUM TAPER: Jan 2017 28mg to March 2019 Zero   Cymbalta has partially stabilized and helped with the Valium taper.  The only sx I have now is 3/10 Tinnitus, which I only notice when it is quiet.

http://survivingantidepressants.org/index.php?/topic/11900-woof-cymbalta-re-stabilization-after-cold-turkey-withdrawal/  Benzo Posts http://survivingantidepressants.org/index.php?/topic/11951-woof-valium-scheduling-and-dosage-with-cymbalta-wd-symptoms/

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  • 5 months later...

Hi is there anyone out there that got relief from horrendous anxiety/panic attacks , depression by up dosing after 2 years of halving a dose, I'm on 37.5 venlafaxine and it's pretty bad ,I'm extremely desperate .

I have to say this but ide triple by dose just for relief ,I can't function at all

Respect PB

Alcohol free since February 2015 

1MG diazepam

4.5MG PROZAC.

 

 

 

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  • ChessieCat changed the title to After reinstating or updosing, how long to stabilize?

Is there a consensus on the time limititations on reinstatement or updosing after destabilization; per others who are also knowledgeable on these issues (eg Dr. Healy)?

If on a Benzo for a relatively short period of time, such as less than 6-12 months, one may want to consider tapering off their Benzo first (please see Will Hall's book on Harm Reduction)

 

Prior to commencing with an AD taper please consider what problems the AD is causing, as tapering is an extremely serious endeavor.   

If one has been on an AD for more than 10 yrs. please consider the potential long term negative consequences of AD withdrawal prior to tapering. (please see Drs. Healy, Glenmullen and Shipko) 

Prior to re-starting an AD taper, please do not resume tapering until all w/d sx's from any prior taper, especially CT, have resolved. 

 

2004 - Dec. 2015,  Cymbalta 20mg/d  for neck pain - Never had problems with Cymbalta.   Dec 2015, CT 20mg/d Cymbalta.  5 weeks later reinstated 20mg/d Cymbalta - without increase in CT sx's.   

Feb 2016 STARTED VALIUM 25mg/d for CT Cymbalta wd sxs.    Jan-April 2016 Held Cymbalta 20mg/d - doing pretty well (AM 3/10 anxiety and 3/10 tinnitus)

April 2016, CT Cymbalta sx's had not yet resolved and I prematurely tapered 10% q 4 wks x 3 mos.  After 3rd cut developed 10/10 wd sx's of Anxiety, Anhedonia, Anorexia, Panic attacks, dark, incresaed Valium to 28mg/d. 

November 2016, after 3 cuts, UP-DOSED all (41 beads) back up to 20mg (193 beads total) Cymbalta - from , dark to light.

VALIUM TAPER: Jan 2017 28mg to March 2019 Zero   Cymbalta has partially stabilized and helped with the Valium taper.  The only sx I have now is 3/10 Tinnitus, which I only notice when it is quiet.

http://survivingantidepressants.org/index.php?/topic/11900-woof-cymbalta-re-stabilization-after-cold-turkey-withdrawal/  Benzo Posts http://survivingantidepressants.org/index.php?/topic/11951-woof-valium-scheduling-and-dosage-with-cymbalta-wd-symptoms/

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14 hours ago, woof said:

Is there a consensus on the time limititations on reinstatement or updosing after destabilization; per others who are also knowledgeable on these issues (eg Dr. Healy)?

Hi Woof, I do not know you'd have to Google your above question and I don't know which Doctor Healy your referring too sorry. All I do know is no one really knows even the drug companies that manufacture these chemicals don't know how these drugs really work its all very sketchy, but personally I would rather take the word of people that have actually been through this experience their than some Doctors 'theory' that's never taken any of these drugs.

 

It was Doctors ''theories'' misdiagnosis from the very beginning before any drugs, then beyond that ruing my life for the last 36 year's . Take Benzos for instance they were actually looking for a new antibiotic but found the side effects, sedation, and many other side effects then packaged Benzos as a cure all for sleep, anxiety, stress, grief, fits etc. But the same drug can actually cause all the stuff its prescribed for and are also now listed as side effects and withdrwal effects on the new ''Patient leaflet' that's suddenly turned up in my latest batch of Diazepam  it look as if the drug companies are trying to cover their arse by now producing a ''warning'' about a LOT more ''side effects and withdrawal symptoms than they have for many year's previously

