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cogitoergonumb: Venlafaxine tapering: tips at this juncture

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cogitoergonumb

Hello,

 

TL;DR I've recently reduced my Venlafaxine fairly quickly(over a month) from 225mg to 75mg.

 

@75mg I'm a little nauseous, anxious and have diahrrea but it's bearable

 

Should I keep it at this level (bearable) till it settles, or should I go up 37.5mg to 112.5mg for a while?

 

Sorry in advance for the essay, it's been a long road.

 

I was going through a rough time last year and was put on Venlafaxine(Age 28, no previous psych experience). After the first dose I vomited and went into severe reaction, not sleeping, psychosis. Fortunately my parents were over visiting for a couple of weeks. Unfortunately my parents took me to a psychiatric ward because I didn't sleep for days on end and couldn't function. Here in Germany it is more common to be in for longer periods of time, I ended up there for 4 Months. The doctors kept putting me on more and more different medications. I was on Mirtazapine(15mg), Escilatopram(??), lorazepam(3mg), Lamotrigine(200mg) and finally Venlafaxine(225mg) again(with Lamotrigine and Mirtazapine and Pipamperone, a first gen antipsychotic). A lot of this was due to me not describing how badly these drugs were messing me up. I do have a fear that I may never fully recover from this assault on my central nervous system but here's hoping. 

 

The final diagnosis was bipolar but a lot of the manic behaviours I displayed, I had never had before antidepressant treatment.

 

I managed to get off the Benzo (lorazepam), Pipamperone and Lamotrigine fairly easily. Lamotrigine was giving me splitting constant headaches so I had to axe that fairly soon.

 

I went back to work in January and have been doing a staged return which will finish with my full 8.5 Hour day in May.

 

Fast forward to now. I've been off the Lamotrigine completely for round about a month not entirely on the wishes of my outpatient Psychiatrist. No negative effects and mentally feeling quite stable.

 

I've been on venlafaxine now for 6 months and have decided to start a reduction in this too as I have not felt positive effects from any of the SSRI/SNRI drugs that I was on, including Venlafaxine. I will still be taking Mirtazapine because I feel it helps with my sleep problems. I may cut that out sometime in the future but definitely not now.

 

I have successfully reduced my dose to 75mg for 2 weeks and I'm feeling a wee bit queezy, headachey and off (lots of toilet breaks at work) but not too much.

 

My plan for the moment is to ride it out at this level for a couple more weeks before I make the next jump (1.5x37.5mg, bead counting method)

 

Because I have light WD symptoms, should I go back up another half dose, or should I just ride it out until I'm stable?

 

Edited by ChessieCat
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ChessieCat

Hi CEN and welcome to SA,

 

Reducing from 225mg to 75mg over a month is a very big and fast reduction.  And it definitely sounds like you are experiencing withdrawal symptoms. I think your idea of updosing is good, and because of when and how you have reduced I think that increasing to 112.5mg is reasonable.  You will probably need to stay at that dose for at least 3 months, possibly longer, depending on how your symptoms are.  I would definitely NOT be making another reduction.  It's much better to use a harm reduction approach and be as comfortable as possible whilst getting off the drug rather than try and go too quickly and suffer unnecessary withdrawal symptoms.

 

When we take psychiatric drugs we develop a physiological dependence on them (not a physical dependence like caffeine or nicotine).  They change our brain.  The best way to get off these drugs is to taper so that your brain can adapt as you go to not getting as much of the drug.

 

SA's recommended taper protocol is to reduce by no more than 10% of the previous dose followed by a hold of about 4 weeks to allow the brain to adapt as you go.

 

I will tell you what happened to me, which I think might help you to understand how these drugs alter our brain.  I was taking 100mg Pristiq and reduced my dose to 50mg.  I suffered extreme cog fog for 3 weeks and had to totally concentrate on everything I did, even walking.  After 3 weeks I was unable to type.  Because I have been a typist for 40+ years I knew that something was wrong.  Thankfully I had joined SA a few days prior to this happening and they had suggested increasing my dose.  When I couldn't type I took extra Pristiq and after about 4 hours I was able to type again.  I knew without a doubt that is was because of the Pristiq.  After stabilising I have since been tapering with only minimal withdrawal symptoms and am now down to 12mg Pristiq.

