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Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

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ChessieCat

The perfect taper in the graph is what it would look like if someone did SA's harm reduction taper.  The reason I included it was to show the similarity to the dose occupancy curve.

 

I doubt that there would be many people who from start to finish have done a perfect taper.  After the hiccups I had at the start of my taper my curve has been less steep than the perfect taper curve.  This graph shows my previous tapering (horizontal lines) with prediction of future taper (vertical lines).  What is good about seeing the perfect taper is it can help you to see if you are going too quickly.  Because I am tapering using capsules I can't do exact 10% reductions so will be holding for 3 weeks and then holding for 4 weeks and then 3 weeks and 4 weeks again which can be seen in the distance between the vertical lines.

 

776391214_PerfectTaper.png.f16551da35c66ed2616e7cdd534b7505.png

 

Edited by ChessieCat
attached new graph

Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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brassmonkey

I think I'm just about the only one that I know of for an almost perfect taper.  The only variations I did were an extra two weeks when I had bronchitics at around 18mg and an extra 6 weeks at 10mg just to let things settle out.  Once I got below .75mg it was tricky to maintain 10% because of the scales, but I kept it as close as possible.  That lasted for about 6 drops.  Then again by necessity the last couple of drops were 25% and 50% because of limitations of the scales and eyeball method.  From everything I've seen I was very lucky to have such a smooth and trouble free taper. 


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.

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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RachelSusan

ChessieCat,

I downloaded the perfect taper graph you posted.  I am using it to compare against mine.  I did notice that the graph looked very similar to the dose occupancy curve.  Mine of course doesn't look anything like this, but it is something to strive for.

 

Brassmonkey, I don't know if you have a graph or even care to share it, however if you decide to share I would love to see yours.

 

RS

 

 


Find my story here:  http://survivingantidepressants.org/index.php?/topic/12649-rachelsusan-my-zoloft-story-on-off-reinstated-in-trouble/?hl=rachelsusan

HISTORY

Feb. 2016 to June 2016  - Was on 100mg to 150mg Zoloft. 

Quit Zoloft (Sertraline) June  2016,  reinstated 50mg of Zoloft July 2016.  From July 2016  to October 2016 went from 50 mg down 2.3 mg. I up-dosed in November 2016 to 12.5 mg. Held there until January 2017 when I started a much slower taper.

STARTING SENSIBLE  ZOLOFT TAPERING USING GUIDELINES FROM THIS SITE

Dec. 10 2016  - switched to Liquid Zoloft (Sertraline) @ 12.5 mg.   Jan 19, 2017 reduced to 12.0 mg (4%).   Feb 9 2017 reduced to 11.0 mg (8%). March 1 2017 to 10.0 mg (9 %).  March 21 2017  to 9.5 mg (5%). April 1 2017  to 9.0 mg (5.3%). April 10 2017 to 8.5 mg (5.6%). April 22 2017  8.25 mg (2.9%). April 29 2017  8.0 (3.0%). May 6 2017  7.75 mg (3.1%).  May 14 2017  7.5 mg (3.2%). May 20 2017 to 7.25 mg (3.3%). May 27 2017 reduced to 7.0 mg (3.4%). June 10 2017  to 6.75 mg (3.6%). June 17 2017 to 6.5 mg (3.7%). June 24 2017 6.25 mg (3.8%). July 1 2017 reduced to 6.0 mg. July 8 2017 5.75 mg. July 15 2017 5.5 mg. July 22 2017 5.25 mg.  Aug 5 2017  5.0 mg.  Dec. 9, 2017  4.75 mg (5%).  Feb. 10, 2018 4.50 mg.   March 15, 2018 4.375 mg (2.8% decrease). April 3, 2018 4.25 mg (2.9%). May 14, 2018 4.125% (2.9%). June 16, 2018 4.0 mg (3.0%).  July 21, 2018 3.875mg. August 11, 2018 3.75mg (3.2%). Sept. 12, 2018 3.62mg (3.3%).  Oct. 13, 2018 3.5mg (3.4% decrease). Nov. 29, 2018 3.375mg (3.6% decrease). Jan. 20, 2019 3.25 mgFeb 16, 2019 3.125mg (3.8%). April 7, 2019 3.0mg (4.0%).  May 18, 2019 2.875mg (4.2%). June 22, 2019 2.75mg (4.3%)July 27, 2019 2.62mg (4.5%). August 18, 2019 2.5mg (4.8%). Sept. 14, 2019 2.375mg (5.0%) Oct.19, 2019 2.25mg.  Nov. 16, 2019 2.12mgDec. 7, 2019 2.00mg (5.9%). Jan. 4, 2020 1.875 mg (6.3%). Jan. 25, 2020 1.75 mgFeb. 29, 2020 1.625mg (7.10%).  Apr. 4, 2020 1.5 mg. May 9, 2020 1.375 mg. June 6, 2020 1.25 mg. (9.10%). July 4, 2020 1.125 mg. (10%).  August 15, 2020 1.0 mg.  Oct 24, 2020 .875 mg.

