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PLEASE READ THIS ENTIRE TOPIC BEFORE GOING OFF PRISTIQ. Pristiq comes in insufficient dosages to taper. Do not alternate doses of Pristiq to taper -- this will cause the levels of this medication in your brain to go up and down and is second only to cold-turkey in causing withdrawal symptoms. AND DON'T COLD-TURKEY EITHER!!!!!!!!! To reduce the risk of withdrawal symptoms and post-discontinuation prolonged withdrawal syndrome, as with other psychiatric drugs we recommend reducing Pristiq by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.) See Why taper by 10% of my dosage? The official prescribing information from the FDA contains this: However, Pristiq is difficult to taper "at a more gradual rate" as it comes in only 3 dosages: low (25mg), average (50mg) and excessive (100mg) -- and officially, the tablets cannot be split. PROTEST THIS DANGEROUS DRUG Phone Pfizer, Pristiq's manufacturer, to make a complaint: (800) 438-1985 in the US Pfizer has not provided any specific information on how to taper from a dosage of 25mg Pristiq, the lowest available dosage. They may suggest alternating dosages to taper Pristiq. Don't do this -- it's like playing ping-pong with your brain. File a complaint about the difficulty of tapering off Pristiq -- the range of dosages is inadequate. Also complain to the FDA 1-800-FDA-1088 Mon–Fri between 8:00 a.m. and 4:30 p.m. EST. Desvenlafaxine is venlafaxine's fancier sibling Pristiq is a drug made of Effexor's (venlafaxine) active metabolite, O-desvenlafaxine. Pristiq is to Effexor as Lexapro is to Celexa -- a tweaked and more powerful isomer molecule. In effect, Pristiq is concentrated Effexor. See http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2464 According to Pfizer http://labeling.pfizer.com/showlabeling.aspx?id=497, Pristiq is available in extended-release tablets of 25mg, 50 mg, and 100 mg; the most common dosage is 50mg. Unlike Effexor, which is metabolized primarily by liver enzyme P450 CYP2D6, Pristiq is metabolized via conjugation and liver enzyme P450 CYP3A4. It attains peak plasma concentrations in about 7.5 hours. As a chemical, before it's put into an extended-release tablet, desvenlafaxine has a half-life of around 11 hours. Pristiq's extended-release formulation According to this paper, the extended-release formulation releases desvenlafaxine over 24 hours. The mean half-life of desvenlafaxine, without the extended-release formulation, is around 11 hours. According to Pubmed on Desvenlafaxine: "....The extended-release tablet does not dissolve in the stomach after swallowing. It slowly releases the medicine as it passes through your digestive system. You may notice the tablet coating in the stool...." Rather than a timed-release coating, the coating on the Pristiq tablet is only protective. The extended-release formulation is in the glue that holds the tablet together, not in the coating. This is called a monolithic matrix tablet. (Here is a description of the similar matrix formulation for quetiapine XR (Seroquel XR) .) I confirmed this in a phone conversation with Pfizer medical information (1-800-438-1985). (Thank you, oaklily, for this information about the matrix formulation.) If the tablet is split, the matrix is damaged and will not reliably be extended-release, though larger fragments are more likely to retain some extended-release capability. When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability. A Pristiq fragment becomes immediate-release desvenlafaxine, with an 11-hour half life. If you cut or crush a desvenlafaxine tablet, prepare to split your daily dose into 2 or more doses. OPTIONS FOR TAPERING PRISTIQ The following are all informal suggestions for tapering desvenlafaxine. Cut up Pristiq tablets Despite the warnings not to cut it up, from reports on the Web, cutting up Pristiq tablets does seem to work for some but it makes others ill, possibly because of "dose dumping" due to the immediate release. The extended-release mechanism is in the glue that holds the tablet together in a matrix. If the matrix is destroyed, the entire dose is released at once or "dumped," instead of being gradually released. Without the extended-release matrix, a Pristiq fragment becomes desvenlafaxine, with an 11-hour half life. To avoid "dose dumping" of the entire dose, you might take smaller divided doses of Pristiq, more than once a day, like immediate-release Effexor, to mimic an extended-release dose. Cut-up Pristiq seems to sometimes cause stomach upset, which may be reduced by taking it with food. Now that the 25mg tablet is available, cutting it into quarters gives you the option to taper by 6.25mg per step. If you are taking 100mg Pristiq or 50mg Pristiq, you may wish to request part of your prescription be written for 25mg tablets. (For insurance coverage of multiple dosages, your doctor most likely will have to specify taking Pristiq in "divided doses.") You may find you need a precise way to measure your tablet fragments. See Using a digital scale to measure doses As you get down to a low dose, you may wish to switch to Effexor to more precisely control dosage decreases, see below. Reducing from 100mg Pristiq to 50mg Pristiq Drug switches incur additional risk. Before trying a switch to Effexor or Prozac (fluoxetine) from 100mg Pristiq, it's probably wise to go down to 50mg Pristiq first, or 25mg if possible. Combining whole tablets, with their extended-release qualities, with tablet fragments probably makes "dose dumping" less likely or noticeable. You might use a 50mg tablet plus a 25mg tablet plus 3/4 of a 25mg tablet (18.75mg) to make the first reduction to 93.75mg 2nd reduction: a 50mg tablet plus a 25mg tablet plus 2/4 of a 25mg tablet (12.5mg) to go to 87.5mg 3rd reduction: a 50mg tablet plus a 25mg tablet plus 1/4 of a 25mg tablet (6.25mg) to go to 81.25mg 4th reduction: a 50mg tablet plus a 25mg tablet to go to 75mg 5th reduction: a 50mg tablet plus 3/4 of a 25mg tablet (18.75mg) to go to 68.75mg 6th reduction: a 50mg tablet plus 2/4 of a 25mg tablet (12.5mg) to go to 62.5mg 7th reduction: a 50mg tablet plus 1/4 of a 25mg tablet (6.25mg) to go to 56.25mg 8th reduction: a 50mg tablet If withdrawal symptoms occur, some people have found taking an additional fragment of a tablet can smooth the transition from one dosage to another. Another way to get from 100mg to 50mg or 25mg is to combine whole desvenlafaxine tablets with a liquid made from immediate-release Effexor (see below). Once at 50mg or 25mg, stabilize for a month at least and consider your plan for the next stage of tapering. Have Pristiq made into smaller dosage capsules or a liquid by a compounding pharmacy Compounding pharmacies can crush the tablets and put the powder into smaller capsules by weight. Like cutting up tablets or crushing, this destroys the time-release quality, but the compounded method is much more exact. In your body, crushed Pristiq is similar to regular immediate-release Effexor, with an 11-hour half-life. You may wish to have your dose compounded to take twice a day. If you are taking 50mg Pristiq, for example, you