Chapter 15
How To Taper Antidepressants
THE FDA HAS
published approved guidelines for tapering off these
medications.
Those guidelines are what the authors published a decade ago
and this approach is as effective now as it was in 1999. The
American Medical Association published a report in 2010
acknowledging at least 10% of the population will not be
able to get off their antidepressant because of the
withdrawal side effects. One particular side effect
associated with antidepressant withdrawal is the “brain
zaps.” This is an electrical jolt that runs from the base of
the neck to the base of the skull and the jolt can happen
several times a day or non-stop.
The Road Back Program is the pioneer in this area and we
were the ones that found the solution years ago. Omega 3
fish oil is the key to get rid of the brain zaps as well as
to never allow them to start. Using the correct omega 3 fish
oil is critical and you need to know just any fish oil will
not do the trick. It takes an omega 3 fish oil made from
sardines and the EPA to DHA ratio content needs to be
specific. Flax seed will not work; please do not waste your
time and the unneeded trauma. If you are a vegetarian it is
time to take a break if you want to have a chance of
eliminating the brain zaps. To be blunt, it is time to
decide which is worse for you; an antidepressant or fish oil
for a short time.
Reducing the
Medication
Reduce the
medication gradually and if side effects begin that are too
severe, go back to the last dosage you were doing fine with,
get stable again and then reduce the medication again, but
this time at a slower reduction amount.
The above can
seem too basic and too easy to understand for it to be
misinterpreted. However, that is not the case.
Gradual –
Most of us take the word gradual to mean slowly, but there
is a need to give a good example of gradual. Imaging you are
in an airplane that is about to descend for the landing.
What would you like that landing to be like? Would you
prefer to not feel the decent and when the plane touches the
runway you do not even feel the tires touch ground? This is
a landing where I have heard the passengers cheer and thank
the pilot when they get off the plane. This is also the
gradual landing we want for you when reducing your
medication.
Gradual when
tapering off a medication would be a slow and steady decent
that does not jar and bump the person reducing the drug.
Gradual would also be a speed of reduction that would allow
the person to still function in life and reduce to a minimum
the chance of withdrawal side effects.
If you agree
with the above, this removes the idea of skipping days of
the medication in order to reduce the dosage and get off the
drug. Skipping days or alternating from a higher dosage to a
lower dosage every other day is not gradual. One only needs
to examine the half-life of the medication to establish that
datum. You go in withdrawal every other day and feel an
overdose effect the days you are going back up on the
dosage.
Reduce the
antidepressant as close to 10% with each reduction as
possible. With this approach 10 reductions and you are off
the antidepressant.
Never Skip
Days of the Drug
All drugs in
this class come in completely different dosages and with
some being in a time-release the variances are too vast to
list in a book of this type.
We will first
take what to do with a non-time release medication.
ONLY REDUCE
MEDICATION EVERY 14-DAYS
Non-Time
Release Medication
If you are
taking a non-time release medication, reduce the medication
at the smallest reduction possible. We understand the
“smallest reduction possible” is an arbitrary and we assure
you it will be interpreted differently by many physicians
and pharmacists.
With most
medications being different there is no way for us to
describe each one and your physician and pharmacist should
be involved in this process regardless.
Some
medications can be compounded in to exact and precise
reductions. Compounding is when the pharmacist takes the
medication and grinds it to a powdered form and then
encapsulates to a new dosage. This is the ideal way to
reduce all medications but some cannot be compounded and the
cost can also be out of reach for some individuals.
With your
pharmacist, see if purchasing a pill slicer will work for
you. You can also purchase a relative low cost digital scale
that will measure milligram amounts. Talk with your
pharmacist about putting the medication in a solution for measuring reductions. Some medications dissolve well and can be
crushed and put in water and then you pour
out of a flask the reduction amount.
An
experienced pharmacist will be of great value to you during
this process.
Remember, as
close to 10% reduction as you can do.
Time Release
or Extended Release Medication
When it comes
to reducing medication that is time release, the process
needs to be a little different with the program. Sometimes
time release medications are also offered in a non-time
release form and it is best to cross-over to the non-time
release form of the drug. Your physician and pharmacist are
the ones to guide you through how to take the medication.
Cross over to the non- time release form of the medication
if that is at all possible. Count the cross- over as the
first reduction and do not lower the
medication for 14-days.
You have
specific dosages of a time release antidepressant.
DO NOT OPEN THE
CAPSUES AND COUNT THE BALLS. Over the years, many people
sent us an e-mail about how well they were doing with
removing the balls from the capsule. Invariably, each of
them contacted us again but this time in full withdrawal and
it took an extended period of time to get them back on track
again. Please, do not taper an antidepressant in this
manner.
DO NOT OPEN THE CAPSUE AND POUR THE
BALLS IN LIQUID AND REDUCE GRADUALLY BY REMOVING A PORTION
OF THE LIQUID EACH DAY. This will cause an overdose. A time
release is designed to slowly enter the body, not all at
once.
Follow the
pre-taper precisely for Time Release Antidepressants. Go to
the next available dosage of the antidepressant when you
have felt stable for at least 5 days and 14-days have passed
since the last reduction.
How to Adjust
Supplements During the Taper
Keeping good notes with your daily Journal during the pre-taper
is worth its weight in gold during the tapering of the
medication.
A rule of thumb: The supplement that got rid of a
side effect or symptom during the pre-taper is the
supplement to adjust during the taper if that symptom
returns while tapering off the drug. An example of this can
be made with the Neuro Day.
Adjusting the
time you take the supplement is the key. Negative symptoms
tend to start around the same time each day. So, if you were
taking the Neuro Day at 9am and symptoms now tend to begin
at 11am, take the Neuro Day at 10am each day. You are free
to adjust the time you take the supplements to help combat a
side effect.
If the information above is not making a smooth and relative
withdrawal free program for you, it is time to reduce the
drug at a slower pace.
Reread and keep in mind Chapter 3, “Nutritionals Used in The Road
Back Program” for tips and how to increase the supplements.
Reducing the medication is actually the easy part of the program
now.
JNK Formula – Only take 1 capsule at a time. No more than 2 capsules in a
day. The second capsule needs to be at least 3 hours after
the first.
Neuro Day
- Only take 1
capsule at a time. No more than 2 capsules in a day. The
second capsule needs to be at least 3 hours after the first.
Neuro Night – Only 1 capsule a day.
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