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Altostrata

About reinstating and stabilizing to reduce withdrawal symptoms

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Staz

Just to add my own views/experience on this topic:-

1. I've been on and off of prozac several times until the last time it pooped out on me. Tried to reintroduce when on mirtazapine and all hell broke loose.

2. Same happened with Mirtazapine although I'm stuck on it right now and upping the dose did nothing except cause insomnia and a quick taper which worked in the past failed so reinstated within days. Mirt did nothing for my depression then and only stopped me going into w/d's when reinstated

3. Diazepam I've used for 1 week short courses with no problem. Having then been put on them to cover my bad prozac mirtazapine situation and left on them for 6 weeks at 15mg I was c/t'd. After 4 weeks I was reinstated at 12mg and apart from a few weeks of moderate stability my experience turned into the hell of c/t again and is where I currently am. This could be due to the many med changes but tbh I believe the reinstatement of benzos after you've stopped them is to be avoided at all costs unless your life depends upon it. Having been thoroughly kindled on benzos I'm anticipating a tough long slow taper next year. I think benzo reinstatement is not worth the risk in my experience. Other a/d's appear more forgiving to updosing and reinstatement.

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Downbutnotout

Do after reading this, it seems like I probably waited too long. It’s been 1.5 months. I tried reinstitutung prozac which I only used for 10 days previously. I’m also a mess: anxious and depressed. I went nuts on Prozac yesterday.?i have the shortacting effexor and the beads. Should I try it? 

Edited by Downbutnotout
Put the wrong drug in .

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Downbutnotout

I also took some ativan, but haven’t used that in 2 weeks. It is also playing on me.  I fo have the desire to use it but I haven’t. I was only usin 1/2 ti a 1/4. 20 pils in 6 months. It’s probably a factor up? Now that I cut out the prozac I ODST I guess I’ll get really miserable. My husband says my violent reaction makes it “badbad,” 

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Altostrata

Downbutnotout, those questions are very specific to your particular situation. Please ask them in your Introductions topic Downbutnotout: Started a bridge to get off effexor

 

What we see here very frequently is that going on and off psychiatric drugs, even if you have no symptoms at the time, makes the nervous system hypersensitive to any neuroactive substance, such as other psychiatric drugs, some supplements, and even foods. The hypersensitiivty can cause outsized adverse reactions to dosages that didn't bother you before.

 

That is why we suggest reinstatement at very low doses, doses that most doctors believe will have no effect at all. We always caution people about thinking more is better. When it comes to psychiatric drugs, more is often not better. When your nervous system is sensitized, it can take quite a while to settle down after you take a dosage that's too high for you.

 

Since we don't know what dosage is too high for you, we always start with very low dosages. You can always increase it (gradually) if , after a trial of at least a week, you feel you need it.

 

 

 

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Downbutnotout

So you only updose if you’re side effects are from getting the medication out of your system? So how do I know my effects are from the medication bring out of my system or just bring depressed? I added 3 mg of Effexor back in but how do I know that’s really the problem? My effects are anxiety, horrible depression. But how do I know it’s from the effexir 6 weeks ago, the upping of trazadone or the short reinstatement if prozac which has made me insane?How will I know the reinstatement of Effexor beads is going anything??

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bob35

Reinstatement Caused my withdrawal symptoms, after being off Paxil 40mg for five months I was fine until I reinstated twice the first time I took a pill I was horribly sick for a few days. It has been almost 3 weeks since I took my last 10mg and I'm still not right. I wish I would have learned about this website first.

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Altostrata

bob, quite often we find people are sensitized to "normal" dosages; our recommendations for reinstatement are usually tiny amounts to start, to see what happens.

 

On 12/19/2017 at 4:46 PM, Downbutnotout said:

So you only updose if you’re side effects are from getting the medication out of your system? So how do I know my effects are from the medication bring out of my system or just bring depressed? I added 3 mg of Effexor back in but how do I know that’s really the problem? My effects are anxiety, horrible depression. But how do I know it’s from the effexir 6 weeks ago, the upping of trazadone or the short reinstatement if prozac which has made me insane?How will I know the reinstatement of Effexor beads is going anything??

