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Altostrata

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

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Altostrata

I'm going to post this here so everyone can see it.
 
Our basic rules of succeeding with tapering off psychiatric drugs or recovering from withdrawal syndrome are the rules of 3KIS: Keep it simple. Keep it slow. Keep it stable.
 
1. Keep it simple.
 
When the body reacts, often it's difficult to tell what the cause might be. When you're tapering or trying supplements or other treatments, keeping it simple helps reduce confusion during trial-and-error. Keeping it simple minimize confounding factors. For example:
 
1.a. Do not CHANGE the dosage of more than one drug or supplement at a time.
When you change 2 or more drugs at once and you get a bad reaction, you won't know which drug is causing it.
 
1.b. Do not ADD more than one drug or supplement at a time.
When you add more than one thing at a time -- or, worse, throw the kitchen sink into some kind of cocktail -- and you get a bad reaction, you won't have any idea what to do. Should you drop one thing or all of them?
 
This is also true of mixed supplements, supplements that contain more than one ingredient. It's better to try one ingredient at a time to see how you react.
 
2. Keep it slow.
 
Many people become very sensitive to drugs and supplements after they've experienced withdrawal symptoms for even a short time. Do not count on taking the big risks you used to take. Make changes slowly.
 
Introducing a drug or supplement or changing a dosage very gradually gives you the ability to sample how it might affect you before you go too far. ALWAYS WAIT TO SEE THE RESULT OF A CHANGE BEFORE DECIDING WHAT TO DO NEXT. For many drugs, it takes 1-4 weeks to see the full effect of a change.
 
A big dose or big change probably will cause a worse bad reaction than a very small dose or change. You can injure your nervous system pretty badly with a big change -- it might take you months or years to feel better.
 
For example:
 
2.a. If you are tapering, we recommend a 10% reduction every month, based on the LAST dosage. (The amount of the reduction keeps getting smaller. Read this explanation: Why taper by 10% of my dosage?
 
2.b. Do not expect to feel better immediately. There are no silver bullets for withdrawal syndrome. There is no pill of any kind that will immediately put you back to normal. If you make a good change, the effect is likely to be slight at first. Be patient. Read this: What is withdrawal syndrome?
 
2.c. Do not jump around in dosage. For most drugs, it takes about 4 days for the change to fully register in your system. Unless you have an IMMEDIATE bad reaction, wait at least 4-7 days to see how the change affects you. Long-acting drugs, such as fluoxetine (Prozac),  do not reach full effect for several weeks. (If you have an immediate bad reaction, go back to the dosage you were taking before.)  See steady state graph for Cymbalta.
 
Since withdrawal symptoms ordinarily fluctuate, you might have hours or days here and there when you don't feel well. One episode does not a pattern make. Do not panic and throw in another drug or supplement. Keep notes on paper of your daily symptom pattern. If you feel worse and worse over a week, the change was not a good one. It may be the decrease or increase was too large. Rather than jumping around in dosage, make an adjustment half-way.
 
2.d. Be patient, recovery is inconsistent and gradual. The nervous system is very complicated. It can repair itself, but it takes time to do this. In the meantime, you may experience The Windows and Waves Pattern of Recovery
 
3. Keep it stable.
 
The nervous system is delicate and very complicated. Normally, the autonomic system runs your body with numerous checks and balances, constantly gauging what hormones and transmitters need to be increased and which need to be decreased. Its job is to keep your body stable, at a tolerable temperature range, with everything running smoothly.
 
Psychiatric drugs interfere with the entire nervous system, not just the brain. This is why changing dosage of just one drug can affect your eyesight, your digestion, and your sleep. Taking psychiatric drugs affects the functions of the nervous system.
 
The nervous system, which works so hard to keep your body running smoothly, thrives on stability. When you take a psychiatric drug over a period of time (usually a month or more), your body becomes dependent on the drug. This is called physiological dependency.
 
The nervous system adapts itself to the drug like a plant growing on a trellis. If you tear the trellis away, the plant will be damaged. You need to remove the trellis gradually and allow the plant to retrain itself to its natural growth pattern.
 
