I wonder if anyone else has thought of this? Could someone with a more experienced and mathematical brain have a look over this? See if I'm on to something or have missed something basic?

I think I may have found a potential flaw in following the current standard approximation of a 10% current dose hyperbolic regime. When looked at in receptor occupancy terms, this method creates a bulge in the middle of the taper. Could this be why so many seem to destabilise at lower doses?

To give some background, I've been on sertraline for roughly a decade and tapering for 3.5 years at a standard 10% of current dose hyperbolic reduction. I'm now at 1.36mg and suffering quite a bit with withdrawal symptoms that have been growing for about 18 months or so. I found tapering was initially easy-ish to tolerate, albeit with some initial hiccups in method and speed, with eventually much fewer withdrawal symptoms than I expected at first. The first couple of years weren't a challenge in comparison to what's come after as I'm meant to be eyeing the end.

I've observed this is a very common experience that is perhaps the most common of reports on these forums and on SA.

As I hit the end of the middle part of my taper, I began to accumulate a slew of withdrawal symptoms that I won't list here. They're all the usual culprits.

This left me with a burning question: Why? Why does this seem to happen to people so regularly? Save for a few early mistakes, I've been so methodical and consistent. There had to be a reason this was getting progressively harder!

I understand that kindling, individual variation, nervous system adaptation etc are all a thing. But, it still doesn't necessarily explain why, if I followed the dose occupancy curve as is currently advised, why did my body have few issues at the beginning, and start of the middle, yet begin to accumulate withdrawal symptoms years into the taper? Surely they should have appeared sooner?

As I understood it, the steps of the Brassmonkey slide are meant to be pharmicodynamically identical, by following the hyperbolic trajectory of the dose occupancy curve.

Then I stumbled on to something. The steps actually aren't pharmicodynamically identical! They're an approximation. To achieve accuracy you'd need to follow a particular percentage of occupancy reduction as per the specific drug's occupancy/dose curve.

I did the math to work out how the standard 10% reduction of current dose translates into percentage reduction of receptor occupancy for sertraline and for every step. It surprised me.

When I started my taper, I assumed that as I'm following the hyperbolic curve, each dose reduction at 10% of current dose would have the same or decreasing percentage occupancy reduction. That sounds logical right?

It doesn't. It bulges in the middle, like the silhouette of a mountain, by ~150%.

Here's an example of a taper schedule following a hyperbolic reduction of 10% each step, with theoretical slices at beginning, late beginning, early middle, middle and late middle points of the taper. Look at the total estimated percentage reduction in SERT occupancy compared with previous step at each of these slices: it peaks at around 10mg for sertraline:

Dose	Total estimated SERT occupancy	Total estimated percentage reduction in SERT occupancy compared with previous step
100 mg	91.7%	0.84 percentage points
50 mg	84.6%	1.42 pp
25 mg	73.3%	2.11 pp
10 mg	52.4%	2.63 pp
5 mg	35.5%	2.37 pp
2 mg	18.0%	1.50 pp
1.36 mg	13.0%	1.15 pp

Now, I don't have any proof at all that this is why so many experience problems later in their taper. But, I find it exceedingly interesting that this bulge is smack bang in the middle of where many people report issues. It seems to coincide temporally with exactly when (give or take the delayed withdrawal response of around 3-9 months) most people seem to start having issues with their tapers.

If this is the cause, or one of the causes of this experience, there is a solution to it.

Rather than tapering following the hyperbolic dose occupancy curve, tapering would follow this curve but aim to keep total estimated reduction in SERT occupancy at a particular percentage at each step. Perhaps ~1%, 1.25% or 1.5% reduction of SERT occupancy per taper step. So, rather than using a blanket 10% reduction as a guide, you'd use an estimated percentage of SERT occupancy as your guide.

How would this look in comparison with a fixed 10% hyperbolic taper?

Roughly speaking, if you were to tolerate a normal dose reduction of around 10%, you would start at this or perhaps just above 10% as per current Brassmonkey wisdom. You would then progressively slow the taper as you head into the middle of your taper. The slow would reach a low of ~4% of current dose reductions in the middle of the taper. This would then ramp up exponentially, up to ~10% at the end of the middle of your taper, and then the smaller the dose gets the higher the percentages of current dose until you drop off to zero.

I'm a bit apprehensive with how quickly this would suddenly drop off right at the end of the taper. I'm not really sure if this would work at the lower end of the dose? Perhaps, perhaps not.

Many on here and SA have reported that as they've gone lower they've been able to speed up their taper and withdrawal symptoms have decreased. But just as many have had the opposite experience. Could it be that the reason this disparity exists, is due to some experiencing destabilisation created by the above bulge? Perhaps, but until someone tests this theory we don't have any kind of indication.

Again, this is just a theory, but mechanistically it seems to make sense. Then again, it relies partially as well on correlation, and correlation isn't necessarily causation. But, it could be.

It might also be a way of adapting the beginning and middle parts of the taper, to then follow the original hyperbolic taper at the end. That seems to be a potentially extra gentle method in my mind, if rather lengthy.

As I'm not at the start of my taper I can't test this theory. It would need to be tested by another. But potentially, it might yield more stable and livable results. Maybe.

I'd need to run the math to be more specific than this and to provide a guide. The only thing is that, if this is correct, the various percentages of SERT occupancy I've proposed above would translate into the following taper lengths:

1% = ~8.33 years

1.25% = ~6.66 years

1.5% = ~5.55 years

That said, whilst at least at this stage, these look to be a bit longer than current guidance, they may be inherently more stable and allow for a fuller and more normal life to be lived during the process.

I'm curious to hear what anyone might think of this approach. Has anyone else before suggested something similar that you know of?

Edited August 22Aug 22 by graininthegrooves

Hey @graininthegrooves

The 10% of your last dose is a max rate not the set rate. The 10% rule is body led. Most have to slow things down as the dose drops, this is likley because of the hyperbolic relationship of the drug to the brain as you have mentioned altough this is not 100% the case how things work. There have been so little studies in this matter, basically none.

We can't take a mathematical approach to tapering really. Both the 10% rule and hyperbolic tapers are simply guides, starting points. The body sets the pace.

Thanks for your thoughtful reply @Chippy. I largely agree with you. Letting your body lead is sound advice.

But I feel there's another experience that the body/sensation/withdrawal symptoms lead approach has the potential to miss.

