☼ lionboy: protracted withdrawal from citalopram

[lionboy]

Hi Jemima

Thanks for replying.

I am on 11.25mg citalopram at the moment. I tapered down to this from 25mg over a 5 month period last year from July to Dec.

Prior to that I had been on 25mg for 3 years and latterly had developed problems that I now understand to be side effects.

During taper I would reduce by 1mg and usually get a bit of destabilisation (for maybe a day or two) followed by a good week to 10 days before the side effects appeared to return and then I would reduce again.

This seemed to be working like clockwork until my last reduction (down to 11.25mg) at the end of December left me destabilised for months.

Professor Healy terms this a "shelf" and he sent me a document explaining that people can reach a point in their taper where they can experience extreme difficulties that can last many weeks or longer.

He says that if you can overcome the shelf it can then be relatively plain sailing again on the taper.

(I guess this is the brain catching up with the cumulative effect of all the decreases ?)

I had been off work since Christmas in this "shelf", with symptoms changing over time etc and whilst ****, I felt I could cope with it and get it done.

6 weeks ago the symptoms suddenly changed into something I have never experienced before and it was terrifying.

I had severe anxiety, agitation, inner restlessness, insomnia etc as if I had been possessed.

Thinking that the shelf may have ended and this could be side effects, I tried a 1mg reduction. Immediately I felt relief from the consuming nature of the symptoms, however as the next days passed it became clear that my body was not ready for this reduction and I reinstated my dose on day 5.

Based on my previous taper experience I think you get a feeling for when a reduction is helping.

This didn't seem right which leads me to think that the problems are part of the shelf and thus a withdrawal problem and as such won't be helped by a further reduction.

If I had to call it I would say I need to wait this out, however the symptoms are so bad at times that I feel like I can't take anymore and that I'm going to die and never get out of this.

 

I used 1 or 2 x 2mg diazepam daily for just over 2 weeks recently to help me through this and I stopped them 11 days ago with seemingly no real problems. My original problem soon reappeared but seemed less constant and less severe. In the last few days however the symptoms seemed to have ramped up again and I have had 2 terrible days yesterday and today.

I took 2x 2mg diazepam yesterday and today although it doesn't really seem to have helped the way it did before ?

 

I just feel lost and confused at the moment and can't see the way out ?

[Jemima]

Thanks very much for clarifying your situation.

 

Most of us have gone through periods when we thought we just couldn't take it any more. That's a part of withdrawal that I admit is very, very difficult to tolerate, but we do get through it.

 

I suspect that you may have developed a Valium dependency over the two weeks that you took it and that's what's come back to bite you, or perhaps it's rebound anxiety from the benzo. That the same dose isn't helping your symptoms as it did before is--maybe--an indication that your tolerance for Valium has increased, an indication of dependency. It's not unusual for any kind of psychiatric drug withdrawal symptoms to be delayed by a few weeks or even months, so this awful period you're going through could be benzo withdrawal or rebound on top of your citalopram withdrawal.  That's my very strong hunch, but I'm not a benzo expert and I'm hoping that the very knowledgeable Rhi will be along soon to help. I'm not sure what to recommend if my hunch is correct, but be assured that this too will pass in time.  We just need to figure out how to do that the most comfortable way possible.

 

You might want to go back and reread Rhi's posts in the meantime.

[lionboy]

Thanks Jemima, your help means a lot.

When this phase of ssri problems started it was so terrifying and all consuming.

I didn't want to ever use benzos but I was desperate.

After I stopped using them I felt my original symptoms return but they were much more manageable. I had a week without diazepam when I felt that my ssri symptoms were waning and that I could get through this.

The ssri symptoms have sort of built up over the last few days culminating in today being the worst day.

Having said that, I have been reasonably relaxed this evening (considering).

I took 1 2mg diazepam this morning at 11 and another at about 1pm and they maybe took the edge of it but not much.

I only really relaxed this evening from about 7.30pm.

Although my worst ssri problems are back and are awful I am just hoping that the last week of more manageable problems and the windows of rest bite such as this evening indicate that they are waning ?

 

I also have no experience of benzos and don't know what to expect ? (Although I would have imagined that any withdrawal from 2 weeks usage at a low dose would have shown themselves in a matter of days as appose some 9 or 10 days later ? However as I say I have no experience).

 

I really really need a good day to give me hope.