would have 60 capsules compounded per month. Each capsule would be 1/2 of 45mg (a 10% reduction of 50mg) or 22.5mg. You would take two capsules per day, once in the morning, and once in the evening. The next month, you would have 60 capsules compounded, each capsule being 1/2 of 40.5mg (a 10% reduction of 45mg) or 20.25mg. And so forth, for each reduction. (According to my compounding pharmacy, they can put in a slow-release additive distributing absorption over 8-10 hours. Whatever extenders compounding pharmacies might put into the capsules will not last 24 hours like the Pristiq time-release coating, but at least it's something. You probably will still need to take the compounded drug at least twice a day. Check with your compounding pharmacy about extenders. See getting-custom-dosages-at-compounding-pharmacies-us-uk-and-elsewhere ) If this does not work, you may wish to switch to Effexor XR and use the bead-counting method. Regular Effexor probably wouldn't be an advantage over Pristiq compounded to custom dosages. One of our members had a desvenlafaxine liquid made by a compounding pharmacy. Most likely, this compounder used pure desvenlafaxine succinate powder to make this liquid, as desvenlafaxine tablets contain a glue that might resist being made into a liquid. But he may have a way to grind tablets up to make a suspension. A liquid would have to be immediate-release, with a half-life of around 11 hours. Generally, you'd take a drug with that short a half-life twice a day. Crush Pristiq tablets, weigh powder with a digital scale This is similar to cutting up tablets -- Pristiq is a "do not crush" medication, as it is a time-release drug. The Pristiq powder becomes desvenlafaxine, with an 11-hour half life. If you pulverize the tablet, you might take smaller divided doses of Pristiq, more than once a day, like immediate-release Effexor, to mimic an extended-release dose. In principle, this would be a more precise way of tapering than cutting up tablets: Crush the tablet Make sure the shell fragments are evenly distributed in the powder Weigh the powder for a dose with a digital scale Put the powder into an empty gelatin capsule to make it easier to ingest Peer discussion of this method starts here http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__27417 Switch to Effexor or Effexor XR Note: If you've had an adverse reaction to Effexor before, do NOT switch from Pristiq to Effexor. "Desvenlafaxine (O-desmethylvenlafaxine) is the major active metabolite of venlafaxine." Since the relationship is so close, switching to regular immediate-release Effexor tablets, which you can cut up or make into a liquid, this may be the best way to taper off Pristiq. Because it has a mean half-life of 5 hours, you'd have to take regular Effexor twice a day. Alternatively, you might substitute Effexor XR, which is released gradually like Pristiq and needs to be taken only once a day. You'd have the difficulty of tapering off Effexor or Effexor XR -- themselves notorious for withdrawal difficulties -- but at least you can do that gradually. See Tips for tapering off Effexor and Effexor XR (venlafaxine). The late Mickey Nardo, the psychiatrist who wrote the 1boringoldman.com blog, reported success in switching one patient from Pristiq to Effexor, then tapering Effexor, here (see comments) Another psychiatrist said when he tried this, the switch from Pristiq to Effexor was "seamless." Dr. Stuart Shipko posts here: Estimating venlafaxine dose equivalents for desvenlafaxine dosages According to FDA Prescribing Information for venlafaxine (Effexor), the usual dose of Effexor is 150mg per day. Since 150mg Effexor and 50mg Pristiq are both "normal" dosages of their respective drugs, these dosages may be roughly equivalent. However, a paper by pharmacists Attfield, et al., 2016 says This would be an approximate ratio of 2mg venlafaxine for each 1mg desvenlafaxine. (If you've just quit Pristiq and are experiencing withdrawal symptoms, you may wish to reinstate a LOWER dose of Effexor XR, such as 37.5mg, to start. This may be enough to stop withdrawal symptoms while avoiding a kindling reaction.) Advice from Dr. Stephen Stahl, author of the manual Essential Psychopharmacology In his widely read psychopharmacology manual, eminent psychopharmacologist Stephen Stahl advises titration by crushing the tablets and mixing in fruit juice, see http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__14799 According to our member oaklily, Stahl is wrong. Making a liquid from Pristiq does not work, see http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/page__view__findpost__p__24822 Dr. Stahl intends to correct his book, according to this correspondence 09/15-9/16/13 with him: Use a combination of Pristiq tablets and Effexor liquid Pristiq cannot be made into a liquid, but its close relative immediate-release Effexor (not Effexor XR) can. You may be able to go off Pristiq by taking part of your dose in lower-dose tablets and part in liquid Effexor, gradually converting to all-liquid Effexor as you get to lower dosages. This may offer a convenient and gradual path off Pristiq. Only regular immediate-release Effexor can be made into a liquid (see Tips for tapering off Effexor (venlafaxine) ). As immediate-release Effexor has a short half-life and is usually dosed twice a day, you may wish to take the liquid portion of your dosage later in the day. For example, if you are taking 100mg Pristiq, you may wish to take your daily dose as one 50mg tablet and the rest later in the evening as a liquid made from immediate-release Effexor. You can titrate the liquid by 10% of your daily dosage to taper until you get to 50mg. Then you can take a 25mg Pristiq tablet with the rest in a liquid made from immediate-release Effexor. When you get to 25mg Pristiq, you might switch to splitting the tablet and taking the rest in Effexor liquid and so on until you are taking only liquid Effexor. To do this, you will have to request a prescription for Effexor tablets as well as Pristiq from your doctor. "Bridging" with Prozac or another antidepressant Any drug change incurs additional risk. A switch to Prozac from Pristiq may not work -- they are very different drugs -- or you might have adverse reactions to Prozac. Prozac is regularly used to "bridge" off Effexor. Given that Pristiq is a sibling of Effexor and Effexor XR, it is possible that one can, similarly, use Prozac to withdraw from Pristiq. Attributed to Joseph Glenmullen, the "bridging" technique is described by a doctor here http://www.bipolarworld.net/Phelps/ph_2005/ph1354.htm Best guess from a professor at a prominent US university pharmacy department (he does not want his name published): Then taper off fluoxetine (Prozac). See Tips for Tapering Prozac Before attempting a switch to Prozac, read this entire topic: The Prozac switch or "bridging" with Prozac There's very little documentation about the success rate for the Prozac switch. It may be best to reserve it as a last resort, if you cannot taper Pristiq by any other means. To switch to Prozac for tapering, consult a doctor knowledgeable about this technique.

