![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by SLS on February 14, 2005, at 9:31:32
I taper by "feel" and use no other substances for remediation.
This is a very clumsy description of what I do:I have always had success discontinuing Effexor and Paxil by tapering by "feel". I taper quickly in the beginning, waiting to find the point at which withdrawal symptoms develop, then I slow down. I take just enough drug to prevent these symptoms from being too uncomfortable. I can usually find a dosage that makes them disappear temporarily. Towards the end of the tapering period, I use factions of pills or capsules instead of being confined to using the whole doses provided by the manufacturer. Of course, a liquid would be better. I also do not confine myself to a therapeutic dosing schedule. In other words, I will take small amounts of the drug several times a day - even when using the extended release preparations. As a matter of fact, I purposely wait until withdrawal symptoms just begin to reappear before taking taking the next dose of drug. I take as little drug as will allow me to go another 6-8 hours with greatly reduced symptoms or no symptoms at all. It is good to observe an pay careful attention to what symptoms are characteristic of your withdrawal syndrome so that you can identify it as soon as it reappears. On an empty stomach, it might take 15-30 minutes after a dose for these to subside. I sometimes allow the drug to dissolve a bit sublingually or bucally. I then wash the rest down with water. I find that I am able to use less and less drug to prevent the reemergence of symptoms for this 6-8 hour period. I also find that, if done correctly, the period without symptoms extends further and further. I have opened up extend-release capsules and used the granules contained in them for these fractional doses. Contrary to what some others have said to suggest that you should not do this because it confounds the purpose of the extended release design, this strategy serves the purpose well as these preparations are currently formulated. Of course, you can just use the tablets and cut smaller and smaller pieces off of them. I just nibble at them whenever I feel the withdrawal symptoms coming on.
I have tried discontinuing these SRI medications without this taper method and experienced many of the withdrawal symptoms that others describe, including those poorly-understood "brain-zaps" or "brain-shivers". I am not one of those people whom can go on and off these drugs easily and without a discontinuation syndrome.
I really hope this strategy works for someone other than me. I have used this same strategy to discontinue benzodiazepines like Ativan.
- Scott
Posted by ed_uk on February 14, 2005, at 10:17:20
In reply to Please list strategies for successful withdrawal:, posted by SLS on February 14, 2005, at 9:31:32
Hi Scott,
>This is a very clumsy description of what I do.
I thought it was a very good description actually, you do underestimate yourself sometimes- but I'm sure you know that :-)
Ed.
Posted by SLS on February 14, 2005, at 10:33:16
In reply to Re: Please list strategies for successful withdrawal: » SLS, posted by ed_uk on February 14, 2005, at 10:17:20
> Hi Scott,
>
> >This is a very clumsy description of what I do.
>
> I thought it was a very good description actually, you do underestimate yourself sometimes- but I'm sure you know that :-)
Thanks, Ed.:-) to you too!
- Scott
Posted by not2late4u on February 15, 2005, at 2:29:15
In reply to Re: Please list strategies for successful withdrawal: » ed_uk, posted by SLS on February 14, 2005, at 10:33:16
Im about done posting on the boards, but thought I'd add to this one since I was successful in tapering off Effexor XR from 225mg. Slowly, listen to your body, DONT rush it. It might be tempting but Im telling you, if you want it to be as smooth as possible, DONT rush it. Stay at a dose for a few days or week, then go down another 37.5 and stay there for as long as you need to and so on. Keep in mind any events you may have coming up, dont go down on your dose until that event is over. Its not a race. It took me 35 days to taper off and I had 1 real bad couple of hours because I rushed it one day. Be aware of symptoms so your not freaked out by them and so you know when they have subsided for a couple of days, then go down another 37.5. Be sure your Doc knows what you are doing. I've been off it now for about 26 days. I have some lingering side effects that come and go, but are dwindling each passing day. Biggest problem for me, irritability and easily frustrated. This too shall pass. Im working with a great doc now who is heling me get my body chemistry/hormones and all back into balance. Good luck to you all. God Bless, Renee p.s. somewhere on this board you can find my journal of updates "renee tapering off effexor". probably in archves since it was around the end of dec/early Jan that I started posting that.
