CharlieBrown13: Reducing venlafaxine and escitalopram

[CharlieBrown13]

Hello everybody 😊, this is my first post!

 

I didn’t know how to add a signature, can somebody please help me?

 

I‘m from Germany, so please excuse my mistakes.

In 2020, I had increasing back pain, worse than I had ever before. I think it was a burnout due to a severe illness of my mother and my workload (I‘m a MD in a hospital). It resulted in surgery in July (my first mistake). Unfortunately, the pain didn’t get better, I developed a very severe depression. Like frozen inside, no emotions at all, I was like a zombie.

I was in hospital for nearly 6 months. For a long time, I refused to take AD, but in Jan2021 I started with escitalopram 5mg, because I felt I had nothing left to lose.

My psychiatrist increased the dosage in March to 40 mg and added venlafaxine  150 mg. I tried very hard for a few weeks, but the side effects were intolerable so I reduced both AD, in retrospective much too fast. My second fault, but at that time, I didn’t know better.

Now I take 50 mg venlafaxine (since 29.6) and 25,5 mg escitalopram and had/have severe withdrawal effects (anxiety, brain fog, brain zaps, joint pain, fatigue, sweating, headache, vertigo etc) so I started increasing escitaloprame  again. 20.9. 25,3 mg, 30.9. 25,5 mg. Sweating and headache is better, anxiety unfortunately increasing, the rest is the same. It’s horrible, but who am I telling this…

And now I don’t know how’s the best way to continue… Should I increase the dose further? If so, how soon?

I can no longer differentiate between what is still depression, what are side effects and what is withdrawal 😟

 

Thank you in advance for every answer!

 

Edited October 9, 2021 by CharlieBrown13
unbolded

[Altostrata]

Welcome, @CharlieBrown13

 

I am sorry you're going through this.

 

Taking escitalopram with venlafaxine is not recommended, as the combination can cause excessive serotonergicity (serotonin toxicity). What times of day do you take each of your drugs, with their dosages? When are your symptoms at their worst?

 

Are you taking any other drugs? Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

Unfortunately, your post-surgery anhedonia might have been from the drugs used in surgery or afterward, and may have cleared up over months when you were off the drugs. If you were taking painkillers, it is a common adverse effect.

 

Your signature looks fine, thank you.

[CharlieBrown13]

Dear @Altostrata

 

thank you for your reply!

 

I now know that the combination of escitalopram and venlafaxine is not recommended, but my psychiatrist sees it differently.  She's a fan of the more the merrier.  At the time last year after 6 month of severe depression with anhedonia, not able to think clearly or function in any way (my family had to do everything for me), I was so desperate that I took it the prescribed way, even though I asked several times about side effects and interactions.  The dose was increased very quickly from 5 to 40 (!) mg escitalopram and from no venlafaxine to 150 mg.  The side effects were so bad that after three weeks I was a trembling and sweating wreck with permanent nausea, headaches, muscle twitching, etc.
That was also the reason why I started reducing again so quickly.  However, after a few weeks it at least helped me with the depression, even if I never felt well to this day.  Unfortunately, I reduced both drugs at the same time, stupid of me.  

Currently I take 50 mg venlafaxine at 8:00 am and 25.5 mg escitalopram at 8:15 am.  Due to the increasingly severe withdrawal symptoms in the last two months, I increased escitalopram by 0.3 mg three weeks ago and again by 0.2 mg 10 days ago (my psychiatrist wanted me to take 150 mg venlafaxine again and additionaly olanzapin + escitalopram, but I refused).

I got a lot of side effects from the beginning phase again since the dose increase (muscle pain - and weakness, joint pain, headaches, nausea, diarrhea, anxiety) but not as severe as at the beginning.  I am currently taking venlafaxine 50 mg, since June 29th. not changed.  
Withdrawal symptoms are strongest in the morning when I wake up and then subside by the afternoon, with the current side effects (particularly muscle and joint pain, nausea, headache and anxiety) remaining throughout the day.  
The back operation was in July 2020, the anhedonia started on October 24th, 2020 after an MRI with the administration of gadolinium-containing contrast media, although nobody believes me, at least none of the doctors I tried to talk to about it.  I also had amnesia for several hours afterwards. I surely was depressed before the MRI due to the intense back pain over several months, but I had emotions. Afterwards-none.

The sweating, the increasing listlessness and the great hopelessness have now improved since the minimal increase in the dose of escitalopram, but overall I feel really bad.  Sometimes I think I'm going crazy, my head doesn’t function like it should…

Should I keep this dose of escitalopram now and wait until hopefully another positive effect occurs?  I will not change venlafaxine in the near future, although I really hate to take this stuff. 

I think my nervous system is very upset, it has to calm down now hopefully someday.  The only other medication I take is metoprolol 23.75 mg twice a day.

Thanks to everyone for reading this and maybe even answering me. I appreciate that very much.

I am so glad I found this forum.

[Altostrata]

On 10/11/2021 at 10:29 PM, CharlieBrown13 said:

The side effects were so bad that after three weeks I was a trembling and sweating wreck with permanent nausea, headaches, muscle twitching, etc.