OTHER MEDICATIONS: Gabapentin - 900 mg since July 2016, Prednisone  5mg.  QVAR Inhalant,  Supplements: Vitamin D, Probiotic, and Fish Oil.

 

 

 

 

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ChessieCat
34 minutes ago, brassmonkey said:

I think I'm just about the only one that I know of for an almost perfect taper.

 

Well done.  I hope you are proud of yourself, it's a big achievement.

 

1 minute ago, RachelSusan said:

Brassmonkey, I don't know if you have a graph or even care to share it, however if you decide to share I would love to see yours.

 

I was about to say something similar :D


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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brassmonkey

I have several pages of hand written data, but I never followed up on creating a graph with it.  Also doing the slide method makes for a lot of data points.  Maybe one of these days.


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.

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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ChessieCat
10 minutes ago, brassmonkey said:

Maybe one of these days.

 

I image you have got lots of much more exciting things to be doing!  And nobody can blame you for that. ;)


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ZK2015

Hi,

 

I started this topic a while ago

 

and it has been 6 months now since my last dose of Prozac, so I'd like to share the way I used to taper so may be someone out there benefit from it, However I'd like to point out that I'm not a doctor and that this worked for me merely through trial and error, so here we go.

 

As I mentioned in my first topic my first tapering attempt was too fast that I had awful withdrawal symptoms and had to reinstate, and the 10% approach was too slow for me as I was able to make larger drops without much symptoms, I then found the following research paper here on the forums:

It's a paper on the percentage of serotonin transporter occupancy of Prozac (and other SSRIs) in the brain, in other words it basically measures the amount of serotonin receptors in the brain blocked by the medication, at 20mg most SSRIs will block 75%-85% of these receptors.

After going through the paper I found that the percentage for Prozac occupancy follows the following equation:

 

Occupancy% = 86*dose/(1.94+dose)

 

So for example, if you take 20mg Prozac, the approximate occupancy% = 86*20/(1.944+20) = 78%, and so on.

What I did next was finding the maximum percentage I can go down without suffering too much withdrawal symptoms, and with some trial and error I found this percentage to be 8%, meaning if I'm currently at 78% I can go down to 70% without much withdrawal symptoms, any higher and the symptoms are unbearable.

So I prepared a table with 8% drop downs, calculated the dosage for every percentage and stayed on every dosage from 2-4 weeks depending on the symptoms, this worked perfectly for me as I was able to calculate the next dosage that wouldn't cause much symptoms, for example I was able to drop directly from 20mg to 10 mg and from 10mg to 5mg, however as the dosage decreased the drops where slower to maintain the 8% drop, this also allowed me to know when to stop taking the medication completely, for example at 0.5mg I was still at 18% so I had to drop to as low as 0.1mg before stopping completely.

My last dose was on 17/4/2017, I had to make 14 drops over the course of a year, and although I had a couple of hiccups toward the end I was able to get through them by staying a little longer on the dosage and doing lots of exercise.


Paxil 20mg 3/2012 - 11/2014 - C/T for 2 weeks then back again till 1/2015

Prozac 20mg 2/2015 - 10/2015 - Tapered down by skipping doses but got withdrawal symptoms

Reinstated 20mg Prozac 18/1/2016

Started tapering Prozac again 3/2016

Off the meds completely since 17/4/2017 - Last Prozac dosage 0.1mg

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ChessieCat

Hi ZK,

 

Thanks for posting about your tapering method.

 

It would be really great if you could post an update in your Intro topic about what symptoms, if any, and their severity since you stopped taking Prozac.