Posted by catachrest on February 15, 2005, at 8:42:26
In reply to Re: Please list strategies for successful withdrawal: » ed_uk, posted by SLS on February 14, 2005, at 10:33:16
Like Renee I'll reiterate, take it slowly! I waited a month or two between steps down and I had an incredibly uneventful withdrawal.
Ed, I have no doubt that you know what you're doing and that you have gone through this before.
But for the newbie, or even just someone who isn't as used to listening to their body's signals, it can be very tempting to think that you are ready for the next step down, that you're feeling good and want to keep moving. But take it slowly!!! Don't let your good mood and enthusiasm (after depression, these feel almost like drugs themselves!) blind you to the necessity to take your cessation slowly and carefully. At each step, before you reduce further, take careful stock of how you're doing emotionally and physically, and discuss it with your doctor. :)
That's my two sense. I'm not a doctor, just someone who's been through this recently for the first time.
Susan
Posted by SLS on February 15, 2005, at 10:29:58
In reply to Re: Please list strategies for successful withdrawal:, posted by catachrest on February 15, 2005, at 8:42:26
> Like Renee I'll reiterate, take it slowly! I waited a month or two between steps down and I had an incredibly uneventful withdrawal.
That is sometimes an unacceptable period of time when one must discontinue one drug so that they can begin another.
> Ed,
Ed is innocent! :-) I think you are reacting to my post.
> I have no doubt that you know what you're doing and that you have gone through this before.
I don't profess to know what I am doing. I am merely asking for people whom have successfully discontinued medications without suffering a severe withdrawal syndrome to describe how they went about it. I contributed. I have not suggested to any one person what they should do for themselves. I was hoping to begin compiling a compendium of alternate methods. Not everyone is successful using yours.
> Don't let your good mood and enthusiasm (after depression, these feel almost like drugs themselves!) blind you to the necessity to take your cessation slowly and carefully.
You don't know the first thing about my mood, my degree of enthusiasm, nor my state of depression.
> At each step, before you reduce further, take careful stock of how you're doing emotionally and physically, and discuss it with your doctor.
> That's my two sense. I'm not a doctor, just someone who's been through this recently for the first time.
I am happy that you have been successful using a 4-8 week taper. Yours is but one strategy. I am hoping to discover more.
- Scott
Posted by SLS on February 15, 2005, at 11:02:21
In reply to Re: Please list strategies for successful withdrawal:, posted by catachrest on February 15, 2005, at 8:42:26
Hi.
> > Like Renee I'll reiterate, take it slowly! I waited a month or two between steps down and I had an incredibly uneventful withdrawal.
> I am happy that you have been successful using a 4-8 week taper. Yours is but one strategy. I am hoping to discover more.Oops. It looks like I grossly underestimated the time it took for you to withdraw from your medication. You remained at each dosage for 1-2 months? Exactly how many weeks did it take for you to taper?
- Scott
Posted by catachrest on February 15, 2005, at 14:21:51
In reply to Re: Please list strategies for successful withdrawal: » catachrest, posted by SLS on February 15, 2005, at 10:29:58
I'm sorry Scott! I think I worded my message poorly. I was hoping to prevent exactly the misunderstanding that seems to have occurred.
> > Like Renee I'll reiterate, take it slowly! I waited a month or two between steps down and I had an incredibly uneventful withdrawal.
>
> That is sometimes an unacceptable period of time when one must discontinue one drug so that they can begin another.
>
>>>I concur. Everyone's situation is different. My point was just not to take it too fast and to be prepared for it to take awhile - not necessarily as long as it took me (and perhaps I needn't have taken so long, but that was my doctor's recommendation) but maybe longer than a person expects.> > Ed,
>
> Ed is innocent! :-) I think you are reacting to my post.
>>>> I think you're right. Sorry Ed!> > I have no doubt that you know what you're doing and that you have gone through this before.