Thus, the nervous system does best in a stable environment. Help your nervous system adapt to life without drugs by maintaining as much stability as you can. This is the way you can take care of yourself and help your nervous system to recover. We are our own worst enemies when it comes to stressing our nervous systems! Examples:
 
3.a. Do not suddenly quit taking your drugs. Do not skip doses to taper. These big, fast changes are the opposite of providing stability for your nervous system. Skipping doses causes the amount of the drug in your bloodstream to go up and down. Do not do this for any psychiatric drug.  See this graph which compares skipping days vs daily dosing.

 

3.b. Avoid binges. Even if you had no problems with them before, avoid overindulgence in alcohol, food, partying, sugar, staying up late, even exercise. All of these put the body and the nervous system under stress.
 
3.c. Manage emotional stress. Yes, that abusive relationship can be keeping you from recovering from withdrawal syndrome. You may wish to reduce contact with any people who tend to upset you. If you are an argumentative person, you may wish to minimize your confrontations.
 
3.d. Direct your time and efforts to pastimes that are calming or pleasurable. Calm is good for the nervous system. Always make time for a pleasant walk of at least a half-hour every day. Many people find a place for meditation in their lives because it makes them feel better. Spending time with pets or in nature ("forest bathing") can also be soothing. See our Symptoms and Self-Care forum for more suggestions.
 
3.e. Keep your daily circadian rhythm steady. Your body runs on a daily pattern governed by sunrise and sunset -- the circadian rhythm. Our bodies do best when we wake in the morning, go to sleep at night, and eat at about the same times every day. You may wish to reduce artificial light at night. Do what you can to maintain a regular daily schedule, this helps your nervous system function. See Important topics about symptoms, including sleep problems.

Edited by Altostrata
updated

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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wantmyhubbyback

might be worthwhile to point out that published medical info on tapering schedules is incredibly wrong

 

https://www.documentforsafety.org/pub/forms/tapering_of_antipsychotic.pdf--25% a WEEK! yikes

http://www.medscape.com/viewarticle/529317#vp_2-- "4-8 weeks" -- yikes again!

http://www.nmsis.org/pages/preventdiscontinuationsyndromes2.asp-- "4 weeks to 3 months" -- still wrong.

 

who are the people writing this crap?

it continues to floor me that the psych community still doesn't understand or seem to care about getting people off of these drugs. i get the whole revenue stream, big pharma, "fox in henhouse' thing ...but still, wow.


diagnosed with MDD/GAD nov 2013, 6 months following CMV complications post-kidney transplant.  lst zyprexa taper 12 months; /increased paxil to 30 mg; crash nov 2014 w/ suicidal ideation & 10day hospitalization.  2nd zyprexa taper 6 months; crash after 6 weeks; reinstated zyprexa 15mg in 6/15 (both tapers worked well to the 2.5mg dose).  3rd zyprexa taper ... 17mg 3 mos;  15mg 1 mo; 10mg 3 mos, 5 mg 3 mos. 2.5mg caused some decompensating, so back to 3mg and  the 10% redux.  UPDATE: moved to FL in late 2016. found great new psychiatrist who agrees that hubby taking too many meds.  continued zyprexa taper and finally  jumped off at .5mg in 2018.  had terrible insomnia. added seroquel @ 300 mg and then tapered 10% to 12.5mg over 2 years. everything was great until it wasnt; hubby suddenly got very agitated and manic.  hospitalized 2x in early 2020 for "idiopathic secondary mania" and diagnosed as bipolar.  seroquel now back @ 100mg plus depakote @ 2500 mg and trazadone @ 100mg. 

mirtazapine 30 mg 45mg 15mg

ativan .5mg 1x/day, occasionally .5 addl  if needed for sleep 3x/day n now 1x/day

paxil 20 mg 1x/day 

gabapentin 1200 - 1800 mg 2 -3 x/day

immunosuppressive drugs for kidney transplant: sirolimus, tacrolimus, mycophenalate, prednisone, levothyroxin and a whole handful of others

 

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Altostrata

At least they give some idea of what "tapering" means.


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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Carouselisalie

Great recommendations.

 

Capacity for self regulation is often lacking in those of us with nervous systems altered to adapt and survive traumatizing social environments. Limited self regulation is often what leads people to starting on anti-depressants and mood stabilizers in the first place.

 

Self regulation and groundedness are skills and capacities we can learn and develop. Good book: "Full Body Presence" by Suzanne Scurlock-Durama.


