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Re: withdrawal from desiparmine-SK » bruin

Posted by SLS on March 20, 2005, at 7:11:16

In reply to Re: withdrawal from desiparmine-SK, posted by bruin on March 19, 2005, at 23:44:02

Hi Bruin.

> You should only cut it 5-10% and wait to become stable before cutting again.

* Using this SCHEDULE, how long would it take the average person to discontinue taking 150mg of desipramine?

How long shall one allow themselves to be "stable" before reducing their dosage any further?

How do you define "stable"?

My suggestion to cut by 50-25mg every three days is aggressive. A very prudent set schedule would be to cut by 25mg every three days. This would take 15 days to accomplish. If it were ME, I would do the following:

100mg x 3 days
50mg x 3 days
25mg x 3 days
0mg

9 days.

> While TCAs normally don't cause withdrawals as frequently as SSRIs,

Tricyclic and SRIs are definitely different beasts. I treat them differently when I need to discontinue them, something I have had the unfortunate experience to do many, many times over the last 25 years. I think it is well justified to taper a tricyclic more rapidly than an SRI. The only exception might be clomipramine. I was on it only once, and I don't recall too well my experience with it. No "brain zaps" though. A rapid taper of a TCA probably makes sense for most people who want to move on to another medication. Your schedule is almost exactly that which is prescribed for discontinuing a benzodiazepine. This is not at all necessary.


* Your taper schedule for 150mg of desipramine would take between 4 - 8 weeks to accomplish if one were to stay at each dosage for 2 days; 11 - 22 weeks at 3 days. This is unacceptable for a tricyclic.

http://www.currentpsychiatry.com/2002_06/06_02_Tricyclics.asp

"Discontinuing tricyclics:

When discontinuing a TCA, taper the dosage no more rapidly than 25 to 50 mg every 2 to 3 days. Abrupt discontinuation can cause cholinergic rebound, with symptoms such as nausea, cramping, headache, vomiting, and sweating. “Rebound hypomania” or “mania” have been reported with abrupt cessation of TCAs,24 especially in patients with bipolar disorder. If the etiology of rebound symptoms is unclear (i.e., medical versus psychiatric), re-administering the discontinued TCA should relieve the symptoms and confirm a diagnosis of discontinuation."


- Scott

 

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