zeromg: Effexor / venlafaxine withdrawal - panic

[zeromg]

Last year, I made three unsuccessful attempts at getting completely off of Effexor. The longest I lasted was two months and they were two of the worst months of my life. With the help of Prozac, I was able to decrease from 225 mg of Effexor to 75 mg and had no withdrawal symptoms. However, going from 75 mg to 0 mg of Effexor gave me terrible withdrawal. The Prozac virtually eliminated the physical symptoms but,  the problem I have with the withdrawal is the panic. It’s a kind of panic that I never experienced before I took Effexor. It feels almost like there are evil forces at play and there is something terribly wrong with my soul. I know that doesn’t sound rational but I can’t get rid of the terror that comes with it. It’s agony. I’m wondering if anyone else has felt this way.

[scallywag]

zeromg - Welcome to SA!  You've come to a good place to get support and answers to your questions.

 

The panic you're feeling is very probably (like almost certainly) a symptom of withdrawal. 

 

I was on Effexor twice - 1997-99 2 x 37.5 mg daily (the immediate release tablets), and 2002-2004 (?) 1 x 37.5 mg XR. I didn't have panic but had inexplicable, intense crying jags for weeks. Effexor XR or not is one of the harder drugs to discontinue.  Have you read the Tips on tapering off Effexor?

 

Surviving Antidepressants takes conservative approach and recommends a slow discontinuation of psych drugs: Why taper by 10% of my dosage?

 

How did you go from 75 mg to 0 and how long did it take?  It looks as if you either did a Prozac switch/bridge or added it at some point.  Are you still taking the Prozac?  If not, what was the starting dose and how did you get to 0? 

 

One of the moderators will likely move this discussion to an introduction thread where it's more efficient for them to follow your situation and where more people will see your questions.  Introductions and updates forum

[SquirrellyGirl]

Thank you for helping zeromg get started here on SA!

 

Yes, I am moving your post to create an Intro for you, zeromg.  Please fill out your signature block with your drug history, including any other meds you take, Rx or OTC, and recreational.  Instructions are here:  Please put your Withdrawal History in Signature

 

SG

[SquirrellyGirl]

I had that feeling of panic/doom you speak of while in protracted withdrawal, zeromg, and had never experienced it before in my life, before or during psych meds.  It is very common for withdrawal to include Neuro Emotions

 

scallyway posed excellent questions.  What are you currently taking?

 

It sounds like your doctor attempted a Prozac bridge, but didn't do it properly.  My understanding of the PB is that once Prozac is started, the Effexor should rapidly be tapered  to 0. 

 

From this topic: The Prozac switch or "bridging" with Prozac

 

• Do not stay on the combination of the first antidepressant and Prozac for more than 2 weeks, or you run the risk of your nervous system accommodating to the combination and having difficulty tapering off both antidepressants.

So, let us know:

 

1) When did you start Prozac and at what dose?

2) What was the taper schedule between 225 and 0?

3) What were the withdrawal symptoms experienced between 75 and 0 mg Effexor?

4) How long have you been off Effexor, or did you go back on?

 

Are you taking any supplements?  The main two that we DO recommend are Magnesium and Omega-3 Fish Oil

 

The main thing is to realize that these feelings you are experiencing are caused by the chemical imbalance caused by dropping Effexor.  It is a sign that your nervous system is grappling with the imbalance.  This topic covers a lot of techniques to help you during this time:

 

Non-drug techniques to cope with emotional symptoms

 

I love this video for explaining the healing process:  Video:  Healing From Antidepressants - Patterns of Recovery

 

One of our mods Rhiannon wrote this excellent piece on what is happening in the brain:  Brain Remodelling (Rhi's Description of Brain Healing)

 

So, if you could fill out your sig block and answer the questions, we can get a clearer picture.  Please come back with questions!

 

SG

[zeromg]

Wow, thanks for all the info. And thanks for getting back to me so fast. Answering your questions:

 

1) When did you start Prozac and at what dose? - May 2015 at 10mg/day

2) What was the taper schedule between 225 and 0? I was supposed go from 225mg to 150mg for 3 days then 75mg for a week. Instead I took 150mg for 1 day and 75mg for 1 day then 0mg.That was my first attempt last year

3) What were the withdrawal symptoms experienced between 75 and 0 mg Effexor? thanks to the Prozac, the physical symptoms were minimal. I only had mild brain zaps a few times per week and felt "out of it" but I could still function. It's the panic that gets me.

4) How long have you been off Effexor, or did you go back on? I've been on Effexor for about 15 years (minus the times I tried to quit). Last night was the first night that I took a 37.5 mg capsule instead of 75 mg. If I'm going to feel withdrawal symptoms, my experiences tell me that I won't start feeling them for a few days. However, I've developed such a fear of that panic feeling that I'm having minor anxiety attacks from worrying about feeling that way. Fortunately, with this type of anxiety, I can use my CBT and other skills to overcome it. Still sucks though.

Are you taking any supplements? no

Thanks

[SquirrellyGirl]

Ok, so the Prozac was on board for all the attempts?  If so, it has lost it's ability work as a bridge, so if you want to be med free you will need to taper both of them.   

 

How is your sleep?  What time do you take each drug?

