Four years ago I posted here about coming off antidepressants
https://forum.tz-uk.com/showthread.p...ntidepressants
And Rocket Man (who incidentally headlined Glastonbury this year) mentioned tapering strips.
This was news to me, and proof (as if proof were needed) that this forum knows everything. Including (or especially) things you didn't even know you didn't know.
A digression: I often think we're a pretty homogenous lot, I'm guessing mostly white, male, middle aged, middle class. However, despite that the diversity of experience and expertise here is breathtaking, both broad and deep. Taken together you -- we -- are an amazing resource. (Maybe we only know about things that affect or are of interest to other white, middle class and middle aged men and that's OK. Think of it as a sort of counterpoint to mums' net if you want. And yes, I know we're not ALL white, middle class and middle aged men -- thank goodness!)
Tapering strips are a Dutch invention. Basically, "strips" with 28 compartments, one per day for four weeks. Each compartments contains a pill (or possibly pills) that are formulated to very slightly decrease the dosage of any given medication. This creates a slow, smooth taper that is accurate and precise.
The rate of reduction and therefore the speed of the taper can be set by the patient. There is also the option of "stabilisation strips" that offer a holding dose, so you can plateau for as long as you need to adjust before resuming your taper.
The work of Dr Mark Horowitz and others shows that antidepressants work hyperbolically, so halving the dose doesn't result in half the effect, nor does doubling them double the effect. (For example halving my dose from 10mg to 5mg would reduce the effect on the brain by about 15% -- not 50%.)
Using this information the tapering strip people have created a hyperbolic curve which means the actual affect on the brain decreases in a slow straight line but the tapering is far from linear: in the first 28 days I will go from 10mg to 7mg but by strip number eight, for example, the reduction is from 2.8mg to 2.2mg over the same 28 day period. Plotted as a graph it's a steep initial descent that flattens out into a very long gradual “glide path” down. The hardest part of course is that final “tail” — the last 0.5mg (5% of the original 10mg dose) takes three time as long to taper as the first 3.5mg / 35%.
I'm hoping to start this process soon. I'm nervous, excited, hopeful, scared and several other emotions (ooh, that's not very white, middle class and middle aged man of me!)
And, if you're interested, I'll keep you posted by updating this thread.
Meanwhile, thanks for reading. And thanks to Jon (Rocket Man) for telling me about this.
Last edited by Rev-O; 29th June 2023 at 22:45.
Looks like I'll be on 12 strips, each being 28 days, so 336 days in total.
To give an idea of the hyperbolic reduction, here's the first and penultimate strips' dosages.
They also offer them for other meds that cause addiction / dependence including benzos and opiates.
HTH
Last edited by Rev-O; 2nd July 2023 at 18:45.
Reading this makes me worry I have done it wrong, 40mg of Citalopram, down to 20mg for a couple of months and then cold turkey over 2 years ago.
I think I have some anxiety presenting now, but that for me is an element of covid where I can present with cheat sheets off cam.
Good luck on the next steps of your journey - drop me a pm if you need a chat at any point, more that happy to listen and talk; I have been lucky, I know that.
Thanks. There's no "right" or "wrong" -- some people can tolerant fast tapers (like yours) others need to go super slow (often 5 or 10 per cent reduction *of the previous dose*, with up to a month between each drop). One key factor seems be how long you were on the meds -- in my case I've been on these ones 14 years and others before that, so maybe 23 years in total. But it is a bit random as to how well a taper will tolerated. It's a case of suck it and see or err on the side of caution and go as slowly as possible.Originally Posted by Mj2k
Glad you managed it quickly and cleanly though.
Cheers
Good info and thanks for posting gents.
I'll keep y'all updated on how it goes. Not started yet but hoping to soon.
I still find this tapering really interesting and been looking over your charts again, amazing the lower dose timing, at a point where it almost seems negligible by comparison.
I was only on them a short period of time relatively speaking at 7 years, there was the odd wobble on the way, where I started again, but realised if they were in the house it could be triggered by simply a bad day, and we all get those.