[lionboy]

I didn't sleep very well last night and kept waking up almost panicked.

It seems to me that whatever is happening to me only subsides when I lower my dose of citalopram or take Valium.

Of course I don't want to use Valium anymore.

 

When I lowered my dose before it gave me relief for a couple of days and then the withdrawal started to ramp up.

 

It seems my only option is to reduce my dose again but I don't feel this is the right thing.

I really don't know what to do ? I just want this to stop. It's now 6 weeks.

[Rhiannon]

LB, you're in a tough situation. I'm so sorry. I know you're feeling absolutely miserable.

 

Since you were already in bad shape before you took Valium (sounds like from about May 24th to about June 11th or 12th?) it's hard to say if Valium withdrawal is contributing to what you're experiencing now. It could be. Benzos are tricky, and mixed med withdrawal is tricky too, and when someone's destabilized, things can affect them in unpredictable ways.

 

My overall sort of hunch about this is that most of what's going on with you is delayed citalopram withdrawal, possibly aggravated by a reaction to the last of the diazepam metabolites finally being eliminated from your system. Those metabolites stay in the body for a long time, and I personally am extremely sensitive to them, so it's not impossible that you could be too.

 

I personally wonder if this "shelf" phenomenon as Dr. Healy calls it might be similar to or related to that kind of delayed withdrawal effect that people sometimes get when they taper too fast off an AD or CT it. It's not uncommon for people to get through the acute withdrawal and then feel better and on the mend, and then to get hit with another round of pretty agonizing symptoms further out.  I'm wondering if whatever is going on with that might be part of what's going on here. Not that any of my speculation helps you at all. 
 

It sounds to me like what you really need to do is hold off on any med changes right now. I suppose it's possible that you're getting citalopram side effects, but I think it's much more likely that what you're experiencing is the long involved process of withdrawal. Side effects usually go down as the dose goes down.

 

You cut from 25 mg to 11.25 mg in six months or so, which is not crazy or reckless but is not super slow either, and it also sounds like you were making cuts the same size the whole time. Since (as in those charts I referenced) receptor occupancy is a curve, not a straight line, if you keep making the same size cuts (like 1 mg for example) your body is going to experience that as making bigger and bigger cuts each time. So my suspicion is that your taper just became too aggressive for what your body can handle.

 

Given that you don't complain of having tons of side effects (like how you're feeling now) from citalopram at, say, 15 mg, or 12 mg, it seems unlikely to me that side effects are the predominant cause of your current symptoms, and more likely that you're experiencing the complex of symptoms that we see so often in withdrawal. 

 

And this may be somewhat complicated by the additional stirring of the pot by putting in Valium and then taking it out.

 

As always, your body is the only expert and the only true guru. It sounds like you've been sensible and cautious with your taper in general, but maybe it got a bit too aggressive for what your body can handle as you got to the lower doses. There is so much variation in what people can tolerate.

 

I hear your concerns about whether maybe you need to cut more to feel better. It's always a rock and hard place situation, when there are nasty side effects versus nasty withdrawal effects. In your case, my hunch is that most of what's going on with you now is withdrawal effects, and that what you really need to do right now is keep your medicating as stable as possible--same doses same times every day.

 

I would avoid Valium but I do understand how hard it is not to take it when you're in the most dire of straits. I've done all kinds of things, meds and what have you, in my worst spells--I really do get it. I do suggest that if you feel you're going to want to make Valium part of your toolbox, you'd be better off either taking no more than one 2 mg dose a week and carefully observing your reactions for a full seven to ten days afterwards; or taking it regularly, every day, same dose same time every day, to keep your brain's chemical environment as stable and steady as you can. (And then of course you will need to taper it off eventually.)

 

I agree with Healy that if you can ride this period out you will eventually improve and feel better and be able to continue your taper, albeit maybe with smaller cuts now that you're at a lower dose. I think the best way to do that would be to avoid adding in any new drugs or changing your dosage and to use all the nondrug tips and tricks you can to just cope and get through it one day, one half day, one hour, one minute at a time.

 

Give your brain all the stabilizing support you can (regular schedule, gentle walking daily, dark glasses and earplugs if you need to reduce sensory stimulation, regular sleep or at least rest if you can, good diet with regular meals, etc.)  I think it's going to be a bumpy ride for a while yet, but if you can avoid disrupting your brain's attempts to settle down chemically (that is, try not to disturb or disrupt its chemistry, so again best to avoid drugs and dosage changes) and if you can trust your body to heal and give it lots of loving support, your body will figure this out and untangle the mess and sort it out and settle down over time.

