Nivsch: what do you think about reducing 1mg every week

[Nivsch]

4 hours ago, Altostrata said:

Not sure why you're here and asking us questions.

 

Maybe I am sensitive but this answer is dissapointing and a bit hurt. I dont want to argue at all. I appreciate deeply this place and your answers to me and take it seriousely and precisely because of that I answered in long answers in the disccusion above, repeated and wrote in more detailes to show the full spectrum of my concerns, but i didnt get explanation about venlafaxine. Only "its not good". How may I feel after that? More sedated or more confused?

Thats why i explained more.

Dont want to clash with anybody only the contrary thats why your last answer hurted me. If it seems argumentative its because of my stress its not as it seen to you.

[ChessieCat]

9 hours ago, Nivsch said:

Even if in march I moved from venlafaxine to duloxetine wothout problems? There were no problems.

 

Just because you were able to do this a few months ago does not mean that you would be able to change back to venlafaxine from duloxetine without any issues.

 

9 hours ago, Nivsch said:

The thing is: I am SCARED to stay on duloxetine because my brain will adapt too much

 

You have been on duloxetine since March this year.  That's about 5 months.  It generally only takes about 1 month or a little bit longer for the brain to adapt to a drug.

[Nivsch]

11 hours ago, ChessieCat said:

You have been on duloxetine since March this year.  That's about 5 months.  It generally only takes about 1 month or a little bit longer for the brain to adapt to a drug.

 Oh ok now i understand.

 

I will try taper the crazy drug not more frequent than every week to let my body calm as I understand from altostrata answer and from my experience last week. If 1% every time will be ok so its ok. If only 0.5% will be ok so I will end the taper in 2035 (really. Thats what the excel says).

 

So its either 1% every week (or more % with more time hold) with cymbalta, or it will be prozac. 

[Altostrata]

I don't know what effect venlafaxine might have on you. It probably will be different from what you felt before. The act of switching the drugs may cause you to feel a lot worse. We advise making as few changes as possible -- advice you have declined to follow since you joined this site.

 

You probably are already physiologically dependent on duloxetine. AGAIN, see Tips for tapering off duloxetine (Cymbalta)

 

AGAIN, we advise waiting a month between changes, not a week. This is to see the effect of the change you've already made. Since you've been taking Cymbalta so irregularly, it's likely you're going to have more difficulty in reducing it.

[Nivsch]

49 minutes ago, Altostrata said:

It probably will be different from what you felt before. The act of switching the drugs may cause you to feel a lot worse.

 

Ok so I won't switch to venlafaxine.

 

49 minutes ago, Altostrata said:

You probably are already physiologically dependent on duloxetine. AGAIN, see Tips for tapering off duloxetine (Cymbalta)

 

Yes I have read it many times this month. Really a dilemma.

 

49 minutes ago, Altostrata said:

Since you've been taking Cymbalta so irregularly, it's likely you're going to have more difficulty in reducing it.

 

You mean that because I changed the dose frequently and not equally - the following changes will be harder?

From now to months to come, or only in the short term?

[ChessieCat]

10 minutes ago, Nivsch said:

You mean that because I changed the dose frequently and not equally - the following changes will be harder?

From now to months to come, or only in the short term?

 

If you do a long hold now and let things stabilise, you could then make a small reduction as a test to see how your respond.  If it goes okay, then you could do a larger reduction.

 

Q:  How did you taper venlafaxine and what was the last dose that you took?  If you can provide approximate dates and doses that would really helpful please.

 

I'm asking about this because it will depend on how quickly you tapered and what the last dose was how long you might need to hold before you started tapering duloxetine again.  You might still be experiencing withdrawal symptoms from going off venlafaxine.  Because you went from venlafaxine to duloxetine it is difficult to know what symptoms are withdrawal from venlafaxine and what are side effects from duloxetine.  And then once you started tapering you introduced another variable, ie withdrawal symptoms.

