jr1985: Effexor / venlafaxine taper

[jr1985]

The insomnia and face numbness went away. I haven't had any suicidal episodes. But my head feels foggier and I have akathisia in the morning, yet it seems to get better as the day progresses. I think it got worse after I updosed but I'm not 100%. I noticed I've had a short temper after updosing, I've been getting angry over little things.

[Altostrata]

What time of day do you take the Effexor?

[jr1985]

I take it at 7pm. It used to make me drowsy, so I took it at that time so the drowsiness would kick in for bed time, and hopefully not linger until morning.

[Altostrata]

Sounds like it's the Effexor XR.

 

Have you tried reducing by one bead every few days? If it goes well, 2 beads every few days, etc. -- a microtaper.

[jr1985]

Sounds like it's the Effexor XR.

 

Have you tried reducing by one bead every few days? If it goes well, 2 beads every few days, etc. -- a microtaper.

 

I could try that, but I'm having to weigh the beads to get 37.5mg, as I'm prescribed 75mg. I wonder if the scales are accurate enough so each capsule has the same number of beads? I'll have to weigh out 37.5mg, then remove one bead from that.

 

I worked out I was removing about 6-7 beads for a 5% drop, so removing one would be much safer.

 

When would I stop to hold, and for how long?

[jr1985]

Oh dear, I just discovered that the Effexor brand my doctor is switching me to only has 6 beads in a 75mg tablet! I just hope they're willing to keep giving me the current brand, because there's no way you can taper with only 6 beads...

[Altostrata]

That is a serious problem. Did you tell him you were tapering?

 

As far as I know, each Effexor XR capsule (the kind with a lot of beads) has a slightly different number of beads. The number of beads varies from manufacturer to manufacturer and from dosage to dosage. The number of beads in a 37.5mg capsule is not half the number in a 75mg capsule, even from the same manufacturer.

[jr1985]

No,I haven't told them I'm tapering.

 

Lord knows what dose I'm on. The beads in 75mg weighed 180mg, so I've been taking 90mg.

[Altostrata]

I think we can call that 37.5mg of Effexor XR.

 

Will there be a problem telling your doctor you're tapering and will need to keep the same brand of capsules?

[jr1985]

Well I don't mind telling them, it's whether they will listen or not. I've no Idea if they'll believe me that I need to taper so slowly. I'll call them tomorrow and see how it goes.

[jr1985]

Good news, I called my GP and he changed it back to the old brand. Phew.

 

Alto, do you think I should start removing beads on Monday, or hold even longer?

[Altostrata]

I don't know, jr. How are you feeling? Listen to your body.

[jr1985]

i feel ok, so Monday it is.

 

How should I got about the micro taper? Just remove a bead every few days, until I feel w/d, then hold?

[Altostrata]

Remove 1 bead and see how you feel. If no danger signs after a few days, remove 2 beads for a few days.

 

If you feel withdrawal symptoms, you've gone too far, you'll have to hold or back up.

 

You're pretty sensitive, listen to your body.

[jr1985]

Ok, I'm pretty sure chocolate and sugar make me feel worse. I ate a load of sugar yesterday and the physical symptoms I've been having got worse. Something similar happened before when I pigged out on chocolate and ice cream and became suicidal afterwards.

 

I have such a sweet tooth, I believe I'm what Kathleen Desmaisons calls "sugar sensitive". IOW, I'm a sugar addict. In her book, "Potatoes Not Prozac", she details 7 Steps to getting off sugar, such as eating a high protein breakfast, keeping food journal, etc. She does spout the old chemical imbalance myth, however, her advice for quitting sugar seems sound.

 

So far I've been stuck on stage 1 - eat high protein breakfast. You have to master each staff before moving onto the next. I think it's time to step up my game and get off sugar for good.

 

PS. I removed a bead yesterday. So far I haven't noticed anything. My symptoms flared up but thus happened before I made the drop, hence it's probably the sugar.

[jr1985]

After cutting down on sugar for past few days my nerve burning/tingling seems to have improved a lot. Might just be a coincidence, time will tell I'm sure.

 

As for Effexor, I've felt ok over past few days but today I feel quite fatigued. Dunno if it's w/d or because I've been working more hours in work, or maybe even sugar/chocolate w/d.

 

I was going to remove another bead tomorrow. I guess if my fatigue gets worse I'll know it's Effexor w/d.

[jr1985]

Ok, I've pretty much decided I'm going to try the Prozac bridge.

 

Dropping even a single bead seems to cause w/d symptoms with Effexor, and spending 5+ years tapering sounds like a nightmare. If I continue tapering Effexor, I know I will always wonder if Prozac would have been easier/faster. So to eliminate any "what if's", I'm going to go ahead and try it. It seems to be successful for a lot on here, and if it's a disaster I can always go back to Effexor.