 

DBNO, we've discussed this in your Intro topic. Please go back and re-read it.

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Pattiop

I had several responses to my signature. I am very concerned about my well being. I am not feeling well and from your response I tapered too quickly. I want to work with my Dr. and be sure that I am doing the right thing. I added the 20 mg Prozac because I have nothing else and need to hear back from Psychiatrist. I tried to summarize my sign. To make it clearer.

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Kozak70

Unfortunately ,too late reinstatement throw me into kindling.It's been 6 years now .stranded whenin I reinstated Prozac after 10 months off .I got adverse reactions since that 2012 ,till now even if I switched to lexapro in 2016 nothing helped.

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Godiswithme
Posted (edited)

So, I really never suffered from depression. I did suffer from anxiety. I had been taking around 1 mg of Xanax for approx 4 or 5 yrs. Due to life circumstances, I made a huge mistake. I was feeling overwhelmed and went to a psychiatrist for the first time in my life. I went on Lexapro, most of the time at 30mg for 2 yrs. I then lost my job. She added 2mg of Abilify for the last 8 mos. of those 2 yrs on Lexapro. Time passed and my life got better. I don’t believe the Lexapro or Abilify helped me in the least. I CT’d off the Lexapro and Abilify at the same time. After about a month, I went into a hell that is indescribable. I suffered for 5 mos and am amazed I am alive.

 

I tried reinstating Lexapro using the liquid. It was a disaster. Someone on the forum gave me advice to stay away from the liquid. The person saved my life. The liquid was much too strong. I then got tablets. I  split a 5mg tablet into quarters. I started taking 1.25mg. I stayed on that for a month. Very, very Slight improvement. I then took 2.5mg. Stayed at that for 4-6 weeks. Then 5 mg, 7.5, 10mg, 12.5, and finally 15mg. I stayed at each increase for 4-6 weeks hoping I could stop. 15mg is when the intense dread and fear subsided. Although there had been improvements along the way. At most every increase, I had a couple of days of awful adrenaline surges. It was rough. I was taking 1mg of Klonopin per day at the time. 

 

I am now tapering the Klonopin. I am down to .475mg per day. I haven’t returned to work. But I am alive. I am there for my children and husband. I feel that I am severely traumatized from what happened. 

 

I think many people would benefit from reinstating with a portion of a tablet rather than liquid.  I would love to get off of the Lexapro someday if I can gather the courage and the strength to try. My heart goes out to anyone dealing with this. I was seriously planning to end my life, the suffering was so intense. No where near anything I had ever experienced in my entire life. 

 

Edited by ChessieCat
added spacing

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Marsx
On 2012-10-08 at 7:17 PM, Altostrata said:

 There are reports of people with prolonged post-withdrawal syndrome who did better taking a drug at full dosage 2 years later. If you want to do this, please consult a doctor, we cannot advise you on it.

Hello, I'm wondering if there are any links to these reports? Trying to find people who reinstate late with success.

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Altostrata

We occasionally have people here who have done this -- reinstate years later at full dosage. Sorry, I can't give you the links.

 

For safety's sake, we advise an initial dosage that's very, very low, to see how it affects you. You can increase dosage gradually if you think that will help, but if you take too much right off, you could be suffering the after-effects for a long time.

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Bonzee

Alto, also the majority of Psychiatrists recommend reinstatement (and ER docs, and cardiologists apparently in my case), so that's something to note. Many patients are pressured by their doctors to reinstate when overwhelming WD symptoms appear. For the most part, reinstatement is the only clinically proven way to alleviate WD symptoms, per the literature for whatever that's worth. :(

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Altostrata

Yes, Bonzee, that's why we recommend it. Please read this topic from the beginning.

 

However, reinstatement need not be at full dose.

 

Quite a few physicans are not aware reinstatement is the appropriate way to treat withdrawal symptoms, and they do not know how to recognize withdrawal symptoms.

