The Road Back. How to taper off Lexapro, Prozac, Paxil, Cymbalta etc.

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Chapter Thirteen

How to Taper Off Antidepressants, Antipsychotics,
and ADHD Medications

(Slow and Gradual Taper)

If you are taking a medication that is time release or can only be reduced by the pharmaceutical company’s available dosages, use chapter fourteen, How to Taper Off Antidepressants, Antipsychotics and ADHD Medication (Fast and Gradual Taper).

Having completed your pre-taper program, you are now ready to start reducing your medication. Though not knowing what you may have experienced personally, I do know that the vast majority of people ready for this step feel trepidation because of terrible side effects experienced when they have tried to quit before.

You might have experienced the “electrical zaps” in the head that are very common with stopping antidepressants, a return of depression, anxiety, fatigue, extreme aches and pain or even wound up in a mental hospital.

Incredible as this might seem, this step should be the easy part of The Road Back Program.

Note: If you are taking Cogentin along with another medication, you will need to rotate the reduction of the Cogentin and the other medication.

Example: If you are taking Cogentin and Haldol, reduce the Haldol first, wait 14 days and then reduce the Cogentin, wait 14 days and then reduce the Haldol once again, wait 14 days and then reduce the Cogentin again. Repeat this process until off both medications. Reduce the Haldol and Cogentin by the same percentage with each reduction.

The Taper

The safest method to reduce medication:

If you have tried to taper off these medications before and suffered withdrawal side effects, start the taper slowly. Successfully reduce the medication by 10% every 14 days for three reductions – then move to the next method for reducing the medication.

People have told me that the 10% reduction every 14 days is far too slow. When I responded, “How long have you been trying to get off the medication?” the answer was usually a few years without success. This is where slow and steady wins the race every time.

Again, if you had a problem in the past with tapering off the medication, use the 10% reduction schedule. Successfully reduce the medication at least 3 times, see for yourself that you can do this and still feel well, and then you and your physician should decide if you should reduce the medication at a larger reduction.

Make sure you work with the prescribing physician before changing the dosage of your medication.

Important Points of Taper

Ask your physician to write a prescription to accommodate a 10% reduction. You will need to use a compounding pharmacy to fill this prescription.
It is important that the compounded drug be identical to the drug you are currently taking.
Changing to a generic drug may not act the same and withdrawal side effects can begin.
Switching from one drug to another because it has a longer half-life will create withdrawal side effects from the drug abruptly stopped.
Do not switch from a tablet or capsule form of the drug to a liquid.
Do not switch from a time release to a tablet form or liquid form of the drug.
Unless the pharmacist can assure you the medication is exactly the same, avoid this method.
Only reduce the medication 10% every fourteen days. The 10% reduction is based on the original dosage of the medication. The 10% reduction is based on milligrams.
Never skip any days taking your medication.
Always take your medication at the same time each day.
If you take your medication more than once each day, make sure the total reduction of the medication is no more than 10%.
Take each supplement at least half an hour apart from the drug, but ideally, 1 hour apart. It is much better to take the supplements 1 hour after taking the drug, instead of before the drug.
Continue with your supplements and “super foods” at the same times and amounts established during the pre-taper.
Take each supplement at the same time each day.
Continue taking your “super foods” and supplements at least 45 days after you take the last dosage of your medication.
Remember fill out your Daily Journal filled day and keep taking all of the supplements exactly as you were at the end of the pre-taper.

After reducing the medication by 10% 3 times you can increase the reduction for the remainder of the taper to a 20% reduction every fourteen days.

Taper Procedure:

Keep taking all supplements exactly as you did at the end of the pre-taper throughout the taper process.
Keep your Daily Journal up to date each day.
Compound medication for a 10% reduction.
Reduce medication by 10% every 14 days, at least during the first 3 reductions.
Only reduce the medication every 14 days.
Make sure you have at least 7 consecutive days of feeling very well before reducing the medication again. If this requires you to reduce the medication every 21 days, do that.
Never skip any days of taking medication.
After 3 successful reductions at 10% and fourteen days have passed begin reducing by 20% every 14 days.

Tapering can be this simple.

What to Do If Side Effects Begin

Withdrawal side effects can happen, but addressing them early and knowing what to do will usually keep them mild and short-lived.

“With little to no side effects” is mentioned several times in this book, but if you were to purchase a $250,000 automobile, it would still come with a spare tire just in case.

Use the following steps if side effects take place while tapering.