 

On a positive note, my akathisia/nerve tingling seems to have improved a lot since cutting out sugar.

 

I was going to try:

 

Day 1+2: 1mg Prozac + 37.5mg Effexor

Day 3-6: 2.5mg Prozac + 28.1mg Effexor

Day 7-10: 5mg Prozac + 18.75mg Effexor

Day 11: 5mg Prozac + 0mg Effexor

 

Then increase to 7.5mg/10mg Prozac if w/d symptoms present and if I can tolerate it.

[Altostrata]

If I were you, I'd stay at 5mg Prozac + 18.75mg Effexor for at least a week, to let the Prozac ramp up, then slide off Effexor in 2 steps.

[jr1985]

I'll try that alto, thanks.

 

Is it true that prozacs long half life means it builds up more in the blood stream, moreso than other AD's? So there's a good chance 5 mg could cover 37.5mg Effexor?

 

How about -

 

Day 1: 1mg with 37.5mg (just to see how it affects me)

Day 2: 2.5mg with 37.5mg

Day 3- 9: 5mg with 18.75mg

Day 10-14: 5mg with 9mg

Day 15: 5mg with 0mg Effexor

 

I'm trying to follow the "don't take them together for longer than 2 weeks" rule.

[Altostrata]

5mg Prozac could cover 37.5mg Effexor, but it's not because of it's half life, it's because of its relative dosage strength.

[jr1985]

I forgot to take my Effexor at my usual time (7pm) yesterday and didn't take it until after 10pm. I then had insomnia and now my akathisia has flared up. Could those 3 hours really make this much difference?

 

The last time this happened my face went numb and I had insomnia.

[Skyler]

I forgot to take my Effexor at my usual time (7pm) yesterday and didn't take it until after 10pm. I then had insomnia and now my akathisia has flared up. Could those 3 hours really make this much difference?

 

The last time this happened my face went numb and I had insomnia.

 

Hi jr.. absolutely. For sure. I changed my dosing to QID and about 30 mins before the dose is due I can hear an uptick in my tinnitus. This happens fairly often, and when I forget to take it on time by an hour or so there is a further and definite deterioration.

[jr1985]

/sigh I wish this wasn't so complicated. I have no idea if the akathisia flare up is due to late dose, removing a bead a few days ago or stabilising on current dose... If I had answers this wouldn't feel so bad. Ofc, I know no one can answer this for me.

 

The thing I fear the most is that I end up like some people I've come across online - one guy had constant akathisia after he quit effexor too quickly and killed himself. Another lady never felt tired and had to use drugs to knock herself out after quitting Effexor, she was in a really bad way and has't been heard of in months. Then ofc, Dr Shipko says some people can never get off these drugs...

[Skyler]

/sigh I wish this wasn't so complicated. I have no idea if the akathisia flare up is due to late dose, removing a bead a few days ago or stabilising on current dose... If I had answers this wouldn't feel so bad. Ofc, I know no one can answer this for me.

 

Just know late dosing causes symptoms that make you feel worse. Maybe anxiety is causing you to overthink here? Why does it matter if one bead more or less is at play, you committed to the reduction so need to ride it out in any case.. and how would knowing this make the akathisia go away (make you feel better).

[jr1985]

 

/sigh I wish this wasn't so complicated. I have no idea if the akathisia flare up is due to late dose, removing a bead a few days ago or stabilising on current dose... If I had answers this wouldn't feel so bad. Ofc, I know no one can answer this for me.

 

Just know late dosing causes symptoms that make you feel worse. Maybe anxiety is causing you to overthink here? Why does it matter if one bead more or less is at play, you committed to the reduction so need to ride it out in any case.. and how would knowing this make the akathisia go away (make you feel better).

 

It probably is anxiety, but I think if I knew what was causing the akathisia it would make me less anxious, because it makes it easier to know how to proceed, i.e. if it's w/d then I just need to ride it out, or if it's side effect then I can make another drop and get some relief.

[Skyler]

It probably is anxiety, but I think if I knew what was causing the akathisia it would make me less anxious, because it makes it easier to know how to proceed, i.e. if it's w/d then I just need to ride it out, or if it's side effect then I can make another drop and get some relief.

 

How about deciding ahead how long to hold, especially given you are prone to up and down dosing. Take that part entirely out of the equation, say hold for a month (or whatever you work out with Alto) and go strictly according to this. Going by the way you feel on any given day(s) seems to have caused probs, and maybe you are doing the same again? So in this case, the anxiety is causing symptoms, not the result of same.

[jr1985]

Yes, I'll ty that Shulyer. Thanks for your support.