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Krasiyan

I'm guessing the forumala for Paroxetine will not be Occupancy% = 86*dose/(1.94+dose) ? This really puts me to question how I've been probably 80% + occupancy on 40 mg for years and stopped in just one months time. No wonder I'm withdrawing.

 

Even if I start 5 mg it's gonna bring the occupancy back to about 50% in a month. Thats a lot considering it's only 5 mg. And even if I stabilize on 50 % occupancy does stupid pills aren't made to be reduced by 1 mg so good luck stopping it without some kind of professional or something.

 


Stimulaton 50mg 28.11.2008 - 01.11.2011

PAXIL (Xetanor) 40mg;  30.11.2011 - 19.09.2017

Tapered : 19.09.2017 - 29.09.2017 20mg

Tapered : 30.09.2017 - 10.10.2017 5mg 

Reinstated : 03.11.2017;  5mg

14.11.2017 - 10 mg

13.12.2017 - 20mg

 

 

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Gridley

Check Brassmonkey's thread.  He reduced from 40mg Paxil cutting pills and using a Gemini 20 scale even at very low doses.


Gridley Introduction

 

Lexapro 20 mg since 2004.  Began taper using Brassmonkey slide 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  

Current from Oct. 21, 2020 at 0.025mg

Taper is 99.875% complete.

 

Lorazepam 1 mg 1986-1991 CT, resumed a few months later. CT 2000.  1 mg 2011-2016.  Sept, 2016 increased to 0.5 X 3 in split dose. Sept. 2019 increased to 0.625 X 3 after crossover to new brand

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 15mg.  Aug 2016, discovered SA, updosed to 25mg and holding.  Taper is 66% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, 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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Krasiyan

Will do thanks!


Stimulaton 50mg 28.11.2008 - 01.11.2011

PAXIL (Xetanor) 40mg;  30.11.2011 - 19.09.2017

Tapered : 19.09.2017 - 29.09.2017 20mg

Tapered : 30.09.2017 - 10.10.2017 5mg 

Reinstated : 03.11.2017;  5mg

14.11.2017 - 10 mg

13.12.2017 - 20mg

 

 

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ZK2015
20 hours ago, Krasiyan said:

I'm guessing the forumala for Paroxetine will not be Occupancy% = 86*dose/(1.94+dose) ? This really puts me to question how I've been probably 80% + occupancy on 40 mg for years and stopped in just one months time. No wonder I'm withdrawing.

 

Even if I start 5 mg it's gonna bring the occupancy back to about 50% in a month. Thats a lot considering it's only 5 mg. And even if I stabilize on 50 % occupancy does stupid pills aren't made to be reduced by 1 mg so good luck stopping it without some kind of professional or something.

 

 

Hi Krasiyan, the equation for Paroxetine will be  Occupancy% = 102*dose/(5.2+dose)

so yes at 5mg you will be at 50% occupancy, however it is really a matter of trial and error you can try different percentages till you find the one that you can tolerate and start calculating your doses based on it.

also as Gridley mentioned you can cut your pills or make liquid from them, personally I found it easier to measure doses from liquid solution.


Paxil 20mg 3/2012 - 11/2014 - C/T for 2 weeks then back again till 1/2015

Prozac 20mg 2/2015 - 10/2015 - Tapered down by skipping doses but got withdrawal symptoms

Reinstated 20mg Prozac 18/1/2016

Started tapering Prozac again 3/2016

Off the meds completely since 17/4/2017 - Last Prozac dosage 0.1mg

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ZK2015
On 10/29/2017 at 12:50 AM, ChessieCat said:

Hi ZK,

 

Thanks for posting about your tapering method.

 

It would be really great if you could post an update in your Intro topic about what symptoms, if any, and their severity since you stopped taking Prozac.

 

sorry I can't edit the intro topic for some reason.

 

but anyway, my symptoms were very mild during tapering even negligible sometimes, they were mostly anxiety and depression, however the hardest part was toward the end when I stopped completely that's when I started having strong feelings of anxiety again "still bearable though", that lasted for almost 2 weeks but I guess I was waiting for some withdrawal symptom to reappear that I made myself anxious.

I felt completely back to normal about a couple of months after I stopped, and I haven't had any problems since then.


