Posted by bruin on March 20, 2005, at 9:34:30
In reply to Re: withdrawal from desiparmine-SK » bruin, posted by SLS on March 20, 2005, at 7:11:16
"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."
No offense, but your experience here means little to nothing simply because everybody's biochemistry and histories are different and because you got off easily doesn't mean the next will. In terms of moving on to another medication, if that is the goal then that changes things. However, if you are going off for good then it is better safe than sorry. You mentioned my "schedule". I don't have one. I thought I was clear on that one. Whether it is quick or long isn't important.
" 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"?"Stable is when withdrawal symptoms have abated to the point that you feel quasinormal again. Depeding on a person's history I would wait anywhere from a few days to a few weeks. The specific drug also makes a difference.
"http://www.currentpsychiatry.com/2002_06/06_02_Tricyclics.asp"
Siting something that is a pawn to big pharma doesn't really hold water for me. THen again, if you have completely bought into the notion of psychiatry then I don't think we will ever agree on anything.
Here is the thing. If the person is switching to another drug then I'd probably side with you because it is my opinion that they are losing the point and probably the battle, but I'll leave it at that. However, if they are ridding themselves of these neurotoxins for good then setting a "schedule" is foolhardy and a recipe for pain and suffering. I know more than anyone the compulsion to rid one's self of these drugs, but prudence and patience will always pay dividends whether it is a TCA, an SSRI, an MAOI, AP, or whatever. You simply can't assess over the internet someone's history or have an idea about their biochemistry and how it reacts under these situations over the internet. Giving them a schedule is wreckless IMO. Hence, all I do is try to emphasize the importance of going slow and suggest some things that are good for restoring health to the CNS and trying to fix whatever damage these drugs did. Take care
> 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
>
poster:bruin
thread:472303
URL: http://www.dr-bob.org/babble/wdrawl/20050228/msgs/473117.html