 

I'm going to ask Altostrata to get involved since she has a better understanding of relative amounts of each drug, Prozac and Ven.  Did your doctor tell you to do this drop in Effexor and increase in Prozac?  I believe that 40 mg Prozac is a rather large dose.

 

What is your symptom pattern (before making this change last night)?  When does the panic rise up?

 

SG

[zeromg]

Before the Prozac, I would start feeling withdrawal symptoms (including panic and physical symptoms) within hours of missing a dose. With the Prozac, it took 3 days for the panic to start but, like I said, the physical symptoms were taken care of. I plan on tapering the Prozac after I get off the Effexor.

 

My sleep is fine. There are some symptoms that I take care of with something else but, on other forums, when I mention it, my comment gets deleted. Let's just say, it helps me sleep and eat.

 

I take all of my meds at night (Prozac, lamotrogine, risperidone, and Effexor).

 

Yes, my doctor suggested that I take 20mg Prozac each night for three nights, then on the fourth night take 40mg then, continue in that manner.

 

The panic starts a few days after I stop the Effexor, it is worse in the morning, and it comes in waves.

 

I really appreciate all the time you've taken to help me out.

[Altostrata]

Welcome, zeromg.

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html
and copy and paste the results in this topic.
 

Have you been having these panic feelings while you've been on Prozac plus 75mg Effexor? When were lamotrogine and risperidone added, and what for?

 

Why did you increase to 40mg Prozac? That is a largish dose.

 

Please keep daily notes on paper about your symptoms, time you take your drugs, and their dosages.

[SquirrellyGirl]

Before the Prozac, I would start feeling withdrawal symptoms (including panic and physical symptoms) within hours of missing a dose. With the Prozac, it took 3 days for the panic to start but, like I said, the physical symptoms were taken care of. I plan on tapering the Prozac after I get off the Effexor.

 

My sleep is fine. There are some symptoms that I take care of with something else but, on other forums, when I mention it, my comment gets deleted. Let's just say, it helps me sleep and eat.

 

 

SA is not like the other forum, zeromg, and it is very important to us that we know everything you are ingesting that could be impacting your situation.  We are not here to judge but to help.

 

As Alto requested, please put all the drugs you take into this drug interaction checker.  This will help us identify if there are any that are adding to the problem, and what the next best step might be.

 

SG

[zeromg]

When I take 75 mg Effexor and the Prozac, I do not suffer from this particular type of panic. I suffer from terrible anxiety (and a few panic attacks) while I'm on my meds but it's nothing compared to this panic I get from withdrawing. It's a feeling I never experienced before taking Effexor. Lamotrogine was added maybe ten years ago for depression but it only helped a little. Then, a few years ago, I went into another depressive episode and was prescribed risperidone, which drastically changed my life for the better. Eventually, I'd like to get rid of all my meds except the cannabis and risperidone. Those are the only two that have improved my mental state. My psychiatrist told me to take 40mg Prozac every fourth night.

I will be sure to keep the data you suggested. Here's my drug list:

Drug Interaction Report

Drug interactions for the following 6 drug(s):

Unsaved Drug List Email | Print | Save | New list cannabis

The interactions information for this drug may not be up to date. More...

Effexor XR (venlafaxine) Lamictal (lamotrigine) Norinyl 1+35 (ethinyl estradiol / norethindrone) Prozac (fluoxetine) Risperdal (risperidone)

• Consumer
• Professional
• Major Moderate Minor Food Therapeutic Duplication

Interactions between your selected drugs

Major fluoxetine venlafaxine

Applies to: Prozac (fluoxetine), Effexor XR (venlafaxine)

Using FLUoxetine together with venlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate fluoxetine risperidone

Applies to: Prozac (fluoxetine), Risperdal (risperidone)

FLUoxetine may increase the blood levels and effects of risperiDONE. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience increased side effects. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate venlafaxine cannabis

Applies to: Effexor XR (venlafaxine), cannabis

Using venlafaxine together with cannabis (Schedule I substance) may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate risperidone cannabis

Applies to: Risperdal (risperidone), cannabis

Using risperiDONE together with cannabis (Schedule I substance) may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate fluoxetine cannabis

Applies to: Prozac (fluoxetine), cannabis

Using FLUoxetine together with cannabis (Schedule I substance) may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate venlafaxine lamotrigine

Applies to: Effexor XR (venlafaxine), Lamictal (lamotrigine)

Using venlafaxine together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate risperidone lamotrigine

Applies to: Risperdal (risperidone), Lamictal (lamotrigine)

Using risperiDONE together with lamoTRIgine can increase your blood levels of risperiDONE. This can cause side effects such as excessive drowsiness, dizziness, increase in heart rate, seizures, and tremors. Talk with your doctor before using these medications together, and report any side effects promptly. You may need a dose adjustment or special tests to safely take both medications. Avoid driving until you know how these medications will affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate norethindrone lamotrigine

Applies to: Norinyl 1+35 (ethinyl estradiol / norethindrone), Lamictal (lamotrigine)