 

We ask all members to create a drug signature.  Please update it whenever you make a change so it remains current.

 

This is the preferred format:

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

  • Please leave out symptoms and diagnoses.
  • A list is easier to understand than one or multiple paragraphs. 
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Why taper by 10% of my dosage?


Windows and Waves Pattern of Stabilization

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Tips for tapering off Effexor (venlafaxine)

 

Brain Remodelling


Video:  Healing From Antidepressants - Patterns of Recovery

 

How do you talk to a doctor about tapering and withdrawal?


What should I expect from my doctor about withdrawal symptoms?

 

Keep it Simple, Slow and Stable


Keep Notes on Paper

 

This is your own Intro topic where you can ask questions and journal your progress.  We encourage members to visit other members' Intro topics so that they can support each other.

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cogitoergonumb

Hello ChessieCat,

 

Thank you very much for your reply

yes, I think that it was too ambitious to come down so fast. The side effects from this drug are very disheartening even though I've been on it for 5 months, I've had terrible reactions to every psych drug I've been put on. I firmly believe that it was medication reactions that ended up in my 4+ month hospitalisation. The general side effects of this med for me make it very difficult to work. (tiredness, mental fog, headaches)

 

I thought I could wing it because I've not been on that long... Once bitten, twice shy.

 

I was feeling quite nauseous and out of it at a meeting today and the customer asked me if I was tired... here was me thinking I was keeping my **** together (on the surface)

 

I'd heard a lot of people saying that they didn't feel any symptoms until 37.5mg. This does not seem to be the case for me. I'll be reinstating at 112.5 for the moment and holding there for at least a month, perhaps the 3 months which you suggested ( I'm an impatient sod, but I'm learning).

 

I'm going to see my psychiatrist on Monday to discuss why I would like to do this and my plan. Another thing I have heard which might make it easier is to slowly start fluoxetine as you are reducing Ven ("The prozac Bridge") Some were saying that this is by far the easiest way to come off Venlafaxine, others said mileage may vary but no-one I saw had much specific negative opinion on this, only positives (very unusual for Venlafaxine withdrawal stories) I'd like to hear from anyone who this didn't work for and if so, why.

 

It's going to be a long road, but I've never been so determined to do anything in my life. I'm sure for some people psychiatric drugs work but for me it's been an absolute trauma. I just want this psychiatric nightmare to end before I lose my job .

 

I just realised I sound super complainy, this is not who I am at all. Was mostly positive before all this.

 

P.S. how do you add a signature? Is it in your profile that you have to change something?

 

Here is my blurb:-

Drugs: Venlafaxine/Effexor 225mg ; Mirtazapine/Remeron 15mg; Propranolol 80mg; Lamotrigine/Lamictal 200mg

Lamictal was tapered very quickly Dec/Jan 2018 with no strong side effects

 

Began Effexor tapering Jan 2018  

Current:  Venlafaxine 112.5mg; Mirtazapine 15mg

 

PLEASE NOTE:  I am not a medical professional.

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Altostrata

Welcome, cogito.

 

If I were you, I would stay at 75mg for some months to let your nervous system settle down. If the symptoms get worse, a very small updose, perhaps to 80mg, might be appropriate.

 

After that, if I were you, I'd taper slower. You have a history of adverse effects from these drugs, which makes your nervous system susceptible to further drug stress.

 

See Why taper by 10% of my dosage?

 

Tips for tapering off Effexor (venlafaxine)

 

Your psychiatrist may not be familiar with the concept of gradual tapering. As it seems your entire history of psychiatric treatment is based on a specious diagnosis arising from adverse drug effects (not unusual), further psychiatric treatment is probably unnecessary.