36 yrs on  BENZOS + poly drugs I was not aware  that all the ''illnesses'' I was getting misdiagnosed with  was withdrawal. I ended up ploy drugged for this reason Various Opiates, Olanzapine, amitriptyline, cipramil, trazadone tramadol   Librium Oxazepam Ativan Clomazepine Temazepam  40mg at night zimovane nitrazepam Diazepam. CT,d or rapid tapered most of  the above by force  was on 20mg of Diaz CT 10mg by force to 10mg

 

Have been trying ot get off   trying to get off the last of the  Diazepam   which I've been on for approx about 18 years since October 2014 where I'd cut to 6+1/2mg , after being steered to the Ashton manual  told that was the ''correct way to taper' not the way I had been doing all along. I got scared by the 'You have to be to heal'' mantra that goes around, but now know, too late for me unfortunately, its not true.

 

 

 

And unfortunately it was too fast a cutting rate with way too short holds and messed me up even worse. I went from  stable with the occasional very easily managed blip  to totally destabilised and disabled and house bound rapidly.

 

And horrible crippling symptoms I never had before, and my ears got hit badly along with crippling pain I have severe hyperacusis and tenacious tinnitus along with ear pain and other ear problems, and my mental realm got seriously smashed to bits too.I up-dosed by 1+1/2mg the first time November  2016 back to 5mg, as I've been stuck at 3+1/2 mg unable to barely taper for 18 months while holding for weeks, then 6 months but was still unstable.

 

Then held the 5mg for nearly 4 months but still no improvement so up-dosed by another 1/2mg February 22nd 2017 putting me at 5.1/2mg  and held  just over 10 weeks 4  days  up till now .8/5/17 Its the only drug I take now, I don't and can't  take no supplements/painkillers  or any thing else as I'm too sensitive due to withdrawal.

 

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  • 2 months later...
  • Administrator

Slightly better is going in the right direction.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • ChessieCat changed the title to Stabilizing - what does that mean?
  • 2 months later...

A lot of the problem of withdrawal and reinstatement is not knowing what's causing what. 

Now I've reinstated Sertraline after 7 months without taking it. It seems that reinstatement doesn't simply alleviate the withdrawal, but that there are onset effects of the medication (as in the first time taking it) that settle down after some time interval. 

The issue is that it's very hard to work out if symptoms are from withdrawal, or reinstatement or even underlying anxiety. And further, it's hard to work out whether a period of destabilisation is a necessary evil to get used to the reinstatement dose, or if the instability is evidence of dosing too high. 

I know that initially SSRIs build up in your blood stream, then later, neurological changes in brain function/metabolism start happening. It seems rational that this all takes time, weeks perhaps. But with ongoing effects, I find myself not knowing whether to hold steady, go down, or go up.

I'm wondering, is there an approximate amount of time that experience here has learned to wait before assessing the effects of a new dosage level?

Would be great if any mods could comment too. 

  • 2008: Started Citalopram 30mg
  • Sept 2014: Tapered down Citalopram over 6 months and discontinued Feb 2015
  • Severe withdrawals peaked in July/Aug 2015. Totally housebound.
  • Sept 2015: Sertraline started @ 100mg on GP advice.
  • Oct to Dec 2015: Reduced to Sertraline 50mg due to side effects. 
  • Jan 2016 to March 2017: Tapered Sertraline to 2mg @ 10% per month. 
  • Severe withdrawals peaked again June 2017. Totally housebound. 
  • Diazepam: July 2017 5mg // Aug 2017 2.5mg // Sept 2017 1mg // 12th Dec 2017 0.85mg 
  • Sertraline Reinstatement: 23 Oct 2017 5mg // 15 Nov 2017 10mg // 23 Nov 2017 15mg 
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I have a question. Is it everyone’s belief that antidepressants don’t help mood? I was on Effexor for many years. I was only onnotizac for 10 days. I just started prozac again st less than O.5 mg. If I take this for awhile snd then taper my mood will improve? How can my mood improve without the antidepressants. Will I end up experiencing emotion again? Be s whole person again? My current depression has robbed me of my humanity. Emotions. I feel like I had s lobotomy. 

 

2001 Remeron , Celexa, prozac a week on lithium. 

2014 went off effexor and trazadone in 3 weeks. 