>
> I don't profess to know what I am doing. I am merely asking for people whom have successfully discontinued medications without suffering a severe withdrawal syndrome to describe how they went about it. I contributed. I have not suggested to any one person what they should do for themselves. I was hoping to begin compiling a compendium of alternate methods. Not everyone is successful using yours.>>> whoa. I meant exactly what I said - that in your situation, your method works well for you. This was the only comment that I was directing toward you, in the hopes that what follows would be understood not to be directed at you specifically. I seem to have achieved the opposite result! Mea culpa.
> > Don't let your good mood and enthusiasm (after depression, these feel almost like drugs themselves!) blind you to the necessity to take your cessation slowly and carefully.
>
> You don't know the first thing about my mood, my degree of enthusiasm, nor my state of depression.>>>> I agree. I shouldn't have used 'you' - I was looking for a non-specific pronoun not as officious sounding as 'one'. I wasn't trying to speak to you personally at this point. I didn't make that clear and I apologise. My experience was, and I have read in several sources that it is not unusual, that when my depression began to lift, I began feeling so hopeful and had so much energy, and wanted nothing more than to get off my meds and get on with my life. This is the feeling I was referring to, and I never intended it to describe you personally.
> > At each step, before you reduce further, take careful stock of how you're doing emotionally and physically, and discuss it with your doctor.
>
> > That's my two cents. I'm not a doctor, just someone who's been through this recently for the first time.
>
> I am happy that you have been successful using a 4-8 week taper. Yours is but one strategy. I am hoping to discover more.
>
> >>>Of course it is. But as you say above, we are all only trying to present the strategies which have worked for us.In friendship,
Susan
Posted by catachrest on February 15, 2005, at 14:32:28
In reply to Re: Please list strategies for successful withdrawal: » catachrest, posted by SLS on February 15, 2005, at 11:02:21
> Hi.
>
> > > Like Renee I'll reiterate, take it slowly! I waited a month or two between steps down and I had an incredibly uneventful withdrawal.
>
> > I am happy that you have been successful using a 4-8 week taper. Yours is but one strategy. I am hoping to discover more.
>
> Oops. It looks like I grossly underestimated the time it took for you to withdraw from your medication. You remained at each dosage for 1-2 months? Exactly how many weeks did it take for you to taper?
>
>
> - Scott
Actually, I don't recall exactly. I didn't keep track. If I really thought about it I could make a decent estimate, but I would say 4 or 5 or so months. Obviously not everyone can take that long, especially if they have been having bad side effects (which I didn't - my SAs were mostly mild), but my doctor was unsure I had been on the medication long enough, and I think that affected his decision. Also, when my father died this summer, I stayed at one dose rather longer than I otherwise would have, as I was not in the right frame of mind to be messing around with my emotional control, as I thought of it then. So that added time too.So, I guess my withdrawal took longer than many others might. But it was also very successful and painless. So I am happy with the way it turned out.
Cheers,
Susan
Posted by SLS on February 15, 2005, at 14:56:09
In reply to Re: Please list strategies for successful withdrawal:, posted by catachrest on February 15, 2005, at 14:21:51
> In friendship,
> Susan:-)
There are many reasons why someone would need to discontinue an antidepressant.
1. Mission accomplished - remission of depression.
2. Mission not accomplished - switch drugs
3. Side effects
4. Conflict with other medications
5. Conflict with other medical procedures
6. Cost
7. Other
With the exception of #1, it is ideal to discontinue the drug as soon as possible. With #1, the idea is to withdraw the drug as gradually as possible over an extended period of time - not to avoid a withdrawal syndrome, but to avoid relapse. It has been shown that the rate of relapse is lower for a slow taper than for a rapid taper or abrupt discontinuation.
- Scott
Posted by dancingstar on February 15, 2005, at 15:09:47
In reply to Re: Please list strategies for successful withdrawal: » catachrest, posted by SLS on February 15, 2005, at 14:56:09
Of course, there's no independent proof at all that antidepressants work.
And there is no definitive way of getting them out of one's system. Each person is different, and what works for one person does not necessarily work for the next. Some people are unable to taper slowly because it sets them up for a situation where they are in too much pain to ever be able to stop taking (in this case Effexor) altogether. These people have to stop taking the drug all at once or be stuck with it for the rest of their lives.