On Zoloft 200 mg for 16 yrs. Lamictal 100-150 mg for 14 yrs. A few times I've lowered the dose of Zoloft from 200 mg to 175 or 150 mg for a day or 2. At 175 mg I have decreased focus/concentration within the same day. From 200mg to 150 mg, some sadness and slight confusion. 2 days at 150mg, shorter attention span, less patience, frustrated easily. I've never tried a slow, long term taper. My only experience being off meds completely has been unintentional, "cold turkey" cessation because I forgot to take them that day or forgot to order refill on time and ran out. Withdrawals start less than 4 hours off regular doses, cold turkey. Symptoms: Very hard to retrieve info and express thoughts succinctly. Circumstantial speech. Lose patience with people. If refill is delayed for several days, by day 2, I start to overeat, eat sweets late at night, oversleep, late to work. Day 2 to day 3, a gradual increase of morbid obsessive thoughts, wrenching guilt for any mistake, suicidal ideation. Day 3, I see the world through a watery lense. Nothing is clear or sharp. Night of day 4 off meds cold turkey - Panic attacks, crying, spikes of suicidal ideation. Day 5, Brain feels like a hard ball jostling around when I turn my head. I lose train of thought, lose sense of direction, get lost easily. I shower but no energy for grooming. Can't get myself together to get anywhere on time. Increasingly convinced my life is worthless. The symptoms completely remit within 2 hours after restarting meds. Never completely off meds longer than 5 days in the past 16 yrs.

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Altostrata

Good points, Carousel. Thank you.


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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2befree4me

Thank you so much for all your work on this site and advise.  This is an invaluable site and am so glad I found it.

 

 I personally love my two cats and one dog a jack russell, I will sometimes on my lunch break come home, lie down and let them all surround me with there love to help me get through the rest of the day.

 

just thought I would throw that in.

 

keep on keeping on

Xena


2011 I was put on Bupropion xl 150 mg, Venlafaxine xr 150 mg, & Zopiclone 7.5 mg & increased my Clonazepam from one pill once a day @ 0.5 to 3 pills a day @ 0.5, I tried going off Bupropion cold turkey a few years back and it caused severe depression, with suicidal thoughts & major flu like symptoms so I had to go back on it within 3 days.  I then tried going down from 150mg to 112.5mg dose of Venlafaxine 3 weeks back and had brain zaps for two weeks & dizziness with it. The first week I had major flu like symptoms, however my blurry vision improved with just one dose lower, and all the other symptoms have cleared, I did have one crying spell and felt like I did not want to face the world that day. I cannot go lower @ 80mg, I go into severe depression, suicidal, nightmares, sick to my stomach.  

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Altostrata

Thanks, dukke.

 

Some people do better with strenuous exercise and some do worse. It's something to try if you're in condition for it, but it can backfire.

 

Please let us know how you're doing in your Intro topic dukke: Tapering seroquel


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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curineia

 

 

Thank you for reminding me of this. ❤❤❤

Edited by mammaP

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Centime

Really valuable info—thanks!


Long history with many psych drugs beginning in 1987. Went through two too-fast Paxil withdrawals in the past. Ended up in ER both times. I successfully got off Wellbutrin, and (occasional only) Seroquel, Concerta, and Klonopin over six months. Current supplements: multivitamin, probiotic, D3, magnesium, CBD. Current drugs: Ranitidine 300 mg. for acid reflux, Paxil (tapering off).

 

Paxil Taper History, 2018/2019

Jan.1: 60 mg. May 1: 55 mg. May 13: 50 mg. June 3: 47.5 mg. June 14: 45 mg. June 21: 42.5 mg. July 5: 40 mg. Switched to figuring by weight. 40 mg. = .704 July 22: .686. July 29: .669. August 5: .652. August 12: .635. September 2: 30 mg. October 2: 25 mg. November 2: 22 mg. December 1: 20 mg. January 6: 18 mg. Now using a digital scale and an emery board to taper. January 16: I decided to go back on the drugs after a year of tapering. I’m more depressed than ever, and do not believe it’s withdrawal. Thank you, everyone, for your support, advice, and kindness. Centime.