Antidepressant “Electrical Brain Zaps”

The “electrical brain zaps” tend to occur when an antidepressant is reduced. If you are tapering off an antidepressant and begin to get the “brain zaps” (electrical jolt that tends to run from the base of the neck to the base of the skull) address them by doing the following:

a. If you are not already taking 5 Ultimate Omega 3 in the morning and 5 at noon, begin doing so.

b. Make sure you take 400 i.u. of vitamin E in the morning.

c. Begin taking 1 CLA softgel in the morning, 1 more at noon and 1 more before 4 pm.

d. Increase the RenewPro by half as much as you currently take.

e. Start taking 2 Probiotic Supreme daily, if you are not already doing that.

f. Make sure you are taking 5 grams of Calsorption each day.

g. Make sure you are taking between 2 and 3 CalesiumD daily. Take each CalesiumD capsule 4 hours apart.

It is important to handle the “brain zaps” fully. If the above steps do not handle the “brain zaps” fully you can start taking the B vitamin biotin. Biotin helps the body assimilate fatty acids and the fatty acids found in Omega 3 are ultimately the best chance of handling the “brain zaps.”

Usually, the side effect will subside the same day or the next day with the increase of the Ultimate Omega 3.

If you are not already taking the Calsorption and CalesiumD, you should being doing so now to avoid any return of the “electrical zaps.” Taking 5 grams of Calsorption daily along with 800 mg of CalesiumD daily is recommended throughout the rest of your taper and for 45 days after the last dosage of medication.

If the head side effect remains mild, but is still present, continue taking the 5 softgels of Ultimate Omega 3 until the symptom abates and then return to your previous amount of Ultimate Omega 3. Wait 7 full days and then continue with the taper.

If the head side effects are severe and you find it difficult to function in life due to the pain of the symptom, go back to the last dosage of the antidepressant before this reduction and remain there for 14 days. Going back to the last dosage should get rid of the “electrical zaps” quickly.

The next time you reduce the antidepressant and each reduction thereafter, increase the Ultimate Omega 3 to 5 softgels in the morning and 5 softgels at noon 2 days before you reduce the medication, and remain at this level for 5 days after reducing the medication. This approach should avert the occurrence of the “electrical zaps.”

If the “electrical zaps” continue with this approach, you will need to lower the medication more slowly. Talk to your physician and get your pharmacist to find a way to fill the prescription to allow for a more gradual reduction. This will handle the taper for you.

Antipsychotic Drug Exception

Antipsychotics tapering side effects can include psychosis, hearing voices, seeing things that are not there or episodes of extreme aggression.

Increasing the Body Calm Supreme has proven to be effective for these side effects.

Increase the Body Calm Supreme to 1 capsule every 2 hours during the daytime and 1 to 2 capsules at bedtime for sleep. Continue taking all other supplements as established in the pre-taper.

Usually increasing the Body Calm Supreme to 1 capsule every 2 hours during the day and 1 to 2 capsules at bedtime for sleep will help with side effects. Sometimes your glucose level may need to be addressed quickly. If you begin to crave sweets, increase the Essential Protein Formula to 4 tablespoons about 1 hour before the cravings usually start. This may take 1 or 2 weeks to handle the cravings.

Use the following steps if side effects take place while tapering

Do not reduce the medication again until the symptom goes away. This takes usually only a few days, or less, and then you can resume the taper.

Do not start making wholesale changes to your daily routine.

Proceed with the following steps, in this order. Once the withdrawal side effect is eliminated, give yourself 7 days.

Then continue with the taper.

1.       Review your Daily Journal and look for changes you might have made to your routine. If you located a change, go back to exactly what you were doing before the change and all should shortly be well. Allow 7 days for the withdrawal side effect to go away. If nothing is found when reviewing your journal, move to number 2.

2.      Usually, the withdrawal side effect will be a side effect you had before doing the pre-taper. Review the Daily Journal and locate the exact step of the pre-taper that eliminated the side effect.

Usually the withdrawal side effect will be one you had before doing the pre-taper. Review your Daily Journal and locate the exact step of the pre-taper that eliminated the side effect.

Increase that supplement slightly when you take it during the daytime or at bedtime, and this should handle the side effect quickly.

Once the side effect is gone, wait 7 days before reducing the medication again.

If you have fallen below a 7 rating, proceed to number 3 below.

3.      If you found that number 2 handled the side effect, and the same side effect begins again with the next reduction, 1 day before you reduce the medication, increase that supplement slightly and stay on the increased amount for 4 days after you lowered the dosage.

This approach should help stop the side effect from ever being present with future reductions.