Since Wyeth hasn't provided any escape hatch, trial and error are our only recourse.
Bitter? Um, yes.
Posted by SLS on February 15, 2005, at 18:54:29
In reply to Re: Please list strategies for successful withdrawal:, posted by dancingstar on February 15, 2005, at 15:09:47
Did you want to offer a strategy for the successful withdrawal of antidepressants?
- Scott
Posted by dancingstar on February 15, 2005, at 23:20:47
In reply to Re: Please list strategies for successful withdrawal: » dancingstar, posted by SLS on February 15, 2005, at 18:54:29
I've been posting just that since September.
Posted by Dr. Bob on February 16, 2005, at 1:11:23
In reply to Re: Please list strategies for successful withdrawal:, posted by dancingstar on February 15, 2005, at 23:20:47
> I've been posting just that since September.
I'd like to redirect follow-ups not about withdrawal to Psycho-Babble Social. Here's a link:
http://www.dr-bob.org/babble/social/20050215/msgs/458592.html
Thanks,
Bob
Posted by jay on February 17, 2005, at 14:24:02
In reply to Please list strategies for successful withdrawal:, posted by SLS on February 14, 2005, at 9:31:32
A most excellent combo for effexor and paxil withdrawl has been a combo of prozac and nortriptyline. Prozac has the long half-life, and the nortriptyline looks after the norepinephrine problem that effexor and even paxil (and now with Cymbalta) can bring. 25-50 mg of Nortriptyline seems to help.
Jay
Posted by SLS on February 18, 2005, at 14:15:46
In reply to Re: Please list strategies for successful withdrawal:, posted by jay on February 17, 2005, at 14:24:02
> A most excellent combo for effexor and paxil withdrawl has been a combo of prozac and nortriptyline. Prozac has the long half-life, and the nortriptyline looks after the norepinephrine problem that effexor and even paxil (and now with Cymbalta) can bring. 25-50 mg of Nortriptyline seems to help.
>
> Jay
Looks good to me!Thanks for contributing, Jay.
- Scott
Posted by Sebastian on February 21, 2005, at 11:34:59
In reply to Please list strategies for successful withdrawal:, posted by SLS on February 14, 2005, at 9:31:32
taper by means of cuting pills. This way the decreases are less, and more suted to the right dose for you at the time.
Posted by KaraS on February 22, 2005, at 21:00:46
In reply to Re: Only ONE contribution so far for WITHDRAWAL, posted by SLS on February 21, 2005, at 8:50:15
> Sorry. The contribution I was referring to was submitted by Jay:
>
> http://www.dr-bob.org/babble/wdrawl/20050214/msgs/459367.html
>
> We need more suggestions.
>
>
> - Scott
Scott,
I don't know if this will help you at all since my withdrawal was fairly standard. I decreased VERY slowly (opening capsules and then later cutting the 37.5 mg. tablets). I had very little problem with this. When I was nearing the smaller dosages and I felt a bit of a problem, I took one 300 mg. capsule of St. John's Wort. I only did this two or three times. I think it helped though I'm not positive because my problems with the withdrawal were minimal at that point anyway. When I finally got off of the last quarter of a pill (a little under 10 mg.), is when I started having some unbearable problems. After two days of that, I took a small amount of Cymbalta for a few days and that completely took away all of my side effects.I have a friend who went off of Effexor recently. Within 3-4 days he went from 300 mg. to nothing. At this point he increased his amitriptyline from 100 mg. to 200 mg. (I'll have to find out over what time frame he increased to that dosage as I'm sure he didn't do it in one day.) He claims to have had very few problems with the withdrawal.
Hope that helps.
Kara
Posted by SLS on February 22, 2005, at 21:00:46
In reply to Re: Only ONE contribution so far for WITHDRAWAL » SLS, posted by KaraS on February 22, 2005, at 15:40:22
Hi Kara.