 

I was all for switching to Prozac last night but after the insomnia/akathisia I'm afraid it might make things worse.

[Altostrata]

You'll have to see if getting back on schedule for a few days helps. Or, you might just put that bead back in, if you're going to be switching anyway.

 

jr, I would feel so much better if you would please send a note to Ireland MindFreedom and see if they can recommend a doctor to keep an eye on you. I don't think their concern stops at the border.

[jr1985]

I'll stay on minus one bead until I feel ok, I think my brain has had enough updosing.

 

I have sent a message to MindFreedom Ireland, hopefully they will be able to recommend someone. :-)

[jr1985]

I've been thinking... the whole reason I'm trying to hurry up and get off Effexor is because I want my cognitive facilities back for when I have to sit my exams, so I don't get super-stressed out again. But it's become increasingly obvious that what I want and what my brain wants aren't necessarily the same thing. My brain has suffered a huge trauma from all the fast taper/med switching I did last year, plus stimulants in the mix probably didn't help things. I've also made matters worse by constantly changing the dose up and down, rather than just staying put. I mean, after all the switches, I only waited for 3 weeks before removing a bead again!

 

So... from now on I'm going to try and listen to what my brain wants - stability. I've already committed to removing one bead, so I'm going to sit here for a good while and take notice of how my symptoms change.

 

As for my "cognitive facilties", well I've noticed since being on 37.5mg that it's become much easier to talk to people in work because my head doesn't feel just as full of cotton wool as it used to. I've also noticed that every time I drop the dose I feel worse for a good while, so trying to rush things only makes it worse in the long run.

 

While I'm waiting I think there are things I can do to help improve my symptoms, including the cognitive ones -

 

1) Building a stable morning/evening routine - I never go to bed or wake up at the same time.

2) Start using my blackout blind more - I only used it a couple of times and then got fed up putting it up

3) Improving diet - I've managed to cut down on sugar but perhaps there's more I could do. I need to keep a food journal

4) Exercise - I try to walk my dog for at least 30 mins per day, but it doesn't always happen, maybe I could do more?

5) Meditation - Again, I try to do this every day but it doesn't always happen or I only do it for 10 mins or so.

6) CBT - I started using TEA Forms but gave up after a while. I should restart this.

[Altostrata]

That sounds like an excellent plan, jr.

[jr1985]

My alerting system has gone a bit crazy again and is jolting me awake as I drift off to sleep. This is exactly what happened the last time I took a dose 3 hours late. It lasted for about a week.

[Skyler]

My alerting system has gone a bit crazy again and is jolting me awake as I drift off to sleep. This is exactly what happened the last time I took a dose 3 hours late. It lasted for about a week.

 

I used to have what are referred to as hipnic jerks that woke me up as I drifted off, these were from an AD. They get worse thru neuroplasticity and you really need to avoid triggering them off. Try very hard to remember to take the meds on time, maybe set up some sort of reminder system. I ended up being put on a benzo for them, which is what I'm tapering off now. Ugh. This whole scene is criminal.

[Brandy]

This will sound trite, but it might be helpful.

 

I'm slowly transitioning from sid to bid dosing on my clonazepam (not tapering), so of course kept forgetting when to take my new second dose (a little later each day or so) at first.

 

So I've been setting a kitchen timer when home, and when I'm going to be out late, like last night, setting the countdown timer on my cell, to remind myself when to take that second dose.

 

(A tip - if you're like me and get really engrossed in things and turn off the timer to finish what you're doing... don't do it! I did that at first and realized hours later I was still engrossed in what I was going to finish doing and forgot all about taking the pill. That's consistent with my personality lol. Being stricter with myself to just get up, take that darn pill, and then go back to what I was doing.)

[Skyler]

This will sound trite, but it might be helpful.

 

I'm slowly transitioning from sid to bid dosing on my clonazepam (not tapering), so of course kept forgetting when to take my new second dose (a little later each day or so) at first.

 

So I've been setting a kitchen timer when home, and when I'm going to be out late, like last night, setting the countdown timer on my cell, to remind myself when to take that second dose.

 

I set my alarm clock, but then I'm always home for the late nite dose. jr, you only dose once a day.. can you do something foolproof like an alarm? Like Brandy, I'd be hopeless without my reminders. I'm QID and it's a constant challenge.

 

Doesn't sound silly to me.

[jr1985]

I use my phone to remind me. Usually I just remember anyway, but this time I was working from 6pm-10pm and I take my dose at 7pm. Of course, I remembered as soon as I arrived that I forgot to bring the pill with me. In future I should set a reminder to bring Effexor with me, or if I do forget I can get my dad to bring it to me, I only work 5 minutes away. :-)