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PostPosted: Sat Aug 13, 2011 4:11 pm 
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Hi Everybody,
I've read a lot of tapering threads and really haven't seen anyone address this much, although Dr. J did a post on it in regards to people on too low of a Sub dose. I find that I can easily get down to 2mg without experiencing withdrawals. The problem is, once I'm at that level, I really "feel" my dose, and it's in a bad way. I feel really foggy, extremely irritable and tired. It kicks in about an hour after I dose and lasts for hours. And it definately doesn't feel like WD - I know that feeling. I'm convinced that it's the result of being below the ceiling level. Has anyone else been through this? I really, really feel crappy and I feel like I can't continue to taper if I'm going to be like this every day. Last week I had a lot of stuff going on, so went back up to 4mg and felt pretty normal. Then I went to 3 for a few days and now I'm back down to 2. Will I eventually adjust? If anybody has any insight I would be grateful.
Lilly
P.S. The same thing happened when I tried to taper a year ago. I ended up saying f*ck it, and just jumped at 2mg, which wasn't successfull, and I really don't think is a good idea.


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PostPosted: Sat Aug 13, 2011 5:19 pm 
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Aw Lilly, I'm sorry that's happening to you. I don't really have any ideas for you, I did want you to know that I'm routing for you though.

OK, I got one idea, what if you take your dose before bedtime? Do you think you could sleep if you dose at bedtime?? If so, the heaviest fog, tiredness and irritability may pass as you sleep?

Sorry dude, that's all I could come up with.

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PostPosted: Sat Aug 13, 2011 7:14 pm 
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Lilly, There in no feeling in the world like what your trying to discribe... I tried anti-depressants like romeo has and still felt like shit... anti-depressants will only work if you need them, lets admit it we need opiates to feel good, thats why opiate addiction is incidious... PLEASE dont live feeling shitty, I dont know you but I know no-one deserves to feel that down down feeling, the only answer is to take a little more Suboxone, sorry....... Mike


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PostPosted: Sat Aug 13, 2011 8:25 pm 
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i have to agree with painter . we don't know how long you have to suffer,and is it worth it. maybe your not in the right place at the right time. go back to 4mg. ahm just wondering". has any one herd of quinie1959/ indogochild?


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PostPosted: Sun Aug 14, 2011 1:25 pm 
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Thanks for the replies you guys. It sounds like I'm in a catch-22. You're saying to get above the ceiling again so I won't feel like shit, but that is exactly what I did the last time I tried to taper, and now a year has gone by and I really want to try to get off Suboxone. I think I know what you are getting at, Painter. It's like opiate addicts have something lacking in their brain chemistry and they need to have an opiate in their system to feel normal. Even my doctor feels that there is truth to that thinking. But I just want to TRY to do it. Even though I have a long history of drug abuse, I really only got hooked on opiates in the last 7 years or so. So I was able to function for quite a while. And yes, I am on an antidepressant that I had high hopes was going to help with this.

As far as dosing at night, which really does sound like the logical solution: This is going to sound like the opposite of what I said above, but I actually stopped dosing too late in the day because Sub kept me awake! I know it sounds like I'm contradicting myself, but saying that Sub makes me tired and keeps me awake at night are both true (I hope some of you out there know what I'm talking about). Also, even in my active addiction I didn't really use at night (or to help me sleep) and as I result, I think, I never went through the horrible insomnia to the extent that others have when I was withdrawing. So I don't want to get into the habit now.

I guess I'm making some progress. I'm down to dosing once a day even though my doc has had me dose twice a day for the last 22 months. Oddly, I'll probably have to go back to 2x/day when I get down to the 1mg range, but I think for me the goal is to stop dosing "as needed".


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PostPosted: Sun Aug 14, 2011 4:18 pm 
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Lillyval,

Just from all the posts I've read here, several times people have stated feeling lousy for weeks until their body adjusted. Have you tried the 2-2.50, 2-2.50, etc. Once again I just dropped from 4 to 3 a week later and then to 2mgs. Next day I took and extra .50 and today the 2.0. I'm going to see if I can adjust to 2mgs for awhile. If not, I'll take the extra .50 every other day until I do get used to it.

For me, 2mgs is pivotal in my recovery. Once you go below that you are basically getting off of Sub. At least that's my interpretation of it. So many others have gone down to 2mgs but I don't remember if they made a 1mg decrease or did it by .50. Either way I'm there like you.

