Micro Tapering

This topic is not medical advice; it is simply sharing the collective experience of those harmed by antidepressants or having difficulty coming off to give you talking points you can share with a medical practitioner who is knowledgeable about AD drug harm and tapering.

 

Mirco Tapering

 

The standard headline advice for safely tapering off of an Antidepressant is to reduce the dose no more than 10% of the previous dose per month. This was based on the observations of thousands of people coming off of their drugs on peer support sites, like Surviving Antidepressants, over many years. It has proven to work well for most people.

For some, however, this rate is too much and often they must reduce at a slower rate such as 5% or less even, this becomes particularly true as the doses get lower.

Others have very sensitive nervous systems due to a history of multiple drugs, incorrect tapering, and erratic dose shifts, which can make tapering a challenge.

 

Micro Tapering is the process of reducing your dose by very small amounts often on a daily basis. Rather than give your brain the job of adjusting to a huge, larger reduction, it has been seen that reducing in smaller ‘steps’ can ‘trick’ the brain sometimes to not even notice the drug amounts have been reduced, allowing the person to ‘creep’ off carefully in tiny little increments. This approach has been observed to be, for some, a gentler way to taper off their antidepressants.

 

Micro Tapering can be particularly helpful tapering a Benzodiazepine where people are often very sensitive to small changes.

 

Micro Tapering 1/30 Method

 

The basics are simple. Take your planned monthly reduction of 10%, or less, of your previous dose and instead of cutting it all in one go and holding the dose for 30 days, simply divide that cut into 30 small even steps which you take each day. The end result is as fast as a ‘cut and hold’ but smoother and more gentle on the nervous system.

 

For example;

 

100mg Sertraline 

 

Month 1

90mg (10% or 10mg reduction)

30 x 0.334mg daily reductions = 10mg

 

Month 2

81mg (10% or 9mg reduction)

30 x 0.3mg daily reductions = 9mg

 

This rate can be adjusted to any monthly amount.

 

For example;

 

100mg Sertraline

 

Month 1

95mg (5% or 5mg reduction)

30 x 0.167mg daily reductions = 5mg

 

Month 2

90.25mg (5% or 4.75mg reduction)

30 x 0.158 = 4.75mg

 

This is not a rigid framework and, as with all tapering, is just a guide. One advantage to the small decreases is you can use the first decrease or two to test the waters to see if you are ready to start tapering again without committing to a much larger ‘chunk’. If you want, you don’t need to keep tapering. You could taper for a week or two and hold there for some time to check for WD symptoms (which can be delayed) and then continue with the rest of the daily cuts until you have completed all 30, then you would assess. As you go lower you should decide to reduce the overall monthly amount before calculating your new daily amount. It has been seen that some manage to not recalculate every month and continue with the same daily reductions for some time, this makes micro tapering actually potentially faster than a conventional ‘cut and hold’ would have been for them. We would still suggest only reducing the overall monthly dose by no more than 10% of your previous dose per month.

 

Brass Monkey Slide

 

Another Micro Taper technique is the Brass Monkey Slide. Developed by one of the senior moderators at Surviving Antidepressants, it is a simpler hybrid approach between a cut and hold and a Micro Taper. It is again, based on a monthly reduction of no more than 10% of your previous dose, but rather than reducing in daily steps, you reduce in even 4 weekly steps, then add in a hold for 2 weeks to allow for the brain to adapt and check WD symptoms to resolve.

 

For example;

 

Sertraline 100mg

 

Month 1 - 90mg (10% or 10mg reduction)

Week 1 – 2.5mg reduction (-2.5%)

Week 2 – 2.5mg reduction (-2.5%)

Week 3 – 2.5mg reduction (-2.5%)

Week 4 – 2.5mg reduction (-2.5%)

Week 5 & 6 – Hold 90mg

 

Month 2 - 81mg (10% or 9mg reduction)

Week 1 – 2.25mg reduction (-2.5%)

Week 2 – 2.25mg reduction (-2.5%)

Week 3 – 2.25mg reduction (-2.5%)

Week 4 – 2.25mg reduction (-2.5%)

Week 5 & 6 – Hold 81mg

 

As with the standard Micro Taper this can be adjusted to suit the individual for a lower monthly reduction.

 

For example;

 

Sertraline 100mg

 

Month 1 - 95mg (5% or 5mg reduction)

Week 1 – 1.25mg reduction (-1.25%)

Week 2 – 1.25mg reduction (-1.25%)

Week 3 – 1.25mg reduction (-1.25%)

Week 4 – 1.25mg reduction (-1.25%)

Week 5 & 6 – Hold 95mg

 

Month 2 – 90.25mg (5% or 4.75mg reduction)

Week 1 – 1.188mg reduction (-1.25%)

Week 2 – 1.188mg reduction (-1.25%)

Week 3 – 1.188mg reduction (-1.25%)

Week 4 – 1.188mg reduction (-1.25%)

Week 5 & 6 – Hold 95mg

 

Some caution should be taken with Micro Tapering. If, for example, you have mild symptoms from a tiny 1/30 drop, these may ‘stack’ and by the end of a month’s worth of daily drops. If you are unable to make such small cuts it is probably too soon to continue with your taper and a longer hold may be needed.

 

It is important to note that strategic holds should be incorporated at regular intervals to let the body catch up, especially if you experience a significant ramping up of symptoms.

 

As with all tapering, it should be led by the individuals and the phrase ‘listen to your body’ is key here. There is no one size fits all tapering plan and even when Micro Tapering, it’s common to have to hold at times, re assess doses and make a new plan before proceeding. Some people find that even small cuts have a significant effect and must find a low percentage to make micro reductions by that they can tolerate.

 

All the standard information for tapering should also be considered when micro tapering please read: Tapering Information

 

Micro tapering can seem daunting at first due to the maths involved but be for those with very sensitive nervous systems it has been seen to be a very useful tool, especially at the lower doses. Even for some who are at the start of their tapering journey and haven’t found significant issues reducing their doses maybe find it useful to Micro Taper. It has been observed that those who micro taper from the start, often have less problems than those who ‘cut and hold’.

 

We have made a 'Cutting Calculator', which has a 1/30 Micro Taper and Brass Monkey Taper Calculator built into it, that can workout each reduction for you.

Here is the link to it: Cutting Calc 2.0

 

Here is a great video from the Medicating Normal YouTube Channel; a great conversation between Nicole Lamberson and Dr Mark Horowitz. In it @ 40.21 they discuss Miro Tapering: Clarifying Controversies w/ Dr. Mark Horowitz: Updosing, Reinstatement, Holds, Microtapering & More

 

Here is a fantastic thread from Surviving Antidepressants where the topic of Micro Tapering is discussed in more depth, along with some other techniques for smaller dose reductions: Micro-taper instead of 10% or 5% decreases

 

In this Thread Brass Monkey from Surviving Antidepressants explains in detail the ‘Brass Monkey Slide’ Technique: https://www.survivingantidepressants.org/forums/topic/27883-the-brassmonkey-slide-method-of-micro-tapering/