 

 

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Jill28

I am sooo thankful for this site and these wonderful moderators. Now that I’ve calmed myself down, I’m able to digest this and learn from it. Thank you all❤️


Jill28

march - June 19, 2018- Zoloft

August 22, 2018- August 24, 2018- Prozac

August 24 to current- clonazepam - still reducing from .25 twice a day.

August 24 to Sept 24th - Cyproheptadine 2mg

August 29- End of November Lunesta 3 mg

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JackieDecides
On 9/22/2018 at 6:35 PM, Jill28 said:

I am sooo thankful for this site and these wonderful moderators. Now that I’ve calmed myself down, I’m able to digest this and learn from it. Thank you all❤️

 

it's very true the more distress we are in, the harder it is to find, read, remember and use the information! 

 

big internet hugs to all of us! 🤗


Currently taking Ramapril (blood pressure) 5 mg twice a day

Omeprazole 10 mg AM and 20 mg PM  (the taper has gone nowhere after the first cut)

Famotidine   once a day (and I still needs tums sometimes)

magnesium 200 mg at night

as of yesterday 2 fish oil capsules "EPA-DHA 1000"

 

off Lexapro as of 5/2018  - last dose had been 5 mg every other day for a couple years

 

highest dose had been 20 mg at which point I was diagnosed with Bipolar II, which went away when I cut the lexapro down to 15 mg. 

 

I spent years on Paxil before Lexapro (can't remember dose), briefly on Effexor and Abilify and others I have forgotten. in fact, when I was diagnoses with BPII I was put on all kinds of things which made me feel so bad I stopped them cold turkey within maybe 3 or 4 weeks, thank goodness. since then I've known these pills were terrible and I weaned down the Lexapro with zero help or support over I'm not sure how many years. 

 

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buzon624

Excellent Advise.  Thanks so much for putting this together.  I wish I would have read this before I started my mass exodus from SSRI's.  Simple, slow, stable....thats a great mantra. 

 

Again, thanks to all who put time into this forum.  Seems to be helping a lot of people.  

 

All the best,

 

Andy 


2016 10mg Lexipro

2014 2mg kpin

2012 10mg Trazodone 

Tapered to 1mg of kpin over 3 months 2018. Holding there until I get off the SSRI'S 

Tapered 3 weeks from 10mg to 5mg of lexipro then from 5mg to 0mg December 8, 2018.

Dec 2018 Currently holding on .5mg 2x a day of Kpin and 5mg of Trazdone at night.  No lexipro

Jan 2019 Dropped to .25 2x per day of Kpin

Supplement Update  Feb 2019 - Fish Oil, B Complex, Magnesium, Lions Mane

Feb 14, 2019 Dropped to .25 1x per day of kpin

Feb 19, 2019 Last dose of kpin.  

Feb 20 SSRI and Benzo Free

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Lzieb

Great advice. Thanks


LZie, Zoloft 25 mg, 3/31-4/6, 

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Bruci

May I add that getting good psychotherapy can go a long way toward making this process easier. A good therapist can help you understand why you got depressed in the first place.


1980s: First diagnosed with depression. Treated with a tricyclic. 1988: Switched to Prozac 20 mg after triclyclic stopped working. 1990s to 2010: On and off Prozac. Increased dose led to side effects. 

2010: Work stress led to increased depression/anxiety. Tried several SSRIs but tolerated none of them. Put on Zyprexa. 

2011: Work burnout and breakdown. Hospitalized for suicidal depression. Switched to Seroquel. Prozac increased to 80 mg.

2017: Started psychotherapy. Helped a lot. Switched to Celexa 40 mg and lithium 300 mg. 

2019: Stopped Seroquel. Lost weight.

2020 June: Added Wellbutrin to try and correct sexual dysfunction. Could not tolerate Wellbutrin.

2020 July: Decreased Celexa to 30 mg in attempt to alleviate sexual dysfunction. Worked somewhat.

2020 August: Decreased Celexa to 20 mg. Sexual function improved but w/d effects started. 

2020 September: Maintaining Celexa at 20 mg. Experiencing w/d effects - fatigue, dysphoria, mood instability

2020 September 13: Increased Celexa to 30 mg due to w/d effects. Still on lithium 300 mg/day.

2020 October 3: Reduced Celexa to 27 mg. Started taper. 10% per month as recommended.

 

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