Looking back over the past three and a half years, one of the biggest issues I've had is differentiating between what is withdrawal symptom, what is health symptoms, what is ADHD symptoms, what is OSA symptoms. The body only has so many ways of informing us something is wrong, and it's so easy to misinterpret.

It would be much easier if much of the withdrawal effects could occur immediately after said withdrawal, but as we both know usually this isn't the case. There's a delay.

Moreover, the withdrawal effects also have the potential to take away our ability to reason well, recognise patterns, remember etc. This makes those going through withdrawal even more vulnerable and less likely to recognise when the taper has gone awry.

So we can't rely on temporal correlation in the short term, and some of us can't rely on bodily sensation or mood either, nor can many of us rely on our cognitive abilities.

I think this idea of letting the body lead you is really good in principle. For many I can see that working. But only when those symptoms/effects can be isolated from other causes. And for many people, this is impossible.

I think that would theoretically only work well for those that have a low health, psychological or physiological burden before starting and during their taper. For those that are juggling many different health issues for instance, especially if they're new/discovered during the taper, I know from personal experience that differentiation often only occurs well after the fact and with much hindsight, experience and mistakes. This ultimately leads to setbacks, and more pain than necessary.

For many years I had trouble differentiating my cardiovascular symptoms. For much of the time, considering they were largely experienced after waking, I considered them to be tied to my sleep apnea. I now know that not to be the case, they're caused by sertraline.

My suggestion is an attempt to prompt improvement of the default guidance on here. At the moment that guidance is based on an approximation. But as per what I stumbled across above, that approximation, at least for Sertraline, could potentially be causing widespread destabilisation during the middle of tapering. For me the timing and experience seems to fit really well. Why don't we improve the accuracy?

If the goal is to follow the exact dose occupancy trajectory, regardless of whether you're able to use the body led approach or not, why not change the default approach to that?

In researching this I also discovered that the Maudsley hospital in the UK also uses this approach much more broadly when tapering people off of psychiatric drugs. That is, they refer to percentage points of receptor occupancy as per the dose/occupancy curve, rather than using a blanket percentage reduction of current dose.

I'm struggling to find it now, but there's a calculator that @LostinCanada posted not so long ago that plots a tapering regime based on an individual drugs occupancy curve rather than the 10% approximation.

Might it not be time to update?

Edited August 24Aug 24 by graininthegrooves

18 minutes ago, graininthegrooves said:

Might it not be time to update?

There is way more at play then SERT.... GABA receptors, histamine receptors, dopamine receptors, muscarinic cholinergic receptors, enzymes, transporters, the list goes on and on.

So it is a massive oversimplification to concentrate on just SERT....it is only one piece of the puzzle. Length of the drug use, age, previous trauma, other illnesses, etc all play a part. Add to that if you are a normal metabolizer, fast, slow or intermediate.

I wish it wasn't so but if it was only SERT occupancy, it would be a very simple mathematical equation...we know it isn't...that is why one person can quit cold turkey with no issues, others can do a 10% reduction and others can barely do 1%.

Taper Calculator (beta) https://share.google/Qn94UE9Tdj9JFwb7l

Edited August 24Aug 24 by LostinCanada

5 minutes ago, LostinCanada said:

There is way more at play then SERT...

You're right to point out how complex the effects of these drugs are.

As an example, personally I've discovered that sertraline was suppressing a histamine intolerance of some kind in me, or at least down regulating histamine/mast cells to some degree. So I totally get that it's not a simple issue. It's a drug that effects the microbiota of the gut, immune system etc.

My aim here isn't to challenge the body led approach. Listening to your body and the withdrawal symptoms is sound advice. What I'm proposing isn't mutually exclusive to that. It still leaves a new default open to adaptation depending on the person experience.

I'm also not trying to simplify a complex process into something easy. That's impossible given how complex pharmacology and the effects of each drug are.

That said, there's a reason the 10% approximation was created. It was based on a rough approximation of the dose/occupancy curve. It is largely speaking our only way of altering how withdrawal effects us. We also know that this dose regime was an attempt to simplify each drugs individual dose/response curve; but in doing so that simplification creates a bulge in the middle of the taper. At least for sertraline (I haven't run the numbers for others).

We only have one way of majorly altering the taper directly and that's via the dose of medication. So what I'm asking, is whether it's time to re-examine the starting point where most begin their taper?

I'd imagine that most that go on this journey aren't going to have healthcare experience, the expertise to understand healthcare research, or a background in mathematics or statistics. Most I would imagine are going to look into this about as deeply as that initial piece of guidance. Shouldn't we optimise the default starting point of the guidance for success?

Another way of asking this is, if we have the ability to calculate a more accurate hyperbolic curve easily, we have evidence that this approach has been adopted by a forward thinking psychiatric hospital, and we have a handy calculator for each, why wouldn't we make this the default starting point?

Can someone point out the downsides?

9 minutes ago, graininthegrooves said:

Can someone point out the downsides?

The SERT curve is based on a compilation of information that has been averaged. It is not absolute.

7 minutes ago, LostinCanada said:

The SERT curve is based on a compilation of information that has been averaged. It is not absolute.

That's true, but PET scans are quite reliable in measuring SERT occupancy in the brain.

Per the study, a 10% approximation creates a ~200% (I actually did the math this time rather than guesstimate) increase in sertraline occupancy reduction speed in the middle of the taper compared with the starting taper dose. That's a three fold increase in taper speed compared with the start!

I was curious to see if this bulge was replicable across all drugs (not just sertraline).

It seems to be a trend. The 10% hyperbolic approximation creates a bulge in the three drugs I just checked - Escitalopram, Fluoxetine and Citalopram:

SSRI	Approx. dose at snapshot	Approx. SERT occupancy	Occupancy change from preceding 10%-taper step
Escitalopram	10 mg	62.5%	1.06 pp
	5 mg	53.6%	1.58 pp
	2.5 mg	41.7%	1.94 pp
	1.25 mg	28.8%	1.89 pp
	0.625 mg	17.9%	1.47 pp
Fluoxetine	40 mg	80.0%	0.47 pp
	20 mg	75.6%	0.85 pp
	10 mg	68.0%	1.39 pp
	5 mg	56.7%	1.95 pp
	2.5 mg	42.5%	2.24 pp
	1.25 mg	28.3%	2.02 pp
Citalopram	20 mg	75.6%	0.85 pp
	10 mg	68.0%	1.39 pp
	5 mg	56.7%	1.95 pp
	2.5 mg	42.5%	2.24 pp
	1.25 mg	28.3%	2.02 pp
	0.625 mg	17.0%	1.48 pp

Even if this data is averaged out, it is still a better approximation than a hyperbolic curve with no relation to any data. It's based on actual measurements, and the rate of tapering in the middle shows a potential discrepancy that may be causing problems.