I’ve never been the cheeriest of people, and often prefer my own company to that of others particularly in large social events. I have my low days, but infrequent and meditation helps me deal with them, but I’m not randomly bursting into tears on the sofa or having a melt down when my cooking goes wrong, so feel I’m safely out the other side.
Parents never really understood it; well paid in a good job, nice house, holidays, cars etc, what was there to be depressed about as so many less fortunate etc. that helped lots, honestly - I look back and laugh now - they were of the generation that put paving slabs under my climbing frame to stop me wearing out the grass so much.
Look forward to your journey here, wish you every success with it all and a freedom from the medication, what a tremendous result it will be for you. All the best.
Sent from my iPad using Tapatalk
The recent Panorama programme on BBC1 was good on the downsides of antidepressants, including withdrawal.
"The Antidepressant Story" here
https://www.bbc.co.uk/programmes/m001n39z
I hope it all goes well :)
So, after some delay I'm hoping to start this process very soon. (Annoyingly the meds have arrived in the UK after various hold ups and hiccups but are now being held by the courier, DHL, as they insist VAT @ £114 is due. I and my doctor have told them that prescription medications are tax free. So far the emails have gone back and forth somewhat frustratingly.)
Thanks for letting me vent / share here -- you guys are the best. Viva tz-uk!
Cheers!
Ollie
(P.S. If this is triggering / boring / etc then accept my apologies and just scroll on by.)
Strange timing, was going to post for an update, had not realised it would be so slow, that really sucks given your enthusiasm & pioneering approach.
Please pm me if you want to connect / chat when it works for you.
I feel I have been lucky, but never sure if I am depressed or just one of the less happy folk in life, regardless of what life gives you.
So today is the day I start.
I've got the first 6 strips (of 12), each having 28 compartments = one per day. Looks like a tapeworm or some sort of old cinefilm reel.
The compartments are perforated and I've torn off the first week's worth (and labelled it with a Sharpie as I'm a bit paranoid and like to double check things).
Each compartment has a dose made up in the same way you'd create an exact amount of money by combining fixed denominations of coins.
Day 1 (today) is easy: 1 x 10mg -- one tablet
Day 2 is more interesting: 1 x 5mg + 2 x 2mg + 1 x 0.5mg + 2 x 0.2mg = 9.9mg (i.e. a 10% drop) comprising six tablets at pre-set doses to make the total.
From a maths / engineering p.o.v. I think that's pretty cool.
So, here goes!
1% drop not 10% though!
Hope it all goes well, Rev.
Don't just do something, sit there. - TNH
D'oh! Thanks.
Cheers! Lunch again soon?
Always a joy. I'll be in touch.
Don't just do something, sit there. - TNH
Just to give you an update. I started the taper last Sunday (August 6th) and the first week went well; no different to normal.
However well all of a sudden I’m really starting to feel it: yesterday afternoon I had a nasty episode (cold, shaking, anxious) and went to bed for an hour. I felt better afterwards but woke up this morning feeling unwell (queasy and tense). Right now the worst of it is a sort of “brain fog” — concentrating, thinking etc all a bit woolly. Feeling sort of jet-lagged. I’m hoping these symptoms will lessen in frequency, intensity and duration as the process goes on.
Bit annoyed / upset / depressed by this turn of events after such a smooth first week. I'm hoping it's a temporary blip while my brain adjusts and catches up with the reduction in medication (to date, a drop of 10% / 1mg -- which ought to be negligible; doesn't bloody feel like it though!) There might also be other factors at play (a bug? tiredness? the usual ups and downs?) as well. Who knows? But they certainly felt like classic withdrawal symptoms.
Anyway, I won't spam this thread with too many updates (this is an 11 month programme and even once a week might be too much) but I thought you might want to hear the latest.
θαρσέω!
Sorry to hear the second week hasn’t started as well as hoped, but stay positive with the process you are following; after all it has science behind it and you’ve done loads of research.
Clearly with the way the pill sachets are put together there can be no user error in the wrong pill mix & certainly a very rare issue at source.
I think you’ve nailed it with your assessment, likely an external factor that triggered this, illness looming, a bug you’ve caught recently that makes you feel like that, or work issues even niggling away. Our bodies and minds are strange machines sometimes.
