MisterKarenB: Hot & itchy while on Effexor

[JanCarol]

Hey MisterKarenB - 

 

That's good news about the sun - and interesting, too, given what Hollick says about psoriasis and Vit D.  You know how we Aussies hide from the sun and "slip, slop, slap!" with the shirt, hat, and sunscreen...

 

I've had a weird afterthought.  This is a remedy which my TCM (acupuncture) gave me for burning hemorrhoids (TMI, sorry).

 

Take a cotton ball, and put Mylanta on it, and use the Mylanta topically to "cool" hot spots.  She said it is frequently used for nappy rash in babies.

 

I reckon, you need a highly variable toolkit to get through this, and wonder if this might be a soothing thing!

 

And - really - I hope you see the sun (but not too hot!) today!

[JanCarol]

Oh heck, I just thought of another one.

 

Potato poultice.  Potatoes have Vitamin K in them, and are excellent for skin.

 

Take raw potato, shred it, pack it into a flannel and hold it on the afflicted area for 10 minutes.

 

This is from my massage therapist, who has something like a masters as a Beauty Specialist, and decades of experience.

 

Just another tool.

[MisterKarenB]

Hi Jan - thanks for those last suggestions.  You are right about needing a highly variable toolkit. 

 

I am still struggling with severe skin issues.  Doctor has referred me to a dermatologist who will probably recommend some sort of antihistamine like loratadine, cetirizine, or in worst case scenario, promethazine.  I've read the thread you have here on antihistamines and see that they are generally not recommended, unless things are so severe that the benefits will outweigh the risks.  I may be in that category.

 

The idea is to try to fix the problem from the inside, rather than topically.  There is also the possibility of some sort of light treatment, which I haven't looked into in detail yet. 

 

There has been no improvement since end of Feb, when a series of missed-pills ruined the good work done from a small up-dose  at the start of Dec 2016. 

 

The degree of symptoms haven't been worsening, however the amount of skin affected has increased.  Now very little skin is unaffected.  It is winter, and I sleep with windows open, a fan on, and two frozen hot-water-bottles in my bed.  I am still doing a lot of topical treatments to try to manage things, plus as much time in the sun as I can.

 

I know there's no easy answers here.  Just would like to hear some thoughts on someone in my situation possibly giving antihistamines a try. 

[bubble]

On ‎15‎/‎03‎/‎2017 at 9:25 AM, MisterKarenB said:

So I have another question about reinstatement in general. Further up the thread you'll see discussion about a successful attempt at reinstatement where I took my symptom levels (rated out of 10 for discomfort) from 7 or 8 down to 3. We increased the dose by a third and the response was very rapid but has then stayed at that 3 level ever since.

 

The problem is that the area of my skin that has problems continues to expand. This is complicated by a series of missed pills (followed by a wave each time) but I'm wondering if another reinstatement might offer some important improvements?

 

And to save reading all of the above thread I did spend all of 2016 doing 10% cuts every month when my body wasn't ready for it - I managed to get down to 20% before reinstating but in hindsight it may not  have been the best way - especially as I kept cutting at 10% of the original weight each time.

 

Hello MisterKarenB,

 

I've been reading through your thread trying to understand what went wrong with your taper and the post I quoted above pretty much sums it up.

 

you cut when your body wasn't ready and you cut 10 % of your original dose as opposed to cutting 10 % of your current dose as we advise here precisely to avoid such crashes like you are going through now.

 

As it was also noted by others it's quite difficult for us to follow your taper, especially from your signature because you write about cutting to a certain percentage of the original dose and what we would need is the information about the dose in milligrams like most of us have.

 

If you were on 150 mg Effexor in November 2015 and in December 2016 you were at 20 mg that's by all means a very fast taper and no wonder you got so symptomatic. (It seems that in November you cut even lower and then you updosed to 20 mg).

 

Does it mean that you have been on 20 mg since December 2016?

 

I would've actually suggested further updosing after your initial fast improvement was followed by worsening of symptoms but since you didn't do that 7 months ago I wouldn't do it now.

