This is from Playing With the Odds, Revisited- by Stuart Shipko, M.D. of madinamerica.com. It outlines an extremely conservative weaning program that has yielded "almost no withdrawal related symptoms". This weaning experiment is ongoing and is being used to withdraw from Cymbalta's evil twin Effexor. I calculated this regimen takes about 30 months
"In 2012 a then 56-year-old person contacted me wishing to stop taking Effexor (150 mg) after a 14-year exposure. The older a person is and the longer the drug has been taken, the less likely the person is to successfully taper off the SSRI. After reading ‘Informed Consent’ and learning about potential difficulties ahead, the patient still wanted to try stopping Effexor. The patient had run out of medication, at times, in the past and experienced a number of unpleasant withdrawal symptoms. It was the withdrawal symptoms that convinced the patient that the drug is toxic and that stopping it was essential. We used the bead tapering strategy, where 5% of the beads from a 150 mg capsule are removed per month until 75 mg was reached. At 75 mg the tapering schedule was changed to 2.5% per month. Some months when things were particularly stressful the patient elected not to decrease the dosage. We are at 54 mg and the tapering continues at this time. To date there have been almost no withdrawal related symptoms. We are optimistic at this point. This is a good experiment in ultra conservative tapering, and may answer some questions about the value of tapering ultra-slowly in preventing both acute and late onset withdrawal symptoms."
There is another long-term tapering regimen that really intrigues me; it's the one where the dosage is reduced by 10% of the current dosage. It starts by reducing the prescribed dosage by 10% for 3-4 weeks depending on how the symptoms go. You may have some symptoms in the first couple of weeks, but they will stabilize. After 3-4 weeks (3 weeks minimum), you reduce the dosage by another 10%, BUT it's 10% of the dosage you have been using for the previous 3 weeks. Therefore, while the length of time between reductions is the same, the dosage drop gets less and less in each step.
After you reach 50% of the original prescribed dosage (about 6 months), you reduce by 10% per week. (That's 10% of the previous week's dosage, extending the time as necessary). This yields baby steps that naturally slows down the reduction in dosage toward the end (which we know is necessary). This regimen takes about 15 months.
There seems to be a trend towards longer withdrawal regimens, and if avoiding symptoms is the name of the game (and it is), this seems to be the way to go. But the thought of taking 1-2 years to taper off seems daunting- I get that. But look, if there is a correlation between no symptoms and successful healing of the brain, it's a no-brainer! Surely the torture of acute withdrawal symptoms indicates something is not going smoothly in your brain. And, no symptoms means no anxiety, and no anxiety means less stress and fewer benzodiazepines.
I don't think it's wrong to view withdrawal symptoms as warning flags that something bad and unhealthy is happening in your brain. Therefore the appearance of symptoms must surely mean the rate of reduction is too fast.