Paxil 20mg 3/2012 - 11/2014 - C/T for 2 weeks then back again till 1/2015

Prozac 20mg 2/2015 - 10/2015 - Tapered down by skipping doses but got withdrawal symptoms

Reinstated 20mg Prozac 18/1/2016

Started tapering Prozac again 3/2016

Off the meds completely since 17/4/2017 - Last Prozac dosage 0.1mg

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bruno2016
57 minutes ago, ZK2015 said:

I felt completely back to normal about a couple of months after I stopped, and I haven't had any problems since then.

wow thats really awesome! Thanks for sharing with others. 


Various SSRIs/SNRIs 7- 1/2 years

Went Cold Turkey from Celexa 2011, Stayed Off

Psych Drug Free and Loving Life (over 6 years and counting)

 

How I Stay Well: Diet, exercise, meditation, supplements, etc

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kesh

If you invert the formula you get

 

Dose = (1.94*Occ)/(86 - Occ)

 

Where Occ is percent receptor occupancy. 

 

This means that you could plug in the occupancy taper you want and get the required dose. 

 

However, I don't think anyone knows what kind of receptor occupancy taper is best.

 

 


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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RealMe
On 11/3/2017 at 9:32 AM, ZK2015 said:

 

sorry I can't edit the intro topic for some reason.

 

but anyway, my symptoms were very mild during tapering even negligible sometimes, they were mostly anxiety and depression, however the hardest part was toward the end when I stopped completely that's when I started having strong feelings of anxiety again "still bearable though", that lasted for almost 2 weeks but I guess I was waiting for some withdrawal symptom to reappear that I made myself anxious.

I felt completely back to normal about a couple of months after I stopped, and I haven't had any problems since then.

Are you still doing well?  I have started a slow taper of prozac 10, so I read your method and got a lot of hope from your experience.

 


Alcohol periodic excessive 1963-1976, Valium sporadic 1964-1973,  Imipramine off & on 1982-1985, Fluoxetine 10mg-80 mg. Oct., 1995-Jan., 2014; Cymbalta, other ADs 1/2014-3/2014; Abilify 5 mg. 3/2014 - 8/8/17; Trintellix 20 mg. 3/2014 - 9/2017; Propranolol 60-80 mg. sporadically Sept-Oct, 2017; Seroquel few days Sept 2017 (c/t); Wellbutrin 150 mg. Sept, 2017 updosed to 300 mg. few days till c/t Oct 8, 2017, fish oil, vitD, vitE Oct 16, 2017-pres. Lipoflavonoid 4/2017-pres.  Fluoxetine 10 mg. Sept-Oct 8, 2017, 20 mg. 10/9- 10/15; 10 mg. 10/16 - 12/29;  9 mg. 12/30 - 2/9; 2 mL liquid (8.1mg) 2/10 - 3/7; 1.8 mL (7.29 mg) 3/8 -3/20; 1.6 mL (6.561mg) 3/20-4/2; 1.4 mL (5.9 mg) 4/3-4/14; 1mL (4 mg.) 4/15-4/22; .9mL (3.6mg) 4/23-5/1; .81mL (3.24 mg) 5/2-5/24; .73mL (2.916mg.) 5/25-6/8; .65mL 6/9-6/23; .6mL 6/24-7/17; .58mL 7/18-7/28; .525mL 7/29-8/13; .5 mL 8/14-21; .45mL 8/22-31; .4mL 9/2-21; .35mL 9/22-10/4; .3mL 10/5-28; .25mL 10/28-11/10; .2mL 11/11-11/24; .18mL 11/25-12/3; .1mL 12/4-12/18. Zero-12/19/18-present.

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ZK2015
On 12/29/2017 at 11:52 PM, kesh said:

 

However, I don't think anyone knows what kind of receptor occupancy taper is best.

 

 

It's a matter of trial and error really, it took me a couple of tries till I found the highest occupancy I can taper without much problems 


Paxil 20mg 3/2012 - 11/2014 - C/T for 2 weeks then back again till 1/2015

Prozac 20mg 2/2015 - 10/2015 - Tapered down by skipping doses but got withdrawal symptoms

Reinstated 20mg Prozac 18/1/2016

Started tapering Prozac again 3/2016

Off the meds completely since 17/4/2017 - Last Prozac dosage 0.1mg

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ZK2015
11 hours ago, RealMe said:

Are you still doing well?  I have started a slow taper of prozac 10, so I read your method and got a lot of hope from your experience.

