Jonathan93: tapering Effexor XR, mirtazapine and sertraline

[DataGuy]

Glad you are feeling better again @Jonathan93. That sounds like a great plan. Hope things keep heading in the right direction 👍

[Jonathan93]

Last taper was on the 6th February just 0,26 mg... everything was going pretty good since mid december. I was feeling just a bit off but nothing  dramatic, last wednesday I plunged into a dark hole. This is frustrating. I am not going to taper like this. I hope it does not last long. Not sure if its a wave or a depressive episode.

 

 

[Jonathan93]

Im honestly thinking about stopping tapering for a longer time. I am scared of withdrawal symptoms because there is so much going on in my life. I have a bachelor thesis right in front of me, I met a woman I like and it seems to become a relationship.

 

Im afraid of tapering because I dont want to risk all this.. what should I do ?? My tapering in one year was just barely 3 mg. On the one hand Id like to taper, on the other hand Im afraid of losing people in my life and failing college and so on.

 

Im confused.. could just 0,26 mg make such a difference or is it just my pschy? (Its not even 1% of my dose, its more like 0,8 % ish )

[DataGuy]

5 hours ago, Jonathan93 said:

Im honestly thinking about stopping tapering for a longer time. I am scared of withdrawal symptoms because there is so much going on in my life. I have a bachelor thesis right in front of me, I met a woman I like and it seems to become a relationship.

 

Im afraid of tapering because I dont want to risk all this.. what should I do ??

 

Hi @Jonathan93,

 

I think I have been saying for a long time now to go slow. There is a repeated pattern of tapering and then experiencing some pretty disabling depression and other symptoms that I think strongly suggests it is withdrawal related. It is often difficult for people to slow themselves down once they decide they want off, but now I think you now have a very good reason to take a long pause. Seems your body and brain are telling you to take a rest, anyway. 

 

Hopefully with that time, your nervous system can consolidate and adjust to the changes you have made in the last few years. Then, when you are feeling stronger and more stable again, you can begin a slow taper, perhaps even slower than the current pace, at least to start. 

 

Does that make sense? I strongly agree with you that taking a long break right now is a good idea. It may even make it easier to taper faster in the future. We'll have to see. 

[Jonathan93]

Thank you so much @DataGuy for always supporting me! It means a lot 🙏. Today is one of the hardest days since long. Depression is crushing. Due to the fact that I have a cold since 1 1/2 weeks, i cant do any exercise. Just doing some walks. 
 

Yes I need to take it slow, I tapered once even though I was slightly depressed and the next 2 months were hell. I think tapering effexor is one the hardest drugs to get off. 
 

Maybe Im now at a point where 0,26 mg is just to much to handle. I dont know,

 

I wish I could taper Effexor in even smaller steps. But then I would have to switch to Immediate Release. I m not sure, how I would make the transition without my nervous system going berserk. 

[DataGuy]

1 hour ago, Jonathan93 said:

Thank you so much @DataGuy for always supporting me! It means a lot 🙏. Today is one of the hardest days since long. Depression is crushing. Due to the fact that I have a cold since 1 1/2 weeks, i cant do any exercise. Just doing some walks. 

You're welcome @Jonathan93 : ). Hang in there. It is always ok to updose if you need to. 

 

1 hour ago, Jonathan93 said:

Yes I need to take it slow, I tapered once even though I was slightly depressed and the next 2 months were hell. I think tapering effexor is one the hardest drugs to get off. 

Yes, Effexor is a famously difficult drug to taper. The SNRIs are all pretty difficult. 

 

1 hour ago, Jonathan93 said:

I wish I could taper Effexor in even smaller steps. But then I would have to switch to Immediate Release. I m not sure, how I would make the transition without my nervous system going berserk. 

It might be worth it to get some immediate release Effexor and just use the small amount you need to make the cut you want, and take the majority of the drug in the extended release version. It would give you a bit more control over the cuts and the subsequent symptoms and could relieve some of the trepidation about tapering. You don't want to be constantly worried about getting hit with symptoms because you had to cut a larger amount than you were comfortable with. Hopefully your doctor is ok with that. I think he has been pretty cooperative. 

[Jonathan93]

Thank you ! I have my quarterly Meet up with my psychiatrist tomorrow. I will tell him this time i want to get rid of effexor really badly. Hopefully he supports me, otherwise I have to change my psychiatrist. I told him about my tapering the last times, he was ok with it .. but he does not support me beyond the 37,5 mg.. lets see how it will turn out.

