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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by Hlar on May 26, 2005, at 8:57:27
I've recently stopped Zyprexa(5months ago)am very,very slowly tapering Klonopin,and since I'm experiencing insomnia,I suspect the Zoloft was being balanced by the Zyprexa before. I'm on 200mg of Zoloft,which is dangerous for me,being diagnosed "bipolar". I ended up in rehab once when I stopped Prozac suddenly(another SSRI)
I do not want to stop the Zoloft altogether,but do want to taper so I don't become manic again.
I want to taper down to 100mg. My Pdoc doesn't seem to know much about tapering. Anyone familiar with a good protocol?
Hlar(again)
Posted by SLS on May 26, 2005, at 11:18:31
In reply to Tapering plan for Zoloft? SLS?Dr.Bob? Anyone?, posted by Hlar on May 26, 2005, at 8:57:27
> I've recently stopped Zyprexa(5months ago)am very,very slowly tapering Klonopin,and since I'm experiencing insomnia,I suspect the Zoloft was being balanced by the Zyprexa before. I'm on 200mg of Zoloft,which is dangerous for me,being diagnosed "bipolar". I ended up in rehab once when I stopped Prozac suddenly(another SSRI)
> I do not want to stop the Zoloft altogether,but do want to taper so I don't become manic again.
> I want to taper down to 100mg. My Pdoc doesn't seem to know much about tapering. Anyone familiar with a good protocol?
> Hlar(again)
I'm not so sure that the precipitation of mania by an SSRI is dosage-dependant within its therapeutic range. It wouldn't hurt to try to reduce the dosage, but if you relapse into a chronic depression in the absence of withdrawal symptoms, you might find it necessary to increase the dosage again. It may be that the best way to treat your condition is to take a full therapeutic dosage of an antidepressant while taking an antimanic mood stabilizer.What were your reasons for discontinuing Zyprexa?
You could opt to use lithium, Depakote or Trileptal in its place. If you are bipolar I, it might be sufficient to take a combination of lithium + Lamictal and slowly taper and discontinue the Zoloft.
I think you have quite a few options, including using Wellbutrin, a drug that has a reduced risk of producing mania.
It may be that it was the abrupt discontinuation of an SSRI that provoked a rebound mania. If this is true, you might be able to stay on Zoloft without much concern.
Designing a taper schedule is still somewhat arbitrary. I don't think there have been studies comparing tapering methods. However, I am guessing that you can reduce the dosage of Zoloft by 25mg every week. You might want to temporarily take Zoloft several times a day to keep blood levels from bottoming-out.
What are your thoughts?
- Scott
This is the end of the thread.
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