Cyclone84: in between a rock and a hard place

[Cyclone84]

Hello all.

 

I've been a lurker here for a little while and just decided to post my story. I'm not tapering at the moment, but am on two different ADs and I'm in a really tough place in my life right now. I guess I just need someone to listen because no one in my life understands, and I'm pretty afraid I'm going to lose my family because of it.

 

I don't remember my exact timeline, but I'm pretty sure it started about 2004, my sophomore year of college. I was put on Effexor XR after my mom and dad had both had their breakdowns (they were both on Effexor, my dad also on Xanax) and they decided for some reason that I needed to see a psychiatrist.

 

Things went fine with it until about 2007, when I was in my first semester of grad school. I decided I didn't want the meds anymore. As far as I remember, I had a doc tell me to do a super quick taper over a couple of weeks from 150mg to 0mg. I followed orders, and within a couple weeks, I was a depressed, crying mess. I ended up dropping out of grad school at that point. The doc told me I obviously still needed the meds, so I was put back onto 150mg.

 

Around that time, I moved to a city just south of where I went to school and spent a couple years there.

 

Fast forward to 2010. I decided I needed to find myself, so I left my friends in the city and had moved out of state for the first time in my life. At that point, I again decided that I no longer wanted to live my life under the thumb of pharma, so when my rx ran out, I just stopped taking them. I remember getting the brain zaps, but not much else in terms of withdrawal effects, until I was at work one day a few weeks later and I had a panic attack and had to leave. Soon after, I moved back home to my parent's house where I was promptly put back on 150mg of Effexor.

 

I spent about six months there, from what I can recall. Eventually, I moved back to the city where I lived after college and reunited with friends. Things were good. 

 

Not long after I moved back, I ended up dating an old friend and we moved in together after a little while. This was some time in 2011, I believe. We decided together that I would get off my meds again, so I'm pretty sure I did a super quick taper again. Again, it took a few weeks and I was a crying, depressed mess. Cue the scene, I went back on 150mg of Effexor and things were good again.

 

We got married in 2013 and bought a house. In 2014, I tried to go off my meds again. Same story. Back on the same meds, but this time, my wife told me I can't go off my meds when we have kids.

 

In 2015, we had our daughter. She is the light of my life. We had a wonderful couple of years together. Ups and downs, and we've been in couple's therapy to work on things. But about six months ago I decided to break my promise to my wife and I secretly weened myself off my meds, this time over the course of a couple months. I made it off them and was doing fine, until one day when I told her on the way to therapy what I had done.

 

Chaos ensued, but she decided to stay around and try and work it out and see what happened to me off the meds. This was the best that I had ever done off them, so she was actually a little hopeful but still very scared and hurt.

 

Within weeks, I was back at the doc trying to get my meds back. This is where things finally took an awful turn, something I'm terrified has messed me up irrevocably. The doc told me I should just go back on my 150mg dose. I had done so in the past, pretty much every time, from what I remember.

 

I took that dose in the middle of the day a day or two later. Before, I could take my meds at any time of the day. They never had any effect on my ability to sleep. That all changed that day.

 

That evening, after work, I went home and went to bed, like usual. At about 4am, I awoke out of a dead sleep to dilated pupils, hot and cold chills, and heavy sweating. Since I knew it was the meds that did it, I backed off the dose to around 37.5mg for the next couple of days. 

 

Sleep didn't get any better. After about four days, I had to go to a psych urgent care where they told me to stop taking the Effexor since it had an activator in it and the effects I was experiencing happened to some people. She told me my body might just be metabolizing the drug differently. At that point, she gave me mirtazapine to sleep and hydroxyzine for anxiety. 15mg of mirtazapine for a couple weeks, then up to 30mg. 25mg of hydroxyzine three times a day.

 

At this point, I lost my purpose. I raised my daughter during the day. I work nights and my wife works days, so I stayed at home with my daughter. Until this happened. Now, she has to go to daycare and instead of seeing her every day for hours, I now see her for a few hours a couple times a week because our schedules are totally opposite. It destroys me inside.

 

I stayed on the mirtazapine and hydroxyzine for a while, and was sleeping, but was also very groggy and not like myself. So, along with that, we reintroduced venlafaxine IR, 75mg. I honestly thought I was taking 37.5mg in order to titrate up, but stupid me, I didn't even check the label to see what I was taking.

 

I got into see a psychiatrist recently. He just switched me over to the venlafaxine XR, 75mg. I've been on that for about a week.

 

But my sleep is still wrong. Since I can remember, I have been able to just lie down and sleep, pretty much whenever, wherever. Now, I don't sleep without the mirtazapine. And it knocks me out. I wasn't sleeping well on the 30mg, so I dropped down recently to 22.5mg. I'll sleep for six hours straight without hearing anything. My wife asks me if I heard our daughter come in the room, and I'll always answer no, because I don't.

 

But I complain about my sleep. Once I'm awakened, I don't go back to sleep. My wife doesn't care. She says I slept, and I should stop complaining, but I know something isn't right. It's different than it's ever been.