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summitbound

In benzo tapering, updosing or reinstating is strongly discouraged due to possible "kindling" which makes it even harder to taper the next time you try.  Is the same true for antidepressants and mood stabilizers?  The reason I ask is my biggest fear is tapering and falling into a bad depression.  It would be nice to know if I could take the "emergency exit" and reinstate if I needed to.  

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Songbird

I'm not sure how kindling happens with benzos, but SSRIs definitely can become more difficult to taper each time.  There is also a risk of severe adverse reactions when reinstating if it is not done soon enough or at too high a dose.  There is a lot of information in this thread :

Your best bet is to taper very slowly to avoid severe withdrawal symptoms.  If they do happen during the taper, you may be able to do a small updose, which is preferable to tapering all the way off too quickly and having to reinstate.

 

 

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Godiswithme
On 12/24/2017 at 5:46 PM, bob35 said:

Reinstatement Caused my withdrawal symptoms, after being off Paxil 40mg for five months I was fine until I reinstated twice the first time I took a pill I was horribly sick for a few days. It has been almost 3 weeks since I took my last 10mg and I'm still not right. I wish I would have learned about this website first.

Why on earth did you reinstate if you felt fine??

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Altostrata

summitbound, we suggest reinstating at a very low dose for this very reason -- to avoid triggering a reaction from a sensitized nervous system. We have seen generally good results with non-benzo drugs. (Even so, reinstating does not always work.)

 

While Ashton was a ground-breaker in many things, this is one area in benzo tapering where her conclusions are debatable. She derived her concepts from addiction medicine, where the drug user is strongly discouraged from updosing for fear of escalating the addiction. We don't think of people as addicts.

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Godiswithme
On 5/1/2018 at 7:21 AM, Songbird said:

I'm not sure how kindling happens with benzos, but SSRIs definitely can become more difficult to taper each time.  There is also a risk of severe adverse reactions when reinstating if it is not done soon enough or at too high a dose.  There is a lot of information in this thread :

Your best bet is to taper very slowly to avoid severe withdrawal symptoms.  If they do happen during the taper, you may be able to do a small updose, which is preferable to tapering all the way off too quickly and having to reinstate.

 

 

Will you please give concrete examples of “severe adverse reactions” to RI? Thank you. 

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Altostrata
3 hours ago, Godiswithme said:

Will you please give concrete examples of “severe adverse reactions” to RI? Thank you. 

 

Not sure how you meant that question, Godiswithme. It has a pugnacious tone that tempts me to respond, "Try it and see."

 

If you read this topic from the beginning, and you really should, you will see full and detailed cautions about why one would be cautious about reinstatement. If you don't know what "sensitized nervous system" means, you are fortunate. Please don't take any risks while going off psychiatric drugs that might sensitize your nervous system.

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Godiswithme
2 hours ago, Altostrata said:

 

Not sure how you meant that question, Godiswithme. It has a pugnacious tone that tempts me to respond, "Try it and see."

 

If you read this topic from the beginning, and you really should, you will see full and detailed cautions about why one would be cautious about reinstatement. If you don't know what "sensitized nervous system" means, you are fortunate. Please don't take any risks while going off psychiatric drugs that might sensitize your nervous system.

I said, “please”. I said, “thank you”. It was a question. How on earth is there a pugnacious tone to it? I know one thing. I would never say “try it and see” to another human being about a question like that for ANY reason. Yes, I did have a sensitized nervous system and I wouldn’t wish that on any other human. So, if anyone could please help me, I’m trying to find out what some examples are of severe adverse reactions to reinstatement. I asked a similar question on my thread a year and a half ago and no one responded. Thank you, Alto, for your gracious response. 

Hopefully, someone will be kind enough to answer my question. 

 

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Altostrata

By your response, I think you already know the answer to your question. By the way, read the topic.

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Godiswithme
4 minutes ago, Altostrata said:

By your response, I think you already know the answer to your question. By the way, read the topic.

I did read it. 

What enjoyment could I get from asking that question if I already knew the answer? 

Whatever. I think the answer would contain valuable information to share with everyone.  

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Altostrata

What that means is: Your question is answered earlier in this topic.