[Rhiannon]

More about Valium: After you take diazepam it goes through a process of the liver converting it to another form, then converting that to another form, and then another one, all of them overlapping and several of them active benzos in their own right, so that for many days after you take a dose you are still having a parade of benzos passing through your body. When you take a dose one day and then another the next and then another the next, over time the level of those metabolites builds up to a steady state level. Then when you pull out the Valium, you get to withdraw not just from Valium, but from each one of those active metabolites as the levels of it fall off over many days. 

 

Other benzos mostly don't have all those active metabolites.

[lionboy]

Thank you Rhi for taking the time to access my situation and for sending me such a detailed and insightful message.

I almost don't dare write this, but I had a distinct window of improvement today so hopefully there is a glimmer of light for me.

Thanks again Rhi x

[Skyler]

I had a distinct window of improvement today so hopefully there is a glimmer of light for me.

EXCELLENT!

[lionboy]

Thanks Sky.

[lionboy]

Rhi

If I could ask you one more technical question:

After I used diazepam for 2 weeks ish I stopped and didn't take any for 9 days.

Last Friday and Saturday I was really bad so I took 4mg on Friday and 4mg on Saturday. This didn't really seem to provide much relief and Sunday was a terrible day.

Monday I had a distinctly better day with a long positive window and the same yesterday.

Is there anyway that the remains of the diazepam are causing those good windows ?

Or is this truly an indication that the ssri problem is now less constant and coming in windows and waves and thus starting to pass ?

 

I know that this is a bit super technical, but to my mind surely if you take diazepam fri and sat and it provides very little relief and Sunday you are also terrible then it would not suddenly relieve you on Monday and Tuesday would it ?

That being so, it would appear that the dreadful ssri problem is subsiding gradually.

 

I am interested to know if you concur Rhi as I was worrying that the only time the ssri symptoms subsided was when I took diazepam and then they ramp up again as I stop taking it.

This doesn't seem to be the case though now ?

[lionboy]

A quick update:

Last week I had four or five really good days and in patches I was almost better. This week that feeling of recovery has gradually slipped away and I have now had another bad few days culminating in today being the worst so far.

Although I feel terrible today and have not felt great for a few days the feelings don't seem quite as strong or as pronounced as they were last time.

Last week the good feelings were also much stronger than the feelings I had had in my ok week before.

I am really hoping that this is the withdrawal problem now starting to iron itself out.

I need to get past this point it has really knocked the wind out of me.

[Rhiannon]

Rhi

If I could ask you one more technical question:

After I used diazepam for 2 weeks ish I stopped and didn't take any for 9 days.

Last Friday and Saturday I was really bad so I took 4mg on Friday and 4mg on Saturday. This didn't really seem to provide much relief and Sunday was a terrible day.

Monday I had a distinctly better day with a long positive window and the same yesterday.

Is there anyway that the remains of the diazepam are causing those good windows ?

Or is this truly an indication that the ssri problem is now less constant and coming in windows and waves and thus starting to pass ?

 

I know that this is a bit super technical, but to my mind surely if you take diazepam fri and sat and it provides very little relief and Sunday you are also terrible then it would not suddenly relieve you on Monday and Tuesday would it ?

That being so, it would appear that the dreadful ssri problem is subsiding gradually.

 

I am interested to know if you concur Rhi as I was worrying that the only time the ssri symptoms subsided was when I took diazepam and then they ramp up again as I stop taking it.

This doesn't seem to be the case though now ?

I'm sorry I didn't catch this question when you asked it.

 

It's possible that diazepam is involved in the ebb and flow of your symptoms--like I described above, it's kind of complex because it has those metabolites that show up after a while and then go away after a while. I know that for me at least one of those metabolites is more sedating than the actual diazepam, because when I first started taking it and was ramping up my dose I didn't feel the sedation until about two days after I took the increased dose.

 

But as you are seeing, the symptoms of withdrawal also come and go and ebb and flow in that "windows and waves" kind of way.

 

So it's hard to say. I encourage you to avoid taking diazepam, and if you do have to take some try taking a smaller dose, 2 mg maybe or even 1 mg, just to see what's the smallest dose that you can take that will make things tolerable for you. Really best would be to avoid it. Going on and off it is just going to complicate your recovery.