It may be cumulative things all creating a feeling, but I know the exact ones you are talking about as experienced the same when I stopped rapidly the first time without thinking of halving the pills for a bit.
Please do keep the updates, as I am 100% interested in your journey and such a different route to what the NHS tells you to do. If you do feel down, or in a bugger of a mood, always happy to chat on a call.
Fingers crossed the next few days improve for you. As you say, the reduction is so small it shouldn’t be that at all.
All the best.
Edit to add - just saw the usual ups & downs comment. This is also true, even the happy people have low days or times, just because. I had to keep telling myself that as almost my mantra to push through and not go back on the pills.
Most annoyingly when I was depressed, my weight was perfect. It now isn’t & about to start going to the gym for the first time in probably a decade. I’m bricking myself.
Last edited by Mj2k; 14th August 2023 at 12:18.
Thanks! Funnily enough most people put on weight while taking anti-depressants (they increase appetite, I think?) and lose it when they come off the meds. I can really recommend the gym: I started at at the beginning of the year alternating between it and the pool. Now I mostly just go swimming but I think I'll get back on the treadmill and machines. Get some earbuds and find a good podcast or comedy show (Radio 4 Extra is brilliant). Take it slow and try to make it as fun as you can.
Thanks again, I really appreciate your reply.
I do know that different makers create tablets with different efficacy, even though (obviously!) they should all be the same...
Once I received a different make of tablets and within days had full withdrawal symptoms. It was if the new tablets (supposedly the same) had no active ingredients!!! Reverted to a previous make and back to normal. Needless to say I'm a bit suspicious now of tablet makers. Some of it involves what is used for fillers
Maybe psychosomatic.
Nope, not in my case at least...
How do you know, was it double blind?
Edit: - And you might notice they were different anyway.
This is one of those issues that divides people. Some say that different brands are different -- and insist on getting their preferred maker. Others say that's nonsense as these are made to very tight tolerances and there shouldn't be any functional differences between brands or batches. (I saw a thing the FDA in the US have did on this that says it's basically nonsense and the active ingredient should be +/- 0.4% or something, I can't remember the exact parameters.)
Pretty much any medicine contains more than just the actual drug; there are fillers for a start. Sometimes drugs are given gastro-resistant coatings or are in long- (or extended-) release form, especially if it's a medication with a very short half-life.
The expert consensus is that people who say "brand x is stronger / weaker / different to brand y" are looking at the packaging and having a psychosomatic reaction. It's basically a kind of auto-suggestion / placebo / nocebo effect.
However, against that are a large number of lay people who insist that they do react differently to different brands of the same medication. Of course, even if it is psychosomatic it's still real.
Personally I don't think I've ever had any issues and just took whatever the pharmacy gave me: as I got two months' worth at time it was often two different boxes (and the different brands' pills themselves varied in size and shape).
Maybe some people are more sensitive; whether physically or psychologically is moot.
If I didn't know I wouldn't have said it...
To put your mind at rest with my comment: I have taken this particular medication for years. Many times the medicine supplied was by a different manufacturer/ distributer and I had no problems. Some years ago though, there was a time when I had been taking my medication as normal but started to get withdrawal symptoms. These got steadily worse until after a couple of weeks I worked out that it coincidenced with my recent prescription collection. I then checked the packaging and couldn't remember ever having that brand before. I went back to my GP who represcribed so that I could get another make. I regularly have approximately 3 different makers of this medication. When I reverted to another make I was fine after around a week. I have not had problems since. My GP concurred that sometimes patients find a particular manufacturer of the same drug will not suit them . This can be down to a number of reasons such as different fillers, or in some cases a lower amount of the Active ingredient.
Hope that explains to your satisfaction but if you require further explanation please let me know...
Last edited by redmonaco; 14th August 2023 at 21:22.
I would suspect that if a problem did occur it would more than likely be because of faulty manufacture. Which is what I suspect happened in my case.
https://bpspubs.onlinelibrary.wiley....1111/bcp.12298
Last edited by redmonaco; 14th August 2023 at 21:24.
