Having trouble tapering. Can't get lower than 7.5mg. Can anyone help?

Hi Andy, 

As you have found, no matter how badly and fast you want off this med, your nervous system has other things to say about it.

Your taper was way too fast. Each time you cut, it was 50% as far as your nervous system was concerned.  On top of that, your system never had a chance to do the remodeling, up-regulation of serotonin receptors, it needed to do before you challenged it with yet another 50% cut.

It takes four days for a new dosage to become steady state in the blood, and then another couple of weeks for the body to respond to this new level of drug, by hopefully up-regulating in the case of reducing the drug.  Then, you need another week of stabilizing at this new level before challenging your system with another cut.

Bigger cuts lead to bigger destabilization and withdrawal symptoms.  The bigger the cut, the longer it takes for the system to make the adjustments.  The withdrawal community has found 10% to be the least-harm approach for most people.  About the fastest you can go is 10% every three weeks.  At this rate, the disruption is so small for most that they hardly feel any withdrawal at all, and so can go on living without losing functionality.  

I think you are thinking that at 10% you would be feeling horrible the whole time, but that is not the case.  

You can't force this to go faster by cutting bigger and more often; it just doesn't work that way and that is so many people fail, go back on, fail again, etc.  So much more time is wasted doing that compared to just doing the 10% when you are stable and only continuing cutting when you are feeling stable.   Never cut on top of withdrawal symptoms!

Your system has been through a lot and so you should stabilize on your reinstatement dose for at least a month before trying again; tapering too soon could make even the 10% taper fail.

Lots of us are making liquid mirt if we can't get ahold of the liquid version from the doc.  Mirt doesn't go into solution very well, so you need to be sure to shake well right before measuring with an oral syringe.  Evergreen on this forum made a liquid mirt solution using half water and half syrup to help suspend the mirt.

Mirt gets very difficult to taper at the low end under 7.5 mg.  This is because even small cuts lead to a proportionately larger number of receptors being freed up by the drug, along with the need for the nervous system to up-regulate (add more receptors), so lots of destabilization. 

If you make a cut and bigger symptoms develop than you can handle, up-dose to the previous dose, stabilize and then try a smaller cut.  You really need to listen to your body in this process.

 

Hi Betsy,

Thanks for your really helpful and most informative comment. It has helped me to get to get to grips with what is going on on my head.

Will try and follow your sound advice.

Do you also know much about use of magnesium and mega 3 to help with WD symptoms. Have also seen that the seasick bands have been recommended for the nausea. Do you know if there is any evidence for this too?

I haven't seen scientific evidence for the supplements but anectdotal a plenty.  I've heard of the sea bands but searching the support forum do not see much info on it being successful for withdrawal.  I think they can be helpful for healthy people but when the nervous system is out of whack they may not work.  The brain is made of something like 60% fat, so the omega 3 fattly acids in fish oil are excellent for a brain that is rebuilding.  I've heard they really help with brain zaps.  Mostly our diets are deficient in magnesium and it is important in autonomic regulation.  A chelated form such as magnesium glycinate is most readily absorbed while not causing digestive upset.  Work up to 400 mg/day of elemental Mag, the recommended daily allowance.

Thanks Betsy. Really appreciate all your advice.

Hi Betsy,

Sorry to bother you again. Not sure what to do. Am trying to do as you suggested and go back on to reinstated dose but finding it difficult as to know what that is. Went back to 7.5mg as that was what I felt good on before but still feel terrible. Do I give it more time or go up again? And if I go up by how much? I am so worried the more I go up again the longer it is going to take to come off this bloody horrible drug. Do you have sny suggestions please. Thanks.

Hi Besty

So glad to read your posts, thank you!! I wonder if you can help me please.   I have been off of Mirtz for just over 3 weeks now and I have to admit I did come off of them fairly quickly as the weight gain was making me feel really uncomfortable, I also decided to com off of Mirtz as I was starting to feel less depressed.  I did experience bad headaches and feeling sick, however I knew I could deal with that.  But this weekend I have been hit with such deep depression I feel as desperate as I did 2 years ago when my depression first appeared.   I am so scared all the time that everything is going to go wrong again and I cant see a happy future.  I also feel such a failure as i really thought i had beaten this horrible condition and now its back!! Could this be a blip from coming off of Mirtz or is the depression back for good!! I wont under any circumstances go back on antidepressants so that is not an option for me.  Is it possible to explain how it works am I missing too much serotonin and will I ever be able to make my own again without the help of drugs?  I would really appreciate any help please, thank you

This deep dark depression is withdrawal-based.  When we go on these meds, the level of serotonin is artificially raised, but the nervous system doens't like this and pushes back with oppositiional compensations, down-regulating (removing) serotonin receptors and decreasing the amount of serotonin released.  This creates a new "homeostasis," with the drug built in.  When you remove the drug too quickly, the compensations are now left un-opposed, so you have an imbalance again!  The problem is, these compensations take a long time to reverse themselves.  In the meantime, you are at risk for such horrible mood problems.  This is all caused by the drug and now it's absense and has nothing to do with your original depression. This is very important to understand.