 

You tend to ask the same questions over and over, Godiswithme. Please look carefully at the information that's already here before asking again, save the staff some work.

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WackoSirJacko

Why it's good to crash!  (MOD NOTE:  Please see this post)


When we crash, it’s scary, very scary. But there is a bright side. Look at it this way. When we take these tablets, our brains adapt over time. The buoyant supply of neurotransmitters makes our brain reduce the production of said neurotransmitters. That’s why they stop working, or why we lose feeling. So we know our brains adapt. So why do we have delayed withdrawal, sometimes leading to a crash? – Well I reckon, (and this has got some scientific basis), that we have a reserve of neurotransmitters, we still have some drug preventing the reuptake, but it’s loosened a little from tapering and the reuptake is happening at a slightly faster rate than our downregulated production can replace them. Now a slow taper gives the brain time to adjust and increase the production as lower levels of neurotransmitters send the signal to our brain to do so. That’s the ideal for a slow taper. But sometimes the brain can’t increase production fast enough. This may be through a too fast taper, or increased stress hindering the process and using increased amounts of those neurotransmitters. This is when we crash! So why is a crash actually a good thing? – Because the brain WILL react, it will be given a very strong signal to increase production of the neurotransmitters. It will kick in to make the brain stable again. This is very uncomfortable to go through, but it’s actually a positive jump in healing. During a crash we should be careful not to react to the panic. Stay calm and accept. Think positively about it. Take the baby steps while our brain adjusts and trust that it will. Try not to go negative and spiral down. There is the option of a small increase in drug to help the brain stabilise, but for many this doesn’t help, it can confuse the emergency process the brain is going through. The best thing to do is recognise, hold the taper and wait it out with strong minded positivity that things will stabilise. I find a mantra of ‘I’m not scared of this, I accept it’ helps.

 

 

Edited by ChessieCat
added mod note

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Hibari
On 9/12/2018 at 7:51 AM, WackoSirJacko said:

Why it's good to crash!
When we crash, it’s scary, very scary. But there is a bright side. Look at it this way. When we take these tablets, our brains adapt over time. The buoyant supply of neurotransmitters makes our brain reduce the production of said neurotransmitters. That’s why they stop working, or why we lose feeling. So we know our brains adapt. So why do we have delayed withdrawal, sometimes leading to a crash? – Well I reckon, (and this has got some scientific basis), that we have a reserve of neurotransmitters, we still have some drug preventing the reuptake, but it’s loosened a little from tapering and the reuptake is happening at a slightly faster rate than our downregulated production can replace them. Now a slow taper gives the brain time to adjust and increase the production as lower levels of neurotransmitters send the signal to our brain to do so. That’s the ideal for a slow taper. But sometimes the brain can’t increase production fast enough. This may be through a too fast taper, or increased stress hindering the process and using increased amounts of those neurotransmitters. This is when we crash! So why is a crash actually a good thing? – Because the brain WILL react, it will be given a very strong signal to increase production of the neurotransmitters. It will kick in to make the brain stable again. This is very uncomfortable to go through, but it’s actually a positive jump in healing. During a crash we should be careful not to react to the panic. Stay calm and accept. Think positively about it. Take the baby steps while our brain adjusts and trust that it will. Try not to go negative and spiral down. There is the option of a small increase in drug to help the brain stabilise, but for many this doesn’t help, it can confuse the emergency process the brain is going through. The best thing to do is recognise, hold the taper and wait it out with strong minded positivity that things will stabilise. I find a mantra of ‘I’m not scared of this, I accept it’ helps.

I found what you have written really interesting.  I wish I could have held on to my crash state recently but could not and made the choice to up dose.   It was too intense for me because of some personal stress as well.  

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apace41

Just to clarify, WackoSirJacko, this is in the case of an unintended crash and you are pointing out that it may have a silver lining.  You are not suggesting that anybody should intentionally cause such a crash. I don’t want anyone in a state of desperation to read this the wrong way.

 

Good post by the way. 

 

Best,

 

Andy

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Blandell

Thanks WackoSirJacko for your thoughts. 

 

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