I was referred here by a psychiatrist I've been corresponding with. He told me you all were spot on in your knowledge about withdrawal and tapering but warned that you typically deny the existence of mental illness. Anyway, I've spent a few days learning it up, reading through stuff. My story: diagnosed bipolar in 2005 and don't really dispute said diagnosis. Doc put me on Paxil in 2016 for anxiety. Shortly after I became unstable in mood. Caught on that it was the Paxil in 2019 so I cold turkeyed. It was an ascent into madness, to say the least. I tried again late last year with the usual fast taper schedule offered by the wonderful field of psychiatry. I can't get from 20mg to 10mg. I'd say probably the worst symptom is the mania/mixed states/panic/terror combination I get plunged into. I was musing about this with the psych who referred me: I'm trying to get off Paxil to improve my moods, yet the Paxil withdrawal messes my moods up worse than being on Paxil. Reading through people's experiences and it doesn't even seem like it's possible to taper paroxetine. I'd very much like to have words with the doc who put me on it. Anyway, that's me. Thanks for reading.

Hello all, first thank you for this really helpful forum. I started taking Venlafaxine 150 back in 2016. Later in 2018 i started tapering it off with 5-10% rule. In 2020 I arrived finally at 50mg. At this point however I got strong withdrawal symptoms even with 5%. I learned then about the Prozac bridge method and i thought I give it a try. So i am now off the Venlafaxine for about 2 months and now i only take Fluoxetine 13mg. However I still have some withdrawal problems from the venlafaxine 2 months later. It is not that bad, but mostly my brain is hurting headache and strange feelings and tingeling at my brain. I think I will now stay on the Prozac 13mg until the problems go away and then see how fast i can taper the prozac. Or would you say it would be better to go back to the Venlafaxine after 2 months now already because of the symptoms, I am now afraid that those will last years as I have read on some other cold turkey cases. Thanks NightWarrior

Hello, I have taken many months to taper off what i consider this evil drug. I have been off it now for approx 2 weeks but i am still experiencing "Brain Zaps". I am very tired. have memory worries, very itchy, sore in corner of mouth and a lot of "aches and pains" and more. how long does it take to feel relief from it all? I have been on other anti depressants for about 40yrs and i am wondering if my body will be unable to function without them T

Hallo. I have been on Paxil for 20 years, 20 mg I went down to 10mg, then I switched to Prozac After 15 months tapering, I am down to 1 mg In my country there is no liquid for Prozac, but I can resolve them in water, just don’t know how to measure. I would appreciate a help with that. Thank you

