Today I’m sharing an update from someone in my community who is tapering from an SSRI (Cipralex/lexapro) in the best way possible – very methodically and doing a very very slow taper, using compounded medication and nutritional support. It is a team approach with a supportive doctor monitoring for serotonin syndrome, her pharmacist compounding her medication and input from me.
She has an excellent diet that contains enough healthy protein and fats, plenty of vegetables, and no sugar or caffeine. She has the basic nutrients covered and is on the pyroluria protocol (these nutrients help make serotonin). She is using the amino acid tryptophan for serotonin support as she tapers. And she is out walking in nature and practicing mindfulness.
All of this sets her up for success and being able to avoid antidepressant discontinuation syndrome.
Here is her story:
I began tapering off 10 mg of Cipralex in November 2017. I have my little “Support Team” that includes a compounding pharmacist and my GP. Feeling very fortunate that I have these people as my taper has not exactly gone as planned (although far better than my last two attempts)
Originally, the plan was to go down by 10% of the dose and stay at that dose for 4 weeks. That didn’t work for me. I was fine when I dropped from 10mg to 9, but after my next 10% drop I experienced that familiar withdrawal hell. I got a little scared, but stuck with it, and decided to stay at that dose for a bit longer. While I leveled out, I did a lot of reading about how SSRIs work. I learned about the 1/2 life of Cipralex (all SSRIs have a different 1/2 life) and what was actually happening physiologically as my body adjusts to the lower dose. It’s a recovery process.
With that new knowledge, I decided to try another approach. I knew I couldn’t handle a drop of 10%. So, I started to taper at a rate of 0.1mg once a week (far less than 10%!). By day three at the new dose, I could feel the withdrawal, but it was far less severe. Small drops=small “withdrawal wave”. I discovered that I am able to manage a 2% drop of the current dose and I have been able to drop that % each week. So, I’m still reducing by 8% a month, which means I am close to the original plan of dropping by 10% a month. At this time I am at 6.24mg.
Yes, it is a very slow process and I have a long way to go, but it’s working. I have read that some people have to reduce by 1% of their current dose and remain at that dose for 4 weeks to allow their body the time to heal and adjust to life on the lower dose. Having the liquid compound has made such a difference! You sure would have difficulty accurately shaving off a pill by 2%!! If anyone is trying to come off of this drug, do your best to find a compounding pharmacist!
I find that I must stick to a very healthy diet. I eat a lot of fresh, raw and cooked vegetables. I mean a LOT of vegetables. I eat good sources of protein and walk for at least 45 min almost every day. I steer clear of sugar and caffeine. Both make my withdrawal much worse.
Every day I take omega 3, vitamin C, vitamin D, vitamin B complex. I take the supplements for pyroluria, vitamin B6, evening primrose oil and zinc. I take magnesium at night. I took Trudy’s amino acids course online and did all of the amino acid trials. I discovered all I really need is tryptophan. It has made a huge difference for me. Yes, I take Lidke tryptophan. For us Canadians, it can be ordered online.
I practice mindfulness. I’ve read a lot about the anxious brain (the reason I took Cipralex in the first place) so I understand what is happening now, what is real and what is just noise in my head.
Antidepressant discontinuation syndrome
This is the best way to taper SSRI medications in order to avoid withdrawal effects, also known as discontinuation syndrome which can be very severe for some folks.
Accordingly to this paper, Antidepressant discontinuation syndrome occurs in about 20% of patients who reduce the dose or abruptly stop an antidepressant that they have been taking for one month. This paper states that “symptoms are usually mild….occur within two to four days after drug cessation and usually last one to two weeks.”
It also states that occasionally symptoms “may persist up to one year…and if the same or a similar drug is started, the symptoms will resolve within one to three days.”
I typically hear from individuals who fall into the category of severe symptoms that are persisting past 2 weeks. It’s not uncommon to see symptoms continue for a year and often longer in some cases.