 

Yes, it's been 8 months now and doing fine, Wish you luck with your taper.


Paxil 20mg 3/2012 - 11/2014 - C/T for 2 weeks then back again till 1/2015

Prozac 20mg 2/2015 - 10/2015 - Tapered down by skipping doses but got withdrawal symptoms

Reinstated 20mg Prozac 18/1/2016

Started tapering Prozac again 3/2016

Off the meds completely since 17/4/2017 - Last Prozac dosage 0.1mg

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Altostrata

The fundamental problem is you do not know the exact shape of your own occupancy curve. The paper is based on an average. You cannot assume your own curve is exactly like this one, or that your own tolerance for tapering is dependent solely on receptor occupancy rates.

 

That said, ZK, I'm glad you're doing well. Please update 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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kesh

Yes, one thing about the original papers is how the data points of individuals' sert occupancy float quite widely around the curve.

 

And the 10mg, 20mg, 40mg typical therapeutic doses for say fluoxetine are in reality likely to have a far wider range for different people. 


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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DoctorMussyWasHere
On 29/10/2017 at 12:13 AM, ZK2015 said:

Occupancy% = 86*dose/(1.94+dose)

 

Is anyone keeping a central record of the equations?

 

This one is for risperidone:

y = 90*(x/(0.8+x))

I am here as a supporter to certain individuals undergoing withdrawal, and to learn from and contribute to the forum where possible.

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Viridian

So as tapering strategies go, this isn't one SA is likely to endorse any time soon? I'll admit I was excited to see someone had managed to taper from the same drug and dosage as me in just over one year with few lasting ill effects, and was wondering whether I should give this a try for my own taper.


Long and troubled relationship with fluoxetine (Prozac).

2002 (age 12): Fluoxetine, unknown dosage. Rapid taper c. 2003/4.

2004-2010: Drug-free for six years. In 2009-10 began experiencing intense symptoms similar to w/d.

2010-2014: Fluoxetine 20mg. Several attempts to cold-turkey.

2014: Briefly raised dosage to 40mg before attempting CT. Did not go well.

2014-2015: Citalopram 20mg. CT after side-effects. Also did not go well.

2015-present: Fluoxetine 20mg.

 

Currently gathering resources for taper (always grateful for advice on these):

Supplements: Prebiotic (Bimuno), probiotic, Magnesium, Omega-3, Vitamin C, D3, B-complex.

Books: Full Catastrophe Living, The Depression Cure, The Power of Now, Overcoming Unwanted Intrusive Thoughts

Other resourcesMeditation and hypnosis recordings by Michael Sealey

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scallywag
On 1/3/2018 at 4:17 AM, Altostrata said:

The fundamental problem is you do not know the exact shape of your own occupancy curve. The paper is based on an average. You cannot assume your own curve is exactly like this one, or that your own tolerance for tapering is dependent solely on receptor occupancy rates.

Another thing to note is the sample size of the group studied.  The main study linked had sample sizes of 14 and 18; the Cymbalta study had a sample size of 3.  Most scientists will tell you that it is extremely difficult to generalize results for a population of millions based on a single study with a small sample size.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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Altostrata
On 2/13/2018 at 8:48 AM, scallywag said:

Another thing to note is the sample size of the group studied.  The main study linked had sample sizes of 14 and 18; the Cymbalta study had a sample size of 3.  Most scientists will tell you that it is extremely difficult to generalize results for a population of millions based on a single study with a small sample size.

 

Correct, scallywag. These curves only give you the basic idea.


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

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freedomfrombondage

Does anyone know how I would begin to apply this equation to Lexapro?

 

sorry, I am a newb on here!

 


27 years old. Been sober from drugs + alcohol for over 2 years.  Was addicted to benzos/opiates/adderall.  Have been on Lexapro since 2004 (I was 13).

Lexapro dates and mg

1/1/2016 - 20 mg

1/1/2018 - 10 mg (weened randomly between the two dates)

2/21/2018 - Cut down to 7.5 mg and am feeling the effects but want to keep going.

3/25/2018 - Cut down to 6.25 mg (although it is tough to say exactly)

4/30/2018 - Cut down to 5 mg

For the four months I switched to liquid dosing and weened down by .5mg each time or so.