Hi, I've been a member of SA for roughly a year, but this is my first post, so hello. I've been taking antidepressants for roughly 23 years now in order to treat OCD and anxiety depression. The greater part of that has been on fluoxetine, which I took intermittently over roughly a period of 15 years. When I say 'intermittently' there would be periods where I would miss a couple of days, up to perhaps the odd month or two when I wouldn't take anything. To a certain extent this was probably down to the side effects I tended to experience and also self-denial about having mental health problems. Unsurprisingly, my mental health didn't improve, even if the drug was likely to do anything - I guess I muddled through. So, as seems to be a familiar story, following a couple of stressful events, I started taking the fluoxetine consistently every day, but found that the side effects - nightmares and leg spasms on falling asleep - were beginning to become a problem. In order to alleviate this issue, my doctor suggested I take sertraline, which I did for several weeks, but found that I actually had more side effects. The next drug that the doctor suggested was Venlafaxine(Effexor) 75mg. After roughly 4 - 5 weeks, once again, side effects, so I asked if I could drop to a smaller dose 37.5mg, which I managed without any real issues - probably because I hadn't been taking it for very long. I took the lower dose for roughly a year, after which, once again due to building side effects and because I actually wasn't feeling too bad - I'm not sure if this was the drug or I just started to feel better naturally - I asked the doctor if I could start reducing the dose. The doc replied, "yes, just stop taking it and we'll see how you manage." This was my first ever experience of withdrawal, made worst be the fact that I had no idea it could happen on prescription medication! Fortunately, I decided to only half the dose rather than stopping completely. It still took me 2 weeks to figure out what was happening however - I simply thought my mental health had suddenly taken a dramatic nosedive. I had three or four more failed attempts at getting off Venlafaxine over the last four years. I reached the stage where even tiny reductions put me into withdrawal. I can't quite remember what led me to Surviving Antidepressants, Glenmullens' book maybe, but I was pretty much at my whits' end on how to get off that awful drug. I found some information on the Prozac bridge and decided to try that. When I took the final dose of Venlafaxine, I was expecting to be hit by the psychological equivalent of a bus, but, luckily, it did seem to mitigate a lot of the severe withdrawal symptoms that made my previous efforts such a nightmare. I also managed to find a GP open to trying this approach. Am I out of the woods yet? Well, that's one of the reasons I've finally decided to post. Thankfully, I'm off Venlafaxine. Am I out of withdrawal? I'm not sure. My anxiety and OCD seem to have got worse over the last 5 - 6 months. This of course could be down to not taking AD's any more which suppressed the anxiety, or that I'm still in some type of withdrawal - maybe both. I guess I'm posting to see if I can figure it out. Thanks, Paul

I was born in 1957 a physician's daughter. I didn't question taking medicines. When my father was dying and my original family was flying apart from the stress, I was prescribed Paxil for anxiety by a psychiatrist. As it has turned out I took Paxil for twelve years until 1/2022. I spoke to my current internal medicine provider who advised me to half my 25mg dose, wait two weeks and take it every other day for two weeks. I was never told of the long term risks of staying on Paxil for so long. My withdrawal difficulties started after I had successfully halved my original dose. Headache, body-aches, gastrointestinal upset, irritability that eventually turned into rage. Luckily I was steered from a friend to someone, a lay person, who understood my symptoms. They suggested switching to liquid and for a year I tapered .5 mg every 14 days. Taking a week off if needed. Fall of this year my body became extremely sick at 5mg and it would not let up no matter what I tried, my taper stopped. I began focusing on nutrition and nothing changed. I was forced to give up all commitments and stay home. During this time I tracked down the original prescribing doctor who had long since moved away. They switched me to liquid Prozac at the same 5mg dose for 5 days. My symptoms immediately improved. This was one month ago. I still have some withdrawal symptoms but nothing like before. To date my body has dropped 30 lbs, 12 lbs in the past 30 days. I'm still focusing on nutrition. My anxiety vs withdrawal is not easy to separate. I don't feel plagued by anxiety but my raging pushed all my family away and I'm in grief about this. I don't know how these relationships can repair themselves. One adult child is no longer speaking to me. I'm sure this has overwhelmed them. My other child I've been able to repair communications with. One complicating factor is that I'm a horsewoman. I fall off occasionally and hit my head. So this weaves in and out throughout this past year. I have GERD, Hypothyroidism, Insomnia, struck by lightning, chronic sensitization to light, sound, smell, migraine sufferer. This past year kidney stones, migrated stint, medical fiasco from a provider clinic. My hope isn't gone, but its worn quite thin. I am isolated and trying to recover. It's clear that it may take months or years.