 

I'm hoping that the fact you're having slightly more window time than wave time now means that things are starting to improve for you. 

 

I'd encourage you to continue to do things that support your nervous system (regular schedule, sleep, low stress, good diet, gentle exercise/walking) and see if the window times continue to grow and the waves continue to be a bit less.

 

I know you're not thinking of restarting your taper yet (don't think you should) but when the time comes, you probably need to go with smaller cuts, maybe 5%, at first at least, and start throwing in some intermittent longer holds. Take a look at the charts in these papers: http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

You can see that at lower doses, the cuts in dose have a much larger effect.

[lionboy]

Thanks Rhi.

I intend to stay away from the diazepam in future.

I never ever wanted to use it, however the onset of symptoms I suffered in May was just debilitating and I was desperate.

After I last used diazepam on that Friday and Saturday I experienced little relief from it and was terrible on the Sunday.

On the Monday I had a distinct window of improvement. This was followed by 4 or 5 more days of almost feeling better. After that I had another 5 days or so of feeling that I was slipping back but not terribly like before.

I've now had 4 rough days like I'm back in the thick of it although not as agitated and panicked as before.

I think this must now be windows and waves of the original problem and most probably the diazepam use was somewhat incidental (as you originally suggested).

Although crap at the moment I don't feel like reaching for the diazepam and I feel that if I can just have another window now it will really be as if I am on my way out of this.

[lionboy]

I seem to be right back in the thick of it at the moment. Day after day of feeling terrible. I can barely get off my bed.

I hope to god I get another good window soon, this is really grinding me down now.

[Petunia]

Its awful to be hit by a wave after having started to feel better, its seems cruel.  I haven't had many windows in my recovery so far, but each time I have, I've been certain that its the beginning of a straight line towards complete recovery, only to have my hopes dashed.  I should know better after having explained about windows and waves enough times to others.

 

I'm sorry you are going through another rough patch, but it will pass.  I've read enough threads here now to know that windows get longer and more regular, waves get shorter and come less often.  Sometimes people get hit with a particularly bad wave after a long stretch of good clear windows, but it rarely lasts long, it just comes as a shock.

 

Hoping you feel better soon.

[lionboy]

Thanks Petu

[lionboy]

Another update to my situation:

I seemed to make some good improvements over the last two weeks. Nothing dramatic, like I was suddenly better but a slow creaping improvement day after day. This was really starting to give me hope until yesterday and today I seem to have again taken a big step backwards.

This is really frustrating and demoralising !

Hopefully this latest wave will be short and soon give way to an even better window.

[lionboy]

Today has been the worst day of this wave so far. Really struggling, although no where near as bad as it was in May etc.

My last wave didn't get AS bad as things were in May etc.

I haven't been in that really terrible state since 22nd June.

The last wave I had seemed to come on really slowly, as if I was gradually slipping into it and then I very slowly and gradually came out of it.

This time I seem to have slipped back much more quickly, so I can only hope I will snap out of it quickly as well.

I guess that my overall pattern is now starting to show gradual improvement in a windows and waves type pattern ?

I really hope I don't have far to go.

As always, I welcome opinions and support from other members.

[mlrp]

Just a fly-by word of encouragement, Lionboy. I'm so new to all of this that "windows/waves" is only just beginning to make experiential sense to me. This site is invaluable.

 

Hang in there. I'm pulling for ya!

[lionboy]

Thank you MLRP !

Yes, this site is excellent for people who find themselves in this unfortunate situation with AD's !

Alto is a real authority on all things AD related and there are some great guidelines on here re: windows / waves, tapering etc.

It's still not much fun though !

Also check out this site for a good description on the process of withdrawal re windows and waves:

http://npanth.wordpress.com/2013/01/31/waves-and-windows-in-ssri-withdrawal/

 

Also below is a document sent to me by Professor Healy which explains the concept of a "shelf" in ssri withdrawal. This seems to fit exactly with what has happened to me. I managed to go from 25mg to 12mg in 5 months with only a few minor problems then I dropped to 11mg and wham ! Months of problems.

This is the document:

 

 

Withdrawal Difficulties

One of the things that’s not widely mentioned in the literature anywhere, partly because it’s not understood, is the concept of a ‘shelf’. A shelf is a point where a person hits where they have marked withdrawal problems and instability even on the dose that they are currently taking. The problems can be so severe that the person thinks that if things get progressively worse as they reduce further from here there will be simply no way to stop.