We talk about kindling, and building stability into the dosing. You yourself @LostinCanada have suggested people use that wonderful calculator. Why don't we make this a standard?

8 minutes ago, graininthegrooves said:

Why don't we make this a standard?

To me it is just one more tool presenting another option.Knowledge is power. Most people don’t want to over complicate the process…..many are challenged in wd to figure out the mathematics…10% keeps it simple for most. Even going at 1% SERT can be too much for me so it has its limits as well. It is what the Maudsley Deprescribing Guide is based on. Many have found the suggestions too aggressive but the disclaimer is there…let the body set the pace.

7 minutes ago, LostinCanada said:

To me it is just one more tool presenting another option.Knowledge is power. Most people don’t want to over complicate the process…..many are challenged in wd to figure out the mathematics…10% keeps it simple for most. Even going at 1% SERT can be too much for me so it has its limits as well. It is what the Maudsley Deprescribing Guide is based on. Many have found the suggestions too aggressive but the disclaimer is there…let the body set the pace.

I can't help but think, from experience, from the patterns I've observed on here and SA, from the magnitude of the change in taper pace I've demonstrated above, from the current most forward thinking clinical guidance; that by simplifying it like that we're likely setting some if not many people up for destabilisation 60-70% of the way into their taper.

What I'm proposing doesn't exclude letting the body set the pace. It just adjusts the shape of the taper. It could be attuned to different rates depending on individual tolerability. It could be explained in simple terms (starts with 10% reduction of dose at the beginning and then slows in the middle, and speeds up more towards the end).

I'm pretty sure that this bulge is what's caused me much pain and suffering this last year and funnily I'm now on an extended taper break. I should be at the point where withdrawal symptoms are decreasing.

It's too late for me to benefit. But when I see something I can change for those that come after me, I always try my best to make that happen. It's never going to effect me, I'm already 80% of the way through my taper. But if I can help prevent some of those that follow go through the same thing...

I'm advocating for a more cautiously shaped and accurate default taper that matches the scientific research. Even if I don't achieve that here and now, I hope that some time in the future someone else might be able to push through this change.

Edited August 25Aug 25 by graininthegrooves

7 hours ago, LostinCanada said:

let the body set the pace.

Sums it up well every time.

Broadly I find the hyperbolic taper interesting and worth following. I think the natural reduction in taper speed that many/most end up doing, takes into accounts for the obvious failing that the 10% rule has. My concern with the Sert curve is the same as Lics, I think it is a large over simplification of the taper process. I suspect those that follow it often can't keep that pace up either and have to slow it down, and again as Lic has said the Maudsley states this too.

So ultimately even Dr H who wrote the book, doesn't suggest you follow the plans religiously and talks much more about body led tapers. It's really all we have until there is more research done that allows for all variables in a persons genealogy, and a whole bunch of other variables that would need to be taken into account, to produce a more taylored taper plan for this stratergy of 'set and forget till zero' to work. That research, if it was even successful, I think is very unlikely to happen. The reality is, and I paraphrase Dr H and Nicole Lamberson, 'noone cares'.

We already promote 10% or hyperbolic tapering in our tapering document, and offer support with either should a person decide to follow that route. For those tapering off high doses of a drug like sertraline I would always offer a 'fast' taper from the upper doses as an option and point out why, whilst letting them know about 10% tapering too, but ultimately telling them to listen to the body and let it set that pace. It was and still is for most the only way to go.

9 hours ago, Chippy said:

Broadly I find the hyperbolic taper interesting and worth following. I think the natural reduction in taper speed that many/most end up doing, takes into accounts for the obvious failing that the 10% rule has.

If we have two options in front of us for guidance, one an inaccurate estimate of a mathematical curve, and one a curve based on data measured in research; why would we not choose the latter as the default starting point and ditch the potentially harmful inaccurate estimate? Much like the Maudsley hospital that use a percentage occupancy reduction as the starting point. Especially considering the latter is a more cautious taper! There would be no risks associated and potentially much to gain for the next generation of people beginning their tapers. I still don't understand the hesitation.

9 hours ago, Chippy said:

My concern with the Sert curve is the same as Lics, I think it is a large over simplification of the taper process. I suspect those that follow it often can't keep that pace up either and have to slow it down, and again as Lic has said the Maudsley states this too.

So ultimately even Dr H who wrote the book, doesn't suggest you follow the plans religiously and talks much more about body led tapers.

I'm not trying to replace the body led approach. I'm advocating one amendment to default guidance which would still include the body led approach, which would still advocate people taking control of their own taper.

Considering the difference between the two different taper speeds is a factor of three I think it is dangerous to underestimate the potential significance here. Especially when taken in consideration of the overall frequently observed pattern of many destabilising in the latter half of their taper.

Surely it's better to set people on a path that is, per the data, most likely to set them up for success, rather than a path that sets them off towards a proven bulge in taper speed? I'm sorry @Chippy I just find the resistance to this baffling. You said it yourself that this is the taper favoured by Dr Horowitz and by Maudsley. Why keep the 10% inaccurate and potentially dangerous approximation in the mix?

Equally, considering all the disadvantages of a body led approach I've listed above, the more you can optimise this process from every angle, the better for the person going through withdrawal. I wish I'd had the cognitive ability to recognise the difference earlier as this perhaps would have saved me a lot of pain in the long run.

I have not been able to rely upon my body giving me clear signals during my taper.From a medical perspective, there's a reason doctors look for diagnostics and imaging over subjectively reported symptoms. Because, so many different issues can have the same presentation, and the more issues a single person has, the more clouded analysis from subjective symptoms becomes. Add into this a lack of awareness of self, cognitive fog, memory problems etc... do you not see where the strength of the body led approach can begin to fall apart for some people?

A body led approach is useful. I'm not denying that at all. But what I'm saying is that, for the subsection of people that can't rely upon their own symptoms as interpretation:

1. Success at the beginning could potentially be lulling them into a false sense of security.

2. A more scientifically accurate taper as the default guidance could negate this issue.

3. A consistent speed of taper could potentially be more reliable in helping judge the speed of the taper required throughout.