2014 zoloft (hyper reaction) put on effexor 75 mg. Was stable until 2017 

2017  Trazadone 50 mg (June) Effexor to 113 mg (2 weeks) Effexor 150 mg for a month . Took 75 mg until November. . Lithium 10 days, Lamactil 10 day  aug-nov15 ativan

October : Prozac bridge to get off 75 mg of effexor Used 10 mg of prozac. Stopped prozac 3 wk 

Dec 6, 7 Upped trazadone from 50 to 100 mg Did it for 3 days Stopped it

Dec 7 , Dec 8 Took prozac again 0.1 , 0.1, 0.6 stopped it

Dec 11 and Dec 12 upped it to 100 again

Dec 15 , 16,17 went back to 50 mg of trazadone

December 18 Began 3 beads of effexor  Dec 25 began 5 beads of effexor take 10 mg of omneprazole daily

 

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I posted a question here: 

 

But I realised it probably belongs in this thread: 
 

A lot of the problem of withdrawal and reinstatement is not knowing what's causing what. 

Now I've reinstated Sertraline after 7 months without taking it. It seems that reinstatement doesn't simply alleviate the withdrawal, but that there are onset effects of the medication (as in the first time taking it) that settle down after some time interval. 

The issue is that it's very hard to work out if symptoms are from withdrawal, or reinstatement or even underlying anxiety. And further, it's hard to work out whether a period of destabilisation is a necessary evil to get used to the reinstatement dose, or if the instability is evidence of dosing too high. 

I know that initially SSRIs build up in your blood stream, then later, neurological changes in brain function/metabolism start happening. It seems rational that this all takes time, weeks perhaps. But with ongoing effects, I find myself not knowing whether to hold steady, go down, or go up.

I'm wondering, are there any guidelines for an approximate time to wait before assessing the effects of a new dosage level?

Would be great if any mods could comment too. 

  • 2008: Started Citalopram 30mg
  • Sept 2014: Tapered down Citalopram over 6 months and discontinued Feb 2015
  • Severe withdrawals peaked in July/Aug 2015. Totally housebound.
  • Sept 2015: Sertraline started @ 100mg on GP advice.
  • Oct to Dec 2015: Reduced to Sertraline 50mg due to side effects. 
  • Jan 2016 to March 2017: Tapered Sertraline to 2mg @ 10% per month. 
  • Severe withdrawals peaked again June 2017. Totally housebound. 
  • Diazepam: July 2017 5mg // Aug 2017 2.5mg // Sept 2017 1mg // 12th Dec 2017 0.85mg 
  • Sertraline Reinstatement: 23 Oct 2017 5mg // 15 Nov 2017 10mg // 23 Nov 2017 15mg 
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  • Moderator

JamesF,

 

You may already be familiar with these links:

 

After Reinstating or Updosing, How Long To Stabilize?

Stabilizing after a reduction -- what does that mean?

 

In one of the posts on reinstating, Alto said if you've been off for several months, it could take several months to stabilize.  It took me around four months to stabilize after an updose of Imipramine after about six weeks at a lower dose.  As with so much of WD, it's all individual.  

 

Here is Brassmonkey's definition of stabilization: "Stability is not the absence of WD symptoms, but rather a steady state of feeling crappy without any major swings either direction."

 

I know your question is not so much about stabilizing as ascertaining what's causing what.  Unfortunately, sometimes that just can't be figured out.

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg to 1.875mg 1986-2020, two CT's and reinstatements

Nov. 2020, 7-week Ativan-Valium crossover to 18.75mg Valium

Feb. 2021, begin 10%/4 week taper.   

March 22, 2022: hold at 4.8mg and shift to Imipramine taper

Aug. 5, 2022: shift to Valium taper.  

Current dose as of Aug. 5, 2022: 4.3mg

Taper is 77% complete.

 

Imipramine 75 mg daily since 1986.  Jan-Sept 2016 tapered to 16mg.  

Held until Aug 2021, tapered for 4 weeks to 14.4mg

March 22, 2022: Begin 10%/4 week taper.  Current dose as of Aug. 5: 9.5mg 

Aug. 5, 2022: hold at 9.5 and shift to Valium taper

Taper is 87% complete.  

  

Supplements: omega-3, vitamins C, E and D3, magnesium glycinate, probiotic, zinc, melatonin .3mg


I am not a medical professional and this is not medical advice but simply information based on my own experience, as well as other members who have survived these drugs.