Talk to your doctor before using lamoTRIgine together with norethindrone. Combining these medications may reduce the blood levels and effects of lamoTRIgine. You may need a dose adjustment if you have been taking lamoTRIgine and are starting treatment with norethindrone. Similarly, if norethindrone is discontinued, your dosage of lamoTRIgine may need to be readjusted. Contact your doctor if your condition changes or you experience loss of seizure control during treatment with these medications. When norethindrone is stopped or interrupted briefly, be alert to potentially increased side effects of lamoTRIgine such as dizziness, drowsiness, nausea, vomiting, diarrhea, blurred vision, incoordination, tremor, restlessness, irritability, depression, anxiety, and mood or behavior changes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate fluoxetine lamotrigine

Applies to: Prozac (fluoxetine), Lamictal (lamotrigine)

Using FLUoxetine together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate ethinyl estradiol lamotrigine

Applies to: Norinyl 1+35 (ethinyl estradiol / norethindrone), Lamictal (lamotrigine)

Talk to your doctor before using lamoTRIgine together with ethinyl estradiol. Combining these medications may reduce the blood levels and effects of lamoTRIgine. You may need a dose adjustment if you have been taking lamoTRIgine and are starting treatment with ethinyl estradiol. Similarly, if ethinyl estradiol is discontinued, your dosage of lamoTRIgine may need to be readjusted. Contact your doctor if your condition changes or you experience loss of seizure control during treatment with these medications. When ethinyl estradiol is stopped or interrupted briefly, be alert to potentially increased side effects of lamoTRIgine such as dizziness, drowsiness, nausea, vomiting, diarrhea, blurred vision, incoordination, tremor, restlessness, irritability, depression, anxiety, and mood or behavior changes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate risperidone venlafaxine

Applies to: Risperdal (risperidone), Effexor XR (venlafaxine)

Using risperiDONE together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate lamotrigine cannabis

Applies to: Lamictal (lamotrigine), cannabis

Using lamoTRIgine together with cannabis (Schedule I substance) may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs and diseases that your selected drugs interact with

• cannabis interacts with more than 200 other drugs.
• Effexor XR (venlafaxine) interacts with more than 500 other drugs and more than 10 diseases.
• Lamictal (lamotrigine) interacts with more than 200 other drugs and 7 diseases.
• Norinyl 1+35 (ethinyl estradiol / norethindrone) interacts with more than 500 other drugs and more than 10 diseases.
• Prozac (fluoxetine) interacts with more than 500 other drugs and more than 10 diseases.
• Risperdal (risperidone) interacts with more than 500 other drugs and more than 20 diseases.

Interactions between your selected drugs and food

Moderate fluoxetine food

Applies to: Prozac (fluoxetine)

Alcohol can increase the nervous system side effects of FLUoxetine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with FLUoxetine. Do not use more than the recommended dose of FLUoxetine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate risperidone food

Applies to: Risperdal (risperidone)

RisperiDONE oral solution should not be mixed with tea or cola. It may be taken with water, coffee, orange juice, or low-fat milk. You should avoid the use of alcohol while being treated with risperiDONE. Alcohol can increase the nervous system side effects of risperiDONE such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate venlafaxine food

Applies to: Effexor XR (venlafaxine)

Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with venlafaxine. Do not use more than the recommended dose of venlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate lamotrigine food

Applies to: Lamictal (lamotrigine)

Alcohol can increase the nervous system side effects of lamoTRIgine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with lamoTRIgine. Do not use more than the recommended dose of lamoTRIgine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate cannabis food

Applies to: cannabis

Alcohol can increase the nervous system side effects of cannabis (Schedule I substance) such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with cannabis (Schedule I substance). Do not use more than the recommended dose of cannabis (Schedule I substance), and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Minor ethinyl estradiol food

Applies to: Norinyl 1+35 (ethinyl estradiol / norethindrone)

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

 

For clinical details see professional interaction data.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication CNS drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'CNS drugs' category to be taken concurrently is usually three. Your list includes five medicines belonging to the 'CNS drugs' category:

• cannabis
• venlafaxine (active ingredient in Effexor XR (venlafaxine))
• lamotrigine (active ingredient in Lamictal (lamotrigine))
• fluoxetine (active ingredient in Prozac (fluoxetine))
• risperidone (active ingredient in Risperdal (risperidone))

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

• venlafaxine (active ingredient in Effexor XR (venlafaxine))
• fluoxetine (active ingredient in Prozac (fluoxetine))

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

[Altostrata]

What is this supposed to do for you: "take 40mg Prozac every fourth night"?

 

That is a very unusual instruction from a psychiatrist. I don't believe I've ever seen it before.

 

(If I were you, I wouldn't do it, if your goal is to take less rather than more drugs.)

 

Do you get these anxiety feelings at any particular time of day? I'm looking for your daily symptom pattern relative to your drug schedule.

[zeromg]

thanks, SquirrellyGirl, I'm glad I can be open about my full medical history and it's nice not to be judged

 

[zeromg]

What is this supposed to do for you: "take 40mg Prozac every fourth night"?

 

That is a very unusual instruction from a psychiatrist. I don't believe I've ever seen it before.

 

(If I were you, I wouldn't do it, if your goal is to take less rather than more drugs.)

 

Do you get these anxiety feelings at any particular time of day? I'm looking for your daily symptom pattern relative to your drug schedule.

He said it has to do with Prozac's half-life. He's trying to give me the best chance of not suffering withdrawal without prescribing too much more medication. I'll try to skip the extra 20mg on the fourth nights. I'm stuck between being terrified of going into withdrawal and wanting to get this poison out of my system as quickly as possible.