In fact if the person is able to get through this juncture it can be relatively smooth sailing again until the next shelf.

Problems like this can happen at a quite a high dose – 12 to 15mg of Prozac for instance – and then there can be plain sailing down to 1 or 2 mg before the person then hits the next point at which they feel that they simply won’t be able to get off.

This links into something else that’s barely discussed in the academic literature which is the concept of instability.

It is recognised that people can become tolerant on drugs that cause dependence. What’s much less recognised is that people can sometimes become unstable on these drugs and unlike tolerance, which usually responds to increasing the dose, this instability doesn’t. Rather than having less symptoms when the dose increases, the person can have more symptoms.

Instability like this faces the sufferer and the doctor with real problems knowing what to do next.

All too often the answer seems to be to introduce a new drug – the latest fashionable one. At the moment gabapentin and pregabalin are high on the list of options. In most cases this is unlikely to be the right answer. These add-ins often seem to add to the problems rather than relieve them, even if they relieve some problems briefly in the short term.

 

Managing Instability

Having said that adding in another drug is not a good option, if the situation becomes particularly difficult on endure, there are probably five options, depending on the profile of difficulties a person has.

1. In the case of someone who at a shelf becomes very severely anxious and almost frozen the best option would be to add a benzodiazepines briefly to help unfreeze them and help them through the period until things ease off. A period like this dominated by high anxiety can be thought of as a catatonic problem and catatonic states often respond well to benzodiazepines.

2. A second option is to try verapamil in a 40mg dose to see if this relieves the problems. The rationale behind verapamil is that close to all of the drugs that cause dependence are channel blocking drugs also. Indeed it’s not clear that the dependence and tolerance comes from an action on the serotonin system rather than an action on some other thing that these drugs do. It’s very difficult for instance to explain the existence of a shelf at a 2mg dose of Prozac as some people have in terms of the serotonin system. It may be a little clearer what’s going on if we think more in terms of a calcium channel blocking effect coming into the picture at this point.

The calcium channel blockers are probably best for symptom profiles dominated by acute withdrawal features such as dizziness, blurred vision, nausea, brain zaps and brain fog.

3. A third option which is linked to opiate withdrawal is to reduce the vigilance that people have. In many withdrawal states people become hypervigilant. This is a form of anxiety which leads them to monitor there bodily processes closely and be hugely aware of every single thing that’s happening to them.

Lofexidine or clonidine work well in opiate withdrawal to manage exactly these kinds of features. If present in SSRI withdrawal Lofexidine or clonidine might work well.

4. A fourth option is that there has for a long time been a linkage between inflammation and fatigue and SSRI withdrawal. There are raised inflammatory markers in patients who are depressed and anxious and anecdotal accounts that a range of anti-inflammatories, such as aspirin or ibuprofen, can be helpful in relieving some of the difficulties that people have. This is something that the person in withdrawal can try out for themselves to see if it makes a difference.

5. For some people who decide the difficulties are too great, one option might be to switch to dosulepin or another weak serotonin reuptake inhibitor. Over months or perhaps years exposed to a less potent serotonin reuptake inhibitor systems may have a chance to adjust, permitting the person to finally get off completely.

Less Helpful Options

Many people faced with difficulties like this turn to supplements of various sorts and get tested for deficiencies of various sorts and consult herbalists or complementary medicine outlets of various sorts. Those testing for deficiencies always seem to find something. While some of the proposed corrections for a deficiency are relatively harmless, efforts to leach lead out of the body for instance can be positively dangerous.

While some people may have a significant deficiency, at this point in time we have no evidence that there is anything deficient in the average person who has withdrawal problems or anything that can be remedied by a supplement or herb.

 

(My wife has finally showed me how to cut and paste on the iPad !!!)

[lionboy]

Further update to my situation and request for some more help / advice / opinions etc. (Calling Alto, Sky, Rhi etc)

 

Since July I guess I have gradually improved. I'm certainly not still having the desperate problems I was before. I am still off work and still not really functioning. I seem to be spending most of the day in bed.

Since July I keep starting to feel slightly better only to feel worse again later that day or the next day, I guess like typical windows and waves. I have not really had a distinctly good period in the last month - 6 weeks however overall I am better than I was. The last month or so seems very same ish.