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  • Administrator

You will stabilize when you stabilize. It will take at least a few months. Please let us know how you're doing in your Introductions topic.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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On 12/7/2017 at 8:30 AM, Downbutnotout said:

I have a question. Is it everyone’s belief that antidepressants don’t help mood? I was on Effexor for many years. I was only onnotizac for 10 days. I just started prozac again st less than O.5 mg. If I take this for awhile snd then taper my mood will improve? How can my mood improve without the antidepressants. Will I end up experiencing emotion again? Be s whole person again? My current depression has robbed me of my humanity. Emotions. I feel like I had s lobotomy. 

 

Antidepressants can improve mood, but long term use comes at a cost (many risks with long term use, including physical dependence and possibly increased vulnerability to depression). They often suppress healthy and good emotion along with "bad" (unpleasant) emotion, leaving you numb or apathetic or both. In some people they worsen depression from the start (an adverse reaction).

 

If you take Prozac for a while at 0.5mg, will your mood improve? It depends. Do you have depression or are you in withdrawal? At 0.5mg, Prozac will do nothing for depression, but might help withdrawal depression, depending on how long you've been in withdrawal and how your body responds to different medications.

 

What you're calling depression (the "lobotomy") sounds like the side effects of long term antidepressant use I described in the first paragraph. Unless this started after a major stressor in your life, it's likely drug-induced. If thats the case, adding more antidepressants will only make it worse. Check the topic on Anhedonia in this forum to understand better. You need to be abstinent of all psych meds for a few years and work with a therapist to help your brain heal. 

 

Anhedonia is my worst symptom, so I can relate. It's taking years to heal and I'm still tapering excruciatingly slow (both Proza and Effexor). Therapy is helping me with skills to rewire my brain faster, but it still takes a long time.

 

I wish you well. PM me if you want to chat :)

 

 

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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On 12/7/2017 at 9:15 AM, JamesF said:

I posted a question here: 

 

 

 

Hi JamesF,

 

You ask very good questions, but I'm afraid it's impossible to know. If you feel worse after reinstating, perhaps you reinstated too high a dose? It's always best to start super low and increase gradually, if lower dose doesn't work. After 7 months being off, it's very hard to predict how much you will stabilize and how fast. It took me 9 months to stabilize after a 7% cut.  It depends on how unstable you were and on your body. Stress can also prolong the time it takes to stabilize too, in my experience-so try to decrease your stressors as much as you can.

 

If you feel worse than you did before reinstating, I personally would cut the dose. Once you find a dose that is not making you worse, you can stay there or increase much more gradually, keeping in mind it can take many months to stabilize. It can take many months or longer to stabilize from protracted withdrawal with no reinstatement as well. So you're basically waiting for your brain to heal, hoping to shorten the time with reinstatement, but not knowing how long it will take or how effective it will be.  

 

I sure hope you stabilize soon!

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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  • 4 weeks later...

I've seen a few people post on this issue when new to tapering protocols and trying to figure out how to get well. I thought it might be a good idea to make a thread.

 

Many of us coming here have been bounced around by different doses and medications, and don't know what a stabilising dose might be. Are we in withdrawal or are we feeling symptoms induced by a dose increase or new drug? Will a hold at where we are actually give us any stability? Maybe on joining this forum we have been on the same dose for a while and feel no stability.

 

Myself, I have akathisia, in windows and waves. I don't know of anyone that stabilizes on akathisia, that is they hold their dose and see it stop or lessen significantly.

 

Healing to all.

Current daily meds. Citalopram 2.5mg morning. Diazapam 1.5mg evening, Propanalol 40mg split 4x10mg throughout day.

 

Recent meds. Fluoxetine 20mg began 24th Nov 2017, CT on 4th December on medical advice due to bad Akathisia. Citalopram 10mg began on 13th Dec 2017, tapered to 2.5mg by 20th Dec 2017 on medical advice. Diazapam 2mg began on 6th Dec 2017 cut to 1.5 mg on 26th Dec. Propanalol 40mg began on 13th Dec. Zopiclone 3.75 mg began 13th December, used maybe 5 times then quit.

 

Previous history. Tricyclics, Fluoxetine or Citalopram for periods of 6mo to 2yrs over last 25 years. Probably 5 yrs in total. No significant ill effects.

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Thanks Kesh

after holding for 5 mo without a true window, I decided to cut my lexapro from 5 to 4.8 mg. I had a couple days where I thought this might be the right decision. 

Now, the akathasia is going full bore. And every symptom I’ve ever had is ramped up along with new ones. One of which is tinnitus. 

 

Did i I not hold long enough? Do I go back to 5 mg or wait it out? 

Am I ever going to stabilize? Or am I doomed to this hell forever?