Then panic comes in about 20 waves per day, throughout the day. They seem to be more intense in the morning. I take all my pills at night but I do have my share of coffee and energy shots in the morning. My psychiatrist urges me to give these up.

[Altostrata]

Good idea to taper off the coffee and energy shots. They can indeed cause waves of panic, also insomnia.
 
If I were you, I would not boost the Prozac. To minimize withdrawal symptoms, we advocate a very gradual reduction, which most psychiatrists don't know about. Please read
 
Why taper by 10% of my dosage?
 
Tips for tapering off Effexor (venlafaxine)
 
This shows why you have trouble reducing below 75mg:
Why taper? Paper demonstrates importance of gradual change in plasma concentration
 
Why do you take all your drugs at night? Why was the risperidone added? Did it do anything helpful?

[zeromg]

Good idea to taper off the coffee and energy shots. They can indeed cause waves of panic, also insomnia.

 

If I were you, I would not boost the Prozac. To minimize withdrawal symptoms, we advocate a very gradual reduction, which most psychiatrists don't know about. Please read

 

Why taper by 10% of my dosage?

 

Tips for tapering off Effexor (venlafaxine)

 

This shows why you have trouble reducing below 75mg:

Why taper? Paper demonstrates importance of gradual change in plasma concentration

 

Why do you take all your drugs at night? Why was the risperidone added? Did it do anything helpful

Okay, I'll skip the Prozac boost. The energy shots and coffee are going to be a little harder because I tend to be tired a lot.

I take them at night because one or all of them make me tired.

[zeromg]

The risperidone was added when I was going through another depressive episode. It's the only drug that has actually made a noticeable difference in my mood.

[zeromg]

zeromg - Welcome to SA!  You've come to a good place to get support and answers to your questions.

 

The panic you're feeling is very probably (like almost certainly) a symptom of withdrawal. 

 

I was on Effexor twice - 1997-99 2 x 37.5 mg daily (the immediate release tablets), and 2002-2004 (?) 1 x 37.5 mg XR. I didn't have panic but had inexplicable, intense crying jags for weeks. Effexor XR or not is one of the harder drugs to discontinue.  Have you read the Tips on tapering off Effexor?

 

Surviving Antidepressants takes conservative approach and recommends a slow discontinuation of psych drugs: Why taper by 10% of my dosage?

 

How did you go from 75 mg to 0 and how long did it take?  It looks as if you either did a Prozac switch/bridge or added it at some point.  Are you still taking the Prozac?  If not, what was the starting dose and how did you get to 0? 

 

One of the moderators will likely move this discussion to an introduction thread where it's more efficient for them to follow your situation and where more people will see your questions.  Introductions and updates forum

Hi Scallywag,

 

I somehow missed your message at first, thanks for your reply. As of a few days ago, I'm taking 20 mg Prozac and 37.5 mg Effexor and I am only having very minor brain zaps occasionally. Also, a little nausea, for which I use cannabis (i also take lamotrigine and risperidone). Do you think my next step should be to start the 10% per month taper off of the Effexor or to get off of the Prozac? Thanks

[mammaP]

Hi Zeromg,  when did you go from 75 to 37.5 effexor and 30 to 20 prozac? Your sig says 'last night' but no date! 

 

As Alto said that extra prozac is going to be problematic, doses need to be consistent.

[zeromg]

Hi Zeromg,  when did you go from 75 to 37.5 effexor and 30 to 20 prozac? Your sig says 'last night' but no date! 

 

As Alto said that extra prozac is going to be problematic, doses need to be consistent.

Hi mammP,

 

Oops, thanks for the heads up. I'll fix that in a minute. As far as the extra doses, I've decided to do as recommended and stay with the consistent 20mg Prozac each night with no extra boosts. Last night would have been time for another boost and I skipped it. So far, so good.

[mammaP]

Thank you, can you put the actual date in there for us? Days really make a difference with these drugs! 

 

You have changed such a lot and need to be stable, if you are going to stick with the 37.5 effexor and 20mg of prozac you need to stay at those doses for a few months to allow your brain and nervous system to work on rebalancing.  They were big cuts and you could find yourself with withdrawal symptoms. Are you counting beads for effexor, or do you have 37.5 tablets? 

[zeromg]

Thank you, can you put the actual date in there for us? Days really make a difference with these drugs! 

 

You have changed such a lot and need to be stable, if you are going to stick with the 37.5 effexor and 20mg of prozac you need to stay at those doses for a few months to allow your brain and nervous system to work on rebalancing.  They were big cuts and you could find yourself with withdrawal symptoms. Are you counting beads for effexor, or do you have 37.5 tablets? 

Sorry I keep leaving out details. I don't always know which information is important. Up until I met my most recent psychiatrist (about 1 1/2 years ago), I was very passive in my treatment (much to my detriment).

 

A few months, huh? I was hoping to start the 10% taper over the summer, as I am off from school. But, I will do whatever I need to do to avoid feeling that panic. I have 37.5 mg capsules. I've read that changing from capsules to tablets can cause withdrawal.

