4 replies to this topic

[thismoment]

We have seen this question in the past and some good responses were posted-- and, Alto Stratus on SurvivingAntidepressants made an excellent post on this a couple of years ago, but unfortunately I could find neither.

 

On August 3rd Sleepyhead posted the question under the heading Why Does Weaning Down The Last 10-15 mg Seem Harder? It'a a worthwhile topic, so I did some research which yielded precious little except that it's not too common with those who withdraw, and in tapering there is a simple math-trap that is easy to overlook-- here's a hypothetical example to illustrate: Let's say your 100 mg capsule has 100 beads, each bead is 1 mg, and you plan to taper to 0 over 100 days. 

 

Seems simple enough.

 

But here's the catch-- it's very important to consider the percentage of drop from the foregoing dosage-- The very first bead you remove from the above example is just 1%. But near the end, the second-to-last bead is a 50% drop! Therefore, you can see the need to alter the percentage of tapering toward the end-- stretch out the timeline and stretch out the remaining dosages. If you have a week to go-- consider stretching that out to a month or more. 

 

Dr Stuart Shipko of Pasadena CA is a good friend to those suffering psychiatric medications. He has written much on the subject, and you'll see his name alongside other outspoken professionals like Robert Whitaker, Peter Breggin, and David Healy. Dr Shipko posts on madinamerica.com and his own website is http://www.stuartshipko.com

 

I asked Dr Shipko this question about the last few milligrams, and here is his response:

 

First of all, this is not the case for everyone.  I don't know why this should be the case.  I can speculate that towards the lower doses the percentage reduction is greater. For example, a cut from 2 mg to 1 mg is a 50% reduction, while a cut from 5 to 4 mg is a 20% reduction.  There may be other factors.  It seems that the SSRIs both cause and mask drug toxicity.  Perhaps when the dose gets low enough there is a secondary problem related not just to receptor changes but to loss of the covering effect.  My answer is that I don't know why this is the case, and that I see this in my practice, but it is not as common as you might think.

[gail]

Thismoment, out of likes but this makes so much sense.

Same as benzos, I was at 30mg last year and dropped by 2mg or 3mg in the first months. Now, down to 5.75 and all I can do is taper by .25 or .50 a month. No more or else I pay a high price if I cut more.

[lady2882Nancy]

Good answer thismoment and it should be flagged to keep it at the top of the forum so it isn't lost.

 

Information like this is always important for those who come after us

[Sleepyhead]

This moment thank you to your attempt at explaining this issue. It does make sense in the percentage drops increasing as dose devreases though as you have discovered there being little explanation as to why this is. A layman like me would think at such small and seemingly insignificant doses that a 50 percent reduction should have a relatively benign effect. But there is much more to the brain than I will ever be able to understand.

I feel, as I am sure many here do as well, a bit of regret for not having educating myself prior to starting this drug...or in some people's cases any pharmaceutical without really knowing the impact it is having on our bodies and our minds. I guess at time we started we felt so desperate for relief from our circumstances and also a blind confidence that our medical system (doctors/pharmaceuticals) would be our saving grace.

After being on 30mg of Cymbalta for 8 months I decided that the side effects weren't worth continuing the drug. I wanted to stop taking it and use food, supplements, exercise and a balanced lifestyle as my medicine. That was 5 months ago and I've only managed to reduce from 30 mg to 15 mg and my plan to get fit and return to a previously known healthy lifestyle has been to a lesser degree because I need to carefully manage the tapering of Cymbalta or I get withdrawal symptoms.

Unfortunately we must 'live and learn'. Oddly the lesson for me in all of this is to take care of myself and avoid pharmaceuticals in the future.

Thanks again Thismoment for taking the time to research this issue! It is very much appreciated!

[thismoment]

Hi Sleepyhead!

Informed Consent is something not every patient receives from the physician, yet it is critical. It should thoroughly cover the ramifications of using the drug-- Here are some things that need to be covered before the prescription is written: progress-review intervals, uploading the drug, dosage changes, stopping/withdrawal, interactions with other meds, the considerations surrounding re-instatement, and the requirement for psychotherapy (should it be appropriate to the reason for prescribing).

I didn't get a proper briefing, but I too was pretty desperate going into this adventure. In the UK, the new protocol is to require an assessment by psychiatrist or equivalent, and to receive appropriate psychotherapy before any prescription is written. Good idea.

We need to be our own medical advocates, and we need to speak up to friends and relatives that are thinking about going on a psychiatric drug-- do your own research, and demand a proper Informed Consent Briefing.

Take care.