Edited August 25Aug 25 by graininthegrooves

@graininthegrooves A hyperbolic taper often suggests making a larger cut at the start, and on paper that makes sense, yet for some this is too much. There simply is no way to mathmatically ensure what is the best path for an individual to take when tapering. As I have said before we inform members about the two different routes that they can take and it is up to them to choose which way they would like to go.

I really appreciate you sharing your views on this, if there is anything else we can do to help you in your journey we are always here for you as we are every member of the site.

Chippy

12 hours ago, graininthegrooves said:

If we have two options in front of us for guidance, one an inaccurate estimate of a mathematical curve, and one a curve based on data measured in research; why would we not choose the latter as the default starting point and ditch the potentially harmful inaccurate estimate?

We don't really have a "default starting point". We're all just harmed patients ourselves trying to put as much clear, concise and helpful information out there with the aim of preventing further harm.

There are various tapering methods that people starting a taper can employ and we are not closed off to any of them. We have tapering posts about multiple methods on our site AND we link to others from SA.

We all seem to agree that any science done is extremely limited and that there is no clear, right answer. So, it is for individuals to decide which method they feel is appropriate.

Your theory is interesting, and may well be a factor in why some people have more difficult parts of their taper, we just don't know- even a few people trying it with success is difficult to draw conclusions from as people's experiences are all so different, which is true of all of the tapering methods. Clearly many people don't have serious withdrawal issues at all and are fine with the standard couple of weeks doctors usually insist on.

We "keep the 10% taper in the mix" because it is one of the methods that people have successfully used, likewise various types of microtapering and so on.

As an aside, we have reached out to Mark Horowitz to try to get some knowledge-sharing going, and I was in contact with him before starting this site, but so far this has been unsuccessful. Note that Mark himself was unaware of protracted withdrawal until going through it himself and learning everything from support groups.

We're not resistant to your ideas. We host all kinds of tapering methods and ideas and I'd be interested to see whether anyone decides to follow this one and what happens. You're meeting resistance to the idea that there is one, official tapering method we have and that yours should replace it.

On 8/24/2026 at 6:26 PM, graininthegrooves said:

Thanks for your thoughtful reply @Chippy. I largely agree with you. Letting your body lead is sound advice.

But I feel there's another experience that the body/sensation/withdrawal symptoms lead approach has the potential to miss.

Looking back over the past three and a half years, one of the biggest issues I've had is differentiating between what is withdrawal symptom, what is health symptoms, what is ADHD symptoms, what is OSA symptoms. The body only has so many ways of informing us something is wrong, and it's so easy to misinterpret.

It would be much easier if much of the withdrawal effects could occur immediately after said withdrawal, but as we both know usually this isn't the case. There's a delay.

Moreover, the withdrawal effects also have the potential to take away our ability to reason well, recognise patterns, remember etc. This makes those going through withdrawal even more vulnerable and less likely to recognise when the taper has gone awry.

So we can't rely on temporal correlation in the short term, and some of us can't rely on bodily sensation or mood either, nor can many of us rely on our cognitive abilities.

I think this idea of letting the body lead you is really good in principle. For many I can see that working. But only when those symptoms/effects can be isolated from other causes. And for many people, this is impossible.

I think that would theoretically only work well for those that have a low health, psychological or physiological burden before starting and during their taper. For those that are juggling many different health issues for instance, especially if they're new/discovered during the taper, I know from personal experience that differentiation often only occurs well after the fact and with much hindsight, experience and mistakes. This ultimately leads to setbacks, and more pain than necessary.

For many years I had trouble differentiating my cardiovascular symptoms. For much of the time, considering they were largely experienced after waking, I considered them to be tied to my sleep apnea. I now know that not to be the case, they're caused by sertraline.

My suggestion is an attempt to prompt improvement of the default guidance on here. At the moment that guidance is based on an approximation. But as per what I stumbled across above, that approximation, at least for Sertraline, could potentially be causing widespread destabilisation during the middle of tapering. For me the timing and experience seems to fit really well. Why don't we improve the accuracy?

If the goal is to follow the exact dose occupancy trajectory, regardless of whether you're able to use the body led approach or not, why not change the default approach to that?

In researching this I also discovered that the Maudsley hospital in the UK also uses this approach much more broadly when tapering people off of psychiatric drugs. That is, they refer to percentage points of receptor occupancy as per the dose/occupancy curve, rather than using a blanket percentage reduction of current dose.

I'm struggling to find it now, but there's a calculator that @LostinCanada posted not so long ago that plots a tapering regime based on an individual drugs occupancy curve rather than the 10% approximation.

Might it not be time to update?

I am in firm agreement with you.

I think conceptually the “body led” approach is absolutely correct and the complicated interpretation required to follow it at a case level is beyond a lot of what we can reallt clearly prescribe.

I definitely sympathize with mods and taper buddies who do not want to be held responsible for destabilizing someone and thus stick to ballpark percentages and highly minimal interventions.

That being said, I also quietly take great issues with the mods in some withdrawal spaces who will refuse to ascribe symptoms to anything other than withdrawal even when the person has clearly indicated the presence of an underlying issue. I recently got a post denied in chw for bringing up dicyclomine even though NO interactions between it and cymbalta exist. I have had dumping syndrome symptoms for over 10 years. Withdrawal definitely has not helped matters but to insist that it will magically disappear if I hold and insist I reconsider a drug that might be necessary and low risk is just a bit silly to me.

Furthermore, not that any of us can give medical advice here, but Anders himself states during a q and a that extra substance and even bridging is a highly individual case thing and there are absolutely cases in which bridging and other medications are reasonable (his hard rule seems to be to avoid any meds that directly act on the same mechanisms that the tapered med act on)

On 8/24/2026 at 6:26 PM, graininthegrooves said:

Thanks for your thoughtful reply @Chippy. I largely agree with you. Letting your body lead is sound advice.

But I feel there's another experience that the body/sensation/withdrawal symptoms lead approach has the potential to miss.

Looking back over the past three and a half years, one of the biggest issues I've had is differentiating between what is withdrawal symptom, what is health symptoms, what is ADHD symptoms, what is OSA symptoms. The body only has so many ways of informing us something is wrong, and it's so easy to misinterpret.

It would be much easier if much of the withdrawal effects could occur immediately after said withdrawal, but as we both know usually this isn't the case. There's a delay.