[JanCarol]

Hey Zero - 

 

In the Tips for tapering off Effexor (venlafaxine) thread, there is a discussion about the best way to taper Effexor capsules.  The capsules are actually easier to taper from.   We call Effexor people "bead counters" - and there are techniques for counting beads to make it easier to taper. 

 

The reason you have had panic, is you've gone too fast.  

 

Your drugs all interact in a very entangled way.  There's not a drug you are taking that has fewer interactions than the others.  If it were me, I'd wait and stabilize on effexor, prozac, lamotrigine, risperdal.  

 

If you can, refrain from the cannabis - it is only complicating things.  You can read more about cannabis and withdrawal here:  http://survivingantidepressants.org/index.php?/topic/5030-cannabis-thc-or-marijuana-to-ease-withdrawal-symptoms/.  If you cannot refrain, try to get medical grade.  Please look for higher CBD content, and lower the THC levels in your preparations.  This is safer, and  more effective for side effects.  There have been many who have been sent to hospital from "too strong" cannabis - it's easy to have an accident with it, and end up sicker.  A very few number of people have gotten help from careful selection of useful strains.  Please read what others have said, and weigh your choices carefully.  Fortunately, it is the one thing you are taking which does not need to be tapered.  

 

Please study this topic:  Polydrugs? Taper off the Antidepressant First!

 

Once you have stabilized, it would be easiest to start counting beads and come off the effexor v-e-r-y slowly.  If you do this well, it shouldn't interfere with school and life.  The goal is to taper sooooo s-l-o-w-l-y that you trick your brain, and you sneak the drug away with as few symptoms as possible. 

 

If you are having symptoms - you are going too fast.  It's better to slow down, take longer, and succeed, than it is to hurry off and end up worse off than before.

 

Please let us know how you are going - have you been taking the same doses at the same times daily?  When you have done that for awhile, and feel more stable, you can consider tapering the Effexor.

 

I hope you see the sun today!

[zeromg]

Hey Zero - 

 

In the Tips for tapering off Effexor (venlafaxine) thread, there is a discussion about the best way to taper Effexor capsules.  The capsules are actually easier to taper from.   We call Effexor people "bead counters" - and there are techniques for counting beads to make it easier to taper. 

 

The reason you have had panic, is you've gone too fast.  

 

Your drugs all interact in a very entangled way.  There's not a drug you are taking that has fewer interactions than the others.  If it were me, I'd wait and stabilize on effexor, prozac, lamotrigine, risperdal.  

 

If you can, refrain from the cannabis - it is only complicating things.  You can read more about cannabis and withdrawal here:  http://survivingantidepressants.org/index.php?/topic/5030-cannabis-thc-or-marijuana-to-ease-withdrawal-symptoms/.  If you cannot refrain, try to get medical grade.  Please look for higher CBD content, and lower the THC levels in your preparations.  This is safer, and  more effective for side effects.  There have been many who have been sent to hospital from "too strong" cannabis - it's easy to have an accident with it, and end up sicker.  A very few number of people have gotten help from careful selection of useful strains.  Please read what others have said, and weigh your choices carefully.  Fortunately, it is the one thing you are taking which does not need to be tapered.  

 

Please study this topic:  Polydrugs? Taper off the Antidepressant First!

 

Once you have stabilized, it would be easiest to start counting beads and come off the effexor v-e-r-y slowly.  If you do this well, it shouldn't interfere with school and life.  The goal is to taper sooooo s-l-o-w-l-y that you trick your brain, and you sneak the drug away with as few symptoms as possible. 

 

If you are having symptoms - you are going too fast.  It's better to slow down, take longer, and succeed, than it is to hurry off and end up worse off than before.

 

Please let us know how you are going - have you been taking the same doses at the same times daily?  When you have done that for awhile, and feel more stable, you can consider tapering the Effexor.

 

I hope you see the sun today!

Hi Jan,

 

Thanks for the information. I purchased a scale and read through the instructions on this website on how to measure the beads. I've been taking the same doses of my meds every day since May 29,2016 (4 days) and I have not felt unstable since my decrease from 75 to 37.5 five days ago. Do you think if I keep feeling okay, I can start the 10% taper in a couple of months?

 

I could be wrong but I feel like things will be much better for me if I don't quit cannabis too. It does good things for me and it doesn't hurt me in anyway. One day, I want to be completely free of any unnecessary chemicals but, for right now, I feel it is helping. I also have stomach problems that are taken care of by my smoking so it would just be added stress.

 

I did see the sun today, thank you I've been walking all week to lower my stress levels. Congrats on being psych drug free!

[SquirrellyGirl]

That's fine, zero.  I wanted to add some tips about the scale.  Did you get the Gemini20 scale?

 

I'm a bead counter who weighs, too.  I have found the Gemini to be finicky.  So, here's what I have come up with from experience:

 

Calibrate at the beginning of each weigh sesison.

 

000.0 doesn't necessarily mean 0.000!  You can tare the scale and it will read 0.000 no matter what, but weigh the same batch of beads on three different occasions and you will get three different answers! It is best to tare the scale and then put one of the 10 g weights on the scale; does it read 10.000?  If not, calibrate.  

 

When it does read 10.000g, leave it on the pan as you weigh the beads.  This keeps the scale in the middle weight range where it seems to be more accurate.  For instance, you are more likely to get an accurate weight at 10.065 than at 0.065 g.

