Apex - Looking for guidance

[Apex]

Hi all - It seems pretty clear that I've tapered too quickly off from Viibryd, but what now?  My situation is a bit complicated because I'm on a few medications to help me sleep.

 

My symptoms right now are severe fatigue, cognitive issues (brain fog, spaciness, lack of focus) and akathasia at night.  Pretty worrisome stuff as I'm a Director at tech company and I need to be on point = / (yes, stress isn't helping my cause).

 

I think I should reinstate, but I'm not sure if I should at 5 mg, 10 mg or higher.  Please see below and thanks in advance for your help.

 

SSRI and Adjunct History:

-At age 33 started Lexapro 10 mg and from summer 2012 to summer 2014 worked great for GAD, OCD

-Lexapro 10 mg seemed to "poop out," but with new symptoms of difficulty concentrating/brain fog so upped to 15 mg and then 20 mg over remainder of 2014.  Anxiety was still managed but my P Doc and PCP believed it was depression symptoms (hence increase)

-Added Abilify early 2015 - did not help with cognitive issues and gave me akathasia so discontinued

-Cross-tapered to Viibryd 20 mg during summer 2015 - still no anxiety, but still dealing with brain fog.  Side effects were worse than Lexapro with upper and lower GI issues

-Over past year went up to 30 mg Viibryd - no anxiety, but still brain fog

-Spring 2016 - Sleep got progressively worse which made it difficult to determine whether cognitive issues were more from lack of sleep or lack of appropriate SSRI dose

-Spring 2016 tried Rexulti - no help so tapered off

-Current - 0 mg Viibryd (tapered recently, though too fast)

Taper:  From 30 mg to 20 mg from 6/20/16 to 6/30/16 (two weeks on 20 mg)

From 20 mg to 10 mg from 7/1/16 to 7/14/16 (two weeks on 10 mg)

From 10 mg to 0 mg (3 days), then up to 5 mg (3 days) then 2.5 mg (2 days) and now 0 mg since 7/23/16

 

Additional medication history:

-From ~2014 to early 2016, took 5 mg valium suppository as needed for chronic pelvic pain - able to stop due to successful physical therapy

-From June 2015 to now, taking 75 mg (yes 75, not 750) gabapentin to help sleep/akathasia

-From May 2016 to recently, taking 0.5 mg lorazepam for sleep (recently tapered this to 0.25 mg)

-Took propranolol 20 mg for about a week in mid-July 2016 due to severe akathasia (assumed due to Viibryd withdrawal).  Tapered down to 0 mg over following week

-From summer 2015 to now, take 10 mg Vyvanse as needed for focus (more days than not)

 

Current supplements:

-5 mg melatonin nightly

-200 mg L-Theanine x2 day

-150 mg Magnesium Glycinate x2 day

-5000 iu D3 1x day

-1000 mg Omega 3 fish oil x1 day

Edited July 28, 2016 by scallywag
tags added

[scallywag]

Hello Apex -- Welcome to Surviving Antidepressants (SA)!
 
Thanks for posting your introduction and completing a signature.  Your question is timely. Reinstatement is likely to be effective for you with so few days passed since your last dose. Reinstatement is not a sure-fire guarantee but it's the best bet to minimize withdrawal symptoms.
 
Your CNS (central nervous symptom) has started adjusting to a lower dose (0 mg) of the drug and jumping back to 10 mg could be too much. You could likely reinstate at 2.5 mg without a problem, and 5 mg *may* give you CNS destabilization symptoms. Those symptoms are likely to resolve but again it's difficult to predict.
 
Dose    days since last dose
 2.5        6
 5.0        9
10.0       12
 
It takes drugs 4-5 days to reach a steady state and then another few days to a week for noticeable relief in your symptoms. In your situation, I'd likely take the more conservative dose 2.5 mg to test my CNS response. You'll need to weigh the need, risks and possible benefits.

About reinstating and stabilizing to reduce withdrawal symptoms

Because you're within a week of your last dose you may not experience the waves of symptoms and windows of symptom-free time. Please read this just in case:

The Windows and Waves pattern of stabilization
 

 

For later reference:  Tips for tapering off Viibryd (vilazodone)

 

 

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Have a look at the link's I've posted. Come back and post questions about your situation here.

[Apex]

scallywag - I really, really appreciate your prompt reply.  I'll give 2.5 mg a shot.  To confirm, presumably I'll need a month or so to know that I've stabilized and only then start a taper from there?  And in my case, I don't expect to feel "great," just a lot less miserable and more functional (as I was at 10-30 mg)?

[JanCarol]

That's a realistic assessment, Apex.

 

It may also help you to look at Magnesium and Omega-3 fish oil

 

as well as learning some Non Drug Techniques for Coping with Emotional Symptoms

[Apex]

Re-started at 2.5 mg yesterday and the akathasia/restless legs came back last night so I had to take 10 mg of propranolol.  It's odd to me that on the one hand decreasing the Viibryd dose causes this symptom sometimes and on the other increasing it causes it...

 

Anyway, looking forward to getting more functional sooner than later.  I'd rather be hungover from my college days as at least you knew when it would pass...  I'll be ordering a digital scale and any other necessary items this weekend.

 

Thanks again all.

[scallywag]

Apex, it's not so much the dose that causes the RLS/akathesia but the fact that there's been a change in dose.  We don't understand fully how our central nervous systems react. Predicting symptoms becomes a gamble equivalent to a dice game.

[Apex]

Out of curiosity, what do I do if a month from now I find that I'm not feeling any better?  Considering the rapid pace that I dropped from 30 mg I'm having a hard time wrapping my brain around the fact that only 2.5 mg will stabilize me to a less miserable/more-functional pre-taper state.

[scallywag]

Apex: It depends on your symptom pattern. Keep good notes on paper about your symptoms, when the occur/intensity/ease/disappear.  Many people start to see patterns -- daily patterns and overall trends.
 
For some suggestions about keeping track of symptoms, please read this topic:

Glenmullen’s withdrawal symptom list