4 replies to this topic

[Ramona80]

I've read about different methods of weaning (by reducing beads). 

Some say reduce each day.

Some say wait 4 days before each further reduction, because that's how long it'd take your body to register a change.

Some say wait a week before your next reduction.

Any thoughts on whether one of these methods is better than another?

 

Also, I know different people require different rates of drops. Some might be able to tolerate bigger drops, whereas others may require a "micro-taper." Do you start out as slowly as possible, and if no problems, do you increase? Or is it best to always start by reducing a certain percentage of your beads? 

[thismoment]

Ramona

 

These are excellent questions.

 

Both the daily reduction and the slow step-down reduction are used with success. The objective, however, is to keep acute symptoms at bay-- therefore either can work if the patient will allow the symptoms to dictate the rate of reduction.

 

Starting out, consider a timeline of (for example) 6-8 months and adjust the daily, weekly, or bi-weekly reduction accordingly. If there are no symptoms you could just carry on and stick with the 6-8 month timeline. Or, you could reduce the timeline and adjust the dosage accordingly-- when symptoms appear, you'll have to make further adjustments to timeline/dosage to make it tolerable.

 

Here is a sample long-term withdrawal regimen given to a patient by Dr. Stuart Shipko of www.madinamerica.com. He is the author of the articles "Informed Consent" and "Playing the Odds, Revisited", both found on that website; I recommend these essays to all. I assume the patient is now finished the withdrawal.

 

"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."

 

Stuart Shipko, M.D.

[fishinghat]

Listen to TM Ramona. You start slow and adjust to your bodies reactions. Each of us has to find out our own limitations. You just have to jump in an do it. If a certain rate is too fast then slow down or even stop until stable then start up at a slower rate.

[Ramona80]

Do you keep re-calculating what 5% or 2.5% is, as you count down, as your total amount of beads left keeps diminishing?

[thismoment]

In the Shipko example, 5% of the beads from the 150 mg capsule was removed each month until 75 mg was reached. That's 7.5 mg taken out from day 1 to day 30; 15 mg taken out from day 30 to day 60; and 20 mg taken out from day 60 to day 90. It takes 10 months to reach 75 mg, or half the original dosage.

At 75 mg, the rate was cut in half to 2.5% of the original dosage (3.75mg) which was removed at the end of each month thereafter. The entire program appears to run about 30 months.

With a long timeline like this to start, you can dial in the amount of suffering you can tolerate and shorten the timeline accordingly. Or just stick with the timeline that yields no suffering at all.

Take care.