Jonathan93: tapering Effexor XR, mirtazapine and sertraline

[Altostrata]

You've been making drug changes frequently since October 2020. You may wish to stop making any changes and let your system settle down for a few months.

[DataGuy]

On 9/14/2022 at 4:19 AM, Jonathan93 said:

Thanks for your thoughts about this! Right now im in this deep depressed state.. I have no appetite and eating is a struggle. Just feel totally bloated. I feel agitated. It is a bit better in the evening. No clue if its withdrawal right now honestly... because September is often a season where my mental health takes a plunge.

I have to get university work done and its a struggle honestly. I have to wait this out. 🤕

 

Hope you are feeling a bit better, @Jonathan93. @Altostrata makes a good point. Although it may feel like you are going too slow now, you made pretty substantial reductions back in 2020, dropping from 150mg of effexor in March 2020 to 51mg by December 2020. I don't know if you could imagine making such a large reduction (around 66%) from your current dose in that time period. In theory, you could still be experiencing the effects of this large drop and it could be contributing to the nervous system sensitivity you feel with the current pace of reductions.

 

It may be good to take a time out from tapering for a few months, allow your nervous system to heal and stabilize and take stock of the progress you've made, while trying to enjoy school. You can consider it both a reward for your progress and an experiment you can learn from after tapering continuously for nearly 3 years. 

[Jonathan93]

Update: Im feeling depressed, but not severly. I can handle the day. Still not fun though. I did not taper since 30th August. Im doing a longer break because of your recommendation. Starting my bachelorthesis for university right now and tapering symptoms would not be a help while doing that.

 

Since my last Post on the 14th september. I had a window from 17th September to the 4th October where I felt good, then I felt okayish till about the 13th October and then my mental took a plunge. Now in a bad wave since 13 th October.

 

Not sure If the tapering still takes a role in this, but I am going to take a longer break at this to see how I function.

[Altostrata]

10 hours ago, Jonathan93 said:

I had a window from 17th September to the 4th October where I felt good, then I felt okayish till about the 13th October and then my mental took a plunge. Now in a bad wave since 13 th October.

 

These look like the usual waves and windows. When you're in a wave, please remind yourself that it will pass.

 

Are you getting regular gentle exercise? This helps the waves to resolve.

[Jonathan93]

Hey Alto thanks for the quick reply and encouragement! I did a lot of exercise, but not gently honestly, more like full on. Made me not really better, maybe even worse. I dont know. 

[ChessieCat]

Yes, it is possible to overdo the exercise.  It is better to start gently and for short period and then build up gradually until you find what works and does not make things worse.

 

exercise-do-more-do-less-do-nothing-what-worked-for-you

 

[Altostrata]

If something makes you feel worse, dial it back. Common sense.

[Jonathan93]

Struggling hard right now, im in a really dark place and really depressed. I try to do everything I can to get out this pit again… but its rough to find the energy. 

went to work saturday and sunday and I was able to do it, but It was tough. I have no appetite, only get hungry. Will do a light jog tonight and hope it increases my mood just a little bit.

[Altostrata]

Please remind yourself to surf the waves, they will pass.

[Jonathan93]

Thank you Alto, today Im feeling a bit better not good, but ok.

[Jonathan93]

Update: If im looking back on the last three months, Im doing bad... I only felt good for 2 and a half weeks in this time. Usually my mood always improved after 5-6 week tapering. But now its almost 10 weeks since last time tapering.

Im functional, but everything is like a heavy burden. I have strong fatigue and its hard enjoying stuff. Im socialising, exercising and doing all this stuff, but it just barely helping. Currently Im really discouraged, I look at all the success stories, but they all seem to be about people who took their antidepressants for anxiety and not depression. If someone has success stories about people who got off antidepressant, while having depressions. Please share.  I need encouragement right now.

[ChessieCat]

Q:  What drugs and doses are you currently taking?

[ChessieCat]

If you are currently taking Effexor, sertraline and mirtazapine then it is most like the drugs that are causing your issues.

 

All 3 of these drugs increased serotonin.

 

When I was taking 100mg Pristiq I had mild serotonin syndrome and I felt anxious, tired all the time (3-4 times a week I would sleep for 2 hours during the day and then sleep all night), I felt agitated and confused and depressed.  Once my dose got lower those issues reduced too.