4.      If number 2 did not fully eliminate the side effect, you will need to give yourself a little additional time. Stay at the increased amount of the supplement that you increased doing number 2, and relief should come within 7 days.

5.      Sometimes you hit a bump in the road as you taper. There is no rhyme or reason to when withdrawal side effects. You might have decreased the medication 6 times with ease and at the seventh reduction, a withdrawal side effect begins.

This usually goes away using the steps above, but sometimes persists.

There are two solutions: reducing the medication once again or increasing the medication back up to the last dosage where you were doing well. Increasing the medication back to the last dosage should be the first choice from these two options.

Give yourself at least 14 days before increasing the medication. Give your body a chance to adjust. If the withdrawal side effect is unbearable, do not wait the 14 days but complete all steps above and then proceed with this option.

There are times when reducing the dosage handles the withdrawal side effect. For whatever reason, your body is reacting to that amount of medication and nothing you do will get rid of the side effect except to be on a different dosage, whether higher or lower.

If, to get relief, you increased the dosage of the medication, and withdrawal side effects started again when you returned to this level, the usual answer is to reduce the medication again rather quickly and get to a new lower level.

Make sure you talk to your physician about this and keep him or her well informed as to how you are doing and what you are doing.

Note: Each supplement used with The Road Back Program has a specific purpose. Below gives each supplement and how they can be used for different symptoms.

Body Calm Supreme (anxiety and insomnia) – If you feel the Body Calm Supreme was the supplement that handled the daytime anxiety or insomnia you can increase the Body Calm Supreme to once every 2 hours during the daytime and up to 3 capsules at bedtime for sleep.

Body Calm (anxiety and insomnia) – If the Body Calm helped you the most with the daytime anxiety or insomnia or was used with Body Calm Supreme you can increase this every too every 2 hours.

Essential Protein Formula (anxiety and insomnia) – This nutritional supplement can be increased to 8 tablespoons per serving.

RenewPro (anxiety, energy and brightness) – You can increase the RenewPro to 1 full scoop 3 times a day.

Nature’s Vitamin C (anxiety) – You can increase this vitamin C to 6 capsules a day. (Avoid vitamin C and other fruit if taking ADHD medication to avoid vitamin/drug interactions. This includes fruit as well as natural fruit drink.)

Probiotic Supreme (anxiety, fatigue and depression) – Do not increase beyond recommendation on the bottle.

Ultimate Omega 3 (fatigue, brain zaps, depression and head feelings) – You can increase up to 5 softgels in the morning and 5 softgels at noon. (Make sure you are taking 400 i.u. vitamin E daily if taking Omega 3.)

Vitamin E – Do not increase beyond the 400 i.u. a day.

CLA (anxiety and depression) – You can increase to 1 softgel in the morning, 1 at noon and 1 additional before 4 pm. (Make sure you are taking at least three Omega 3 and 400 i.u. vitamin E daily if you are going to use the CLA.)

Calsorption (brain zaps) – You can take 5 grams each day. There is no benefit taking more. Calsorption increases the absorption of calcium and can be helpful with side effects in the gut. CalesiumD is the only recommended calcium supplement.

CalesiumD (brain zaps) – CalesiumD and Calsorption work together as a team. To achieve the highest potential calcium absorption Calsorption is needed. Take 800 mg of CalesiumD daily or the amount recommended by your physician.

Biotin – Biotin may very well be the answer for depression or tingling or numbness of the extremities. Start with 5,000 mcg in the morning and give the biotin 3 days to be effective. If no change you can increase to as much as 10,000 mcg in the morning and 10,000 mcg in the afternoon. If these symptoms continue to persist, keep taking the biotin daily. Several clinical trials confirm benzodiazepines deplete biotin from the body and depression and the numbness of an extremity are symptoms of biotin deficiency.

Once you are off the medication, make sure you keep taking the supplements for 45 days.

Read the chapter, “Once Off All Medication” and follow the ending program completely.

The claims, information and products mentioned through this site or within the book, How to Get Off psychiatric Drugs Safely have not been evaluated by the United States Food and Drug Administration and are not approved to diagnose, treat, cure or prevent disease. The information provided on this site or within the book, How to Get Off Psychiatric Drugs Safely is for informational purposes only and is not intended as a substitute for advice from your physician or other healthcare professional. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem.

Copyright 2006 The Road Back. All rights reserved. No part of this Web Site may be reprinted or distributed without permission.
Copyright 2006 - How to Get Off Psychiatric Drugs Safely by James L. Harper used with permission.
Copyright 2007 - How to Get Off Psychiatric Drugs Safely by James L. Harper used with permission.

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