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ChessieCat
15 minutes ago, Altostrata said:

If I were you, I would stay at 75mg for some months to let your nervous system settle down. If the symptoms get worse, a very small updose, perhaps to 80mg, might be appropriate.

 

After that, if I were you, I'd taper slower. You have a history of adverse effects from these drugs, which makes your nervous system susceptible to further drug stress.

 

Yes, I can see that this would probably be a better way.  I hadn't considered the adverse effects when I made my previous post.

 

Clicking on this link takes you to where you can create your signature:  Account Settings – Create or Edit a signature.

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cogitoergonumb

Hello AltoStrata, ChessieCat,

 

Ooof, It's been just over a week since my last dose reduction and let me tell you, it's not good at the moment, a little insomnia started on Monday evening, didn't get to sleep until 2ish and waking up with Severe physical symptoms of anxiety(nausea, upset stomach, diarrhea), nothing to be anxious about though... Fast forward to last night I needed to take my sleep aid which I haven't needed in months (Pipamperone; Antipsychotic; nobody else seems to be on this drug which is weird) and still woke up this morning too early feeling that I want to vomit.

 

There are absolutely no reasons why I should be feeling this way apart from WD

What really scares me is the prospect of this getting harder, the further down I go(occupancy; that my receptors even at this dose are >80% blocked)...baby steps I guess. :-)

 

So the consensus is I would be better to do a smaller updose then (or should I go a bit higher)? 

Do you guys work, if so, how do you deal with some of the dose reduction effects

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ChessieCat

This is the topic about reinstatement.  Even though we are discussing updosing the same things apply.  It is better to try and stabilise on the lowest dose possible.  Please read Post #1 of this topic:  About reinstating and stabilizing to reduce withdrawal symptoms

 

7 hours ago, Altostrata said:

If the symptoms get worse, a very small updose, perhaps to 80mg, might be appropriate.

 

Altostrata, who made this suggestion, is the founder of this website and is very knowledgeable.  If you find that after 2-3 weeks that the withdrawal symptoms are still unbearable you could then updose by another small amount.

 

Keep Notes on Paper

 

Windows and Waves Pattern of Stabilization

 

1 hour ago, cogitoergonumb said:

What really scares me is the prospect of this getting harder, the further down I go

 

I've been tapering by using the SA tapering protocol for my own taper and I have had only minimal withdrawal symptoms.  I work 3 days per week.

 

1 hour ago, cogitoergonumb said:

Fast forward to last night I needed to take my sleep aid which I haven't needed in months (Pipamperone

 

Do you practise good sleep hygiene:

 

Sleep problems - that awful withdrawal insomnia

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cogitoergonumb

Hi there,

 

MOD NOTE:  Trigger warning

 

Thank you both so much for your support here, I really admire what you guys do! I've reinstated at 80(ish) mg now. I was pretty dumb to think that I could drop so far so fast...

My problems with side effects were the reason I decided to go the route I did. I attempted suicide twice during my hospitalization  (seriously, suicide had barely crossed my mind before and if so, only briefly. :-/ )

 

We'll see how it goes from here. I need to work on my self discipline a little too. :-)

 

11 hours ago, ChessieCat said:

I've been tapering by using the SA tapering protocol for my own taper and I have had only minimal withdrawal symptoms.  I work 3 days per week.

 

It's good to hear that you have only had minimal withdrawals. I was considering temporarily putting my life on hold (for ca. 6 months) in order to wean off. I think I have enough savings to quit my job for a few months and luckily work in a career with quite good prospects for getting a new Job (Electronics Engineer). personal upheaval probably isn't the best thing for me right now though. Catch 22. Still on my staged return to work and struggling with 4 hours a day. (I used to be able to work 10Hrs a day...)

 

I'd love to be free of this mental prison... Haha, as I said in my last mail, really complainy (I'm just quite angry at the injustice of it all)

 

I can still picture exactly when I took that first pill and was vomiting on the floor and threatening to jump out a window.

Why didn't I just stop then? My girlfriend and I split up the same day, I thought that the effects were due to that. I now am 100% certain that it was a drug reaction (knowing how I reacted back then.)