The whole point of the slow taper is to very gradually get your nervous system to adapt back, so that most of the healing takes place while you are tapering.  The taper is so slow as to keep you comfortable and functional in the process.  There may still be withdrawal symptoms but they should be at a tolerable level, otherwise you are going too fast for your nervous system to keep up with.

Though you hate the idea of going back on ADs, your best bet is to reinstate a very small amount, get stabilized, and then do a proper taper from there.  

What dose did you jump from?  It has been only 3 weeks, so if I were you I would go on the last dose you were on before you went off.  You will be saving yourself a lot of suffering, because withdrawal from a cold turkey or too fast taper can in fact go on for months and even years for those who have been on ADs for years.

Like you, I wish I could stop and never take my AD ever again, but having done that and failed, I now know that I am between a rock and a hard place:  don't want to be on them but suddenly NOT taking them is not an option because my nervous system can't handle big drops in drug.  So, a 10% taper is it for me, and really the kindest thing I can do for my brain.  You simply can't rush the nervous system because you want it to be so!

If you haven't already, read the 10% taper topic in this link:

https://patient.info/forums/discuss/depression-resources-298570

I forgot to emphasize that if you were tapering too fast to begin with  (likely), then you should stay at that last dose for a month or two before resuming a 10% taper off the rest.  This is because your system was likely not keeping up to begin with, and needs time to up-regulate to the level of that last dosage.  Messing with drug levels is destabilizing and causes the nervous system to become very sensitive to changes.  You want to have your nervous system be good and stable before you challenge it with tapering again.

Hi Betsy

Thank you so much for your reply it all makes sense now so glad you explained it to me.  Originally I as on 45mg and went down very very slowly until I got to 15mg and then I stayed on that for 2 weeks then down to 7.5mg for 2 weeks and then off it completely.  I know that was probably really fast but I couldnt bear it any more, I didnt want to be fat and every time I took those evil tablets it reminded me of those very dark depressive days where I just wanted it all to end and Im not that person at all and dont ever want to be again.  Im very very stubborn so I wont go back on any kind of dose even if it is a very low dose as I will feel like I have failed myself so I guess I will have to just suck it up and deal with whatever mood swings come my way next.  Now I know its the withdrawal I will hopfully keep that in mind and know that its not me and Im not depressed again as that scares me more than anything its just those bloody horrible tablets. Betsy you have been such a great help and I wish you loads of luck with your withdrawal its not easy but you will get to your ultimate goal and hopefully without any side affects at all x

I understand where you are coming from, WTGB, and I think you are of the right frame of mind to get through this.  Please keep us updated as to your journey, since I think it can bring comfort to those that have passed the point of no return, reinstatement-wise.  Just to add, if one is to reinstate, it needs to be within the first few months as after that it may not work.

Thank you Betsy I will definitely keep you updated.  On Monday I found out my best friend has got cancer back, she has had breast cancer twice before and now its back in her lymph nodes.  I think we both knew that didnt sound good.  I had very dark depressing clouds over me all last week and when i heard this news I thought oh my god how is my brain going to deal with this when i just need to be strong and there for my amazing friend.   Yes I have cried and cried, we both did, but I think that part of my brain is healing and going back to normal as I feel depressed obvsiouly but because my friend is not well not because of my brain readjusting.  Every day I am getting stronger and as they say you go into fight or flight mode and right now I cant be flying anyway I need to be there strong and positive for my friend and I absolutely will.  Fingers crossed every day it will get better but i will keep you updated.  Thank you so much for your help and advice.

I am so sorry about your friend :-(  That is a terrible stress to be under while tapering.  Take it easy, and hold if you need to.  Sometimes if we know we are going to be under stress, it is best to just hold.  Stress can bring on WD when our nervous systems are fragile from tapering and we are hit with stress. Be gentle with yourself :-)

Thank you Betsy for your support I will try my best to stay positive and dont let the depression back in.  Wishing you loads of luck with your WD take care