 

What I definitely wouldn't do is continue decreasing hoping the symptoms will get better. The way I see it the brain is very unhappy with all the reductions and is missing the drug in order to function properly so the last thing it needs is reducing further.

 

7 month hold after such fast taper is not so much... I'm not so sure but if your symptoms continue getting worse with holding I would rather try a small, small updose to test waters.

 

Before anything I would give myself more time to stabilise. Eliminate all possible stress, take time off work if necessary, lavish yourself with self-care and total focus on yourself and your needs for let's say two weeks at least and than reconsider.

[MisterKarenB]

On 14/07/2017 at 3:21 AM, bubble said:

Does it mean that you have been on 20 mg since December 2016?

Yes, that's right. 

 

On 14/07/2017 at 3:21 AM, bubble said:

7 month hold after such fast taper is not so much... I'm not so sure but if your symptoms continue getting worse with holding I would rather try a small, small updose to test waters.

 

I think this is what might be needed.  Last up-dose was from 15 to 20mg, shall I try another 5mg higher? In teh context of originally being on 150mg, it is still a small amount.

[bubble]

Do you have a log of your symptoms: how they change throughout the day especially in relation to when you take the drug? What other symptoms do you have apart from skin issues?

 

Were you doing any better after the missed doses period? If you were, this would be just a wave and it should clear with holding and a more intense self-care.

 

I would warmly recommend a total focus on self-care. Not only less work but no work at all. 

 

I'm reluctant to think about an updose after 6 months but if you decide to test waters with that I wouldn't go for more than 1 mg.

 

It minimises the risk of bad reaction and if there is one, it's easy to drop it. In any case it will give you an answer: you will either get some relief or know that updosing is not the answer.

[MisterKarenB]

2 hours ago, bubble said:

Do you have a log of your symptoms: how they change throughout the day especially in relation to when you take the drug? What other symptoms do you have apart from skin issues?

A few months ago, I would get very mild dizziness just before my evening dose.  But now this is not happening.

 

Apart from that, I get no changes to symptoms through the day.  At night I get muscle spasms, a bit, not major.  A few weeks ago, I started getting akathisia, which I hadn't had for a while.  It preceded this latest wave of worsened skin issues and is still here a little bit. 

 

It is the fact that the skin issues have stayed bad for so long that concerns me the most.  I think this is the most significant issue.  I think the previous up-doses' benefits many have been ruined by the missed doses.  This is why I particularly think an up-dose might be worth it.  If 1mg does nothing, after a proper wait, I could try going higher?    

 

Quote

Were you doing any better after the missed doses period? If you were, this would be just a wave and it should clear with holding and a more intense self-care.

No, things never settled down after I missed those doses.  It has just stayed at a consistently bad level of w/d.

 

I have been doing as much self-care as I can.  The work I do is now completely minimal and does a nice job of distracting me from the w/d.  It isn't stressful - it's fun work.  I am surviving because of the way I am micromanaging all my self-care throughout the day and night.  I rest for large parts of the day.  I eat well and drink water.  I've been doing this for some time now, with no relief.  This is why I am thinking of an up-dose. 

 

It's good to have your input here Bubble - I really appreciate your time and attention. 

Aaron

[bubble]

On ‎18‎/‎04‎/‎2017 at 3:55 PM, JanCarol said:

But wait, there's more!

 

There was a bit of a mod discussion, trying to figure out what was going on with you, and whether or not you should updose - or other suggestions.

 

The conclusion of the mods is that you probably shouldn't updose, that you may be approaching tachyphylaxis.  That's a fancy word for having to keep increasing dose, or "poop out."  That the doses aren't working like they used to.  Updosing may lead to the need for further updosing, and that's a scary prospect.  So nearly all the mods said, "please hold," and "if it were me, I wouldn't updose." 