 

 

[Jonathan93]

Im currently taking Effexor XR 31 mg, Sertraline 25 mg and Mirtazapine 15 mg. Additionaly I take Omega Fish oil and a mushroom complex with lions mane.

[Altostrata]

That's still quite a mix of psychotropics -- you're taking 3 antidepressants a day.

 

How long have you been consistent with your current drug schedule?

[Jonathan93]

Consistent since October 2020. Yes 3 Antidepressants, but low doses.

[Altostrata]

Those are not especially low doses, Jonathan, and in combination, they could be causing a lot of your problems. 

 

On 5/20/2022 at 2:55 PM, DataGuy said:

Hi @Altostrata,

 

Here are the results of Jonathan's interaction checker: 

 

 

[Jonathan93]

Ok, thanks Alto. I considered them low doses because they are all under therapeutic dosage except Mirtazapin.

[Jonathan93]

Still doing badly, its honestly tempting to go back on a higher dose right now, because Im only partly functional right now. Not sure If this will fix things though.

Im praying right now, to have better days. I try to accept my situation and try to work on it, sometimes it works, sometimes I still get angry and frustrated.

 

Sympoms right now: Depressive mood, mild to medium depersonalisation and derealisation, unable to concrentrate, weird sensations in my feet, especially when walking. Sometimes tinglings around my face.  Socially awkward around people.

 

 

 

Are there any Sucessstories from people who had multiple depressive episodes and are thriving without medication?

 

I just need some hope & encouragement right now.

 

 

I also started journaling, ... in order to get to the root cause of my depressed state because right now Im not sure if its withdrawal induced.

 

I had a great childhood and was raised by loving parents and still I have a history of depressive episode. But still my first depressive episode was caused by someone on the internet not liking me.. seems banal I know, so I wonder if my depressive is history is trauma related. The fact of a person not liking me set on my first depressive episode. But how can I work on trauma like this, not beeing liked. Even though my parents loved me, I can remember my mom having extremely histerical outbursts when I was a kid (when we were behaving badly) , which made me super anxious when I think back. 

 

Any book recommendations for trauma healing?

 

[DataGuy]

I will get back to you a bit later @Jonathan93. For now I think it is best you just sit tight and practice self-care. You could always try a small updose if you think it might help. Historically, you have felt this way after tapering too quickly, so I suspect that is the cause. Pushing the envelope on tapering can definitely catch up with you after awhile. I know it doesn't feel like you went fast, but fast vs ideal tapering speed is really an individualistic thing based on symptoms. It's ok. Everyone wants to get off faster than they can and we all tend to get burned when we are testing the limits.

 

As for books, I am no expert, but I read "In The Realm of Hungry Ghosts" by Gabor Mate, and that was pretty good. Maybe someone else would have better book suggestions. 

 

Hope you feel better soon 🙏

[DataGuy]

Not sure how much I have to add, @Jonathan93, but I think a good general rule is that if nothing else has changed, the symptoms are likely to be withdrawal related.

 

You should definitely be open to the possibility that there is nothing fundamentally wrong with you, other than suffering from withdrawal symptoms. Many people become depressed as adolescents or young adults, but it doesn't mean they have any fundamental flaw. It could simply be a situational vulnerability...I don't think there is much evidence for depression as a genetic trait. Can try to dig up a reference later. 

 

In the meantime, please remember you have had long periods of feeling well during tapering. Those windows will most definitely return. 

[Jonathan93]

Thank you @DataGuy! Yes I really hope it is withdrawal! Im doing already a few things to make me feel better but its not working so good, but if its withdrawal induced depression the only thing I can is practising self care and let my brain do healing.

 

A habit i really try to reduce is beeing on this forum and google everything. Dont get me wrong the forum is a great support, but a lot of times I tend to scroll through a lot of stuff on here and it does not always make me feel better, especially seeing a lot of people struggling. I better try to look at all the success stories!

 

I wish there would be something which would heal up the process, but since I have a history of 10 years of ADs this will take time..You never know, a window could just be around the corner.. for now I probably just have to accept this state. 