Moreover, the withdrawal effects also have the potential to take away our ability to reason well, recognise patterns, remember etc. This makes those going through withdrawal even more vulnerable and less likely to recognise when the taper has gone awry.

So we can't rely on temporal correlation in the short term, and some of us can't rely on bodily sensation or mood either, nor can many of us rely on our cognitive abilities.

I think this idea of letting the body lead you is really good in principle. For many I can see that working. But only when those symptoms/effects can be isolated from other causes. And for many people, this is impossible.

I think that would theoretically only work well for those that have a low health, psychological or physiological burden before starting and during their taper. For those that are juggling many different health issues for instance, especially if they're new/discovered during the taper, I know from personal experience that differentiation often only occurs well after the fact and with much hindsight, experience and mistakes. This ultimately leads to setbacks, and more pain than necessary.

For many years I had trouble differentiating my cardiovascular symptoms. For much of the time, considering they were largely experienced after waking, I considered them to be tied to my sleep apnea. I now know that not to be the case, they're caused by sertraline.

My suggestion is an attempt to prompt improvement of the default guidance on here. At the moment that guidance is based on an approximation. But as per what I stumbled across above, that approximation, at least for Sertraline, could potentially be causing widespread destabilisation during the middle of tapering. For me the timing and experience seems to fit really well. Why don't we improve the accuracy?

If the goal is to follow the exact dose occupancy trajectory, regardless of whether you're able to use the body led approach or not, why not change the default approach to that?

In researching this I also discovered that the Maudsley hospital in the UK also uses this approach much more broadly when tapering people off of psychiatric drugs. That is, they refer to percentage points of receptor occupancy as per the dose/occupancy curve, rather than using a blanket percentage reduction of current dose.

I'm struggling to find it now, but there's a calculator that @LostinCanada posted not so long ago that plots a tapering regime based on an individual drugs occupancy curve rather than the 10% approximation.

Might it not be time to update?

35 minutes ago, Jazzjunkie84 said:

dicyclomine

Has psychoactive properties and I would never be comfortable suggesting someone in wd used it or a member on here suggesting it either.

37 minutes ago, Jazzjunkie84 said:

extra substance and even bridging is a highly individual case

Here on the forum we try to be as minimalist as possible and keep things clean. Sometimes people get desperate and they can choose to take what they need to, we find it often makes people worse.

Our experience here is that bridges go wrong and don’t seem to ever work properly. We have so many members bridge qnd start tapering before joining without feeling stable and are still having an awful trouble working out what to do as their nervous systems are so destabilised in part due to the bridge.

Ultimately we are not medical professionals, just members of the community who give up our time to try to offer help to others who are suffering. We can only share our thoughts and members have to make their own mind up what they think is the best course of action based on ALL the source of information available to them.

This thread is really about @graininthegrooves thoughts on hyperbolic tapering. Let’s try to keep it on topic please.

1 hour ago, Jazzjunkie84 said:

I definitely sympathize with mods and taper buddies who do not want to be held responsible for destabilizing someone and thus stick to ballpark percentages and highly minimal interventions.

The information here is based on an amalgamation of patient experiences from the time running this site, the 15+ years of the SA forum, plus a number of other support groups.

When we advise that people avoid taking certain actions, it is because across these platforms they have been observed to make people worse in a number of cases and these actions are therefore quite risky.

I suspect you'd have a different view had you spent thousands of hours helping people, and having a certain percentage of them (that's really quite high) ignore this advice and harm themselves.

We don't "stick to minimal interventions". We state that we have observed certain things harm numerous people. This often ends up being to people who don't want to hear it and then go ahead and harm themselves doing what we suggest that they don't do.

1 hour ago, Jazzjunkie84 said:

I recently got a post denied in chw for bringing up dicyclomine even though NO interactions between it and cymbalta exist. I have had dumping syndrome symptoms for over 10 years. Withdrawal definitely has not helped matters but to insist that it will magically disappear if I hold and insist I reconsider a drug that might be necessary and low risk is just a bit silly to me.

What is chw?

There are active members on this site who have taken drugs that don't list an interaction with their psychiatric drugs who have gotten much worse.

1. drug interaction lists are comprised of known, proven interactions and are not exhaustive

2. your own signature shows you having been sensitive enough to react poorly to a change in brand and needing to updose, the pharmaceutical companies don't list this as a possible harm, does this mean it doesn't exist? Of course not.

3. you are going to trust the pharmaceutical companies who do not inform users of withdrawal harms at all to reliably list every single drug that can cause harm...during PAWS that they don't even recognise?! This is not reasonable.

1 hour ago, Jazzjunkie84 said:

Furthermore, not that any of us can give medical advice here, but Anders himself states during a q and a that extra substance and even bridging is a highly individual case thing and there are absolutely cases in which bridging and other medications are reasonable (his hard rule seems to be to avoid any meds that directly act on the same mechanisms that the tapered med act on)

We explicitly state that all members are making their own decisions and should be considering the information on this site alongside other sources of information.

Time and time again we have watched people add in new drugs and harm themselves significantly in the process. There are numerous members active on this forum right now who have experienced this and sorely regret it. Can it go well? Maybe. Does anyone know how to make it go well without risking very serious harm? No.

You're more than welcome to consider this, and then disregard it, but a pile-on where people are posting about how all the staff here are wrong is not fair.

1 hour ago, Jazzjunkie84 said:

That being said, I also quietly take great issues with the mods in some withdrawal spaces

If you have an issue, please let us know, we have an active team of staff and turnaround time on queries and PMs is quite fast. We have received nothing from you.

This is a community forum that multiple staff members have already poured more than 1k hours into each, plus we run it at a loss spending our own money just to help others. Never contact the staff and then go around the rest of the community telling everyone there are issues with what they're doing is extremely unhelpful.

If you feel that there are issues with how you're being treated by the staff, then contact us so we can deal with it. If your only issue is that you disagree with the FREE advice you're getting that costs us money and time, then that's not an issue, you're free to do whatever you like and we only ever make suggestions.

4 hours ago, Luke said:

The information here is based on an amalgamation of patient experiences from the time running this site, the 15+ years of the SA forum, plus a number of other support groups.

When we advise that people avoid taking certain actions, it is because across these platforms they have been observed to make people worse in a number of cases and these actions are therefore quite risky.

I suspect you'd have a different view had you spent thousands of hours helping people, and having a certain percentage of them (that's really quite high) ignore this advice and harm themselves.