 

I talked about getting a Vitamin D profile, because the D-Doctor, Michael Holick, uses vitamin D to treat psoriasis.  He recommends topical mega dosing for psoriasis, but it would be a good idea to get a blood profile done before fiddling around with it.  He gives a talk about it, here:  Michael Holick - The D-lightful Vitamin D for Good Health  I can get an inexpensive Vit D oil from iHerb in America, and slather it on my rough spots.  It's very sticky, so there's not much doing while waiting for it to absorb.

 

Have you tried Aloe?  MammaP suggested aloe juice for soothing those itches and healing your skin.  

 

Your lovely wife mentioned some swollen ankles and feet, and BrassMonkey talked about getting your kidneys checked out.  He suggested salt / electrolyte intake (I am fond of pink salt and coconut water for my electrolytes), as well as lots of tomatoes (if you don't react to them) and dandelion root.  If you are concerned about your kidneys, I'm a big fan of Barley Water:  http://survivinganti...311#entry220311    I was told by my acupuncturist to use it to nourish my kidneys when I was having trouble - and - as always lots of good, clean water is good for them, too.

 

How do I know when my kidneys are acting up?  My urine is dark and smelly, my skin is less pliant, my mouth is dry, I need to urinate more often, these are all signs of dehydration.  

 

I hate to mention it but swollen ankles remind me of circulation, cardiovascular, and diabetes type issues, too.  Maybe some Legs Up on the Wall Yoga will help that?  Legs on the wall - switch off your nerves, calm and heal

 

So this is the summary of what moderators were talking about.  The conclusion was - we need to look for something besides an updose, and I'm sorry - but I think it may be quite a challenge to unlock the solution to your symptoms.  I wish I had a magic wand or a spell, that you could click your heels 3 times and say "I will itch no more!"

 

I hope you see the sun today!

 

No problem Aron. My husband is also tapering Effexor so I fully sympathise. (He started from 37.5 mg in 2014 and is now at 8 mg - taking it very, very slow but almost entirely symptom free).

 

We are now totally in the sphere of your guess is as good as mine. I quoted the above post by JC from April to remind you that it was the consensus of the mods at the time not to updose. I wasn't around at the time but I would have a dissenting opinion based on your initial good response to updosing and the fact that had you tapered off the current dose as opposed to the original one you would be on a higher dose now.

 

I'm always for trying to achieve stabilization through holding. And as I said I'm very reluctant about updosing but based on the two observations above not entirely against it.

 

If your other symptoms except the skin are bearable, your sleep is good it seems you are stabilizing after all and the skin issue might be a result of something else (although you seem to have noticed that it definitely correlates with WD). We all have this one organ that is predominantly affected: some get headache, eye problems, ear pain,  a lot of people get GI issues and skin is definitely your 'weak spot'.

We were actually looking at environmental factors and so on.

 

As you can see I'm just thinking out loud to provide more options for your decision making process which is not necessarily making it easier....

 

If you do decide to updose I wouldn't go for more than 1 mg to test waters and yes, you can always updose bearing in mind JC's  post I quoted.

 

As always there are only 3 options: hold, updose or decrease. I wouldn't decrease and about other two options I would prefer holding. Once I held for 9 months and I really believe that holding can help (almost) everyone. In the end, after we discontinue the drug we enter the final hopefully life-long hold.

 

20 mg out of initial 150 in an achievement and I hope it stops interfering with your quality of life soon. 

 

Sorry that I can't help more...

[MisterKarenB]

It is helpful to have you 'thinking aloud' Bubble - it's hard to think clearly in the middle of it all.  I'm going to try up-dosing by 1mg tonight and I'll let you know how it goes.   

[Altostrata]

How are you, MKB?

[nz11]

Mister KB from one kiwi to another can i ask if you and the good wife have done the wdl survey yet.

if not please may i ask you to give it serious consideration.

go well

nz11

[nz11]

Greetings Mister KB i bring you good news i had a word with the survey organisers and told them there were a few kiwis dragging their gumboots and still to make it the internet cafe. Calving season came early this year. Can we have an extension...like a couple of days. They told me okay you got three. We are now in overtime and you got the ball.....