 

Thanks for the links to forum topics. I will read them later today.

 

11 hours ago, ChessieCat said:

Do you practise good sleep hygiene:

I try to practice good sleep hygiene and have stopped taking my laptop into bed with me.

 

Once I'm better (which I WILL be one day) I think I will continue to be involved in this community. It seems really active and supporting.

 

 

Edited by ChessieCat
added mod note and removed unnecessary details

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Altostrata
13 hours ago, cogitoergonumb said:

Once I'm better (which I WILL be one day) I think I will continue to be involved in this community. It seems really active and supporting.

 

I certainly hope you do remain a part of our community. :)

 

Please let us know how you're doing. It's possible 80mg is a low enough dose that it won't cause side effects.

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cogitoergonumb

So I'm struggling on the 80mg. Nausea, headaches, insomnia, Gastro-intestinal/diahrrea(sorry TMI...), Increased pulse, concentration problems, ANXIETY. The anxiety is very strange because I have literally nothing to be anxious about. Total physiological symptom. I also went into a weird arrythmia (which is dangerous because of previous heart problems) but I might have forgotten to take my beta blocker today... I really can't be sure.

 

Trying to stick it out, if I stabilize on this level it will really reduce my steps down to 0 and now I'm worried if I go back up, the symptoms wont get any better. Any advice here would be appreciated. Part of me wants to go up to 150 again but that would probably be a bad idea for homeostasis now, wouldnt it?

 

Several people at work have been commenting on how tired I look. Luckily I'm still only on 4 hours until march which is the only reason I'm still standing.

 

I've reinstated a very small dose of the antipsychotic (pipamperone) that I was taking in order to help with the sleep because it was becoming unbearable. It seems to be working but obviously not ideal. I'm wondering if this is a good idea in the long run.

 

Only one word can discribe my current situation... aaaaaaargh

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cogitoergonumb

It could also be the fast Lamotrigine taper that I did ending in January. Should I reinstate that at a small dose too or you think I should leave it for the moment?

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ChessieCat

It takes about 4 days for the drug to get to full dose in the blood and a bit longer for it to register in the brain.  It would be best to be patient and give the updosing of Effexor a chance.  Making too many changes in a short period of time is like playing ping pong with your brain.

 

Keep it Simple, Slow and Stable

 

I also suggest that you read through Post #1 of this topic:  About reinstating and stabilizing to reduce withdrawal symptoms

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cogitoergonumb

Thanks CC, I'll stick with 80mg.  :-)

I've got some Burning sensations in my arms today which was the same as when I started these meds. Also not eating due to nausea and insomnia still there.

 

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cogitoergonumb

A little side question. In your experience, do people who had a severe reaction when starting these meds but continued (in my case due to hospitalisation and psychiatric mismanagement) have worse withdrawals?

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ChessieCat

Altostrata (this site's founder) has made the comment that we are all an experiment where N=1.

 

There are so many variables, genetics, personality type, diet, life stressors, as well as the types of drugs and going on and off and on and off etc that there is no answer to your question.  We have members who have gone off a drug years ago and sometimes a couple of times and have had no difficulties, yet are now having issues getting off a very low dose of the same drug.

 

We have to accept that there are some unanswerable questions in life, and yours is just one of them.

 

Q:  Are you keeping notes on paper?  This can help you/us to work out if reinstatement is working.

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Altostrata

cog, how did the symptoms change when you increased from 75mg to 80mg? It's only been a couple of days, correct?

 

Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. This is very important.

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cogitoergonumb

My first Journal Entry

80mg (ish) Ven; hold 7.5mg Mirt; Propranolol 80mg; Pipamperone 20mg

Woke up with massive physical anxiety/stomach churning. Dark thoughts. Talked to dad.

Nausea not as bad, had a window so drove to the baker and joked with the server about the cakes.

Psychologically good; Headache and lethargy mixed with physical anxiety symptoms (slight burny skin but handlable)

 

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