> I don't know if this will help you at all since my withdrawal was fairly standard. I decreased VERY slowly (opening capsules and then later cutting the 37.5 mg. tablets). I had very little problem with this. When I was nearing the smaller dosages and I felt a bit of a problem, I took one 300 mg. capsule of St. John's Wort.
That's an interesting approach.
> I only did this two or three times. I think it helped though I'm not positive because my problems with the withdrawal were minimal at that point anyway. When I finally got off of the last quarter of a pill (a little under 10 mg.), is when I started having some unbearable problems. After two days of that, I took a small amount of Cymbalta for a few days and that completely took away all of my side effects.
Did you continue with the Cymbalta, or use it only to ease your withdrawal? Do you recall how much you needed to take to resolve the Effexor withdrawal symptoms?
- Scott
Posted by KaraS on February 22, 2005, at 21:00:47
In reply to Re: Only ONE contribution so far for WITHDRAWAL » KaraS, posted by SLS on February 22, 2005, at 16:29:27
> Hi Kara.
>
> > I don't know if this will help you at all since my withdrawal was fairly standard. I decreased VERY slowly (opening capsules and then later cutting the 37.5 mg. tablets). I had very little problem with this. When I was nearing the smaller dosages and I felt a bit of a problem, I took one 300 mg. capsule of St. John's Wort.
>
> That's an interesting approach.
>
> > I only did this two or three times. I think it helped though I'm not positive because my problems with the withdrawal were minimal at that point anyway. When I finally got off of the last quarter of a pill (a little under 10 mg.), is when I started having some unbearable problems. After two days of that, I took a small amount of Cymbalta for a few days and that completely took away all of my side effects.
>
> Did you continue with the Cymbalta, or use it only to ease your withdrawal? Do you recall how much you needed to take to resolve the Effexor withdrawal symptoms?
>
>
> - Scott
Scott,I only took Cymbalta at 10 mg. for about 3 days (opened the capsules and estimated about 1/3 of the amount within). That's all I needed for the withdrawal symptoms to stop. I meant to continue and build up on the Cymbalta but I was having a hard time tolerating it. When I stopped the Cymbalta I was free of all withdrawal effects.
Kara
Posted by SLS on February 23, 2005, at 7:06:30
In reply to Re: Only ONE contribution so far for WITHDRAWAL » SLS, posted by KaraS on February 22, 2005, at 19:56:31
Thanks Kara.
> > When I finally got off of the last quarter of a pill [of Effexor] (a little under 10 mg.), is when I started having some unbearable problems. After two days of that, I took a small amount of Cymbalta for a few days and that completely took away all of my side effects.
> > Did you continue with the Cymbalta, or use it only to ease your withdrawal? Do you recall how much you needed to take to resolve the Effexor withdrawal symptoms?
> When I stopped the Cymbalta I was free of all withdrawal effects.Hmm. Very interesting.
- Scott
Posted by Phillipa on February 23, 2005, at 18:27:10
In reply to Please list strategies for drug WITHDRAWAL » KaraS, posted by SLS on February 23, 2005, at 7:06:30
I withdrew from cymbalta the same way, by opening the capsules, and pouring out some of the contents. We kept reducing the amt until I just stopped at what I believe to be about 5mg. I didn't have any side effects while on the med or on stopping the med. Fondly, Phillipa
Posted by LER on March 9, 2005, at 22:21:50
In reply to Re: Please list strategies for successful withdrawal:, posted by jay on February 17, 2005, at 14:24:02
> A most excellent combo for effexor and paxil withdrawl has been a combo of prozac and nortriptyline. Prozac has the long half-life, and the nortriptyline looks after the norepinephrine problem that effexor and even paxil (and now with Cymbalta) can bring. 25-50 mg of Nortriptyline seems to help.
>
> JayJay, thanks for this info. I took Prozac about a year before I took Effexor and had no problems or withdrawal symptoms when I stopped taking it. Your combo of Prozac and Nortriptyline sounds promising. How long do you suggest taking this combo and what dosage of Prozac, 20 mg? Thanks!
Leslie
This is the end of the thread.
Psycho-Babble Withdrawal | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.