Lex  4.3mg,  3/2/18  Ativan ,5 mg,  lunesta 2 mg , toprol  25 mg                                                            

 

Oct 16-28 2018 C/O to 19 mg V from 1.5 mg Ativan, 1.3 mg lunesta 

jan 22 2019- 11 mg V

jan 23 - pneumonia, 2 AB’s. 

    Hold taper

july 5- 10.72 V

July 6- 11 mg V- ugly bad

july 11- 10.72 mg V, 4.3 lex, 

              25 mg toprol

 

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I'd love some answers to all this.

Current daily meds. Citalopram 2.5mg morning. Diazapam 1.5mg evening, Propanalol 40mg split 4x10mg throughout day.

 

Recent meds. Fluoxetine 20mg began 24th Nov 2017, CT on 4th December on medical advice due to bad Akathisia. Citalopram 10mg began on 13th Dec 2017, tapered to 2.5mg by 20th Dec 2017 on medical advice. Diazapam 2mg began on 6th Dec 2017 cut to 1.5 mg on 26th Dec. Propanalol 40mg began on 13th Dec. Zopiclone 3.75 mg began 13th December, used maybe 5 times then quit.

 

Previous history. Tricyclics, Fluoxetine or Citalopram for periods of 6mo to 2yrs over last 25 years. Probably 5 yrs in total. No significant ill effects.

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I'm sorry , I don't know why my post ended up here . I'll repost . But I'm also interested In This question of stabilizing too ! 

Maresat 🌺

Feb 2015 - 1 st Xanax for anxiety 1/8th mg X prn 2.5 mg ambien night 6- 900 Gabapentin RLS (GPn15 yrs) 2015 - CT steroids Sept 2015- started daily benzos , Xanax 1/8-1/4 mg and Ativan .5 mg after life trauma/900 gabapentin nightly
Dec 2015- klonopin for panic. Dropped Ativan and ambien ,.125-.25 mg Xanax plus .25 to .5 mg Klonopin /Jan 2016- dropped Xanax , WD hell! Feb 2016- wanted off klonopin,Mar 16 to May'16- crossed to 10 mg Valium from.375 mg k /March17-390 GPN June -360 GPN - 8mg V,  june 7.93 mgs V stability gone ,very sick /9/6/17- cross to .40 K in one day - WDs /K better than V / VERY unstable /using dry pills and scale to measure doses . 9/20 -1mgV/.35K. 9/24 -2 mgs V/ .30 K

gabapentin-360 mgs night 

 

 

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On 1/6/2018 at 5:17 AM, kesh said:

I've seen a few people post on this issue when new to tapering protocols and trying to figure out how to get well. I thought it might be a good idea to make a thread.

 

Many of us coming here have been bounced around by different doses and medications, and don't know what a stabilising dose might be. Are we in withdrawal or are we feeling symptoms induced by a dose increase or new drug? Will a hold at where we are actually give us any stability? Maybe on joining this forum we have been on the same dose for a while and feel no stability.

 

Myself, I have akathisia, in windows and waves. I don't know of anyone that stabilizes on akathisia, that is they hold their dose and see it stop or lessen significantly.

 

Healing to all.

 

There is no answer to this question -- it depends on individual circumstances.

 

For example, kesh, you are just starting to manage your own situation in the context of a naturally pessimistic outlook.

 

Is it too soon to say you'll never get stable? Why anguish over something that may never happen? Is this good for you?

 

If you are in a difficult spot with drugs, is it constructive to think it will last forever? As we can see over and over, many members here, even those who frequently post with  incessant irrational worries, get better, much to their surprise. They put energy into enhancing all that suffering for nothing.

 

In the converse, if you knew you were going to have to contend with symptoms of a chronic disease for the rest of your life, what would you do? This is a real test of character. Can you rise to dealing with that reality? Or would you sink into self-pity?

 

The one question I get most often is "When will I recover?" If I was able to answer that question, I'd use my prognostication abilities to do something a lot bigger than this Web site.

 

If anyone can do this, please get in touch with me!

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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8 minutes ago, Altostrata said:

 

There is no answer to this question -- it depends on individual circumstances.

 

For example, kesh, you are just starting to manage your own situation in the context of a naturally pessimistic outlook.

 

Is it too soon to say you'll never get stable? Why anguish over something that may never happen? Is this good for you?

 

If you are in a difficult spot with drugs, is it constructive to think it will last forever? As we can see over and over, many members here, even those who frequently post with  incessant irrational worries, get better, much to their surprise. They put energy into enhancing all that suffering for nothing.