Dear All, I can not begin this post with out sharing a massive thank you to you all for all your personal insights, knowledge, and camaraderie. I may have only just joined (and, I never thought I would) but my tapering journey has vicariously benefited via your experiences and your sharing of them on SA so generously. Like many, I was horrified when I first realised that I was ‘addicted’ to such powerful drugs, after a powerful label (aka diagnosis) was bestowed upon me by a powerful professional (aka psychiatrist) operating within and for powerful industries such as mental health care system and big pharma. Here’s my drug history… 1995 -2000: Addictive sleeping tablet use. 2000: Abrupt withdrawal of sleeping tablet. 2000 - 2001: Multiple drugs with multiple switching on various doses including antipsychotics, antidepressants, mood stabilisers, and other possibly other psychotropics (forgotten which). As well as sleeping tablets and benzodiazepines (forgotten which), while at most unwell ‘manic’, ‘depressed’, etc. 2001 - 2011: ‘Stable’ on Paroxetine 20mg and Carbamazepine Prolonged Release 400mg (200mg morning and night). Some occasional sleeping tablets use for approx. 3/4 years during this time, more during the middle of the decade. 2011: Abrupt withdrawal of above medication, tfollowed by severe headaches. Some occasional triptan use for 1/2 months. 2012: Reinstated Paroxetine 20mg and Carbamazepine Prolonged Release 400mg (200mg morning and night) for 2/3months due to ‘depression’ 2012: Abrupt withdrawal of above drugs. Severe headaches continued this time with some kind of burning prickly type sensations at the face. 2013: Trialled multiple drugs to manage headaches, including one antidepressant at low dose for 1 week (forgotten which), then Pregabalin for 2/3 months (adverse affect followed), then crossed-switched/cross-tapered to another antidepressant (forgotten which) at low dose. More multiple physical difficulties followed (pain again, mostly headaches with the same some kind of burning prickly sensations. but also back, neck and limbs). 2013: Abrupt withdrawal from low dose antidepressant for headache. 2013 - 2014: Multiple antipsychotic drugs with multiple switching on various doses, as well as sleeping tablets and benzodiazepines. 2014: Reinstated Paroxetine 20mg and Carbamazepine Prolonged Release 400mg (200mg morning and night). Anxiety and still occasional headaches. 2014 - 2017: ‘Stable’ on Paroxetine 20mg and Carbamazepine Prolonged Release 400mg (200mg morning and night). Addictively using sleeping tablets during this time. Continued anxiety and still some headaches. 2017: Trailed melatonin for 1 week, then promethazine for 1 week (forgotten doses) for sleep. Trailed another antipsychotic (maybe Chlorpromazine) for sleep for another week (forgotten dose). No sleeping tablets during this time. 2017: Abrupt withdrawal of all above medication. 2018: Reinstated Paroxetine 20mg and Carbamazepine Prolonged Release 400mg (200mg morning and night). 2018: Began slow taper off Paroxetine. At 10mg severe headaches began, switched to 10mg fluoxetine. Continued on Carbamazepine Prolonged Release 400mg (200mg morning and night. Continued occasional use of sleeping tablet. 2018 - 2023: Stable’ on Fluoxetine 10mg and Carbamazepine Prolonged Release 400mg (200mg morning and night). Continued occasional use of sleeping tablets and and sometimes benzodiazepines during this time. Continued pain, headaches, anxiety. Note - Throughout the above years I have been an inpatient and outpatient with decisions made for me regarding drugs including abrupt withdrawals. Some withdrawals were planned planned by me when unaware of withdrawal knowledge. Others while I was ‘unwell’ and began by unwittingly missing a dose. Throughout the years, like many of us I have experienced so many ‘symptoms’ either on or off the drugs already well documented throughout the SA website. Above, I have tried to share my main complaints and history as best as I can remember. I would also like to make known that there are some non prescription remedies/herbs/vitamins I have tried and still use including CBD, Omega 3. Beyond the drugs, I have tried to live a life as best as I can at times working within the mental health care system supporting other patients in various roles. I have recognised some of the more destructive ways I have coped e.g. alcohol misuse, poor/toxic interpersonal relationships, etc. and developed new ones especially with my people such as ourselves aka peers. It’s all still a learning journey, and I am far from perfect and never expect to be. I have been the best I have been in some time since I began my taper in 2018, and my partner and I have decided to have a child and that’s what has promoted me to join the site. I am hoping to understand how best I can taper from Carbamazepine Prolonged Release 400mg (200mg morning and 200mg night). Unfortunately, I began a rather rapid taper 4 weeks ago without realising that it too would come with quite significant withdrawal affects similar to that of AD. Yes, of course I feel rather silly, sad, and annoyed with myself for not realising this given what is on the site already. I genuinely thought as it’s a different type of drug it wouldn’t cause such problems. Alas, that’s not the case and I have learned my lesson fast. The rapid taper went like this: Original Dose 400mg Carbamazepine Prolonged Release (200mg morning and 200mg night). Week 1 - 200mg morning, 100mg night Week 2 - 100mg morning, 100mg night Week 3 - 50mg morning, 50mg night Week 4 - 50mg morning, 50mg night. Today (still week 4) - reinstated 200mg morning (as more withdrawal symptoms developing which are not being mitigated by Omega 3 and CBD). With it being prolonged release I am unsure how to progress from here. Doctor had agreed to prescribe 100mg of immediate/usual release so I can figure this out. My thinking is I can treat this morning 200mg dose as a ‘rescue dose’ and reinstate at 100mg of immediate release daily but cut it into 3-4 doses spread out in the day. The brand is Tegretol by Norvotis. I welcome any advice you all have. Just to be clear, I am not a Doctor, or any other Physician, and can’t not give advice. Nothing I share should be construed as an expert view please. Nor do I recommend a rapid taper. As mentioned, I mistakenly did not think carbamazepine would cause such a problem with it being a different type of drug. Perhaps I was having a rose-tinted glasses affect on account of wanting a child, which I accept. Thank you. WeLiveInHope