We don't "stick to minimal interventions". We state that we have observed certain things harm numerous people. This often ends up being to people who don't want to hear it and then go ahead and harm themselves doing what we suggest that they don't do.

What is chw?

There are active members on this site who have taken drugs that don't list an interaction with their psychiatric drugs who have gotten much worse.

1. drug interaction lists are comprised of known, proven interactions and are not exhaustive

2. your own signature shows you having been sensitive enough to react poorly to a change in brand and needing to updose, the pharmaceutical companies don't list this as a possible harm, does this mean it doesn't exist? Of course not.

3. you are going to trust the pharmaceutical companies who do not inform users of withdrawal harms at all to reliably list every single drug that can cause harm...during PAWS that they don't even recognise?! This is not reasonable.

We explicitly state that all members are making their own decisions and should be considering the information on this site alongside other sources of information.

Time and time again we have watched people add in new drugs and harm themselves significantly in the process. There are numerous members active on this forum right now who have experienced this and sorely regret it. Can it go well? Maybe. Does anyone know how to make it go well without risking very serious harm? No.

You're more than welcome to consider this, and then disregard it, but a pile-on where people are posting about how all the staff here are wrong is not fair.

If you have an issue, please let us know, we have an active team of staff and turnaround time on queries and PMs is quite fast. We have received nothing from you.

This is a community forum that multiple staff members have already poured more than 1k hours into each, plus we run it at a loss spending our own money just to help others. Never contact the staff and then go around the rest of the community telling everyone there are issues with what they're doing is extremely unhelpful.

If you feel that there are issues with how you're being treated by the staff, then contact us so we can deal with it. If your only issue is that you disagree with the FREE advice you're getting that costs us money and time, then that's not an issue, you're free to do whatever you like and we only ever make suggestions.

I think I have come across incorrectly here. I do not want to derail this conversation further as it was not my intent. I will post in my own thread. Thank you.

I think like others have said (or correct me if I misunderstood) the issues with letting "the body set the pace" are more from the collective lack of support and research that PAWS has rather than the collective community overlooking something so simple.

IMO, if we are critiquing the flaws in setting our own pace (but I think its the best approach we have so far):

-Certain dose levels cause certain symptoms. I remember having symptoms only when I was at 7.5mg or 6mg or random certain levels of citalopram.

-I've had immidiate reactions to tapering or super delayed reactions. I feel like if you follow a strict schedule with no breaks, your body gets used to it and masks its withdrawal symptoms until it is too late. But I was also pretty sloppy I think. (factor in which I went from monthly to even bi-weekly at a certain point)

-Outside factors that change our body's chemistry. We try to keep it stable as best we can but stress, foods we eat, even age and so many other things impact our body which concurrently change how it communicates with us.

Throughout my taper even in the most stable spots and the unstable spots; I feel like I am constantly relearning my triggers, symptoms and issues. Some tricks work for months, others fail in only weeks/days. It feels like not only is my body chemistry constantly changing, but I feel that my nervous system is also constantly adapting as well (sometimes in favor of healing and others times the opposite).

Any thoughts?

12 hours ago, Luke said:

We don't really have a "default starting point". We're all just harmed patients ourselves trying to put as much clear, concise and helpful information out there with the aim of preventing further harm.

I so very appreciate the hours of time every day you must all each individually put into running this site. Especially considering you're all likely going through your own tapers/withdrawal process. It's quite a thing to behold and I am very grateful for this resource and support site you're cultivating. It's a ray of light in an otherwise dim darkness. Please don't let my passion and mild irritation here distract you from this gratitude ;).

12 hours ago, Luke said:

There are various tapering methods that people starting a taper can employ and we are not closed off to any of them. We have tapering posts about multiple methods on our site AND we link to others from SA.

We all seem to agree that any science done is extremely limited and that there is no clear, right answer. So, it is for individuals to decide which method they feel is appropriate.

Your theory is interesting, and may well be a factor in why some people have more difficult parts of their taper, we just don't know- even a few people trying it with success is difficult to draw conclusions from as people's experiences are all so different, which is true of all of the tapering methods. Clearly many people don't have serious withdrawal issues at all and are fine with the standard couple of weeks doctors usually insist on.

We "keep the 10% taper in the mix" because it is one of the methods that people have successfully used, likewise various types of microtapering and so on.

You're absolutely right that one size doesn't fit all. On reflection I shouldn't be trying to push everyone through a square hole so to speak. I think you're right that removing the old style taper entirely would be an overzealous request on my part.

I agree that this pattern isn't enough to rely upon ditching the standard taper in its entirety, especially considering some have good success with it, but could it be enough to push the hyperbolic method up the priority list?

If you think about it from a newbie's point of view. The first method encountered is the most likely to be the first experimented with. It may also be the framework in which the rest of their taper is then viewed through.

If we instead try to get newbies to think less about dosage, and more about occupancy percentage points as the speed at which they taper; modifying that taper at a later date becomes less about "from 10% to 5% of current dose" and more about from "1.5% occupancy to 0.75%" occupancy per step.

I understand that this probably fills you with worry, especially considering what Chippy noted about the increase in dosage reduction at the very beginning and end of the taper.

But there are options.

I do wonder whether, we could further modify the occupancy approach to give a more gentle start and finish. Under this regimen, most of the taper would follow the occupancy curve, but the start and finish would be gentler and have a buffer.

That said, and in contrast to the above, I also wonder if the percentage reduction occupancy approach without the buffers might be a good indicator of speed tolerated throughout. I know that sounds counterintuitive but humour me!

Another pattern I'm sure you've noticed, is that people frequently report that it is easier to make larger decreases earlier in their tapers. Could the bulge in taper speed I've noted with a standard hyperbolic curve be a potential explanation for this? As at the beginning of the taper the percentage reduction is lower per step.

Let's say hypothetically an occupancy based taper is started at too rapid of a pace (2%?! what were you thinking?!): this could actually have potential long-term benefits. The person tapering would be able to adjust the rate of the taper at the start, before years worth of kindling has taken place and true destabilisation is able to set in. This could potentially give the person ample opportunity to adjust the speed earlier, before much damage has been accumulated and know that the rate would then be consistent in occupancy terms throughout after they've settled on a comfortable speed.