Also from the above paper, is the mnemonic FINISH which summarizes these symptoms:
- Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating)
- Insomnia (with vivid dreams or nightmares)
- Nausea (sometimes vomiting)
- Imbalance (dizziness, vertigo, light-headedness)
- Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations) and
- Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness).”
How you will feel if your serotonin is low and how to learn more
With low serotonin you will have the worry-in-your-head and ruminating type of anxiety, panic attacks and phobias, lack of confidence, depression, negativity, imposter syndrome, PMS, irritability, anger issues, insomnia and afternoon/evening cravings.
If you suspect low serotonin symptoms and are new to using the amino acids and do not have my book I highly recommend getting it and reading it before jumping in to taking supplements and navigating this with your prescribing physician: The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings. You may need to lend him/her a copy of my book too.
There is a complete chapter on the amino acids and one for pyroluria, plus information on real whole food, sugar and blood sugar, gluten, digestion and much more. If you’re not a reader there is now also an audible version.
Here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution and additional information on Anxiety and targeted individual amino acid supplements: a summary
Please also read and follow these Amino Acid Precautions.
This lists The Antianxiety Food Solution Amino Acid and Pyroluria Supplements that I use with my individual clients and those in my group programs – you will find the Lidtke Tryptophan here. You can also read more about why I prefer the Lidtke tryptophan on this blog.
I would like to end off by saying how much I appreciate this woman and others sharing their stories like this so we can all learn!
Please also share your taper story and what you did to make it easier. If you had challenges share those too. Let us know if you can relate to any of the above FINISH symptoms and how long they lasted.
Feel free to post your questions here too.
Hey Trudy, I really appreciate all the information you’ve provided about amino acids. I especially thought the interview you did with Jason Prall was excellent. I’m looking to supplements with tryptophan as I have been using a topical preparation for sometime but don’t still have the source. What brand do you recommend?
Also I think I may have pyroluria. Is there a particular brand of evening primrose oil that you like?
Thanks so much
Debbi
Debbi
So glad to hear you enjoyed my interview with Jason. I like the Lidtke brand of tryptophan. The blog has a link to the supplement blog and you’ll find it there. You’ll also find all the pyroluria supplements I use there too.
Thank you for this. I have been on venlafaxine for 30 plus years(occasionally swapped to other drugs but this has been most recent and constant) I am now on 150 mg and need help coming down to total withdrawal as it just does no good at all and side effects are intolerable. I need help as where to start as current docs reluctant to help at all? I will buy your books first but is there any advice or others with experience as how to withdraw from this particular drug-Efexor /venlafaxine XL (the prolonged release one)
many thanks and also for your email which I read with great interest each time, it helps enormously.
Rachel
Best is to read this blog and work with and discuss with your prescribing doctor as there is the risk of serotonin syndrome with SSRIs and tryptophan https://www.everywomanover29.com/blog/taper-from-antidepressant-tryptophan-amino-acids/
If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/store/aafsbook.html
Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.
I slowly tapered (over 2 years) off from 150mg of EffexorXL. I was on them for 20 years for anxiety/depression. Finally during lockdown I was able to completely come off Effexor (i was down to chopping 37.5mg tablet in 3 pieces at the end!). I take 500mg tryptophan at night and also have 5HTP 50mg or 100mg which I take with B6 daytime if necessary. I still suffer from “brain zaps”, a hard to describe vertigo-like withdrawal symptom which made withdrawal such a slow process. That sensation continues but is not debilitating any more, hope it goes away soon though! I also take evening primrose oil caps & zinc as suspect pyroluria. I have Trudy’s book. What I do not understand is how long I need the aminos for, I don’t see how I can ever stop taking them. Anxiety is still an issue as is social anxiety.
Maggie
I’m sorry to hear about what you have been through. The “brain zaps” are so common and a big issue for so many. Mitochondrial support, addressing fatty acid imbalances and using detox approaches (like liver/gallbladder support, castor oil packs, coffee enemas, rebounding and dry-skin-brushing, infrared sauna and red light therapy) can often ease these symptoms and others. We also always address diet – so no gluten, sugar, caffeine, real whole food, quality protein and healthy fats, organic fruits/veggies, fermented foods (everything I write about in my book). Gut health, adrenal and sex hormone health is important too.