So, for some background, I had a rough time in junior high, and things peaked when I was in 9th grade and my grandmother died. I was very depressed, and my mother, being someone who takes antidepressants herself, took me to a doctor to try some. Now, nearly 20 years later, I’m tired of them. Most recently, I was on Effexor 150 mg., and that has been my only medication for about 15 years. When I started taking it, I was at such a low point in my life as college wasn’t going how I’d expected, and I felt lost in my life. I fell into drinking, rather than attending class, and I went from an A student to failing out of college. However, since that time, I realized what I wanted to do with my life, and now I’m doing it. I’ve been living and working abroad for nearly 6 years now, and in the last couple of years I’ve really noticed how Effexor is more of a hindrance to me. It worked so well for a long time, but eventually my weight issues got worse, even though lab work all comes back spotless, my body doesn’t ever really feel good physically, and mentally I feel very subdued and not present. Like I’m watching everything happen around me with such passivity. I don’t have many emotions. I don’t get excited. I have no passion for my own life, and I don’t want that anymore. There’s also the terrible sexual dysfunction issues which are very detrimental to my relationship, but that’s just one more issue on top of the many others that already exist from this medicine. So after having one last setback with my inability to lose weight, something which has been affecting me for the last 2.5-3 years, and also having this feeling that something isn’t right with how I feel, an endocrinologist suggested changing my antidepressant. Rather than going through that process again and risking worse side effects, I made the decision to stop Effexor. So far, things haven’t been terrible. Tomorrow will be day 5, and I’ve even able to go to work (though I’m a bit spacey and antsy). I did have a couple of really bad days when I thought I’d caught Covid due to how feverish and flulike I felt, but apparently that’s common with withdrawals. I’m hopeful that things will continue to get better from here. I already feel like my body just feels more “normal” and happy, even after just a few days, and my weight seems to be on a downward trend already. I do have waves of nausea and jumpiness, and the hot and cold sweats are rough, but I’m managing. Right now I’m just excited to get through this time of physical withdrawals and figure out how to manage my emotions and anxieties without the help of Effexor.

Hi all. Found this site by accident but glad I did. I’m struggling a lot after recently stopping AD’s and so trying to educate myself, encourage a semblance of kindness towards myself 🙄and get a bit of support and a more objective perspective on this bloody difficult journey. Been on Prozac for 25 years and then replaced with Duloxetine/Cymbalta in 2014 (after failed attempts to come off Prozac). During the majority of this time I have had no psych service input other than putting me on and leaving me on AD’s. At present - Was on 60mg Duloxetine which I tapered over the last 2 months 🤔 with vague advice from an NHS psychiatrist. This advice now feels very vague and a little dismissive given withdrawal effects and current situation. Anyway, I have been completely off Ad’s for approx 2 weeks. The main symptom during taper- brain zaps, dizziness and irritability. Then the symptoms seemed to disappear. However the last 2 weeks with no drugs has been like nothing I imagined. It has completely pulled the carpet from under me. Brain zaps that make me so dizzy I feel I could fall, spontaneous and uncontrollable crying, severe insomnia, feeling super anxious and panicked at times and generally odd, a bit removed and frightened of it all. On the plus side I feel less numbed, verbal fluency is returning and I feel a little more hope 🤞 (that this is the right thing and all will be well), relief (that these symptoms that when stopping the drugs had me straight back onto them as ‘I was ill’ were/are actually withdrawal) and an immense sadness that I am only at this point 30 years later and this is sprinkled with a rage (at the psychiatric/pharmaceutical world). Sorry...blaahhh. I guess I’m looking for someone else to say it will be ok, it gets better, well done. Some kindness. More hope and success stories. I really can’t believe how hard this is. I see that it appears my ‘taper’ was very quick but I do not want to go back on anything and am riding it out. I feel so isolated as I really don’t feel people who haven’t had this journey really understand. Thanks in advance for any replies. This is so, so damn hard. Kind thoughts to you all 🙏🏻 S, Scottish Lass Prozac 60mg ( 1996-2014) Duloxetine/Cymbalta (2014-March 2021)