Quit from 1.5mg on 9/26/2018.  Been off Lexapro and all medication since

 

 

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Altostrata

The best you can do is approximate it with a 10% taper. See Tips for tapering off Lexapro (escitalopram)

 

Please post questions about your taper 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

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Altostrata

Merged related topics.


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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panic27

I came across this paper, Serotonin Transporter Occupancy of Five SSRIs at Different Doses, that shows a very non-linear relationship between SSRI dose and serotonin transporter occupancy (the alleged "therapeutic" effect). Graphs are shown for citalopram, fluoxetine, sertraline, paroxetine and venlafaxine.

 

This shows that ADs are often prescribed at far higher doses than necessary, and may also suggest that when tapering from a large dose, you could make relatively large reductions at first, then slow down as you approach the "knee" point on the graph. (note that the sample sizes are small and there is still a large variance between multiple people at the same dose, so ymmv).

 

Thought this might be useful information for this section of the forum.


Citalopram:

Started late 2016, dose increased every few months up to 30mg

June/july 2018: mental breakdown

August 2018: dropped 30 -> 20mg. put on lorazepam 3x0.5mg

September 2018: dropped 20 -> 10mg. brief switch to effexor, then back to citalopram 10mg. dropped 10 -> 6mg

October 2018: brief switch to wellbutrin, then reinstated citalopram 4mg. started tapering more gradually.

April 2019: switched 0.25mg lorazepam -> 2mg diazepam.

July 2019: mental breakdown. jumped off 0.6mg citalopram.

January 2020: last valium dose (0.5mg)

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Altostrata

Please see this topic from the beginning.


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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panic27

Ah. Could've guessed this was already posted here. It's good to keep all relevant information in one place.


Citalopram:

Started late 2016, dose increased every few months up to 30mg

June/july 2018: mental breakdown

August 2018: dropped 30 -> 20mg. put on lorazepam 3x0.5mg

September 2018: dropped 20 -> 10mg. brief switch to effexor, then back to citalopram 10mg. dropped 10 -> 6mg

October 2018: brief switch to wellbutrin, then reinstated citalopram 4mg. started tapering more gradually.

April 2019: switched 0.25mg lorazepam -> 2mg diazepam.

July 2019: mental breakdown. jumped off 0.6mg citalopram.

January 2020: last valium dose (0.5mg)

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ChessieCat
4 hours ago, panic27 said:

This shows that ADs are often prescribed at far higher doses than necessary, and may also suggest that when tapering from a large dose, you could make relatively large reductions at first

 

I was fortunate in being able to reduce my Pristiq dose from 100mg to 75mg fairly easily (after 3 weeks of extreme cog fog after I tried to go from 100mg to 50mg and thankfully found SA).  However when I got to 50mg I held for 3 months and again at 20mg for 7 weeks just to give my brain a chance to catch up if it needed it.


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Andie

Hi All 

 

I found this journal article about Desvenlafaxine (Pristiq).  I will try to obtain  the full text article. 

 

An open-label positron emission tomography study to evaluate serotonin transporter occupancy following escalating dosing regimens of (R)-(-)-O-desmethylvenlafaxine and racemic O-desmethylvenlafaxine.

Frankle WG, et al. Synapse. 2018.

Abstract

SEP-227162 [R(-)-O-desmethylvenlafaxine] is an enantiomer of the venlafaxine metabolite O-desmethylvenlafaxine (ODV, Pristiq™, Wyeth). This study compared the serotonin transporter (SERT) occupancy achieved by SEP-227162 and ODV, at daily doses of 25, 50, 100, and 150 mg using [11 C]DASB positron emission tomography (PET). Sixteen healthy male subjects participated in one of four dose groups (N = 4 per group) during which they were administered two doses of the study drug (SEP-227162 or ODV). For each study drug, total daily doses of 25, 50, 100, and150 mg were studied. Subjects underwent three PET scans with [11 C]DASB. A baseline, off-medication, scan was performed prior to dosing and a [11 C]DASB PET scan was performed after 72 hr at each dose level. [11 C]DASB binding potential (BPND ) was calculated using the simplified reference tissue method. SERT occupancy was calculated as the change in BPND (ΔBPND ) from baseline scan to the on-medication scan relative to the baseline BPND value. SEP-227162 and ODV significantly reduced regional distribution volumes and region BPND values in a dose-dependent manner. Across all doses ODV produced significantly greater SERT occupancy than SEP-227162 (ANOVA F = 21.8, df = 1,23, p < .001). The total daily dose required to provide 50% SERT occupancy was 24.8 mg for SEP-227162 and 14.4 mg for ODV. In vitro data suggests a ratio of 3.3:1 for binding at human SERT for SEP-227162 relative to ODV. Our study suggests a ratio of 1.7:1, highlighting the value of in vivo imaging in the drug development process.