 

It is better to hold for longer now and get stabilised.

[Nivsch]

31 minutes ago, ChessieCat said:

 

Q:  How did you taper venlafaxine and what was the last dose that you took?  If you can provide approximate dates and doses that would really helpful please.

 

Venlafaxine:

1. April 2015 - january 2016: 150mg

 

2. End of january - march/apr/may/jun (dont remember) 2016: 225mg

 

3. Summer 2016: reduced directly to 187.5mg (1.25 pill relaying on my eyes only).

 

4. Stayed for 2 years on 187.5mg during them, for some months, I did one day 225 and the other day 150 (to get average of 187.5) when i bought the capsules. The psych said its ok.

 

5. December 2018 - reduced directly to 168.5 and stayed until march 2020 (1.125 pill very not accurate because i was relaying on my eyes again).

 

6. Mid March 2020 - cross taper between venlafaxine and duloxetine - 150mg venlafaxine + half capsule of 60mg duloxetine for 7 days, then droped the venlafaxine.

 

7. Mid march - mid may 2020 - 60mg duloxetine every day.

 

8. Mid may 2020 - started taper duloxetine.

 

[ChessieCat]

Please copy and paste the link below and put it in your drug signature like shown below.  This will make it easier to find this information if we need it.  Thank you.

 

2015-2020 Venlafaxine 150-225 mg.  venlafaxine duloxetine cross taper details

 

Edited August 23, 2020 by ChessieCat

[Nivsch]

42 minutes ago, ChessieCat said:

Please copy and paste the link below and put it in your drug signature like shown below.  This will make it easier to find this information if we need it.  Thank you.

 

2015-2020 Venlafaxine 150-225 mg.  venlafaxine duloxetine cross taper details

 

👍

[ChessieCat]

I've just found this on drugs.com under the Professional tab for both of the drugs.

Metabolism

Duloxetine

Hepatic, via CYP1A2 and CYP2D6; forms multiple metabolites (inactive)

 

 

Venlafaxine

 

Hepatic via CYP2D6 to active metabolite, O-desmethylvenlafaxine (ODV); other metabolites include N-desmethylvenlafaxine and N,O-didesmethylvenlafaxine

 

Edited August 23, 2020 by ChessieCat

[ChessieCat]

5 minutes ago, Nivsch said:

👍

 

I've just checked it and it works.  Thank you.

[ChessieCat]

I posted this before but I might have accidentally deleted it when my posts were merged and I edited the post.

 

You've been on duloxetine since March 2020.  It only takes about 1 month for the brain to adapt to so your brain has already adapted to the duloxetine.

 

With your cross taper from venlafaxine to duloxetine, it would probably should have reduced more of the venlafaxine before stopping it.

 

Dose comparison from:  https://ahpnetwork.com/wp-content/uploads/2017/09/Switching-Scenarios.pdf

 

Duloxetine      30 - 60

Venlafaxine    37.5 - 75

 

This is my thoughts.  Because you stopped venlafaxine at 150mg, and not at a lower dose, you are may be experiencing withdrawal symptoms from venlafaxine.

 

I think the best thing to do would be to hold on your current dose of duloxetine for at least 3 months.  After 3 months you could then assess how you are.  You may need to hold for longer, or if you are feeling reasonable then you could do a test reduction of a small amount to start with to make sure that you are okay to start tapering.  If after the test reduction you feel okay, then you could reduce by a larger amount.

[Nivsch]

Ok it surprised me but I think I found the answer after I read here the "tips of tapering venlafaxine".

 

I had venlafaxine XR and Therefore I took only one capsule a day. So every day I took 150+.

 

I think the dose equivalency in this table you add is about the regualr venlafaxine so you have to double the nember there. Again I think.

 

I see here in Israeli sites (I'm from Israel) that the common dose of duloxetine is 60 and the common of venlafaxine is 150-225. 