Stick with it and let your body tell you what to do. Up and down, up and down. It should settle in I would think.

Keep it up, we are on the same path and now I'm following your progress.


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PostPosted: Sun Aug 14, 2011 8:41 pm 
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I think I'm not making clear what the issue is. I am not experiencing withdrawal symptoms. When I get down to 2mg or less my dose makes me "high" for lack of a better word. It's not a good high, it's more like a burned out stoned feeling. It's really hard to describe.

Here is something Dr. J. wrote on the TalkZone about the issue. It was in response to someone who wrote in saying they felt "drugged" on 2mg of Suboxone:

"If a person takes an amount of buprenorphine that does NOT push brain levels above the ceiling level, the person will feel the same response to buprenorphine as he would feel from an opiate agonist. The degree of opiate stimulation would change as the buprenorphine level goes up and down, never reaching the ceiling level where constancy is achieved."

He also explained how once you get to the ceiling level the effect remains constant over time, so you no longer "feel" any effect.

So my issue is that I went from feeling fairly normal (with some side effects) on doses of Sub from 12mg to 4mg. Once I got down to 3 and 2mg I started to feel out of it all the time, foggy and irritable. I'm feeling that it's hard to deal with everyday life like this, and at the same time if I go lower withdrawals are going to kick in.


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PostPosted: Sun Aug 14, 2011 10:32 pm 
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I read your thread. I can relate to what you are talking about... it has a lot to do with homeostasis, which is the body's state of equilibrium...which is what we need to be normal. The body naturally wants to reach equilibrium and it will fight to do so, which can make us feel shitty.

I recently, these past few days have been on 2mg's once daily. Before I was talking multiple doses everyday, usually up to 3 or 4 mg's a day, scattered at random hours throughout the day. It has totally confused my body.

I know that probably doesn't relate exactly to how you dose but you need to just be patient. What Dr. J has been saying with doses above ceiling is that the specific receptors in the brain that buprenorphine occupy are saturated with bupe. If you keep dosing above the ceiling level eventually your body will reach homeostasis on whatever dose you are taking that is above ceiling. To reach a good saturation level, you need around at least 6-8mg's daily...or even 4mg is considered a high enough dose, but it is borderline...like the cut off point.

The trick is taking the lower doses once a day at the same time everyday. It doesn't need to be the exact same time but try to make it the same time or 3 hours over or under at the most. It shouldn't be a bid deal. What I do if I sleep in is take my dose and go back to sleep.

Just be patient. You shouldn't be having problems at 2mg's. It actually is the ideal sub dose IMO. But only if you take it the right way. I'm on day three of 2mg once daily so I'm in a shitty mood too and not 100%. It takes about a week to start feeling better, but it is worth it. I've been on sub for 4 years and I have tapered down to as low as 0.5mg. I just struggle to follow through when I get to the lower doses and end up spiking the dose to catch a cheap buzz, which is like relapsing if you think about it. I started snorting sub a while ago, which is why I started having problems with my treatment. Luckily, they came out with the films though and I was able to put that behind me. I've been on the films since they came out and I am now just starting to regain control. It is awful to misuse the medication that is supposed to be making you better. Good luck.


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PostPosted: Mon Aug 15, 2011 12:36 am 
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Instead of cutting down your daily dose, you could try waiting longer between doses. Since subs have a half life of 36 hours + it should not be necessary to take the same dose every 24 hours.


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PostPosted: Mon Aug 15, 2011 10:00 am 
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At low doses, such as 2 mg for some people and definitely lower, the long half-life of 37 hours does not apply. And Dr. Junig actually recommends that people tapering that low actually dose twice per day and not once per day.

I do agree, though, that it might just take time to adjust. I hope that's all it takes, Lilly. Keep us posted. I'm also thinking that even though what you're feeling isn't really withdrawals, maybe taking your taper a bit more slowly still might help. Just my two cents. I'm sorry you're feeling so crappy and I hope it passes soon.