When the really bad stuff happened in May I tried a 1mg reduction that was unsuccessful, leading me to conclude that the problem was withdrawal as appose side effects.

Normally when a period of withdrawal ends I have a distinctly good period before the side effects start and then I need to reduce again. As I've not had a distinctly better period I suppose this is still withdrawal ? However it seems unbelievable that I am still going through it 9 months after my last 1mg reduction ?

If it were side effects I would have expected a better reaction in May when I tried another 1mg reduction and I would have expected the withdrawal period to end in a distinctly better period before the emergence of side effects.

 

As always, any comments and / or opinions are always welcome.

[Altostrata]

My guess is you are one of those people who are extremely sensitive to reductions. Good to hear you're feeling better.

 

I might hold longer, don't worry about another reduction.

[lionboy]

Thanks Alto. I must say I find it really confusing ?

[Altostrata]

If you have been feeling better by holding, why rock the boat?

[lionboy]

Sure Alto. I think holding at the moment is the best option. I just find it so confusing that I managed to reduce 25mg to 12mg in 5 months with only minor problems then I went from 12mg to 11mg and wham 9 months of problems and counting including a two month period when I thought I was going to die !

[lionboy]

Just to further update my situation: I had a period of 8 days over the last week or so where I started to feel much better as if this withdrawal was coming to end. I had started to consider returning to work etc until a couple of days ago when it slipped away and I am now back to how I felt before that period. That 8 days was the best I have felt in the last 9 months. Not perfect, some over stimulation etc but good as if the sun had come out. So frustrating and demoralising to slip back again !!!

Windows and waves I guess, but I wish it would just fcuk off !

[Skyler]

Hi Lionboy... sorry you slipped back, but very glad you had such a long window! I know the waves are very frustrating, and even seem worse when they return than before they abated, but take heart, you are going in the right direction, and success will soon be yours!

[lionboy]

Thanks Sky. I hope so !

[Petunia]

Hi Lionboy,

 

It can be disheartening when symptoms come back after a period of feeling better, its natural to start thinking that recovery is linear and that we will just continue to feel better and better.  I find it particularly difficult to accept the waves after feeling a little better for a while, so I understand how you feel.

 

But the fact that you had an 8 day window is encouraging and a real sign of recovery.

 

 I just find it so confusing that I managed to reduce 25mg to 12mg in 5 months with only minor problems then I went from 12mg to 11mg and wham 9 months of problems and counting including a two month period when I thought I was going to die !

 

This article shows why tapering can cause increased symptoms as the dose gets lower:

 

The Science Behind Slow Tapering at Low Doses

[lionboy]

Hi Petu

Thank you for your response. I am feeling bad today and seeing another response on my thread always makes me feel that bit better.

You are right that it feels very disheartening to see some decent improvements and then get hit by a wave and feel back at square one.

It's like snakes and ladders. You think you are nearly there and then you slide down all the way back to the start.

 

Of course in reality that's not true as you don't actually go through the same experience twice. You may have 100 bad waves to get through but after each one is done that is a wave you won't go through again and you are another step towards the end.

It really is demoralising though as I think it is a natural human condition to not dwell on the past when we feel better and just move on.

I read somewhere that people often only turn to forums such as this in the bad times and as soon as they are well they just get on with their lives. I am certainly guilty of this myself. In the really bad times I am constantly checking in for advice and support, as soon as I feel well I want to be out with my children living.

I believe this explains the lack of total success stories. Once people are healed from SSRI withdrawal, other diseases, cancer or whatever it is they just want to get on with living.

I personally always feel a responsibility to others on here to check back in and update the success as well. I hope one day to be able to write my success story and I think that it is so admirable that people who are healed or much better, stay around as staff etc to help others.

 

I am familiar with the document you posted.

I certainly accept that slow tapering is the best way to get off AD's. I think that if Alto's protocols were more widely adopted it would save a lot of people a lot of problems. Making small dose cuts with sufficient time between each is certainly infinitely better that large aggressive cuts or cold turkey. Alto's 10% rule of thumb is a great general guide.

I have learned loads via this site.

 

As I personally suffer side effects when stable at a dose as well as withdrawal effects when cutting I have found tapering challenging. As can be seen in my thread, I found success last year with 1mg reductions. I really do hear and understand peoples cautionary words to me that I should keep the % reduction the same throughout the taper or to say it another way make smaller cuts as the dose gets lower.

