CHAPTER 14

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 me 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.

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 mg 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.

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.       

DO NOT OPEN THE CAPSULE AND REMOVE THE BALLS.

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 increase during the taper if that symptom returns while tapering off the drug. An example of this can be made with the JNK supplement.

If all of your anxiety vanished during the pre-taper after starting the JNK and anxiety creeps back when you start reducing the medication, increase the JNK to another packet at noon. When the anxiety vanishes again, reduce the JNK back to 1 packet in the morning again.

You can increase any of the supplements to eliminate the side effects again. After the side effect diminishes, reduce the supplement back down again to the amount you were taking.

If you experience withdrawal side effects every time you reduce the medication increase the supplements the day before you reduce the drug, wait 4 days to ensure there is no withdrawal and then reduce the supplements back down again.

If you are reducing a time-release medication you should ALWAYS increase the supplements the day before you reduce the drug. Your reduction amount will be higher than desirable and increasing the supplements will be required to eliminate the withdrawal.

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 the chapter, 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.

Note: If you have had difficulty reducing the medication in the past, compounding the drug for a 5% reduction is advised. Reduce every 14-days, have success and then try reducing by 5% every 14-days.

If this is your first attempt tapering the medication, start with a 10% reduction, reduce again in 14-days and repeat at the 10% reduction two additional times. If successful, you can try a further increase of reduction, but that is not advised. If withdrawal side effects begin, go back to the last dosage you were doing fine with and for the next reduction, reduce at a more gradual rate.