Tapering Off Multiple Drugs

There are three schools of thought on tapering multiple drugs:

1. Taper one drug at a time in order to see how decreases affect withdrawal symptoms.
2. Taper all at once - very slowly -  your brain and body are already used to the combination of drugs.  So this will cause the least amount of disruption to  your brain. The problem with this method is that if one of the drugs is causing a problem, you won't know which one. Trying to figure out the different doses of all the drugs could be a challenge, too. (Antidepressant expert Ann Blake-Tracy recommends this method.)
3. The stair-step method: one drug is slow-tapered for a while, and then tapering that drug is stopped.  Then tapering the next drug begins. By alternately tapering each drug, all drugs are slowly and deliberately discontinued.

We recommend you taper the most activating drug first

• Normally, Cymbalta is the most activating, so you should taper that fully.  Then you taper off the ones that are more sedating.
  From Surviving Antidepressants: http://survivingantidepressants.org/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/
• "If no one drug is clearly causing an adverse effect, discontinue the more activating drugs first."
• Antidepressants and ADHD drugs (mostly amphetamine analogs) tend to be activating drugs.  These cause jitteriness, anxiety, or sleeplessness.
• Benzodiazepines, the "Z" drugs for sleep, anticonvulsants (such as Lamotrigine), Lyrica, Gabapentin (Neurontin), and antipsychotics tend to be regulating or sedating drugs. These cause drowsiness, sluggishness or dopiness.
• The two types of drugs can be thought of as "accelerators" and "brakes."

Many people have a sedating drug -(a brake) added to an activating drug (an accelerator) to treat drug-induced anxiety or sleep problems.

• In this case we suggest you taper the antidepressant or stimulant first, unless you are having clear adverse reactions to a particular drug. Otherwise, you will experience activation from the other drug as you decrease the "brake." The brake may make it easier to manage withdrawal symptoms.
• The most common and significant antidepressant withdrawal symptoms are: nervous system activations (indicating a too-fast taper); hyper-alertness; sleeplessness; abnormal anxiety; agitation etc.
• Withdrawal sleeplessness makes tapering much harder and recovery from post-withdrawal syndrome more difficult.
• If you reduce the accelerator while taking a sedating drug, the sedating drug may help you manage the withdrawal better. You may plan to taper the sedating drug later.

BUT ... Don't add a "brake" to prepare for withdrawal

• Do not increase your risk of neurological damage by increasing the number of different drugs you take. A new drug may interact with one you are already taking.
• The sedating drugs will also need tapering and can create a withdrawal syndrome of their own.
• Remember to check drug interaction at www.drugs.com/drug_interactions.html