PMID

 29216407 [Indexed for MEDLINE]

 

Edited by ChessieCat
reduced font

Current Dose

0.5mcg Clonidine and 1.25 Diazepam PRN for treatment of iatrogenic hypertension. 

2010 .Prescribed Pristiq 100 mg in July by GP

2010 .Reduced to 50mg by splitting and weighing. Held at 50mg

2014. Reduced from 50-35 .Held at 35mg. 

2017. Taper from 35mg commenced using compounded Desvenlafaxine

2018. 23/06 13.5mg. 21/07  12.5mg. 25/08 11.5mg. 09/2018 10mg. 14/11 11mg (updose) 21/11 -12mg (updose)

2019. Still holding at 12mg and stuck. 

2020. January 2019 Prozac Bridge-- Prozac 2.5 to 10mg and

Pristiq 23rd Jan 6mg/ 27th Jan 5mg/ 28th Jan 3mg/ 30 Jan 0

Prozac 6th Feb 9.5mg. Vitamin D3 5000iu with K2

Magnesium Glycinate with Glycine and Passionflower  600mg 

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btdt
On 8/29/2014 at 12:26 PM, Barbarannamated said:

Because i have an underactive SERT gene, I was interested in how that plays in and found this in one of the citations:

 

Effects of Chronic Antidepressant Treatments on Serotonin Transporter Function, Density, and mRNA Level

http://m.jneurosci.org/content/19/23/10494.short

 

Excerpt from abstract:

 

"Based on these results, it appears that the SERT is downregulated by chronic administration of SSRIs but not other types of antidepressants; furthermore, the downregulation is not caused by decreases in SERT gene expression."

 

I hope this is not deviating too far from main topic. I believe it may be a part of why some of us who have been on these drugs for many years experience poopout and/or greater difficulty in discontinuation.

Because i have an underactive SERT gene,

Could you explain this to me ...how you know... what does it mean ...how has it affected your drug use and withdrawal?  Bit offtopic I know if you would like to post in on my page or any other place and link to it here that would be find with me... thanks. B


WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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Glosmom

I would like to offer up the below research article in light of the fact I am very certain when Glo was decreased in dose of her risperidone from 1.0 mg to .06 mg, changes occurred relating to smooth muscles (autonomic nervous system (ANS)).   Gloria has had fairly regular periods for the last 9 months (23 to 25 day cycle) when we dropped to .06 her period was late and she did not start until day 33. Additionally, she had difficulty knowing she had to urinate or have a bowel movement.  I had to take her to the bathroom several times in an attempt to get her to urinate, even though she had slept all night or it had been many hours since she had last gone.  Gloria knows when she has to use the restroom and can and does get herself there.  This is the first time i have ever witnessed this phenomenon in her.  I imagine it is due to the fact that her lower dose is 'hitting different receptors' in her brain.

 

Below they state larger doses of risperidone decrease activity of ANS......but they don't know for sure as the subjects were on multiple meds.  In Gloria's case, the ANS was impacted by a much lower dose.  Scary thing is smooth muscle (ANS) also regulates the heart activity.....dear goodness....these drugs are poison.

 

From the Discussion and Conclusion Section of the below article

 

Quote

 

In contrast, a few studies state that medication affects ANS activity in patients with schizophrenia. Studies have reported that some antipsychotic drugs, such as clozapine, with wide-ranging receptor affinity profiles, show imbalance between sympathetic and parasympathetic nerve activity [18,19] and that other antipsychotics drugs, such as haloperidol, which are relatively free of significant effects on neurotransmitter receptors except dopamine receptors, have no significant effect on ANS activity [19,38]. The results of those studies suggest that the effects of antipsychotic drugs on ANS function are derived from anticholinergic and antiadrenergic activity. In the present study, levomepromazine and chlorpromazine, which have potent anticholinergic and antiadrenergic effects, were commonly used, and many of our subjects were treated with multiple antipsychotic drugs.