Whereas if we compare it with the current situation we instead have a relatively slow start in taper speed that increases in the middle by a factor of three regardless of the chosen % dose reduction. This speed ramps up gradually over years, and as such so would the increase in withdrawal effects, kindling etc. In this scenario you can see how it would be easy to mistake the effects you're experiencing if they're subtle and insidiously slow in build. it's also worth noting that you could be reducing by 1%, 4% 10% or 15% as per the standard hyperbolic and still the speed would increase in the middle relative to the start.

I realise we're all feeling around in the dark here. Such is the ridiculous situation we all find ourselves in. But, it's important to remember that PET scans are considered very good for measuring SERT occupancy. This is because tracers such as carbon-11 DASB selectively bind to the serotonin transporter, allowing researchers to quantitatively compare transporter availability before and after an SSRI is introduced. The method has been extensively validated and replicated across multiple SSRIs, doses, and studies, producing consistent dose/occupancy relationships such as the 80% occupancy see at most SSRI therapetuic doses. Furthermore, these dose/occupancy relationships are used by forward thinking psychiatric services.

So whilst yes it is an average, and there are flaws, it is still the best we have at the moment, and a good indicator.

I think what could be a potential compromise here, would be to consider a reordering and fleshing out of the tapering document, so that the dose/occupancy hyperbolic tapering is the first to be read in the introduction and there is more detail regarding it. That could be an excellent, if bold, step in the right direction.

I am sorry to be creating more work for you here Luke (even in just replying to me!). I can be a right pain in the neck when I see a potential way of improving something in an unjust situation.

Remember in my introduction when I said injustice gets to me? I don't see what you're doing here as unjust, far from it, but the situation as a whole is! Anything I can do to push through changes that could help others not go through the pain I have is something I feel I have to do.

12 hours ago, Luke said:

As an aside, we have reached out to Mark Horowitz to try to get some knowledge-sharing going, and I was in contact with him before starting this site, but so far this has been unsuccessful. Note that Mark himself was unaware of protracted withdrawal until going through it himself and learning everything from support groups.

I'd be really curious to hear his thoughts on this. But I'd imagine he's a rather busy man!

12 hours ago, Luke said:

We're not resistant to your ideas. We host all kinds of tapering methods and ideas and I'd be interested to see whether anyone decides to follow this one and what happens. You're meeting resistance to the idea that there is one, official tapering method we have and that yours should replace it.

Yep and I was overzealous to push it so hard. My apologies.

Believe it or not I used to be so sensitive and empathic in the way I navigated discussions. Placing other peoples experiences at the forefront of my mind in an empathic and emotionally sensitive manner. Now, whilst at least some of the reasoning remains, it is colder and harsher and for that, I apologise. It's not how I want to be; and hopefully one day I will be myself again.

Edited Wednesday at 10:44 PM5 days by graininthegrooves

That's a rather interesting discovery.

My personal experience was with the two meds I was on, is WD symptoms got better and better as I kept halving the AP, where the last few reductions before CT were not felt at all over the existing PWS symptoms. That drug has a 96 hour half life. I only experienced an obvious increase in WD some multiple weeks after the last dose of the AP.

The AD I was on however, was much rougher with symptoms during the taper. But I have a completely different hypothesis on why it got much harder towards the end, the last couple of were absolutely horrific, more due to the paradoxical reactions immediately after each dose rather than the reduction itself. The reduction would make me more and more sensitive to the drug being taken itself.

My hypothesis was the due to the super short half life of the AD drug I was on, being only 2 hours. The receptors were being cleaned between doses when the dose got low enough that it was no longer allowing a steady plasma concentration and such that the liver could completely eliminate it between doses, the lower the dose the more the drug was giving a short duration spike. So it was something like CT and then reinstating every single day and I would reaction severely with LSD like hallucinations, extreme pain, and extreme anesthesia, tremors and despair with each dose in the morning.

I figured this out and split the dose to morning and night to allow a more steady plasma concentration. But by the time I got to the 15 -10mg daily total, it was too low again that I had this adverse reaction both morning and night. I had to quit early and I still believe I should have quit at 20-30mg rage because I believe the paradoxical/adverse reactions caused most of the damage to to, especially my vision which has still not recovered in any meaningful way. 90% of my vision damage was done from taking the med during that low dosing scheduled from repeated reactions to each dose.

So I think for short half life drugs, this is an over looked factor that makes some drugs extremely difficult and often paradoxical towards the end.

I speculate that in these cases, it may possibility be safer to CT a little earlier before total elimination between doses can occur. I am not giving that advise, but I sure wish I had done that my self, because when I finally couldn't take anymore and CT, I had immediate relief from these reactions and did feel much better for a few months before the PWS really settled in. I also stopped my vision from getting any worse too, so I feel like I could have avoided much of the damage if I had gone with my gut feeling at the time instead of trying to stick to holding and the slow and steady taper that is pretty universally recommended.

I'll also mention, that some of the weaker short half live drugs rely on saturating liver enzymes that do the elimination to achieve that steady plasma concentration, but once below the min therapeutically dose, that mechanism started to go away and eventually doesn't work at all, ie the very low taper doses.

I never had any issues in this regard with the AP as it had the very long half life which avoided the issue altogether.

So I think in the future, tapering might include strategies to include the pharmacokinetics of the particular drug, including the occupancy hump you noticed.

On a unrelated side note, I draw parallels to my aquarium hobby where chemical/nutrient influx forms steady states with water changes which is one of the elimination pathways, and when you run some of the online calcs that graph your chemical of interest, you get exactly the same sort of graph curves that drugs generally follow in the body, and too low of an influx or too large/frequent water chance you can bottom out the graph and get gaps of zero chemical between cycles. When I learned all of this, I thought back to my experience with my AD taper and how I could have done it differently if I had know this ahead of time.

19 hours ago, graininthegrooves said:

You're absolutely right that one size doesn't fit all. On reflection I shouldn't be trying to push everyone through a square hole so to speak. I think you're right that removing the old style taper entirely would be an overzealous request on my part.

I agree that this pattern isn't enough to rely upon ditching the standard taper in its entirety, especially considering some have good success with it, but could it be enough to push the hyperbolic method up the priority list?

We don't have a priority list. We don't have an internal rating system where a specific type of tapering is preferred to another.

We have no expertise and no scientific background in pharmacology.

We tell members what tapers have been observed to work reasonably well to minimise harm for others in the past, and sometimes try to suggest which one we feel that they may tolerate better if their situation or past provides a clue based on experience if it is appropriate to do so.