 

Also I see that max dose is 120 for duloxetine and 375 for venlafaxine. Again it shows that venlafaxine is much weaker.

 

 

[ChessieCat]

35 minutes ago, Nivsch said:

Ok it surprised me but I think I found the answer after I read here the "tips of tapering venlafaxine".

 

Please quote the information so we can assess it.  Thank you.

[Nivsch]

15 hours ago, ChessieCat said:

 

Please quote the information so we can assess it.  Thank you.

"He said if the dosage of Cymbalta is "normal" -- 30mg-40mg -- he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Cymbalta."

https://www.survivingantidepressants.org/topic/283-tips-for-tapering-off-cymbalta-duloxetine/

 

"Another doctor explained his technique to me:
For a "normal" dose of Effexor (150mg per day or more), he would switch to 10mg Prozac with a week of overlap."

https://www.survivingantidepressants.org/topic/272-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine/

 

"For example, in the UK, generic venlafaxine XL (similar to extended-release or ER) comes in 75mg, 150mg, and 225mg tablets, per this pdf"

[Altostrata]

Hello, Nivsch. I noticed this in your signature

Quote

I'm not "reducing". I'm doing a cross-taper between the drug and something else 

 

If what you want to do is switch from one antidepressant to another for therapeutic reasons, that's your doctor's job, not ours. Your doctor gets paid for this, we don't.

 

This explains why it's so frustrating working with you. What we do here is help people minimize drugs by tapering. Please come back when you're interested in tapering. Until then, we can't give you any more assistance.

[Nivsch]

1 hour ago, Altostrata said:

Hello, Nivsch. I noticed this in your signature

 

If what you want to do is switch from one antidepressant to another for therapeutic reasons, that's your doctor's job, not ours. Your doctor gets paid for this, we don't.

 

This explains why it's so frustrating working with you. What we do here is help people minimize drugs by tapering. Please come back when you're interested in tapering. Until then, we can't give you any more assistance.

 

I sent you a message now.

No no no. 

Its an attitude sentence. 

Just to show that walking, nature, sunlight, meditating etc will help to slowely replace the drug. Its metaphoric (metaphoric and real). Not about any other drug in any kind.

 

I understood your answer about the switching few days ago when you explained. I dont want to talk about any switching.

 

2. The quotes of the doctors about prozac were not meant to the prozac, but to show that according to him - 30-40 cymbalta = 150 venlafaxine and thats a response to ChessieCat that talk about withdrawal from the venlafaxine i took in the past. Not switching anything to anything.

 

[Nivsch]

I have a question about half-life.

Just from curiousity and desire to understand more 

 

I know that short half-life drugs are harder to reduce. But there is something here I still not completely understand.

 

Because, I know that Celexa for example is much easier to taper in comparison to venlafaxine or duloxetine because celexa has half life of 35h and venlafaxine and duloxetine has only 12-15h.

 

BUT - I stiil dont understand why this is SO crucial. 

 

Because - say you do a reduction only once a month. And it takes generally 4-7 days to change to fully register.

So it means that if vanlafaxine it taks maybe 4 days for the change to fully register, In celexa it will take maybe 8 days (probably I am not accurate here its only my assumption). So ok the slope it indeed higher in venlafaxine and I indeed will excpect to harder withdrawal.

 

BUT - it only 4 days every month that during them the change is realtively not comfortable in duloxetine/venlafaxine.

 

So why still I read articles over the Internet that say that venlafaxine its SO much harder to reduce and that the withdrawal can be much more difficult (than celexa) for months ahead.

 

Do not misunderstand me, I know celexa and everydrug has to be reduced safely and no more than 10% per month.

 

I just dont understand why from 20-22h of difference in the half life that affects mainly the first week every month, we get that venlafaxine is so much harder to many people to months forward after the reduction/quit, in comparison to the months after a big reduction in celexa/prozac.

 

Because again, you do only one reduction every month/couple of weeks. Yes they are delayed effects but still it doesnt explain (at least to me) this such great difference in the difficulty in both cases.