It’s always so hard for me to start and it’s even harder now because of the state I’m in, but I’ll do my best… The good: Around 2014 I’ve been put on Paxil 20mg due to anxiety and my first panic attack. Well, it was a miracle pill for me, can’t deny that. After roughly two years (2016) my doc suggested that it might be a good idea to get off the meds since I was doing so well - sure, let’s do it! - I said. The taper plan she gave me was minus 5mg each week, so from 20mg to 0mg in a month. I did that and as you may suspect, it wasn’t the most pleasant experience. Took me around three months to get back “from the dead”, but I managed. Didn’t have much obligations at that time, so it wasn’t so stressful since I could just spend my days in zombie mode and not care. The bad: Shortly after my revival something… hit the fan and due to extreme anxiety I had to go back to meds. In my ignorance, stupidity and fear I asked my doctor to reinstate Paxil, because hey, it worked wonders previously and I didn’t feel like experimenting. It worked again, sadly, taking me hostage for the next eight years. Why I say hostage? Because from that time my life changed quite a bit, adulthood hit hard. I couldn’t allow myself to take a few months break just to get off the meds. I tried a few times, but I simply couldn’t handle the reduction, no matter how slow I tapered. I started to wonder if I may need to stay on it for life. It worked, so where’s the harm I asked? But I’ve decided to give it a one last try, especially since I’ve been in a pretty good moment in my life. The final push - and that’s the moment my life falls apart. The ugly: June 2023, I went from 20mg > 17.5 mg. Some heightened anxiety, waking up a bit earlier than usual, no biggie. I’ll give it a month and go down again. July 2023, 17.5mg > 15mg. First two weeks were pretty consistent, a little more of insomnia, anxiety and anhedonia. I noticed that I probably should stay on that dose a bit longer than a month. Fine, I said, but life had a surprise for me and this is where things start to get hectic and blurry… Around week 3 on 15mg I woke up with SEVERE brain fog, anhedonia and fatigue. At first I brushed it off on a bad nights sleep, but next day I slept much worse and my condition did not improve. Okay, this’ll pass soon, a bump on the road I thought. Guess what, it started to get worse. Panic and anxiety started to slowly creep into my life. I’ve lost my edge, become dumb in a very short time - if that’s not a reason to panic then I don’t know what is. So I’ve started searching, could this be withdrawal? Turned out it could, so I went back to 17.5. No improvement, hell, it’s getting worse! Back to 20mg. For a few days I’ve felt a bit more clear headed, but it faded away quickly. At this point I’ve stumbled upon a paper linking Paxil and its anticholinergic effects to dementia. One word. Panic. Consulted this with my dr, she upped me to 30mg because yeah, I’ve been on 20mg for quite some time. This helped for like three weeks and started to dive rapidly. At this point I’ve been through some major diagnostics like brain imaging and extensive bloodwork. All came back without issues, except for the neuropsychological testing that confirmed that I’m indeed lightly cognitively impaired. I wanted out from Paxil immediately, because the thought of each day on it adding a fraction to the chance of dementia literally made me puke, but I knew that cold turkey is not a way to do it. It’d probably kill me and as you may suspect, I was already a mess. Prozac bridge emerged on the horizon, appearing to be the only reasonable way out of this impasse. My doc approved the idea and I started the transition from 30mg Paxil to 30mg Prozac, 5mg each week. That took me about 1.5 months. Rough months during which I’ve experienced a plethora of symptoms that fueled my health anxiety like nothing else could. The main things were paresthesias in my body’s right side, tinnitus, insomnia, fatigue and brain fog. Not to mention the anxiety, mood swings and crying spells. I went to the doc and described how I’ve been feeling. Their response? Let’s up Prozac to 40mg, this should help! Craving any relief I did as instructed and here I am now, second week on 40mg Prozac, one month paroxetine free with brain fog, fatigue, muscle aches in my right side of the body, dry heaving each morning, zero appetite and constant diarrhea paired with anhedonia. Sure, the anxiety has been mostly clubbed by Prozac after upping the dose, but I don’t think I feel alive and I don’t know what to do. I thought about staying on 40mg for some time to stabilize, but there’s this pressure in me saying “drop to 30mg, it’ll make you feel better!”. I don’t know what to do anymore and I’m scared and tired as hell.

Hi there, I have been lurking on this site for quite a long time and too afraid to share my story, but I am reaching the point where I really need some help. To give you a bit of a case history: I am 38 now and was diagnosed with depression and anxiety at the age of 14 after suffering some pretty debilitating and terrifying panic attacks. At 14, I was put on Paxil (20mg) and later Wellbutrin (300mg), which was added to address the sexual side effects of Paxil. The Paxil seemed like a miracle when I first began it, and for many years later, and I felt entirely in "remission" for nearly two decades. Over the years, I would occasionally attempt to lower my dosages, but would suffer from brain fog and a recurring depression. About 6 years ago, I began to feel that the medication was no longer actually working -- I was depressed and felt an increasing sense of numbness and anhedonia. I experienced no happiness at all from my life -- no sadness either, really. Just blah. My memory was also getting quite worrisome -- I'd begun to regularly forget people's names. I met with a psychiatrist who advised me to switch from Paxil to Prozac to bridge to zero meds. I cross-tapered from the Paxil to the Prozac (20mg) over a period of about three months. It was a rocky period, with lots of what I now recognize as akathisia, anxiety, agitation, and GI symptoms. But I managed to make it without any brain zaps, which had hobbled all other previous attempts of mine. I then did a very fast taper of the Prozac and Wellbutrin to zero in probably two and a half months. At first, all seemed fine enough. And then, like clockwork, three months in, I suffered a terrible depressive episode, much worse than any I'd had before the meds. I reinstated the Prozac but now at 15mg, because I found side effects at 20mg (tremors, anxiety, palpitations) undoable. At this first resinstatement, I began to have tinnitus, which has never gone away, but otherwise seemed to do okay, if not great. This sense of not really doing great caused my psychiatrist to try to switch me from Prozac to Cymbalta. After a month on the latter, severely depressed, I went back to the Prozac, and then switched to Trintellix. The Trintellix was awful and left me in a terrible depression, although I now wonder if this was also due to withdrawal symptoms from the Prozac. Over this time, I began to experience debilitating brain fog along with the mood swings and intense anhedonia. Last September, 2021, I finally went back to the Prozac after three months off. The reinstatement took away the worst of the depression, but the brain fog never abated and I began to suffer from terrible fatigue as well, along with recurring episodes of derealization and depersonalization. I tried ketamine infusions, which I found did nothing but make me feel even more derealized. Over the last year, I changed my diet entirely, adopting a whole-foods, gluten-, dairy-, alcohol-free diet. I began to think my symptoms (the brain fog, attentional difficulties, fatigue) were due to an organic physiological issue and did a battery of tests with a battery of physicians, none of which revealed anything wrong. Finally, over the last several months, I found this website and began to suspect that my symptoms were not being alleviated by the medications but exacerbated by them. In July, I began a very slow taper of the Prozac. It has been quite difficult even with very small cuts. Essentially, I am now in a place where I am wondering two things: 1) Because of the timeline of my symptoms, is it possible that what I have been experiencing is actually an adverse reaction to the reinstatement of the Prozac? I never had any fatigue before the back-and-forth of drugs and then landing back on Prozac, for instance. If so, does that mean I should be accelerating my taper? 2) The advice on this site is to cut and then hold until the nervous system stabilizes, but it feels to me like my nervous system never quite really stabilizes. Do I keep going anyway? Thank you to anyone for your help. This is such a difficult, lonely process, and I am very grateful that this group even exists.