That sounds very plausible. I do remember one incident some years back when I had a horrible reaction to my meds. It was my usual dose, usual brand at my usual time of day etc but it felt like it was much, much stronger than normal. I nearly passed out. I took the pack back to the pharmacist and they filled out a "yellow card" (I think?) and gave me a new box. I can only assume that there was some production error (either in the manufacturing or packaging stage). It was unpleasant and scary. It also left me wondering: was that me? or the meds? Objective or subjective? As I said, it was all "normal" so I figured it wasn't psychosomatic and was a real thing. (And, yes, I know: psychosomatic events are real, too.)
We think we live in a world where machines have made things uniform and repeatably the identical but human error or simply the vicissitudes and vagaries of the world as it is creep in.
Besides that, plenty of things that we think are standardised actually have quite wide variations. For example an AA battery should measure 49.2–50.5 mm (1.94–1.99 in) in length and sometimes short ones won't hit the terminals, esp if they are replacing longer ones (stop sniggering at the back). Football pitches, too, are allowed to vary: "Premier League pitch sizes do vary slightly between clubs. For example, the smallest is 100 metres by 65 metres, while the largest is 105 metres long by 70 metres wide."
No, not to my satisfaction.
Two week update.
Today (Sunday) is the end of my second week (only 46 more to go!)
As I mentioned I had a rough patch last Sunday (at exactly 1 week in and 1 milligram reduction as it happens). I was fine before and after that until another one hit me yesterday. By rough patch I mean physical symptoms. It’s like low blood sugar + too much caffeine + a stomach bug (queasy, nauseous, loose stools) + a touch of flu (aching muscles). Based on my two experiences (a very small sample) it seems to last 24 hrs and then fades. I think this is what they call “waves and windows” - waves of symptoms and then windows of normality. Interestingly all the symptoms have been physical rather than psychological; my mental health has been pretty good throughout. The “waves” are unpleasant (to say the least) but I tell myself that it will pass. Interestingly the one yesterday/today was less bad than the first one. Extrapolating from that very small data set I’m hoping that each subsequent “wave” will be less severe but maybe not (who knows?)
If this is the worst of (and, again, it might not be) then I reckon I can do this. A duff 24hrs once a week is tolerable.
I’ll try not to post too much here but wanted to update the thread on how it’s going. I’ll leave off posting here now for a while unless / until anything “interesting” (ie bad!) happens. Hoping for a slow, smooth and uneventful taper!
Thanks again.
I think you have the right approach in your thinking, that a bad 24hrs once a week is an alright trade off against the journey you are on here.
Perhaps it is some form of threshold your body is crossing each time, or it is just a random phase on your journey. My inner geek would be plotting it on a graph to see if there was anything I could deduce from it, but thats probably driven by my career lol.
I still remain amazed at this process and the thinking that went into it versus the standard medical approaches of simply reducing to 5mg and stopping; or 2.5mg if you break the tablet.
Look forward to the next update & fingers crossed no days when you feel unwell this week!
Alas, things have not gone according to plan.
Sunday night / Monday morning was horrendous. I felt like my body was on fire, but also very cold; I was anxious, restless and very nauseous. I couldn’t sleep and ended up calling the Samaritans at 3am in tears. (More just for someone to talk to though, rather than because I was contemplating anything drastic.) So, all in all not what one would call a success.
I did manage to sleep for about an hour yesterday morning (maybe 5-6am) more out of sheer exhaustion than anything else. I emailed my psychiatrist who was wonderful; despite being on holiday he took time out to reply and advised me to increase my dose slightly and hold there for a bit. (He's also seeing me through the magic of Zoom tomorrow.)
So I upped the dose last night (I take it in the evening) and slept soundly. I'm definitely doing better than I was 24 hours ago but still feeling pretty wobbly and unwell. Glad to be seeing my psychiatrist tomorrow to discuss the medication. Thanks again for all your support. I really appreciate it.
Oh wow, you have certainly had a shocking time of it this week, so sorry to hear it.