 

 

[MisterKarenB]

We have discovered that Venlafaxine is used to treat skin problems!!! This is a penny-drop moment that explains a lot of what has been happening to me.

I saw a dermatologist last week.  She said my problems had nothing to do with my CNS being messed up, and that the strong correlation between cutting my dose and the increases in skin irritation happened because I was cutting back something that was "treating" my skin.

 

The dermatologist wasn't totally comfortable with me having my own theories, and I still have no explanation as to why Eczema and Erythroderma (as she diagnosed it) has gone rampant while I've tried to get off Venlafaxine, but making this connection is very important. I had eczema as a child, in a minor way, but not when I originally went on the Venlefaxine - so I'm still guessing why it currently covers about 90% of my body. My guess is that Venlafaxine took over from my body the role of controlling eczema, and that I cut back too rapidly for my body to readjust. 

 

Important Question 1: Is this a  valid theory - or are there better explanations?

 

I have been prescribed Predisone and Methotrexate pills, along with a Beta cream.  This is the nuclear option of conventional treatment and will have side effects, however my condition was so serious I felt I had no choice.  The anti-inflammatory component of the pills has improved my quality of life massively over 4 days. I've gone from rating the irritation at about 7 to 3 or lower.  At the moment I am in a state of immense relief :-) :-) :-)

 

Important Question 2: The Dermatologist said to stop taking Venlafaxine altogether (cutting all unnecessary medication is recommended for Erythroderma).  I'm very wary of doing this but on the other hand, I have had zero emotional side effects from withdrawal, so could I start to cut back?

 

Important Question 3: How do I get my body back to not being dependant on medication to treat skin problems? The good news is I probably can start taking supplements again now my skin is no longer super sensitive.  

 

Some context:  1) my skin is very 'expressive'.  2) I've had no changes to the mild psoriasis I had both before and whilst on Venlafaxine.

 

As, always, help is appreciated.

 

 

[Altostrata]

Hmmmm, did your skin problems stop when you started to take venlafaxine? If not, I do not believe the venlafaxine has been treating your skin problems.

 

Rather, it seems more likely to me that reducing venlafaxine caused a chain reaction that erupted where your system is most sensitive, in the autonomic processes that govern skin maintenance. It's where you were most vulnerable.

 

I can't find any evidence that venlafaxine treats skin disorders, except http://www.skintherapyletter.com/2001/6.8/2.html

-- what they're saying is that psychiatric drugs can treat idiopathic skin disorders with a psychiatric cause, or the psychiatric drugs that are antihistamines can act as antihistamines. Venlafaxine is not very antihistaminic.

 

Given the date on this article is 2001, the heyday of promotion by drug companies, the idea that skin disorders can be "treated" by venlafaxine or any antidepressant or psychiatric drug might be attributed to the usual hucksterism. Like any random treatment, it may work from time to time. Given these drugs are all hormonal disruptors, if one disrupts your system in the right way, it could cure whatever ails you.

 

It is possible that the dermatologist's "nuclear option" will stop the chain reaction, like an emergency shot of epinephrine will stop a severe allergic reaction. What is your schedule for predisone, methotrexate, and Beta cream? It may make sense to carefully taper off those, when the time comes. Let us hope your skin system regains its former equilibrium.

 

You're at 20mg venlafaxine now? I would not simply quit it.

 

Please put your current batch of drugs into the Interaction Checker https://www.drugs.com/drug_interactions.html

and copy and paste the results in this topic.

[MisterKarenB]

1 hour ago, Altostrata said:

What is your schedule for predisone, methotrexate, and Beta cream?

Prednisone: 2 x 20mg pills daily for 2 weeks, then 1pill daily for 2 weeks then half a tablet daily for 1week and stop.

Beta Cream (Betamethasone valerate Cr) daily for 2 weeks then reduce to alternate days as directed.