 

 

[Jonathan93]

Update: I had a 2 weeks window from 13th November til 28th November, where I had some really great days. Now slipping into a depressed mood again.. Dont want to taper right now honestly.. I will hold long and see how it goes.

 

I did some big lifestyle changes. I try to do lots of sports, dont consume pornography and try to stay away from social media. Right now implementing mediation after waking up and before bedtime.

 

The Mirtazapin/Remeron does not work for sleep anymore. I used to sleep through but now I wake up in the night from time to time. It pretty much lost this effect.

 

Things I do to try improve sleep. No screen time before bed. Meditating. Wearing a sleeping mask.

[Faure]

8 minutes ago, Jonathan93 said:

Update: I had a 2 weeks window from 13th November til 28th November, where I had some really great days. Now slipping into a depressed mood again.. Dont want to taper right now honestly.. I will hold long and see how it goes.

Great. You had a window now it sounds like a wave. Remember to surf it (I like this from Alto!) and that it will pass, even when it feels like it won’t). Wait till you feel WD normal for a while the you can do a little taper again. You will get there. It sounds like you’re doing lots of healthy things right now. Remember excessive anything, but especially exercise can being on a wave so keep the exercise gentle. 

[Jonathan93]

Thank you @Faure. I hope you are right that this is still the window and wave pattern, its been more then 3 months since my last reduction. Im just to scared to tapper right now honestly. 

[DataGuy]

Important to trust your instincts, @Jonathan93. If you are scared to taper, it is probably for good reason. 

 

Also important to be mindful that the waking up in the middle of the night could be a wd symptom, and may not necessarily reflect tolerance to mirtazapine. 

 

It could be very useful for you to hold for at least a couple more months to sort out exactly what is and is not a wd symptom, as well as establish the difference in quality of life you might expect from getting closer to "normal" and perhaps slowing down the taper (at least temporarily). Then you can make a more informed decision about the speed of your taper and when exactly to cut or hold. 

[Jonathan93]

Im suffering immensly. Depression is so bad right now... Im really thinking about going up my dosage. Life was much better in the 37,5 - 50 mg range... If my next window will only last 2 weeks again Im really thinking about taking a really long break from tapering and uping my dosage. Its so hard keeping up with my daily life. Winterdepression is so crushing. I am so desperate to feel better. I honestly have no clue how I can deal with this mental illness without medication. I meditate, do sports, but periods of good phases are still so rare right now. Its so hard getting work done. I have no clue right now how I am supposed to work after college like this. PLEASE tell me this is still a window.

[Jonathan93]

Ok, Im not updosing. First Im gonna try alternative options.

[Jonathan93]

Changes Im going to do:

 

going to get up everyday at the same time. Building structeres and routines for the day.

 

Taking medication everyday at 08:00 am. 

 

Try to journal everyday

 

Writing gratitude journal everyday 

Edited December 8, 2022 by Jonathan93

[Faure]

Quote

On 12/6/2022 at 11:14 AM, Jonathan93 said:

I honestly have no clue how I can deal with this mental illness without medication.

 

Hi Jonathan, what you are most likely experiencing is not mental illness but withdrawal symptoms that look exactly like mental illness. This is why doctors love to “treat” it with more medication. Because they don’t understand about withdrawal. If you can hold on, keeping your dose steady things will likely gradually improve for you. 
 

Effexor is a difficult drug to get off so holding on the taper till you feel more stable is probably a good idea. Your ideas for things to change - routine, meds at the same time each day, structure will probably help you.  Also a small amount of gentle exercise (nothing vigorous as it can make things worse because your central nervous system gets more stress).  Do consider some breathing or meditation, just a few minutes a day to start May also help you. I read that deep breathing is like a bit of Valium for the brain and the more you do it the more benefits you’ll get. I know that when people are severely depressed this is very hard to do so it may not work for you at the moment. 
 

Hang on in there and let us know how you are. Well done with your ideas to improve things for yourself - this is a really positive step. 