[ChessieCat]

Each person is an individual.  SA's general information is exactly that, general.  Members need to monitor their withdrawal symptoms and adjust their taper as needed.  People can be fast/average/slow metabolisers.  Different drugs work differently.  Different drugs have different half lives (Prozac has a long half life and withdrawal symptoms can take a few weeks to appear if a person is reducing too quickly).  One person might be able to reduce their drug by 20% and have no issues whereas a different person (on the same drug) might have to taper at no more than 5%.  However, a person generally does not know if they are a fast/average/slow metaboliser.  It is usually from observation that they can work this out.  If a fast metaboliser made a 20% reduction then their withdrawal symptoms might be very bad and they might notice them within a short period of time, whereas if a slow metaboliser made a 5% reduction they might hardly notice that they have made a reduction.  The 10% reduction approximately every 4 weeks is a guide only.   A starting point.

 

Please remember that your situation is not a simple case of having been on one drug for a while with no other drug/dose changes involved.  Your change from one drug to another earlier this year and then you commencing your taper only 2 months later complicates your situation.

 

We understand that you trying to work things out about the differences with the drugs, but SA is a very busy forum with lots of members needing assistance with their CURRENT situation.  Membership of the site was closed for a couple of months and SA opened up membership again earlier this month. 

 

You are now taking duloxetine and not venlafaxine.  From now on SA's assistance will only focus on your duloxetine taper.

 

PLEASE NOTE:  If you bring up irrelevant discussion of venlafaxine or other discussion not relevant to your duloxetine taper  you may be issued a warning point.

 

Edited August 28, 2020 by ChessieCat

[Nivsch]

Updose or keep the hold?

 

The situation:

 

During last year I reudeced my duloxetine (cymbalta) as shown in the signature.

July was terrible with a huge OCD seatback. Updosed back at the end of July didnt help at all, and August was the same.

 

started CBT with a very good and proactive therapist, do some tests with a naturopath and with an holistic psychiatrists - I am telling that to show I try now to adress my OCD from another directions and therefore won't do any reduce in the med in the next few months.

 

My question is, is it better now to keep the dose as it is, OR to crawl up in the dose (increase to 41 for example and wait a month)?

 

In one hand maybe I had tapered too fast relative to my OCD condition (in its current intensity) and maybe its better to meet with my body in higher dose.

 

But in the other hand more change might maybe sensitized my body more. 

 

But then again, the first half of september was still very difficult with no real improvememt. So i dont know what is the (more) right thing to do.

 

[Altostrata]

What do you mean by OCD?

 

Did you get withdrawal symptoms at any time you were tapering last fall and winter?

 

Your history shows a repeated pattern of updosing. This suggests your mode of tapering is too fast for you, and you might be getting withdrawal symptoms from it.

[Nivsch]

@Altostrata I'v been diagnosed with OCD 12 years ago and that my mental condition, The mechanic of my mental problem.

 

Yes I felt symptoms after reductions but they were not nearly as what I feel during this summer which is totally another thing that made me start the current therapy.

 

During winter the symptoms were quite menagable and I even felt improvement. But from march/april and above it started to be harder and during the last two months the anxiety is too high and untolerable. Now I feel an improvement starts (but there are still tough couple of hours during the day) and I dont know if to hold or to updose a little bit.

 

[Altostrata]

1 hour ago, Nivsch said:

Now I feel an improvement starts (but there are still tough couple of hours during the day)

 

How long has it taken for you to feel improvement?

 

If even tolerable symptoms last beyond a few days after a decrease, your body is telling you that you're tapering too fast. If you do not listen to your body, you will continue to have problems tapering. We do not have a remedy for this.

[Nivsch]

17 hours ago, Altostrata said:

How long has it taken for you to feel improvement?