If someone is getting some benefits with low levels of the amino acids, we increase slowly to get additional benefits. Keep in mind 1 x 500mg tryptophan is a very low starting dose for many.
Hi Trudy,
I am a counsellor and health coach working in UK. I’ve developed a mood coaching programme which combines my counselling knowledge with lifestyle medicine. I love your book and often recommend to clients. I would love to learn more about the amino acids and using them with clients and wonder if you do any trainings for practitioners? I seem to remember you mentioning that but can’t find anything any where. I am reluctant to start using amino acids with clients without further training – although I do sometimes recommend Patrick Holford’s supplements which contain amino acids – I have found them brilliant when going through low mood and clients have found them useful too. But would love to learn more from you.
Hi Hilary
I love that you combine counseling knowledge with lifestyle medicine and appreciate you sharing my book with your clients. And I’m thrilled you’d like to learn more about the amino acids so you can use them with clients (and are already seeing some success).
Here is the information on the amino acid training for practitioners. As well as the valuable content, it’s an opportunity to interact with me and other practitioners who are also using the amino acids. https://www.anxietynutritioninstitute.com/balancingneurotransmitters/
Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.
Dear Trudy,
At first I would like to thank you for your incredible work. I am sure you are helping a lot of people with it.
I have a question regarding apple cider vinegar, and would love to get your acknowledgement on it. A year ago, I drank daily apple cider vinegar 3 times a day. And after a few days/weeks I recognized that it worked wonders for my social anxiety. I was so clear in my mind, where very stable and was self confident like never before in my life. It was incredible. I felt like a new person. Unfortunately I also had a few side effects. Such as back pain, I catched colds often etc. So I didn’t take it anymore.
Do you have any experience with apple cider vinegar or such? Would love to hear from you!
Thanks again a lot for your work!
Eve
Eve
I’ve not had this feedback before and it’s interesting.
If you have vivid dreams after taking tryptophan, does this mean you do not need it? I took the smallest amount last night and had intense vivid dreams.
Jennifer
It may be a sign of a good night’s sleep. If it’s helping with low serotonin symptoms my clients continue to use it.
We also always address other dietary factors too. If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/store/aafsbook.html
Hi Trudy,
Thank you so much for being such a wonderful source of education! I have your book and am trying to work my way up to tapering off bupropion, which I’ve been taking for nearly 9 years. I have been working on my overall health through a detox protocol (Microbe Formulas) as well as doing most of what you recommend in your book. I haven’t been able to give up caffeine yet, because I have significant emotional stress in my life and am a definite comfort eater who has had to give up all of my favorite foods because of food sensitivities. So when my energy tanks or I need a mood boost I turn to coffee. Obviously this is something I need to address. Right now I’m doing a trial of tryptophan, which has noticeably decreased my weepiness and given me more emotional stability and overall well being. I’m only taking 500 mg because I’m not working with a physician and I’m quite tired in the morning (take it at night). Also, I’ve taken dl-phenylalanine for some time and find that I need the extra energy boost it gives me versus the l-phenylalanine. It also helps decrease my arthritis pain and gives me more motivation and less apathy.
What I’m wondering is when am I safe to try tapering my bupropion? Would it be better to finish my protocol and have my gut completely healed first? I’m really anxious to get off of the medication, but don’t want to set myself up for failure.
Thanks so much for your input!
Kim
Best is to read this blog and work with and discuss with your prescribing doctor as there is the potential risk of serotonin syndrome https://www.everywomanover29.com/blog/taper-from-antidepressant-tryptophan-amino-acids/
This paper discusses this … Serotonin Syndrome Induced by a Combination of Bupropion and SSRIs https://journals.lww.com/clinicalneuropharm/Abstract/2004/09000/Serotonin_Syndrome_Induced_by_a_Combination_of.5.aspx
The coffee does need to go – sorry to be the bearer of bad news.