Someone wanting to start a taper could do it in a large number of different ways. We present the ones known to have been used successfully by others, and people make their own decisions based off of this.

In a lot of your post, the wording seems to be written in a way that suggests you are under the impression that we have designed a tapering schedule and are reluctant to change it. This simply isn't the case.

Your ideas about structuring a taper around receptor occupancy are very interesting. However, nobody has tried it yet. I can tell people that you have an interesting theory about a potentially more tolerable tapering method that is totally untested. I cannot tell people that this tapering method has been successfully used by lots of prescribed harm community members over a couple of decades with a decent amount of success.

All we do is present information. What people do with it is their choice.

19 hours ago, graininthegrooves said:

I realise we're all feeling around in the dark here. Such is the ridiculous situation we all find ourselves in. But, it's important to remember that PET scans are considered very good for measuring SERT occupancy. This is because tracers such as carbon-11 DASB selectively bind to the serotonin transporter, allowing researchers to quantitatively compare transporter availability before and after an SSRI is introduced. The method has been extensively validated and replicated across multiple SSRIs, doses, and studies, producing consistent dose/occupancy relationships such as the 80% occupancy see at most SSRI therapetuic doses. Furthermore, these dose/occupancy relationships are used by forward thinking psychiatric services.

Sure, and SERT occupancy changes being the only or primary driver of withdrawal symptoms is an extremely recent theory that remains pretty much entirely an untested theory. SERT occupancy changes in relation to the dose of these drugs taken in people who do not get protracted withdrawal symptoms, and people who get no withdrawal symptoms at all. The simple answer is that we don't know and as you said, are all feeling around in the dark.

Would you agree that given we have absolutely no pharmacological expertise, and all of the above is feeling around in the dark, that all we can confidently offer people who come here is what has worked for others and what has harmed others, and that this is information that members must use to make their own decisions with?

19 hours ago, graininthegrooves said:

I think what could be a potential compromise here, would be to consider a reordering and fleshing out of the tapering document, so that the dose/occupancy hyperbolic tapering is the first to be read in the introduction and there is more detail regarding it. That could be an excellent, if bold, step in the right direction.

I'm a bit perplexed by your line of thinking on ranking tapering methods and which order they appear in and which you feel we prioritise over others. I assume you mean this thread?

Tapering Information - Tapering - The Antidepressant Harm and Recovery Forum

I am open to the idea of providing members with more information but I would like you to consider that the rest of the thread does not say "this is the tapering method you should use" nor does it say "this tapering method is best", and in fact it lists other tapering methods that have been used with some success on other forums and those being recommended by Mark Horowitz, with a heavy emphasis on these being general guides.

We also have a number of other topics within the area, such as the one on micro tapering:

Micro Tapering - Tapering - The Antidepressant Harm and Recovery Forum

Again, we just present information on tapers that have worked well for some, so that people can review it and think for themselves.

19 hours ago, graininthegrooves said:

I am sorry to be creating more work for you here Luke (even in just replying to me!). I can be a right pain in the neck when I see a potential way of improving something in an unjust situation.

Remember in my introduction when I said injustice gets to me? I don't see what you're doing here as unjust, far from it, but the situation as a whole is! Anything I can do to push through changes that could help others not go through the pain I have is something I feel I have to do.

Injustice is a primary driver behind almost everything that we do here.

I would very much like it if a new tapering method was found to be much more tolerable for a range of people. At the moment, the only reliable indicator we have of this would be many people using such a method and there being a much lower rate of them experiencing issues with it than others. We just don't have this right now.

I would also like to add the following point- the overwhelming majority of members who sign up here are already suffering withdrawal symptoms/symptoms from dose changes, and/or are having an adverse reaction to one of often even many drugs taken at the same time or very recently. The majority of the time we are trying to help people stabilise from the above and this is usually very messy.

Occasionally we do provide information to those who have been on a drug and tolerated it just fine and haven't changed this around but who are seeking safe tapering information, but this is a very tiny minority of what we put our time into, and often people who are aware of safe tapers before they start any taper tend to tolerate them reasonably well no matter which method they employ, or if they don't, minor adjustments to them and a body-led approach gets them past this.

19 hours ago, graininthegrooves said:

Yep and I was overzealous to push it so hard. My apologies.

Apology accepted, don't worry about it.

21 hours ago, Luke said:

All we do is present information. What people do with it is their choice.

This is the key. Everyone is responsible for there own taper, their own research. No one can expect anyone to do it for them. There are risks to any method and it is up to each individual to carry those risks.

If one was adamant about a specific method being superior and it wasn't, then there would be culpability. Suggestions can be made and you have done that. People can read your ideas and decide @graininthegrooves They can read the Maudsley Deprescribing Guide to see examples. Again the information is out there and it is the individuals choice.

Paroxetine doesn't have the bulge that you mention....and as I have shown in the Paroxetine topic I wrote, there are numerous variables involved. To just look at SERT would be an oversimplification.

These drugs do not work based on logic, reason or mathematics so we need to be adaptable no matter what approach we take.

Edited Friday at 04:49 PM4 days by LostinCanada

Hello @graininthegrooves What you say is interesting; I'd noted the 'bulge' as you call it (with citalopram), but didn't have the mental capacity to look into it any further. For similar reasons I may have misunderstood some of what you write, so forgive me if I have this wrong.

If your argument is that tracking SERT occupancy , rather than dose, might be a more accurate guide to a smooth taper, that seems reasonable. Dose is used as a proxy for SERT occupancy after all. Obviously, as @LostinCanada says, it is all much more complicated than this, and SERT occupancy is only part of the story, but if this method provides a warning that a particular reduction may have greater functional effect than the last similar reduction, and indicate a smaller cut that might be a good thing.

One of the problems is the unpredictability of symtoms, and how they correlate to dose reductions. Waves just seem to happen... Listening to you body often means shutting the stable door after the horse has bolted!

Also, one issue I've just realised is the difference in bioavailability of tablets and solution (at least for citalopram- one contains the chlroide and the other the hydrobromide). I did know this when I started taking drops, and transitioned accordingly, but hadn't really thought about this in calculating reductions. The 25% in 'strength' means that the current SERT occupancy is quite a lot higher than I thought- and this of course would be relevant to the 'bulge'. (it also means my 'sentence' is longer than I thought!).

Let's just leave it with LIC- it's all complicated! Anyway, thanks for your posts- it's good to ponder these things.