Exploring what “stable” means on a psychiatric drug withdrawal journey, and discerning for oneself when to continue with a taper.
When I first began to learn about very slow harm-reduction tapering methods on my journey off of the drug Celexa, I would hear other people who were self-tapering talk about making a reduction and then waiting until they felt stable again before making another one.
And I would think: what exactly does “stable” mean, and how do I know if I have stabilized enough to try reducing again?
It took me some trial and error to answer this question, and like most everything else about tapering and withdrawal, it’s subjective and personal. There is no universal definition of “stable” in this context, nor is there universal criteria for measuring or assessing stability. Ultimately you make these determinations for yourself because you are your own best expert.
For me personally, “stable” simply meant that any withdrawal-related symptoms or issues I was experiencing had been consistently manageable for at least a couple of weeks, if not longer. That sounds really nebulous because what is consistently manageable is also subjective and personal, and often more intuitive than anything.
I would typically decide to make another reduction when I had been feeling stable for a few weeks, and when my life circumstances were such that I felt I could risk my symptoms getting worse again for a little while (in other words, I had no known major life events or stressors coming up that might have an impact on me). The goal of very slow tapering is to help prevent withdrawal symptoms from ever becoming unmanageable, but there is usually some fluctuation in the level of manageability and I always needed to take that into account.
Why is this important?
As I said, people have different definitions of “stable.” For some, “stable” might mean that all symptoms have completely resolved. For others that is not a reasonable or practical expectation. I often see confusion and fear around this… that somehow if symptoms don’t go completely away it means that the taper cannot continue, and yet it has been a long time and there are still some symptoms present. So it’s important to know that “stable” is flexible, subjective and largely up to each one of us to determine for ourselves.
If I had waited between reductions until any symptoms I was experiencing had completely resolved, I might still be waiting. I say that because, even though I consider myself to be healed now as I approach 5 years post taper, I still had the dregs of a few symptoms that would pop up for the first few years post taper. For me during my taper, the keys were discerning if 1) I felt I could cope with my life consistently, and 2) I felt I could continue to cope if things got more intense again for little. Using this to guide me, I was never once led astray.
But, what happens if someone has been holding their current dose for a long period of time and they’re still not stabilizing?
Sometimes people do encounter this situation. If you find yourself here, it’s up to you to decide if you’ll carry on tapering anyway. For some people it does end up making the most sense to continue with the taper. In these instances it may be especially important to try making very conservative dose reductions, unless there is a significant reason to risk tapering faster from an already destabilized place. It is also always worth considering what other factors might be hindering stabilization. Common factors I often see include: inconsistent dosing either currently or in the past (ex. skipping doses, or not measuring doses precisely enough), the use of caffeine, alcohol, or other drugs (including prescription or OTC medications), the use of herbs or supplements, a diet high in processed foods, and significant life stress.
The following questions may be helpful to consider and reflect upon if you are on a tapering and withdrawal journey:
- What does “stable” mean to me?
- How do I decide what is manageable or not?
- Are there specific metrics I personally use in making these determinations, and if so what are they? Or is it more intuitive?
- What helps me feel confident in making another dose reduction?
- Are there particular life/personal stressors that I have noticed are especially destabilizing for me?
- Are there particular life/personal supports that I have noticed are especially stabilizing for me?
I have seen countless people define and refine their understanding of “stable,” and successfully self-taper off of psychiatric drugs. You always get to decide what serves you the best on your journey.
Reminder: this post is for informational purposes only and is not medical or personal advice.