 

Weigh your sample a couple of times to be sure the read is the same each time before accepting it.  These scales tend to drift.

 

Calibrate during your weigh session if things seem to be too drifty.

 

Weigh out a batch of a couple of weeks' doses in one weigh session for consistency.  Use empty gel caps (available from Amazon).

 

Finally, the danged weigh pan itself doesn't sit readily in it's spot and that can cause different reads. I have nudged it when the 10g weight didn't weigh true, and been able to settle the pan such that the weight DOES weigh 0.000.  Really bad design!

 

It takes forever to get through two weeks' worth of doses, but I've suffered the results of trusting the scale was reading true when it always fell to 0.000, so lesson learned!

 

SG

[zeromg]

That's fine, zero.  I wanted to add some tips about the scale.  Did you get the Gemini20 scale?

 

I'm a bead counter who weighs, too.  I have found the Gemini to be finicky.  So, here's what I have come up with from experience:

 

Calibrate at the beginning of each weigh sesison.

 

000.0 doesn't necessarily mean 0.000!  You can tare the scale and it will read 0.000 no matter what, but weigh the same batch of beads on three different occasions and you will get three different answers! It is best to tare the scale and then put one of the 10 g weights on the scale; does it read 10.000?  If not, calibrate.  

 

When it does read 10.000g, leave it on the pan as you weigh the beads.  This keeps the scale in the middle weight range where it seems to be more accurate.  For instance, you are more likely to get an accurate weight at 10.065 than at 0.065 g.

 

Weigh your sample a couple of times to be sure the read is the same each time before accepting it.  These scales tend to drift.

 

Calibrate during your weigh session if things seem to be too drifty.

 

Weigh out a batch of a couple of weeks' doses in one weigh session for consistency.  Use empty gel caps (available from Amazon).

 

Finally, the danged weigh pan itself doesn't sit readily in it's spot and that can cause different reads. I have nudged it when the 10g weight didn't weigh true, and been able to settle the pan such that the weight DOES weigh 0.000.  Really bad design!

 

It takes forever to get through two weeks' worth of doses, but I've suffered the results of trusting the scale was reading true when it always fell to 0.000, so lesson learned!

 

SG

Hi SG,

 

Thanks for the tips. I got a different brand of scale, hopefully it works okay. I'm a veteran and I get seen at the VA so I'm  going to ask my psychiatrist if the VA pharmacy will do the doses for me. I read somewhere that some pharmacies provide that service. If not, I'm going to see how much it costs to have it done at a civilian pharmacy. I'm going to do it myself as a last resort because I'm worried about messing up and also my hands are very shaky.

 

On the Excel spreadsheet for measuring out doses, I notice that the dose changes go by tenths of a milligram. Is that what is recommended? That would take over three years. Does that sound right?

 

Z

[SquirrellyGirl]

 

That's fine, zero.  I wanted to add some tips about the scale.  Did you get the Gemini20 scale?

 

I'm a bead counter who weighs, too.  I have found the Gemini to be finicky.  So, here's what I have come up with from experience:

 

Calibrate at the beginning of each weigh sesison.

 

000.0 doesn't necessarily mean 0.000!  You can tare the scale and it will read 0.000 no matter what, but weigh the same batch of beads on three different occasions and you will get three different answers! It is best to tare the scale and then put one of the 10 g weights on the scale; does it read 10.000?  If not, calibrate.  

 

When it does read 10.000g, leave it on the pan as you weigh the beads.  This keeps the scale in the middle weight range where it seems to be more accurate.  For instance, you are more likely to get an accurate weight at 10.065 than at 0.065 g.

 

Weigh your sample a couple of times to be sure the read is the same each time before accepting it.  These scales tend to drift.

 

Calibrate during your weigh session if things seem to be too drifty.

 

Weigh out a batch of a couple of weeks' doses in one weigh session for consistency.  Use empty gel caps (available from Amazon).

 

Finally, the danged weigh pan itself doesn't sit readily in it's spot and that can cause different reads. I have nudged it when the 10g weight didn't weigh true, and been able to settle the pan such that the weight DOES weigh 0.000.  Really bad design!

 

It takes forever to get through two weeks' worth of doses, but I've suffered the results of trusting the scale was reading true when it always fell to 0.000, so lesson learned!

 

SG

Hi SG,

 

Thanks for the tips. I got a different brand of scale, hopefully it works okay. I'm a veteran and I get seen at the VA so I'm  going to ask my psychiatrist if the VA pharmacy will do the doses for me. I read somewhere that some pharmacies provide that service. If not, I'm going to see how much it costs to have it done at a civilian pharmacy. I'm going to do it myself as a last resort because I'm worried about messing up and also my hands are very shaky.

 

On the Excel spreadsheet for measuring out doses, I notice that the dose changes go by tenths of a milligram. Is that what is recommended? That would take over three years. Does that sound right?

 

Z

 

 

My hands don't work so well at times when measuring my doses - I fumble a lot, just another sign of what these drugs are doing to me.  Good idea to have the pharmacy do it for you.  That will also help you step away from the obsession with tapering...

 

As for the spreadsheet, yes, sometimes it does take that long to taper, unfortunately, but the alternative isn't any better.  It's a matter of tapering off slowly like that and having the healing happen while you are doing so, hopefully keeping you comfortable and functional throughout, vs go faster and risk protracted withdrawal syndrome for the same three years, or some combo of the two if you taper too fast.  Having been in protracted withdrawal syndrome for months, myself, I'll choose the former any day!

