Hello i ak taking ssris from age 16 now i am 39!! After a bad withdrawal in age 33 with fluvoxamine i started again with 20mg escitalopram until..now. My doctor says to fron 20mg to 15mg. I think its too fast. She says its safe. I am confused

Hi @kas

Welcome to the forum!

 

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9 hours ago, kas said:

i started again with 20mg escitalopram until..now. My doctor says to fron 20mg to 15mg. I think its too fast. She says its safe. I am confused

Doctors don't know about how dangerous it is to taper these drugs too quickly.

There is broadly two ways to taper ADs.

1. Using the 10% rule, where you reduce the drug a max 10% of your previous dose each month.

2. Hyperbolic Tapering, this is where you match the non linear curve of the effect on the brain the drugs have to your taper. Essentially the lower you go the slower you must go.

It is your choice which way you choose to go. We can help with either. You can mix and match the approach too.

Escitalopram is very potent at lower does. So 20mg down to 10mg you may find you can cut pretty quickly, 10mg-5mg you should be slower and 5mg downwards much much slower again.

There are 3 ways to taper the drug from a practical perspective.

1. Dry cutting, you will need a set of micro scales like the Gem-20 and you shave a little off your pill to make a smaller dose.

2. Making up a liquid from your tablet.

3. Using a manufactuered liquid version of your drug.

Please note using a pill cutter is not accurate enough to make even large cuts.

How stable is your nervous system do you think? If you have no symptoms at all you might be ok to reduce to 15mg then go slower from there. If you are not then I would suggest no more tha 10%.

Here are some documents which you may find useful.

Tapering Information

Preparing Doses for Tapering - Weighing & DIY Liquids 

Using Manufactured Liquid Antidepressants

Micro Tapering

The Windows and Waves Pattern of Stabilization

Hypersensitivity and kindling

In the mean time this is what I would do if I were you:

 

-Stay Hydrated 

 

-Eat a good clean whole food diet, avoiding processed foods and sugars.

 

-Stay away from caffeine, alcohol and antihistamines and any other psychoactive substances.

 

Supplements are to be avoided initially, as they often irritate our nervous systems. Try to get your nutrition through food.

 

Down the line, you may wish to introduce Fish Oil and Magnesium. Those who can tolerate them have found them calming to the nervous system. Be careful try one at a time and start low and see how you get on should you choose to try them.

 

A daily walk is very important as much as you can manage, if you can manage it. Gets you your fresh air and Vitamin D does wonders for your mind!

 

You are very welcome here and I hope you find the site supportive.

Chippy

Welcome to the forum.

After such a long time, it is likely too fast. Some people can tolerate the rate of tapering commonly proposed by doctors, however, if you can't and it goes wrong, things can get very bad and it can be difficult to get a grip on this and stabilise out of it once you've been harmed by a taper that was too quick.

If you're stable on the drug, and living a normal life, why risk that by rushing?

It's better to go slower (as per the guides linked by @Chippy ) and maintain a normal life and your wellbeing, and slowly come off of the drug without major issues.

You could risk going faster, and it might be ok, but if it's not, the consequences can be extremely severe and very long-lasting. Longer than a slow taper, that's for sure.