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PostPosted: Mon Aug 15, 2011 12:27 pm 
Lilly....I'm sorry you're having a hard time. I'm right in there with you. Although I don't completely and specifically identify with what you're experiencing being under ceiling with your Sub dose, I do 'get' what you mean when you say that you "feel crappy."
As you know, I, too, am working my way off Sub and have been under that ceiling dose more than once myself. It's the strangest thing.....There are times when I feel pretty good, physically and mentally on the lower doses (less than 2mg/day) and there are times when I feel like absolute crap. I've been in crap mode for several days running now and it sucks!
Like you, I would not describe it at all as feeling like withdrawal....I know what that is and this ain't it! Conversely, I know what "high" is and sure ain't that either! And I get that you're not saying you feel necessarily "high" either. I guess it feels so lousy to me that I just can't use that word. In any case, what I feel is somewhat of a 'drugged' feeling but with absolutely no euphoria or burst of energy, etc. I just feel blahhhhhh!! It's hard to want to do anything, motivation is low. Mood is not particulary depressed, but a far cry from happy. Anyway, being an addict, I think the first thought that comes into my head is that perhaps I need more medication (Sub) to make me feel a little better. The thing is, though, taking a bit more doesn't really seem to help much, if at all. If it does, I think it's probably more placebo effect than anything else. So, I'll start thinking....Okay, maybe I just need to leave my dose alone or even drop again, which doesn't seem to make a difference either! It's a catch-22 for me right now! Very frustrating indeed!
I'm coming to believe that the situation is just as you have said yourself......I have messed up my brain with the opiate abuse to the point that it thinks it can't be satisfied without opiates on board, and it isn't quite being satisfied with the little amounts of bupe I'm giving it right now.
So, what to do? I think you and I are alike in wanting very much to see if we can't get off this stuff and eventually be okay. If we're to reach that goal, I'm thinking we are just going to have to adjust to feeling crappy for a while. Personally, I'm so tired of it! I feel like I have felt like crap at least 50+% of the time for so long now that I can't take it anymore! But what choice do I have? For me, taking 4mg or more a day of bupe is not acceptable. Although in many ways being above ceiling does feel better, it does not feel right or normal anymore. More and more, I feel that bupe alters my state-of-mind, or at the very least, my spirit, in some way. It feels more and more as if I am on the outside looking in at myself, like some wierd half-dream state that I can't wake completely up from. I mean no offense to anyone with what I am saying here and I am only speaking for myself.....how I feel after being on Sub for more than two years. I'm not comfortable on it anymore, yet I don't seem to be comfortable without it (or on small doses) either.
I'm rambling, Lilly. I understand (as much as I can without being 'you') how frustrated you're feeling. I certainly wish I had an answer for us. But I'm afraid the answer is something we already know......Stick with your convictions, but be safe and avoid relapse even if that means going up or staying on the bupe. If committed to getting off.....keep at the tapering despite the crappiness (as I believe tapering will pay off in the long run), get out and exercise (much easier said than done) and keep the faith that things will get better.


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PostPosted: Mon Aug 15, 2011 12:57 pm 
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What you are saying makes complete and total sense to me. I went through this exact thing, either 'feeling' the dose, although it wasn't even a very pleasant feeling most times, and then feeling crappy the rest of the time. I really was at my wits end, thinking it would never get better....I felt totally hopeless. For me, that lasted a long time and I nearly gave up several times. I believed it wouldn't get any better, so I either had to jump (didn't want to do that) or face this eternal discomfort/mental funk.

However, miraculously, I adjusted and finally felt completely fine. The best thing I ever did was to start dosing once a day. It was a transitional thing, but it has made a HUGE difference. I was dosing three times a day for a while and guess what? Three times a day my body would be throwing symptoms at me. I also felt tired, achy, blue....just blah all over under the ceiling. Once I got used to dosing only once, these things basically vanished. The only thing I get now is some RLS and anxiety at night when waiting for it to kick it.

I really recommend you try to switch to dosing just once, if you can. I'm not saying it will absolutely work. We are all different. However, seeing what a change it made for me makes me believe it's at least worth a try. And BTW, you WILL eventually get used to this dose. You will eventually not be up and down all the time. It's about patience....and lots of it!

laddertipper

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PostPosted: Mon Aug 15, 2011 1:05 pm 
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Lilly, with what Ladder just said, maybe sticking with once a day is what you need. I hate that you're going through this and I wish I had some magic answer to help you through this. You may just have to do some trial and error with regard to what works best for you dosing-wise (once, twice, etc). Whatever works FOR YOU is what's RIGHT FOR YOU. I hope you know we ALL support you in this.

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PostPosted: Mon Aug 15, 2011 2:11 pm 
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I too hate to hear your going thru this.

I remember there was a point ( when I went lower then 2mg) where I just felt miserable and not like withdrawal miserable just miserable .... by the time I got to the end of my taper I was so tired of feeling crappy it seemed I felt that way for months...
but I did survive it and get thru it.
good luck girl.........


