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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by SLS on February 23, 2005, at 16:07:39
With the exception of Prozac (fluoxetine), it seems that skipping days in between doses of medication is counterproductive. It makes the tapering process more painful, not less. You are better off taking smaller amounts of the medication every day, even if it means dividing the pills into fractions.
With Paxil and Effexor, I have had great success taking very small doses several times a day.
- Scott
Posted by TamaraJ on February 23, 2005, at 18:24:03
In reply to Do NOT skip days when tapering medications!, posted by SLS on February 23, 2005, at 16:07:39
Scott,
I think I was one of the fortunate ones. When I discontinued Paxil a couple of years, I had initially reduced my dose in half and then started taking a dose every second day, then every third day until I stopped completely. I did not experience any noticeable or debilitating effects. Mind you, I occassionally took Xanax. My cousin, on the other hand, has been trying to discontinue Paxil for a while now, and is having a real hard time.
I stopped Effexor last September after a taper from 150mg to 0 over a two-week period. I haven't participated in the Effexor withdrawal threads because I can't say for sure what I experienced in terms of withdrawal symptoms. Before I discontinued, I had been given a Depo Provera injection, and was extremely ill from sides effects (throwing up every day, severe anxiety, mood swings, achy, flu-like symptoms and an overwhelming worsening of depression). But, I can say for sure that I did experience the "zaps" because I didn't have those after the Depo shot.
Tamara
> With the exception of Prozac (fluoxetine), it seems that skipping days in between doses of medication is counterproductive. It makes the tapering process more painful, not less. You are better off taking smaller amounts of the medication every day, even if it means dividing the pills into fractions.
>
> With Paxil and Effexor, I have had great success taking very small doses several times a day.
>
>
> - Scott
Posted by Phillipa on February 23, 2005, at 19:56:46
In reply to Re: Do NOT skip days when tapering medications! » SLS, posted by TamaraJ on February 23, 2005, at 18:24:03
I guess I was lucky, I didn't experience any w/d from AD's except when I first took paxil 8yrs ago. Then I kept taking smaller amts. I had brain "zaps." I wonder how I was able to stop all the others without symptoms? Does this mean that this is why none of them worked for me? Fondly, Phillipa
Posted by SLS on February 24, 2005, at 7:16:17
In reply to Do NOT skip days when tapering medications!, posted by SLS on February 23, 2005, at 16:07:39
Hi.
> With the exception of Prozac (fluoxetine), it seems that skipping days in between doses of medication is counterproductive.
I would say that my statement is an overgeneralization with regard to which medications it applies.
For now, I think a daily taper guideline applies best to SRI antidepressants (Zoloft, Paxil, Luvox, Celexa, Lexapro, Effexor, Cymbalta) along with many benzodiazepines. I don't know to what degree it would apply to Remeron and Wellbutrin, for instance. I would like to see more data concerning tricyclics and MAOIs, but my own experience with these drugs persuades me to use a daily taper schedule. It does seem most critical for the serotonergic drugs, though, particularly Paxil and Effexor, which have short half-lives.
Paxil is a drug for which the half-life varies greatly between individuals. The range seems to be between 5-21 hours. This might offer one reason for why some people have more trouble skipping days than others. Although the drug company doesn't give much of an idea as to which values are most common, my guess is that most people experience a half-life of 11 hours or less. Still, I think a daily dosing guideline is a more conservative approach that should make the discontinuation of the SRIs less eventful.
For those people for whom no taper strategy seem to be effective for Paxil, Effexor, and Cymbalta, I think Jay's suggestion makes a lot of sense. He substitutes the offending drug with a combination Prozac + nortriptyline. These drugs are much easier to discontinue, and complement the chemistry of the original drugs.
Of course, many people have no trouble discontinuing serotonergic drugs regardless of how they go about it. However, I believe there is an increasing risk of inducing a withdrawal syndrome with subsequent drug discontinuations. For this reason, I would still argue in favor of a taper schedule that involves daily dosing.
- Scott
Posted by Phillipa on February 24, 2005, at 17:03:25
In reply to Re: Do NOT skip days when tapering medications!, posted by Phillipa on February 23, 2005, at 19:56:46
I guess what I said above was not entirely true. Even though I was on small doses [considered subclinical by data], I always was switched onto another the next day. This probably avoided the W/D symptoms. Or maybe, the reason I couldn't tolerate the new ones was because I was in W/D from the others. Any thoughts? Fondly, Phillipa
Posted by banga on February 25, 2005, at 9:24:14
In reply to Re: Do NOT skip days when tapering medications!, posted by Phillipa on February 24, 2005, at 17:03:25
I think knowing half-life is important in deciding how to taper. The longer the half-life the more probablility that you can employ a taper-by-taking-it-every-other-day strategy.
I like Scott have done it by feel....
Posted by SLS on February 25, 2005, at 9:44:41
In reply to Re: Do NOT skip days when tapering medications!, posted by banga on February 25, 2005, at 9:24:14
> I think knowing half-life is important in deciding how to taper. The longer the half-life the more probablility that you can employ a taper-by-taking-it-every-other-day strategy.
Yes.
:-)
I agree with you. I wish I had not generalized so much. I should have given more thought to the wording of the subject line and initial post. I guess I felt an urgency to post something. I was very frustrated to see so many people suffer with a day-skipping strategy to discontinue the SRI antidepressants. I hate to see people suffer needlessly.
- Scott
Posted by TamaraJ on February 25, 2005, at 10:35:11
In reply to Re: Do NOT skip days when tapering medications! » banga, posted by SLS on February 25, 2005, at 9:44:41
The way you worded it helped establish a dialogue. That's the important thing. People sharing their experiences. You done good! :-)
This is the end of the thread.
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