 

So at this point, I'm not myself at all. I'm lethargic and depressed, but I can't sleep. I really want to be off meds forever, and do it right this time, but no one understands. My wife is on Lexapro. Her best friend is on Lamictal. My parents are on Effexor. My sister is on Cymbalta. My brother is on Effexor. My mom's siblings are on meds. My dad's siblings are on meds. They all think I need meds. I'm totally stuck. Either I live how I feel right now, forever, or I switch to yet another med and hope I feel better, or I lose my entire family and the life I have built. My daughter. My wife. My friends.

 

My brother said he would take me in if it came to that. But he lives 15 hours away. If it comes to that, my entire life is going to be in ruins. I'll never see my daughter again.

 

So that, minus lots of details, is my med story. Things went well for a lot of years. I got lucky CTing so many times and having a med to fall back on. I'm kicking myself every day for weening myself off that last time because now things are changed far beyond how they ever have been. I'm scared. I feel like I'm going insane. I'm depressed, my head feels like it's on fire a lot of days. I don't know where to turn. Suicide feels like a viable option most days, but I could never leave my daughter like that. I guess I just need someone to listen, maybe some advice from anyone that has been in a similar situation. I know I messed up, time and time again, and this last screw up seems like it's going to be my downfall.

 

 

[Cyclone84]

I'm sorry about the first post. The end seems a bit fatalistic, now that I am reading it with a fresh set of eyes. I guess I have a question or two about my dosages. Obviously, the last reinstatements of Effexor at 150mg and then again at 75mg were a mistake. I should have started waaaay smaller. Had I found this forum a couple weeks prior, I would be in a much different situation. It just feels like my head is in a vise most days, and I've never had to deal with headaches like this so I'm wondering if it is my bouncing around on dosages, or that the dosage is too high at this point? Or that I'm experiencing withdrawal even though I am back on Effexor? I feel like my emotions are a bit more stable, but I still have crying fits from time to time. Maybe it's just not effective for me anymore? I don't know if I should keep moving around, as I need my CNS to stabilize as much as possible, and it's already been through the wringer, especially most recently.

 

Thanks for building a place to turn for comfort and reassurance. I don't know where most of us would be without it.

[Shep]

Hi, Clyclone.

 

Welcome to Surviving Antidepressants.

 

How long have you been at 75 mg Effexor? How and when did you decrease from the 150 mg? What was your taper rate? 

 

You are taking mirtazapine and Effexor, or what is called "California Rocket Fuel", which is potentially very dangerous. Please see:

 

About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

 

Please note Alto's comment from that thread: 

 

On 3/26/2016 at 5:39 PM, Altostrata said:

If you are taking this combination, you probably will want to taper the Effexor first with the hope that the remaining mirtazapine will maintain sleep. See 
 
Why taper by 10% of my dosage?
 
Taking multiple psych drugs? Which drug to taper first?
 
Tips for tapering off Effexor (venlafaxine)
 
Also see Tips for tapering off Remeron (mirtazapine) for background.

 

Adding in periodic Hydroxyzine is likely also causing problems. I placed all three drugs in a drug interaction checker and here is the report:

 

Drug Interaction Checker Report

 

Please start a drug and symptoms journal so we can sort out what is causing any possible adverse reactions and what is withdrawal. Then we can help you set up a safe and careful taper plan. 

 

Here is what we need:

 

On 9/27/2016 at 2:49 PM, Altostrata said:

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 
6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

 

Please post your drug and symptoms journal here in your thread daily and we can guide you in a safe and slow taper. 

[Cyclone84]

Hey Shep,

 

Thanks for the response. I'll do my best to keep a journal over the following days. My sleep schedule is a little erratic since I work in the restaurant industry and don't always get to sleep at the same time, but I suppose that wouldn't matter as long as I keep a journal of all symptoms throughout every day.

 

I have had mydriasis since starting the Effexor maybe 5 or 6 weeks ago, along with some mild muscle twitching. I dislike both side effects very much. I was on Effexor IR 75mg twice daily for a few weeks and now I am stabilizing at 75mg on Effexor XR and 22.5mg of mirtazapine. I take the Effexor in the morning, usually around 10, and the mirtazapine before sleep.

 

Unfortunately, as you read in my first post, my entire family is opposed to my life without meds (particularly Effexor), so tapering the Effexor might have to wait for the moment. My plan is to slowly come off the mirtazapine first, even if it causes sleep issues. Eventually, my plan was to start dropping a couple beads out of my Effexor every month over the course of years since I have had an impossible time removing it from my life previously.

 

Cyclone84

[Cyclone84]

The mydriasis is responsive to light and is mild, though it is present. I remember having this side effect years ago after I CT'd the first time and reinstated, but it went away quickly. This time it has stuck around.

 

I have been on and off 150mg Effexor XR for about 14 years. My last fast taper was from about June/July-September of this past year. Reinstatement at 150mg happened in late October I believe, but I was only at that dose for one day and then I was at approximately 37.5mg for about four days following. A couple weeks later I got on a measured dose of Effexor IR, 75mg twice daily, but now I am at 75mg XR once a day. I have a compounding facility in town, so I'm going to look into getting my mirtz in liquid form to help with the taper.