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PostPosted: Mon Aug 15, 2011 3:24 pm 
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hatmaker510 wrote:
At low doses, such as 2 mg for some people and definitely lower, the long half-life of 37 hours does not apply. And Dr. Junig actually recommends that people tapering that low actually dose twice per day and not once per day.

I do agree, though, that it might just take time to adjust. I hope that's all it takes, Lilly. Keep us posted. I'm also thinking that even though what you're feeling isn't really withdrawals, maybe taking your taper a bit more slowly still might help. Just my two cents. I'm sorry you're feeling so crappy and I hope it passes soon.



I never knew that Dr. J recommends to dose twice a day at lower doses. I could only assume these are doses that are relatively much lower than 2mg, and that it is to simplify everything. I'm not one to always practice what I preach when it comes to proper opioid addiction advice, because I myself am an opioid addict...but, dosing once a day is the best way to go for many reasons that you an many already know; the most important thing you can do if you want to make it work is dose at the same time every day.

The half life will always apply...and it is just a matter of adjusting and being patient. The half life will not simply just go away, diminish, or etc... just because the dose is relatively much lower than the ceiling dose. Again, I think Dr. J may recommend dosing twice a day at doses below 1mg or even microgram doses because it takes more time to adjust to these lower doses and it is easier to "double dip" to get through the WD. I think we need to get used to the idea of year long tapers. Consider how long you've been using all opioids, including suboxone and it makes perfect sense that a proper taper takes nearly a year for most of us. I notice that people rush, jump at a high doses, and are unreasonable when it comes to tapering.

The hardest part is just maintaining the discipline to do it right. It is easier to cut corners than it is stay on the prescribed path you set. Some times you just have to grab your balls and stick to the plan...YOUR plan. I myself still struggle with tapering the right way. My best friend George just recently tapered off suboxone. The whole thing took around 8 months since he first decided to do it. The first thing he did was stabilize on 2mg once a day. Once he got comfortable, he started reducing the doses as slow as he could with the 8mg film at his own pace. No journals... no over thinking it every step. He would text me every other week for advice and support, and he stuck with the once a day dosing and swears by it. He jumped off at around 0.25mg with no WD or PAW. He even yells at me..."Mike, once a day" if I complain I'm not taking my sub the right way. Even though we know what the right way is, it can be very hard to follow through...because we all have to battle with are frontal lobes every day, and sometimes the animal wins.


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PostPosted: Mon Aug 15, 2011 3:38 pm 
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I'm sorry, but I must respectfully disagree with you. And I'll say first off that this is from Dr. Junig. The mean half life of 37 hours DOES NOT APPLY when one is at low doses, such as 1 mg. That is why Dr. Junig often recommends going to twice daily dosing. The person tapering down that low could very well experience withdrawals before the day is over. Now, that's not to say that they won't get used to dosing at those low doses once per day. It's all about what the individual needs.

I suggest to you that you need to read and or watch some of Dr Junig's blog posts (Suboxone TalkZone) or his YouTube videos. I know for a fact that he discusses this in his blog, but I'm not so sure about his videos.

This paragraph is from his most recent blog post:

Quote:
As the dose is lowered, the effects of buprenorphine become shorter in duration. So the person tapering buprenorphine need to not only take smaller amounts each day, but must also divide that daily amount into two, then three, then maybe even four doses to avoid withdrawal symptoms at the end of the dosing interval.


So you see, I'm not making this shit up or talking out of my ass. Not that you said I was, but I want to make it clear that I don't post something on here if I'm not sure it's accurate. And if I'm not sure, I will say just that.

Now for a person on sub maintenance (one who is NOT tapering off), once per day dosing is best (I'm not talking about pain patients here). That's because it breaks the addict cycle of taking something whenever we feel we need a pill of some kind. It gets us to simply take a pill once a day, at the same time every day, then just forget about it. Just like any other meds we might take.

If you have more questions, or disagree further, maybe you might want to follow up with Dr. J's blog first so we're all on the same page. But I'm sticking by what I posted before and what I'm posting now.

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PostPosted: Mon Aug 15, 2011 3:42 pm 
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Mike T said, "Even though we know what the right way is, it can be very hard to follow through...because we all have to battle with are frontal lobes every day, and sometimes the animal wins.", that's a BIG part of the reason I jumped from a high dose, I knew me doing a taper was a joke. If I had it all to do over again, I'd jump again for the simple fact that I would inevitably bugger up my taper.