 

Only starts in the last few days after 2 months. But these few days I just started to do the therapy (exposure to the fears etc) and maybe the improvement is mainly because of that, and not because of the time🤷‍♂️

 

Yes you are right and I got to the conclusion that from now on I will not accept w simptoms that are not mild and short and when I will reduce again it will be only 2%+ or less (rather than 3%+ I did in all the changes last year).

 

The only thing I am struggling to understand now is if to hold (fear of change itself) or to go up a little bit (if i have tapered too fast then maybe a change is justified) this is the dilemma.

 

[Altostrata]

If you've seen improvement, a long hold might be best, let your nervous system settle down.

 

You might give it another 2 weeks to see if improvement continues. If not, you might consider updosing then.

 

You need to get out of the habit of making your own problems with too-fast tapering and then updosing. Going up and down in dosage is stressful for your nervous system, it has to keep working hard to maintain balance.

[Nivsch]

On 9/19/2021 at 2:28 AM, Altostrata said:

You might give it another 2 weeks to see if improvement continues. If not, you might consider updosing then.

 

Ok I choose to do an updose.

What's the better way - 1 bead (~0.1mg) every three days, OR 15 beads (~1.7mg) at ones and then hold for a month?

 

What will less sensitize the system?

 

[Altostrata]

What is the symptom pattern that's causing you to updose?

[Nivsch]

12 hours ago, Altostrata said:

What is the symptom pattern that's causing you to updose?

An anxiety attack that comes surprisingly at any time of the day, every day the time is different, and lasts between 1 to 3 hours with physical/mental ocd compulsions.

During the rest of the day there are secondary anxiety attacks that are much shorter but still totally unpredictable and often difficult.

[Altostrata]

How much duloxetine are you taking now? Please update your signature.

[Nivsch]

20 hours ago, Altostrata said:

How much duloxetine are you taking now? Please update your signature.

Updated. 40.7 mg. I did as you suggested to me to wait 2 weeks. I waited, but then after those 2 weeks it was still very difficult, so I started to add only one bead every 1-3 days. After a week of doing that I just felt I am not sure if this is the best way to do it. Maybe it's better to updose 15 but then hold for at least month. I don't know what's the better way to do it.

[Altostrata]

How long have you been taking 40.7mg? How has your symptom pattern changed over that time?

[Nivsch]

1 hour ago, Altostrata said:

How long have you been taking 40.7mg? How has your symptom pattern changed over that time?

I updosed graduately from 39.5 to 40.7 over the last two weeks. 1 bead every 1-3 days. From yesterday I'm in 40.7. The pattern is similar although has become a little better.

[Altostrata]

You might want to stay at 40.7mg for a week, see how it goes. Could be enough. Let us know how you're doing.

[rubywednesday]

@Nivsch, just thought I'd pop in and say hello as I'm tapering duloxetine too.   Glad to hear you're getting help for your OCD but the anxiety sounds awful too.  I don't know if you've tried any mindfulness/meditation/gratitude practice (I've only read some of your posts) but many people swear by them.  Hope you manage to stabilise on your current dose and can eventually come off this s**t.  

 

Take care.

 

Ruby x

[Nivsch]

On 10/11/2021 at 11:44 PM, Altostrata said:

You might want to stay at 40.7mg for a week, see how it goes. Could be enough. Let us know how you're doing.

I saw your message and I did it.

But this week was very difficult with anxiety cycles of couple of hours almost every day.

[Nivsch]

On 10/12/2021 at 12:54 AM, rubywednesday said:

@Nivsch, just thought I'd pop in and say hello as I'm tapering duloxetine too.   Glad to hear you're getting help for your OCD but the anxiety sounds awful too.  I don't know if you've tried any mindfulness/meditation/gratitude practice (I've only read some of your posts) but many people swear by them.  Hope you manage to stabilise on your current dose and can eventually come off this s**t.  

 

Take care.

 

Ruby x

Hey thank you for your support! Nice to hear from you.

How are you doing with your duloxetine taper?