[Shep]

30 minutes ago, Cyclone84 said:

My sleep schedule is a little erratic since I work in the restaurant industry and don't always get to sleep at the same time, but I suppose that wouldn't matter as long as I keep a journal of all symptoms throughout every day.

 

30 minutes ago, Cyclone84 said:

Unfortunately, as you read in my first post, my entire family is opposed to my life without meds (particularly Effexor), so tapering the Effexor might have to wait for the moment. My plan is to slowly come off the mirtazapine first, even if it causes sleep issues.

 

With an erratic sleep schedule, I would be very cautious about coming off your sleep drug first. 

 

You may want to message this to your family as "I'm feeling much better with the mirtazapine and it's controlling most of my symptoms. Time to slowly reduce the Effexor". If you message the fact that it's the mirtazapine that's helpful, your support team of family and doctor will likely back you up. 

 

Just a thought, Cyclone. Insomnia is one of my worst symptoms and it makes everything worse. You simply can't function without sleep.

 

Please don't start reducing the mirtazapine yet. Give yourself time to read over all of the links and let's get a few days worth of your drug and symptoms journal before you make a decision. 

 

You've made a lot of rash decisions in the past. I'm not blaming or judging you because you're like most of us here - we received a lot of bad information from our doctors. But now that you've come to a place where thousands of people have shared information on how to safely come off these drugs,  please take a step back, take a deep breath, do some research and really plan this out so this time, you'll be successful in your taper. 

[Cyclone84]

The thing is that my family knows the mirtazapine is not what is effective for me. I took it at 30mg by itself for a while during accute withdrawal (after my last fast taper) and it made me sleep and not want to off myself, but not much other than that. Once I started taking Effexor again, I became an active part of my family and society again. So, telling them I am going to start tapering Effexor again is going to be very tricky. I saw another user post about talking to their doc about "finding the lowest effective dose," which would involve a very slow taper down to zero, in time. Or, possibly, a VERY small dose, measured in single digit mg. But, I have only met with my psychiatrist once, and he does not have very good bedside manner. He also told me that I could take mirtz "as needed" at this point, so he obviously has no concept of the dependency some people have on these drugs. If I could find a psychiatrist in my area that is responsive to a very slow taper and "finding the lowest effective dose," that is probably my best bet.

 

And thank you for your advice. Sometimes I can be my own worst enemy, making rash decisions that are poor choices for my long-term well-being. This forum really is a haven, a well-worn path that lost individuals can follow to find their way out of the woods.

 

Cyclone84

[Altostrata]

 Welcome, Cyclone.

 

First off, your story is not unusual to us. You do not have an exotic psychiatric disorder, you have had several episodes of withdrawal syndrome. This may be of some reassurance to your wife.

 

To us, "lowest effective dose" means the lowest dose that will relieve withdrawal symptoms.

 

Could you please summarize: What times of day do you take each drug, and their dosages?

 

Please keep daily notes with times of day for when you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right. Post your notes here in your Intro topic.

 

This will help us determine if you are having adverse effects from your drugs, and which should be lowered first in dosage.

[Cyclone84]

Thanks for the reply. I understand my symptoms off the drugs have been withdrawal related. Unfortunately, it won't be of any reassurance to my wife or any of my immediate and probably most of my extended family. As my wife says, I'm "not functional" without them, and she refuses to believe that all of my "relapses" were just acute withdrawal, nor will she wait around for me to recover if and when I do go through withdrawal. The rest of my family is the same.

 

I'm not really in a position to have a go of this on my own, divorced from my wife, so at this point I'm just looking to lower the dosage as much as possible until I get to a point in my life where things settle in and I can actually make a lengthy go at life removed from psych drugs.

 

Dosages are loosely as follows:

Venlafaxine XR 75mg, after food in the morning, typically around 10am

Mirtazapine 22.5mg (this is not an exact measurement at the moment. I've had to break pills in half and don't have a scale yet) in the evening right before I go to sleep. Days when I'm not at work, this could be 10pm. Days when I'm at work, it could vary between 10:30pm-12am. I'll start keeping a detailed journal of times, dosages and side effects during the day.

[Altostrata]

Few people, even doctors, don't understand how severe withdrawal syndrome can be. We aim to give you guidance that will avoid your going through withdrawal. You have been tapering too fast, that's why you've had problems going off the drugs, and now your nervous system is hypersensitized and a little unsteady.

 

Via the same gradual tapering process, you can find a minimal dosage as well. For background, see

 

What is withdrawal syndrome?

 

Why taper by 10% of my dosage?
 
About reinstating and stabilizing to reduce withdrawal symptoms
 
The Windows and Waves Pattern of Stabilization

 

Tips for tapering off Effexor (venlafaxine)

 

Tips for tapering off Remeron (mirtazapine)

 

But for now, we need to see if 75mg venlafaxine and 22.5mg mirtazapine is causing any of your daily symptoms.

[Carmie]

Hi Cyclone, 

 

How are you doing?💚