[DataGuy]

He should certainly support you getting rid of at least one or two of these drugs. If you plug them into the drug interaction checker at drugs.com, it comes back with three potentially major interactions. Taking effexor and sertraline together increases the risk of serotonin syndrome, as does taking sertraline and mirtazapine, and ditto with mirtazapine with effexor. It is not a combination of drugs that has any evidence for safety or efficacy, as far as I know. Here is the drug interaction checker if you want to provide evidence of that. https://www.drugs.com/interactions-check.php?drug_list=2296-1524,1640-0,2057-0

 

You can also note that there is no randomized evidence for long term use for any of these drugs beyond a few months, so even he cannot say with any certainty whether taking them long term would make you better or worse off. Here is an article by Mark Horowitz supporting that claim: 

 https://dtb.bmj.com/content/60/1/7.long

"Much of the evidence of their efficacy comes from short-term placebo-controlled trials which tend not to include outcomes that are of greatest relevance to patients, such as social functioning or quality of life, but rather restrict outcomes narrowly to symptom measures. On such measures these studies do not demonstrate clinically significant differences from placebo for depression. A range of adverse effects are also recognised, often greater in naturalistic studies of long-term antidepressants users than those measured in short-term efficacy studies, including emotional numbing, sexual difficulties, fatigue and weight gain." 

 

Long term use can potentially lead to tardive dysphoria and other conditions and the effect on health is essentially unknown. https://www.breggin.com/admin/fm/source/6905_breggin/antidepressant-drugs-resources/El-Mallak-2011-chronic-depression-dysphoria-caused-by-antidepressants.pdf

 

I hope that is enough ammunition for you, @Jonathan93 : )

Edited March 8, 2023 by DataGuy

[Jonathan93]

Its to hard… I updosed 1 mg today.

[RachelSusan]

@Jonathan93 It sounds like you are in a difficult situation.  I hope the small up-dose helps you.

[Jonathan93]

Yes Im am! Thank you for looking by, I added 1 mg this afternoon. I will probably increase my morning capsules tomorrow at least a 0,5 mg.

 

I am scared. I feel so detached.

 

[Jonathan93]

I will slowly increase to 37,5 mg in the 5 to 6 weeks. I will stay there for longer. Just need stablility in my life. Im tired of tapering Effexor XR. Then I will decide my next move after I feel stable. Today I will take 32mg for this week. Next 33 mg and so on, till i am at 37,5 mg again. Then I will rest.

 

Probably will decide to taper another medication maybe remeron to 7,5 mg or sertralin to zero so at least I can get of the polypharmacy at the moment.

 

 

[DataGuy]

That sounds like a good plan, @Jonathan93. Please let us know how it goes. 

[DataGuy]

How have things been going, @Jonathan93? Have you increased as much as planned? How do you feel?

[Jonathan93]

Hello @DataGuy thanks for checking by. I was psychological in a really good state from the 1st april to the 17 th april. But I have to to pause remeron for a week due taking a terbinafin for each day for seven days. Since not taking my remeron since Monday I feel pretty bad,  but I want to get rid of this stupid nail fungus. I already have it since 4-6 years... Just a few more days and I can take my remeron again.

[DataGuy]

I'm glad you were doing well before stopping the Remeron, @Jonathan93. What doctor told you to stop the Remeron while taking the Terbinafine? The only interaction I see between those two drugs is that Terbinafine may increase the blood levels of Remeron (substantially in some cases). You can see the drug interaction checker here: https://www.drugs.com/interactions-check.php?drug_list=1640-1015,2161-0&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication&professional=1

 

I'm guessing you are taking it by mouth and not simply using it topically? 

 

Thanks for the update, Jonathan. If you are not doing too badly symptom-wise from this cold turkey of Remeron, it might be worth tapering that one first if you want to see if you can make a bit more progress on things. Hope you get rid of that fungus and finish the course of medication safe and sound 🙏

[Jonathan93]

Hello again, I decided to up my dose to 50 mg Effexor.. I will stick to this decision for now and plan to stabilize on this dose for longer. When Im feeling good/ functional again I will taper sertraline and probably remeron after this. Will stay on Effexor 50 mg for now.

[Jonathan93]

Days since my last postings are really mixed. I had some good days, I had some okay days and I had some days were depression and anhedonia was really crushing. Right now Im having some bad days.

[DataGuy]

Sorry to hear, @Jonathan93. Did updosing the Effexor improve things at all? Have you been keeping a symptoms journal since then?

[Jonathan93]

@DataGuy I dont have a symptomjournal but a mood journal. 

 

Hey its me again, Im not tapering anything right now. Im still at 50 mg. Will not think about tapering anything about a long time. At this point I honestly can not think about getting rid of antidepressants any time in the future. 
 

I had a lots of severe depression the last 11 years, Im honestly not sure if getting rid of antidepressants will solve this or maybe make it even worse. Please respect that I dont want to start a discussion right now. This is a personal choice. 
I had a pretty rough time the last few months. 

 

My goal right now is to stay on antidepressants. I still want to get rid of at least one medication because taking 3 medications cannot be healthy.