Considering the results of previous studies and receptor affinity profiles, it is a consensus view that antipsychotic drugs have more or less of an effect on ANS activity. However, there is little evidence to indicate the dosage of antipsychotic drugs necessary to affect ANS activity. We investigated the dose-dependent effect of antipsychotic drugs on ANS activity. Our results suggest the following. If the daily dose of antipsychotic drugs is ≤500 mg/day, ANS activity in patients with schizophrenia is not significantly lower than that in controls. If the daily dose of antipsychotic drugs is 501 to 1000 mg/day, antipsychotic drugs exert a large effect on ANS activity and decrease ANS activity. If the daily dose of antipsychotic drugs is ≥1001 mg/day, antipsychotic drugs exert a very large effect on ANS activity and decrease ANS activity significantly. In short, the effect might be large if the dose of antipsychotic drug is high. There was a statistically significant difference in mean GAF scores among three subgroups. However, the result of the multiple regression analysis showed that there was no association between the spectral components of HRV and GAF score after adjustment for variables such as age, sex, BMI, duration of illness, CPZeq, BPDeq, and DZPeq (Table (Table33).

 

 

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534356/


2016 - Oct -Daughter started Risperdal (for steroid induced psychosis that never went away after stopping prednisone)

Nov - dose increases stopped at 1.5mg in Dec

2017 - Jan- weaned from 1.5 to 1.0 in 2 weeks then 1.0 to .5 in two weeks and then off. Feb. 3 weeks of increased psychosis, pacing, insomnia, other awful symptoms so late Feb  - Back on 1.5 mg Risperdal. May  - decrease to 1.25mg, two weeks later 1.0mg - symptoms started again. June - held steady at 1.25mg for 6 weeks and switched to liquid (3 ml syringe). July - started 10% taper every 3 weeks, October -  .8 mg, December - .7 mg .

2018 -Jan- 0.65 mg,  Feb- 0.59,  Mar-0.50, late April - .40mg, July- .36 mg, Aug - switched from 3 mL syringe to 1 mL syringe for more accuracy (her dad and i were not sure we were giving her the same dose when in between the 'dashes' on the 3 mL syringe.) Aug -.30 mg (3mL syr)/.44 mg (1 mL syr) difference due to med in the tip of both syringes). Sept- .28 mg (3mL syr)/.42 mg (1 mL syr). Oct - .16 mg (3 mL syr)/.30 mg (1 mL syr). Nov.- .06mg (3mL syr)/.20 mg (1mLsyr). Dec. - tip only/unmeasurable (3mL syr)/.10 mg (1mLsyr)

2019- Jan -.06 mg (1 mL syr), Feb- .025 mg (1 mL syr), Feb 27, 2019 - jumped to zero!!

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carefulprayerful
On 3/28/2014 at 12:20 AM, dcrmt said:

 

If you find a paper, please post the both the name of the medication and a link to the paper

Risperdal (risperidone)

atypical antipsychotic

June 1999

See top p. 873 in the PDF attached

(found at https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.156.6.869)

Risperidone occupancy dose plasma level charts.pdf


Jan. 2018:     900 mg  Lithium      1.0 mg Risperidone            250 mg Lamotrigine

Jan. 2019:     0 mg Lithium           0.625 mg Risperidone        175 mg Lamotrigine

Jan. 2020:     0 mg Lithium           0.260 mg Risperidone        175 mg Lamotrigine

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carefulprayerful

I apologize for not reading this entire thread, but I wanted to share an image that gives a pie chart for each antipsychotic drug illustrating its preference for various neurotransmitters.  

 

“Possible Dose-Side Effect Relationship of Antipsychotic Drugs: Relevance to Cognitive Function in Schizophrenia”

Medscape

https://www.medscape.com/viewarticle/584586_1

 

Login required. 

 

"Pie charts of receptor affinity of antipsychotic drugs. Affinity ratios for various neurotransmitter receptors are shown..."

 

 


Jan. 2018:     900 mg  Lithium      1.0 mg Risperidone            250 mg Lamotrigine

Jan. 2019:     0 mg Lithium           0.625 mg Risperidone        175 mg Lamotrigine

Jan. 2020:     0 mg Lithium           0.260 mg Risperidone        175 mg Lamotrigine

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