Methotrexate 2 x 10mg once a week on Monday - potentially for months or longer

Folic Acid 1 x 5mg once a week on Friday - to counter some of the side effects of the Methotrexate

 

1 hour ago, Altostrata said:

I can't find any evidence that venlafaxine treats skin disorders

The Dermatologist is an Adjunct Associate Professor as well so perhaps has read widely?  I get what you mean about bold claims by drug companies though.

 

1 hour ago, Altostrata said:

did your skin problems stop when you started to take venlafaxine?

No change at all

 

1 hour ago, Altostrata said:

You're at 20mg venlafaxine now? I would not simply quit it.

Now at 30mg. We tried an up-dose a few weeks ago as a hopeful measure to help cope with our upcoming summer but it had no effect at all. My wife KarenB is wondering if I should just jump back to the lower dosage immediately?

 

Thanks

[Altostrata]

No, don't change the venlafaxine at all. Let the other drugs -- which are quite powerful -- do what they can to stop the chain reaction from your previous Effexor cut.

 

I hope they work well. If I were you, I'd ask the dermatologist if there's an even more gradual way for you to taper off the predisone, methotrexate, and Beta cream. Assuming your nervous system, which includes autonomic processes that regulate skin sensitivity, has been sensitized by Effexor withdrawal,  it may be jolted by too-fast withdrawal of the steroids as well.

 

Don't believe her if she says there is no more gradual way. Prednisone, for example, comes in a wide range of dosages. You don't have to be limited to cutting up 20mg tablets. You should present your own schedule.

 

I have heard plenty of misinformation about psychiatric drugs from university faculty. In my humble, amateur opinion, Effexor didn't have any beneficial effect on your skin condition; going off Effexor upset your nervous system equilibrium. I'm sure she know the functions of the autonomic nervous system in the skin, she simply hasn't bothered to connect the dots because most physicians have an almost religious belief that psychiatric drugs don't cause any harm to the nervous system.

 

 

[MisterKarenB]

Further info about Erythroderma from Dermnetnz.org below: The Dermatologist has discounted the theory that Venlafaxine has much to do with my problems but note the bolded items:

 

"Erythroderma is rare. It can arise at any age and in people of all races. It is about 3 times more common in males than in females. Most have a pre-existing skin disease or a systemic condition known to be associated with erythroderma. About 30% of cases of erythroderma are idiopathic.

 

The most common skin conditions to cause erythroderma are:

• Drug eruption — with numerous diverse drugs implicated (list of drugs)
• Dermatitis especially atopic dermatitis This is the one they say I have
• Psoriasis, especially after withdrawal of systemic steroids or other treatment
• Pityriasis rubra pilaris"

I also now have a letter from the Dermatologist that says Venlafaxine has been used to treat Prurits - which is a medical term for itchy skin.  Dermnetnz says: " Pruritus is often a symptom of an underlying disease process such as a skin problem, a systemic disease, or abnormal nerve impulses. "  and  " There are no specific skin signs associated with pruritus, apart from scratch marks "

 

This describes the condition I had while on Venlafaxine before starting withdrawal - which would make it a cause, not a cure but there you have it.

 

[ChessieCat]

2 hours ago, MisterKarenB said:

This describes the condition I had while on Venlafaxine before starting withdrawal - which would make it a cause, not a cure but there you have it.

 

Do you think they might be pulling the wool over your eyes?  Sorry, couldn't resist the New Zealand and sheep relationship!

[MisterKarenB]

50 minutes ago, ChessieCat said:

Do you think they might be pulling the wool over your eyes?  Sorry, couldn't resist the New Zealand and sheep relationship!

 

ah yes, always with the sheep jokes :-)

 

They can be used on Australians too btw.

[ChessieCat]

 

An update on MisterKarenB from his wife KarenB:

 

18 minutes ago, KarenB said:

 

Aaron is doing reasonably well. Still has the hot/itchy skin if he's not careful to keep cool, but he is actually on steroids to control that:-(  He is able to decrease faster than I can though. He is now at a wee way past 2/3 of the way off.