[DataGuy]

On 12/6/2022 at 6:14 AM, Jonathan93 said:

Im suffering immensly. Depression is so bad right now... Im really thinking about going up my dosage. Life was much better in the 37,5 - 50 mg range... If my next window will only last 2 weeks again Im really thinking about taking a really long break from tapering and uping my dosage. Its so hard keeping up with my daily life. Winterdepression is so crushing. I am so desperate to feel better. I honestly have no clue how I can deal with this mental illness without medication. I meditate, do sports, but periods of good phases are still so rare right now. Its so hard getting work done. I have no clue right now how I am supposed to work after college like this. PLEASE tell me this is still a window.

 

I don't see any problem with updosing a bit to see if it helps you, Jonathan. The main goal throughout the taper is stability, not necessarily speed, or avoiding going backwards. By tapering slower to maintain stability, it may paradoxically result in the entire taper being over more quickly, not to mention being much less unpleasant. I honestly don't think there is any benefit to be had from suffering through excessively unpleasant symptoms if it can be avoided. 

 

It sounds like you are doing plenty to help yourself outside of tapering properly, @Jonathan93. You're a model citizen when it comes to proper self-care. Keep up the good work 👍

[Jonathan93]

Thank you @Faure and @DataGuy for the kind words.

 

Interestings thoughts @Faure, I hope you are right that Im still in a wave. But even though it would be my mental illness I have no interest in taking Antidepressants till im 90 years old.

 

I think there might me people who have predispositions for "mental illnesses", but even then maybe this "mental illness" is a a cause of unresolved trauma and that there are certain things in your life just not going as you want to. I think purpose in life, having a social support system and having passion for things in life is a better antidot for depression then Medication usually. I think there are cases, when you tried everything else besides medication and your are not getting better and ending your life would be the alternative, yes i am pro medication.

 

Although I think  Medication can save lifes, it also can destroy lifes. If there is no option left, ADs should be the absolute last resort.

 

My situation is problematic since ive taken Ads for more then 10 years, it will take a long time to feel normal again. But hopefully Im on the right path even though im struggling right now.

 

Today is a "good" day in terms of withdrawal. Feel ok, not suffering. Holding on my dose at least for 1-2 more months.

 

 

[Faure]

I’m glad today is a better day for you. Did you know there is now research showing that people using antidepressants in the long term actually have worse outcomes? You might be interested in reading Joanna Moncrieff’s latest book, she’s a psychiatrist in the UK. Mad in America also has some useful information if you haven’t come across it before.  
 

I can speak from personal experience about trauma and mental health problems. I’ve had many mental health problems over the years, which after about 15 years of looking for what the problem was, I finally found a psychotherapist who was able to help me. My life has been so much better since then. So if there is trauma in your past, or even if you don’t think there is - you may not even know about it, (I didn’t), then a good therapist will help you start to deal with it. I also think some of my more recent problems have come from going on and off antidepressants too quickly. I’m doing a very slow taper off mirtazepine and it’s going incredibly well. After several months of tapering I found that my ups and downs were much reduced and I was more emotionally stable! Quite bizarre when you consider what antidepressants are supposed to do.

 

You are on the path to recovery. Your brain has a lot of recovering to do with three ADs but if you keep it slow and listen to your body you will get free of these drugs. 

 

 

[Jonathan93]

Hello @Faure, Ive heard a lot about studies that you will worsen long term on Antidepressants. The only study I've found so far were the ones from Giovanni A. Fava. If you have different studies on long term use, Im happy to hear.

 

The only problem with these studies is that people are doing mentally worse will more likely to take Antidepressant. So maybe these studies are a bit biased? I wonder what your take is on this.

 

I have a psychotherapist and I was improving a lot. But honestly I have the feeling I had more longer windows last year then this year. But of course Im getting now into a really sensitive area of striatal 5-HTT Occupancy in terms of effexor. I hope this explains my long waves I am experiencing the last months. 

[Jonathan93]

Doing pretty good, will update soon.

[Jonathan93]

So over all im doing much better. I had a pretty bad down in december in the beginning of december, but the wave did just last a week. Since mid december I consider myself pretty stable. After my last tapering at end of August/ beginning of September it took a pretty long time till I would be stable again and windows and waves were pretty frequent. After a few months it finally seems to stabilize and windows seem to get longer. I will hold for stabilization now til about february and if I feel stable enough I will continue my journey after a pretty long break from tapering.