I did try half and three quarter mg cuts a few times during my taper and the results, for me , we're not successful.

Each time the side effects came back much more quickly and thus I then had to cut again meaning that by making smaller than a mg cuts I actually ended up cutting more over the same time period as appose sticking to 1mg cuts.

I don't claim to understand this, it is just my experience.

 

With regard to the article, I am cautious to make the connection ,that some seem to have, that this article demonstrates proof that the effects of these drugs are at a level of 75 - 80% at 10mg.

I know that people feel the graphs curves fit with their experience and I am quite prepared to accept that this is correct and true. I have no experience of tapering from 10mg to zero so I am not the best person to comment on that.

If we are to consider this article as finite proof, as above then I feel that we need to accept two things:

1. The process used to measure SERT occupancy in the living brain is accurate.

2. SERT occupancy is a credible measure of the drugs action on the body.

 

For me I have no clue on point one as I don't have the knowledge or understanding to form a judgement.

On point two, I feel reluctant to believe this is correct. I feel that the picture is just not that simple. I think that SERT occupancy is a part of the jigsaw but only a part.

 

Of course I don't really know either way.

I have met with and corresponded with Professor Healy in the past and I will now sent this to him for his opinion and post up his response. I am really interested in his perspective on this for my own understanding and maybe others would also like to see that ?

[Petunia]

Hi Lionboy,

 

With regard to the article, I am cautious to make the connection ,that some seem to have, that this article demonstrates proof that the effects of these drugs are at a level of 75 - 80% at 10mg.
I know that people feel the graphs curves fit with their experience and I am quite prepared to accept that this is correct and true. I have no experience of tapering from 10mg to zero so I am not the best person to comment on that.
If we are to consider this article as finite proof, as above then I feel that we need to accept two things:
1. The process used to measure SERT occupancy in the living brain is accurate.
2. SERT occupancy is a credible measure of the drugs action on the body.

For me I have no clue on point one as I don't have the knowledge or understanding to form a judgement.
On point two, I feel reluctant to believe this is correct. I feel that the picture is just not that simple. I think that SERT occupancy is a part of the jigsaw but only a part.

Of course I don't really know either way.
I have met with and corresponded with Professor Healy in the past and I will now sent this to him for his opinion and post up his response. I am really interested in his perspective on this for my own understanding and maybe others would also like to see that ?

 

Yes, please do, I would be interested in his response.

 

Your comment about snakes and ladders reminded me of playing that game as a child, I never liked it.  Someone should make a withdrawal version where you ride a wave down to a lower level or fly out of a window to a higher one.... maybe not

 

I hope you get another nice, long window soon. 

[lionboy]

Lol yeah...

The withdrawal game. Best to set aside at least a few years if you want to play.

 

I'll see what Professor Healy has to say.

[lionboy]

After another really good week or so I seem to have slipped back again. I have now had approx two good weeks in the last three, so I guess that is significant progress.

When I have my good weeks it is kind of like the drugs have suddenly started working again and I feel much better and really positive but a bit over stimulated. Maybe a bit restless and erratic but not in a really negative way.

As soon as a wave comes I start to feel withdrawn, cold a bit anxious like I just want to be in bed.

I know this is probably nonsense but I can't help feeling that this withdrawn feeling is what it will be like when I get off the drugs completely.

Has anyone else experienced this type of feeling ?

[Altostrata]

How are you doing now, lionboy?

[lionboy]

Hi Alto

Thanks for asking.

I'm improving with time I guess. As you know, it's slow and just when you feel you are really getting somewhere a nice big wave comes along to kick you back down.

I would say that I am improving, it's a long arduous journey though !

I'm still off work. I started to seriously consider going back and then the latest wave came.

I feel fairly optimistic that I am getting there though.

I took your advice re: omega 3 fish oils and now take 3000mg per day EPA + DHA.

That does seem to have helped. My GP, who is a decent supportive guy, also suggested i use Omega 3 as he believes it helps with neuroplacy.

[Altostrata]

Very happy to hear you're doing better. I added our cheerful "here comes the sun" symbol

 

☼

 

to the title of your Intro topic, to show you're recovering.

 

Please continue to let us know how you're doing. I hope you will add your story to our Recovery Success Stories eventually!