Honest to goodness, I don't know how anyone maintains the discipline to taper, but they do and it's great. Tapering is certainly the best way to go for most folks, but there are several of us whose addict brain makes a taper all but impossible.

Lilly, I hope you get past this stumbling block that you're facing, be strong and don't give up!!

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 Post subject: Tapering???
PostPosted: Mon Aug 15, 2011 4:09 pm 
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After being on here for few weeks now, and having gone the "jump" route vs. the "taper" route i've got a question...and i do not mean to in anyway sidetrack the topic...i hated the week i went through after i jumped...and i'm sorry to LV to hear that shes not doing so great.

At what point does one say to themselves that tapering, or striving to get to as low as does as possible puts you through more shit and miserableness than a week of withdrawals??? I've read quite a bit about people who are tapering who claim to "feel like crap" for days on end while they adjust to their new does (whatever it may be) only to stay there for a week or so just to do it all again when they drop their dose the next time. I to am like Romeo in the sense that i am not disciplined enough to taper anything...if i didn't force myself into a situation to run out and jump (at 3mg/4mg) i would still be on subs mind you, with no real plan to taper.

I guess my question is (to the taperers) why put yourself through a few days of mild withdrawals who knows how many times, only to lesson the w/ds that you are going to go through when you stop altogether? Why not just jump when you get to the lowest does when you start to feel the mild (tapering) w/ds. I guess to me it seems like people are putting themselves through more than they have to. Please keep in mind i've never tapered, or attempted to, i've jumped only once, and truly believe my acute symptoms we rarely short lived, but the more i read about people tapering for months and months only to have to deal with multiple 3-5 day stretches of crappiness doesn't make a lot of sense to me...wouldn't you just want to get it over with once and be done?

Again...to LV...i mean absolutely no disrespect, and am truly sorry for what you're dealing with...i really whatever it is goes and goes quickly so you can back to the hard work your doing.


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PostPosted: Mon Aug 15, 2011 4:27 pm 
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B Real - I'm not tapering, but I can give you my answer to your question. A good long, slow, low taper gets one's brain/body to slowly adjust to being without opiates. Jumping is more like ripping a band-aid off. When you do that with opiates, it's like a shock to the system and usually the acute AND the post acute (PAWS) withdrawals are both worse. Or at least that's the thought process behind the tapering. If it's slow and low enough, then it's like pulling the band-aid off slowly, a millimeter at a time, thus allowing the brain to adjust very very slowly. And if the brain can adjust more slowly, then the acute AND PAWS should be much much more tolerable. There's a thread out now that entitled something like, "First three days - not what I expected". Check it out. He tapered for 8 months and was at under 1 mg for a month. He's uncomfortable, yes, but he's out and about and kept asking, "when's it gonna hit? Is this the worst of it?". I think the way he did it is a perfect example of why people do the long taper. Of course with him it's too soon to see if he'll suffer from PAWS or not.

Lastly, even if the acute phase of withdrawals were to be the same both jumping from a high dose or a slow taper, the main thing is to have less in the way of PAWS. You wouldn't believe how many people end up back on suboxone because the PAWS was so unbearable. We have a few members who experienced that and are now doing a really slow taper in the hopes of not experiencing it this time.

I hope this helps explain it for you. I'm sure others will come by and give you their take, too.

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PostPosted: Mon Aug 15, 2011 5:57 pm 
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i may not know ". but is all this tapering giving all the brain levels a chance to go back to normal. it makes no diff if you jump or not. the suffering will still be there a year later. weather you do the short or long run like what romeo and b real said.
so witch is harder". the paws after the jump". or the crappy slow year taper. and then much less paws after that. i feel so muchfor what lilyval and setmefree are going through . i have had that in be tween feeling for years and years. like setmefree saying about the half dream state. i hate to say this but i have been going through that comatose state of mind for a long time. it was caused by, hope i'm wrong? but in my younger days i sniffed gasoline for i week with other idiots and hit the ground passed out and then saw the ace of spades in the sky. i never really felt fully awake after ". i just got use to being this way, and things lighten'd up a little. but then of course all the alcohol and drugs did not help much ether threw the years. but what i put my brain through was like a mack truck going through it over and over again. but guess what? i'm still here talking to you all". the brain can repair it self,like dr junig talked about some where, i forget where. so lilyval and setmefree your going through changes in the brain , and a big bright light is awaiting you!! God bless


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