 

In the converse, if you knew you were going to have to contend with symptoms of a chronic disease for the rest of your life, what would you do? This is a real test of character. Can you rise to dealing with that reality? Or would you sink into self-pity?

 

The one question I get most often is "When will I recover?" If I was able to answer that question, I'd use my prognostication abilities to do something a lot bigger than this Web site.

 

If anyone can do this, please get in touch with me!

I know I am like this too. I don’t want to be. How can I stop thinking like this.? 

 

2001 Remeron , Celexa, prozac a week on lithium. 

2014 went off effexor and trazadone in 3 weeks. 

2014 zoloft (hyper reaction) put on effexor 75 mg. Was stable until 2017 

2017  Trazadone 50 mg (June) Effexor to 113 mg (2 weeks) Effexor 150 mg for a month . Took 75 mg until November. . Lithium 10 days, Lamactil 10 day  aug-nov15 ativan

October : Prozac bridge to get off 75 mg of effexor Used 10 mg of prozac. Stopped prozac 3 wk 

Dec 6, 7 Upped trazadone from 50 to 100 mg Did it for 3 days Stopped it

Dec 7 , Dec 8 Took prozac again 0.1 , 0.1, 0.6 stopped it

Dec 11 and Dec 12 upped it to 100 again

Dec 15 , 16,17 went back to 50 mg of trazadone

December 18 Began 3 beads of effexor  Dec 25 began 5 beads of effexor take 10 mg of omneprazole daily

 

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4 minutes ago, Downbutnotout said:

I know I am like this too. I don’t want to be. How can I stop thinking like this.? 

 

We have discussed this extensively in your Intro topic.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Just now, Altostrata said:

 

We have discussed this extensively in your Intro topic.

Okay, I’ll look back on it. I’m sorry I bothered you. 

 

2001 Remeron , Celexa, prozac a week on lithium. 

2014 went off effexor and trazadone in 3 weeks. 

2014 zoloft (hyper reaction) put on effexor 75 mg. Was stable until 2017 

2017  Trazadone 50 mg (June) Effexor to 113 mg (2 weeks) Effexor 150 mg for a month . Took 75 mg until November. . Lithium 10 days, Lamactil 10 day  aug-nov15 ativan

October : Prozac bridge to get off 75 mg of effexor Used 10 mg of prozac. Stopped prozac 3 wk 

Dec 6, 7 Upped trazadone from 50 to 100 mg Did it for 3 days Stopped it

Dec 7 , Dec 8 Took prozac again 0.1 , 0.1, 0.6 stopped it

Dec 11 and Dec 12 upped it to 100 again

Dec 15 , 16,17 went back to 50 mg of trazadone

December 18 Began 3 beads of effexor  Dec 25 began 5 beads of effexor take 10 mg of omneprazole daily

 

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Very great answer Altostrata , thank you for reminding us , me , of how acceptance is where out power lies, and the choice we have of how we choose to relate to what is happening . It is a learning curve for sure and maybe the most difficult thing about this whole process. I am grateful for this aspect , even though I wouldn't choose the suffering for any price! 

 

Maresat 🕊🌺🙏🏻

Feb 2015 - 1 st Xanax for anxiety 1/8th mg X prn 2.5 mg ambien night 6- 900 Gabapentin RLS (GPn15 yrs) 2015 - CT steroids Sept 2015- started daily benzos , Xanax 1/8-1/4 mg and Ativan .5 mg after life trauma/900 gabapentin nightly
Dec 2015- klonopin for panic. Dropped Ativan and ambien ,.125-.25 mg Xanax plus .25 to .5 mg Klonopin /Jan 2016- dropped Xanax , WD hell! Feb 2016- wanted off klonopin,Mar 16 to May'16- crossed to 10 mg Valium from.375 mg k /March17-390 GPN June -360 GPN - 8mg V,  june 7.93 mgs V stability gone ,very sick /9/6/17- cross to .40 K in one day - WDs /K better than V / VERY unstable /using dry pills and scale to measure doses . 9/20 -1mgV/.35K. 9/24 -2 mgs V/ .30 K

gabapentin-360 mgs night 

 

 

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You're very welcome, Maresat. I wouldn't wish this character-building exercise on anyone, but here we are and we have to deal with it.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • Altostrata changed the title to Stabilizing, what does that mean? How long does it take after reinstating or updosing?
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