 

You might find that once you are stable, you can tolerate doing the cuts every three weeks, speeding things up for awhile.  

 

I am tapering Effexor and have micro-dosed my way down to 24.5 mg over the last 11 months while focusing on my mirtazapine taper.  I was looking at the occupancy graphs from Why taper?  For Effexor, it looks to me like it will be very important to take it nice and slow from 20 mg and below, because that curve drops off really steep from that point on.  My point being, you may be able to get to that point cutting every three weeks.

 

However, I will say this after that:  everyone is different and you may be too sensitized at this point to go that fast.  The beginning of your taper should be every four weeks so you can get a sense of how you do with it.  If you are nice and stable and don't feel much in the way of symptoms, then you could try the three week plan and see how it feels.  REALLY LISTEN TO YOUR BODY!  And when people  do manage the three week plan, they really need to hold an extra month here and there to be sure their nervous system isn't falling behind.

 

I think the trick for us is to try to get on with living life and not focus so much on the taper day to day; knowing that as we get lower and lower, we are operating more and more with our native nervous system coming back online, and that less and less drug is better than staying on these meds for life.  It's all relative.  That helps me keep my antsy-ness in check.

 

SG

[zeromg]

 

 

That's fine, zero.  I wanted to add some tips about the scale.  Did you get the Gemini20 scale?

 

I'm a bead counter who weighs, too.  I have found the Gemini to be finicky.  So, here's what I have come up with from experience:

 

Calibrate at the beginning of each weigh sesison.

 

000.0 doesn't necessarily mean 0.000!  You can tare the scale and it will read 0.000 no matter what, but weigh the same batch of beads on three different occasions and you will get three different answers! It is best to tare the scale and then put one of the 10 g weights on the scale; does it read 10.000?  If not, calibrate.  

 

When it does read 10.000g, leave it on the pan as you weigh the beads.  This keeps the scale in the middle weight range where it seems to be more accurate.  For instance, you are more likely to get an accurate weight at 10.065 than at 0.065 g.

 

Weigh your sample a couple of times to be sure the read is the same each time before accepting it.  These scales tend to drift.

 

Calibrate during your weigh session if things seem to be too drifty.

 

Weigh out a batch of a couple of weeks' doses in one weigh session for consistency.  Use empty gel caps (available from Amazon).

 

Finally, the danged weigh pan itself doesn't sit readily in it's spot and that can cause different reads. I have nudged it when the 10g weight didn't weigh true, and been able to settle the pan such that the weight DOES weigh 0.000.  Really bad design!

 

It takes forever to get through two weeks' worth of doses, but I've suffered the results of trusting the scale was reading true when it always fell to 0.000, so lesson learned!

 

SG

Hi SG,

 

Thanks for the tips. I got a different brand of scale, hopefully it works okay. I'm a veteran and I get seen at the VA so I'm  going to ask my psychiatrist if the VA pharmacy will do the doses for me. I read somewhere that some pharmacies provide that service. If not, I'm going to see how much it costs to have it done at a civilian pharmacy. I'm going to do it myself as a last resort because I'm worried about messing up and also my hands are very shaky.

 

On the Excel spreadsheet for measuring out doses, I notice that the dose changes go by tenths of a milligram. Is that what is recommended? That would take over three years. Does that sound right?

 

Z

 

 

My hands don't work so well at times when measuring my doses - I fumble a lot, just another sign of what these drugs are doing to me.  Good idea to have the pharmacy do it for you.  That will also help you step away from the obsession with tapering...

 

As for the spreadsheet, yes, sometimes it does take that long to taper, unfortunately, but the alternative isn't any better.  It's a matter of tapering off slowly like that and having the healing happen while you are doing so, hopefully keeping you comfortable and functional throughout, vs go faster and risk protracted withdrawal syndrome for the same three years, or some combo of the two if you taper too fast.  Having been in protracted withdrawal syndrome for months, myself, I'll choose the former any day!

 

You might find that once you are stable, you can tolerate doing the cuts every three weeks, speeding things up for awhile.  

 

I am tapering Effexor and have micro-dosed my way down to 24.5 mg over the last 11 months while focusing on my mirtazapine taper.  I was looking at the occupancy graphs from Why taper?  For Effexor, it looks to me like it will be very important to take it nice and slow from 20 mg and below, because that curve drops off really steep from that point on.  My point being, you may be able to get to that point cutting every three weeks.

 

However, I will say this after that:  everyone is different and you may be too sensitized at this point to go that fast.  The beginning of your taper should be every four weeks so you can get a sense of how you do with it.  If you are nice and stable and don't feel much in the way of symptoms, then you could try the three week plan and see how it feels.  REALLY LISTEN TO YOUR BODY!  And when people  do manage the three week plan, they really need to hold an extra month here and there to be sure their nervous system isn't falling behind.

 

I think the trick for us is to try to get on with living life and not focus so much on the taper day to day; knowing that as we get lower and lower, we are operating more and more with our native nervous system coming back online, and that less and less drug is better than staying on these meds for life.  It's all relative.  That helps me keep my antsy-ness in check.