Hi, I’m new. Here is my currently-unfolding story… My doc recently swapped my 100mg sertraline rx for 10 mg fluoxetine and advised me to not taper, to just stop taking the one and start taking the other. The rationale for stopping sertraline is that I was found to be a poor metabolizer of both SSRIs I’ve ever taken (escitalopram and sertraline) due to non functioning CYP2C19. I have found very few answers to what the resulting effect was. Was I ending up with more sertraline in my system than 100 mg would be for normal metabolizers? To complicate matters I ended up having to do a very quick taper of sertraline before I was able to get fluoxetine from the pharmacy, due to an error at the mail order pharmacy that held my prescription from being filled. As a result I tapered my dose of sertraline quickly as I was running out of medication. A second snag filling the fluoxetine rx caused me to be without any medication for a few days. Trying to switch medication while working between a local and a mail order pharmacy is difficult but I don’t have a choice on my insurance. The first week off of sertraline I felt better than I had in years. My constant tension headaches & acid reflux disappeared immediately. I got an amazing 1 night of sleep. I thought of maybe going off SSRIs entirely because I was even in a good mood. Then, I had a dizzy spell that subsided over an hour or so. I had ringing in my ears and over the next few days found it difficult to move my eyes from side to side (that’s the best I can describe it, like it took a lot of effort to physically move my eyes). I got very, very tired each afternoon and had strange dreams every night, with occasional nausea and bad acid reflux returning. I started to take 10 mg fluoxetine and my symptoms got a little better, but the effects don’t last long. I’m now going through hours of nausea and crippling fatigue. I took 3 naps today. I’m worried about being able to get through a whole day of work (my job can be very taxing and unforgiving sometimes and I’m responsible for people and that adds anxiety). Im worried that I’m going to face an indeterminate amount of time with horrible symptoms. Mostly I don’t know what to do and I don’t trust that my doctor has a great idea either of how my poor metabolizing of sertraline is going to affect this whole process of stopping it. I have spent years in therapy learning to understand and manage anxiety and I feel like I could stop SSRIs for good if only I didn’t feel physically ill. In the few moments I am not feeling sick, I don’t feel depressed. It’s the nausea, the vision problems, and waves of exhaustion that are really messing with me. Is there a roadmap for the poor metabolizer?

Hello Im 2 weeks off of Pristiq. My idiot NP decided to switch me from 50 of pristiq to 20 of prozac. Now getting off prozac. Symptoms started about 4 or 5 days in. Intolerable restlessness, irritability, hopelessness, and tremors in face, hands, arms, neck, trunk. Big problem is they r still getting worse at this point. When I was on the 50 I felt at least ok, but I wanted to get off because I thought it was causing the tremors, which have now gotten much worse in withdrawl. Effexor use and withdrawl also cause tremors. Should I get back on the pristiq and let myself stablize hoping the tremors and depressive symptoms go away, and then work down slow?

I am withdrawing from Effexor it was a brutal withdrawal. My dr put me on Prozac 5 mgs for a few weeks and I stopped the effexor I was down to 25 a day. I’m hoping I can stop the Prozac too but feel awful. Can’t sleep kind of queezy physically not myself. Better tho than the withdrawal from Effexor where I had cold, sore throat, dizziness nausea. I was on the Effexor for over 5 years so I guess tapering off is hard.

Moderator note: added link to Gato123's Introduction topic: Gato123: withdrawal from Cymbalta and Prozac; Introduction topic Gosh, I don't even know where to start. The short of it is, you WILL get better if you do not give up. I entered into withdrawal 14 months ago and was absolutely debilitated. Fast forward 14 months and most of my physical symptoms I was presenting are much less intense and the paralyzing anxiety and black depression I sank into are much more manageable. When I was in the middle of withdrawal "hell" I truly didn't know if I believed recovery was possible and it.was.terrifying. No medical professional knew what to do to help (Note: This was if they even recognized the "discontinuation syndrome" (which the very terminology makes me so angry because it's SO misleading but that's for another post) other than recommended I reinstate the drug. I refused. All I kept thinking during this time was, "What is going to happen to me?" "When will this end?" "Will it end?" "What has chronic, long-term exposure done to my body? My brain? My Central Nervous System?" These were constant questions running through my mind for a long time. But I am here today to share my experience with you. No matter how bad you feel in the middle of it, your body IS capable of healing and WILL! I will share my experience in more detail below if you are interested to know more. I am a female in my 30s. I was prescribed Wellbutrin over 17 years ago to help with the side effects of the birth control pill I was taking. In the last 17 years I've been on most of the "common" SSRI/SNRIs/benzodiazepines/sleeping pills including but not limited to: Wellbutrin, Effexor, Lexapro, Paxil, Cymbalta, Prozac, Lorazepam, Alprazolam (Xanax), Ambien, and more. Each one brought new side effects, and in general, made me sick. I felt like I was on a roller coaster and never quite at peace. I am 14 months out and much better than where I was day 1. It is has been the hardest, most trying, exhausting experience of my life but I have survived. And YOU will too!