I had assumed anti depressants had a long half life and it would take a while to feel the change of a missed dose / treatment, let alone getting into the issues you have experienced early in the week & increasing a dose helping it, but glad it has. Genuinely feel for you having to call the Samaritans, but glad it was for someone to chat vs anything more.
That’s really good of your psychiatrist, especially on holiday; a true professional and someone clearly passionate about his role and his patients. I really hope you can work with him to get a tweak / slower taper (if such a thing exists easily, given you already have a load of pills).
Really want this to work for you, the science is strong, and I’m gutted you are having the experiences you are through this. Fingers crossed for the journey improving significantly for you with tapering.
Well done on sharing your journey for others to learn from, exceptionally brave and leaves a great resource for others in the future, as this will likely become more common in coming off the happy pills as an increased numbers of people become aware of the other options.
Does make me reflect back on how lucky I was with my rather unscientific approach to being med free.
Thanks, Mj2k.
The half-life varies hugely and has an effect on missing or reducing doses. Classic Prozac, for example, has a relatively very long half-life and takes weeks (iirc) to fully clear the system. Mine, along with many others, have a half-life of approx 24hrs, so there's no "self-tapering" or smoothing-out of any missed / reduced doses, very little "carry over" from the previous intake.
Yeah, that was a first for me. As a Vicar I occasionally get 3am phone calls from people in distress so it was bit of a swap for me.
Yes indeed! I do have tons of pills in 5mg, 2mg, 1mg, 0.5mg, 0.2mg and 0.1mg so in theory I can mix and match like loose change to create a precise dose.
Me too!
Thanks. I should say to anyone reading this: Don't be put off by my experience -- many people stop taking antidepressants quite easily, often with a short taper lasting weeks or months. A lot depends on how long you've been on them (in my case 24 years!) and possibly genetics (it just seems some people take longer and need to go slower.)
Thanks again.
I wasn't sure if your user name was due to actually being a member of the church, or some random naming thing!
You have listened to your fair share of others' woes, it is time for that balance to be addressed & glad you contacted them.
I am assuming my half life view was based on the older meds as you mention - my mother was on it some 30 years ago, so perhaps that is where I got it from.
Genetics are likely not on your side, as the science and maths most certainly is; fingers crossed you can find the right dose & taper rapidly.
All the best.
Just to let you know that I had an excellent session with my psychiatrist. (He is actually away on annual leave and broke into his holiday to see me. For which I am extremely grateful. That really is going above and beyond.)
Anyway, his advice was to stop the taper and go back my original dose. He says there's a bell curve when it comes to stopping medication: a minority at one end of it can just stop cold turkey and get few if any withdrawal symptoms; the majority of people in the middle need to taper to one degree or another and at the other end there's people like me who have a really hard time even with slow and small reductions in dose. He's going to chat to some colleagues and asked permission to share my case with them to see if they have come across this before and/or can suggest anything. We also looked at why I wanted to come off them in the first place (actually, there's no really compelling reason; I don't get any side effects, they're not causing any damage or contraindicated with any other meds etc. And I think I'm unlikely to fall pregnant at my age.)
It’s been a nightmare but hopefully after three or four days I should be back to normal -- or what passes for normal with me, ha ha!
That sounds a good response from your psychiatrist and interesting what you mention on the bell curve, as we are clearly opposite ends - which was good for me, less so for you at the polar opposite.
It is an interesting question on why you want to stop taking them, I could not answer that either at the time, or even looking back. I just wanted to stop taking them, period.
Like you, no reactions to them and I don’t take other drugs. I cannot recall what I was on with my first bout of depression in my early 20s which was 25+ years ago, but felt slightly in a blur - I didn’t get the low days, but equally never had amazing ones.
This was brought to life when I got a 50% pay increase moving to a new job & was just meh about it all. That was my trigger point to get off them back then, I felt nothing either way.
Modern stuff is clearly much better, but also limits the answer to the WHY question. Perhaps sometimes a question does not require an answer beyond simply, because.
Hope you feel back to yourself soon & maybe there is some ultra slow taper that can be devised for you over a much longer duration. Fingers crossed.
Well, what else do you want to know...???
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