 

SG

 

I'm going to take your advice and go slowly. I've actually developed a fear of going into withdrawal and into that panic state. I often worry about finding myself in a situation where I can't get to my medication and I go into that state. That's actually the main reason I want to get off of it. So, at the same time that I want to go slow and avoid withdrawal, I'm also very eager to get this poison out of my system. But, your advice is exactly what I needed because I am obsessing a little about this. I just need to relax and take it slow. As Lao Tzu said, "the journey of 1000 miles begins with a single step"

Thanks

[SquirrellyGirl]

Well done, Zero - you're going to be ok!

 

Please post updates here; we are here for you.  Hopefully it will be smooth sailing :-)

 

SG

[zeromg]

Well done, Zero - you're going to be ok!

 

Please post updates here; we are here for you.  Hopefully it will be smooth sailing :-)

 

SG

Thanks, SG! You guys have really made me feel prepared for this. I'll be sure to keep you updated.

[Miko789]

Hi Zero,

 

its very important with effexor to go very slow  as it it a drug with high withdrawal symptoms if you taper fast.

 

why you were prescribed risperdal for depressive episode? its not for depressive episode

 

good luck

[zeromg]

Hi Zero,

 

its very important with effexor to go very slow  as it it a drug with high withdrawal symptoms if you taper fast.

 

why you were prescribed risperdal for depressive episode? its not for depressive episode

 

good luck

Hi Miko,

 

I'm not sure why they chose the risperdal but it worked really well. I'm a veteran and get seen at the VA and the turnover is so high that I've seen about 10 different psychiatrists in the last 15 years. Each one has his or her own way of doing things and so I've been diagnosed with major depression from some doctors and bipolar disorder from others. Thanks, Z

[zeromg]

I have another question. I opened up one of my 37.5 mg capsules and found that there were only 62 beads in there. That means that my decreases can't be any smaller than .6 mg. Has anyone else run into this problem? If so, what did they do about it? Thanks

[scallywag]

zeromg:  I was on Effexor XR 2002 - 2005 and counted beads to come off. My taper was too fast for me. Looking at a spreadsheet I still have from then, there were 110 beads in my 37.5 mg capsule and it seems I cut 5 beads or 1.7 mg every two weeks.

 

Are you on the brand name (wyeth) Effexor or a generic? The 0.6 mg/bead sounds like a generic based on my notes and what I've read here at SA.

 

The 0.6 mg/bead might be a problem for you at the end of your taper, and it might not. No one can accurately predict this. When you get below 5-6 mg  removing 1 bead will be greater than 10%.  If you are using a generic, you could request your Doc specifically prescribe brand-name capsules, which by having more beads allow smaller % cuts. If cost is a concern, remember you'd need far fewer capsules because a single 37.5 mg capsule yields more than 7 doses of 5 mg; you'll get a 4-week supply of 5 mg doses from 4 37.5 mg capsules.

 

Make sure you've bookmarked or saved the topic on tapering Effexor; it will come in handy now and when you get to the lower doses.  Tips for tapering off Effexor

[zeromg]

zeromg:  I was on Effexor XR 2002 - 2005 and counted beads to come off. My taper was too fast for me. Looking at a spreadsheet I still have from then, there were 110 beads in my 37.5 mg capsule and it seems I cut 5 beads or 1.7 mg every two weeks.

 

Are you on the brand name (wyeth) Effexor or a generic? The 0.6 mg/bead sounds like a generic based on my notes and what I've read here at SA.

 

The 0.6 mg/bead might be a problem for you at the end of your taper, and it might not. No one can accurately predict this. When you get below 5-6 mg  removing 1 bead will be greater than 10%.  If you are using a generic, you could request your Doc specifically prescribe brand-name capsules, which by having more beads allow smaller % cuts. If cost is a concern, remember you'd need far fewer capsules because a single 37.5 mg capsule yields more than 7 doses of 5 mg; you'll get a 4-week supply of 5 mg doses from 4 37.5 mg capsules.

 

Make sure you've bookmarked or saved the topic on tapering Effexor; it will come in handy now and when you get to the lower doses.  Tips for tapering off Effexor

Hi Scallywag,

 

Thanks for the reply. I have the generic ones. I'm not sure if the brand name is available from the Veteran's Administration but I'll definitely ask.

 

-Zero

[scallywag]

The VA probably doesn't provide them under the plan. It's worth asking though.  Investigating how much it would cost you out-of-pocket to get the brand-name costs you only a little time and having information now doesn't hurt, at least I've never seen it listed as a withdrawal symptom or pdrug "side" effect. You may find that holding for longer periods when you get to small doses handles the larger % cut for you and switching to brand-name won't be necessary. 

[SquirrellyGirl]

You might look into whether they would prescribe the immediate release tablets which can be made into a liquid and dosed with an oral syringe.  The problem there is that you'd need to take it twice a day. 

 

Keep in mind anytime you switch to a different brand or form, you need to cross taper because a direct switch could lead to withdrawal symptoms, even without changing the dosage!  I had to cross taper mirtazapine, taking part dry and part liquid and gradually switching to all liquid.  Never change the dosage at the same time that you do a switch!

 

Perhaps review this topic:  http://survivingantidepressants.org/index.php?/topic/272-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine/

 

SG