 

This is serotonin syndrome or near to it, which is exactly why combining these drugs is not recommended. Warnings are prominent. You have grounds for formal complaint against this doctor.

 

On 10/11/2021 at 10:29 PM, CharlieBrown13 said:

Currently I take 50 mg venlafaxine at 8:00 am and 25.5 mg escitalopram at 8:15 am.  Due to the increasingly severe withdrawal symptoms in the last two months....

 

Why are you taking these drugs at the same time? 

 

What are the withdrawal symptoms, what was the drug change or other change that preceded their appearance?

[CharlieBrown13]

@Altostrata

thanks a lot for your reply!

54 minutes ago, Altostrata said:

This is serotonin syndrome or near to it, which is exactly why combining these drugs is not recommended. Warnings are prominent. You have grounds for formal complaint against this doctor.

At the beginning of therapy I was in a state where I could no longer make good decisions.  It is obviously not uncommon for psychiatrists here in Germany to combine several antidepressants in high doses. My psychiatrist said that this is the quickest way to achieve success with such a severe depression.  I have mentioned this again and again in the last few months, but she doesn't want to hear anything about it ...

1 hour ago, Altostrata said:

Why are you taking these drugs at the same time? 

That was how it was prescribed, she told me to take both AD in the morning. I didn’t question it. Should I change this? Take one of the ADs in the afternoon?

 

1 hour ago, Altostrata said:

What are the withdrawal symptoms, what was the drug change or other change that preceded their appearance?

I stopped reducing venlafaxin at 20 Jun at a dose of 50 mg (max. dose in April 150 mg) and escitaloprame at 29 Jun. at a dose of 25 mg (max dose in April 40 mg)
I know now it was very stupid to reduce both drugs at the same time, but I actually didn't know any better and I was feeling so so bad with the high doses.

In June, I felt relatively ok, not very good, but I could do more things like photography or meeting friends. I’m currently still on sick leave.
A month later, end of July, I felt more and more lethargic, tired, began to sweat profusely again, had headaches, increasing nausea, brain zaps and brain fog. I therefore tried on Jul 28 a dose increase to escitalopram 27.5 mg, but the side effects were so severe that after 6 days I reduced it again to 25 mg. The next weeks were horrible, then after three weeks it got a little better.  

However, a new deep hopelessness occurred, especially in the morning hours, and I became more and more depressed with partly suicidal thoughts.  Although I think life is actually very nice (or could be without this…) and I have no plans at all to do so.  
So I decided again to carefully increase the dose at Sep 20 by 0.3 mg escitalopram to 25.3, and at 30.Sep to 25.5 mg.

The brain fog, the tiredness and the depressive symptoms got significantly better, but the side effects that I had initially with escitalopram came back, just not quite as strong (muscle and joint pain, headache, diarrhea, tachycardia, tremor, muscle twitching),  it's getting a little better now after three weeks.  What is new is tinnitus and, most of all, strong feelings of anxiety that I never had before.  
I think the whole thing is a mixture of the withdrawal symptoms and side effects of escitalopram.  

Now my question is, should I stick to the current dose?  

There was so much back and forth with the dosages and I made some very wrong decisions in the last few months, there shouldn't be any more ...

 

And I would like to thank you for the great help here and for establishing the forum in general (today I have read the very interesting interview with Amy Biancolly) it’s so good to read you’re not alone in this and somebody is believing you. Not many people did in the last year.

[Altostrata]

You're welcome.

 

2 hours ago, CharlieBrown13 said:

I have mentioned this again and again in the last few months, but she doesn't want to hear anything about it ...

 

You don't have to get her to agree she was remiss in your care.

 

2 hours ago, CharlieBrown13 said:

However, a new deep hopelessness occurred, especially in the morning hours, and I became more and more depressed with partly suicidal thoughts.  Although I think life is actually very nice (or could be without this…) and I have no plans at all to do so.  
So I decided again to carefully increase the dose at Sep 20 by 0.3 mg escitalopram to 25.3, and at 30.Sep to 25.5 mg.

The brain fog, the tiredness and the depressive symptoms got significantly better, but the side effects that I had initially with escitalopram came back, just not quite as strong (muscle and joint pain, headache, diarrhea, tachycardia, tremor, muscle twitching),  it's getting a little better now after three weeks.  What is new is tinnitus and, most of all, strong feelings of anxiety that I never had before.  

 

If I were you, I would not try to treat that hopelessness with increased dosages of antidepressants. Your nervous system has been through a lot. It's not unusual for people to have those kinds of symptoms after experiencing serotonin toxicity, your system needs to recover.

 

It appears that the increase of escitalopram September 20 and September 30 again evoked excessive serotonergic activation.

 

You are still taking 50mg venlafaxine? Are you taking the type of venlafaxine that is a capsule filled with tiny beads?

 

There may be no way for you to reduce these drugs without brain fog, the tiredness and depressive symptoms, which appear to be your withdrawal symptoms. However, at your current drug mix, you are getting adverse effects of TOO MUCH serotonergic (muscle and joint pain, headache, diarrhea, tachycardia, tremor, muscle twitching, tinnitus, activation).

 

FYI, milligram for milligram, escitalopram is a very strong SSRI, several times stronger than its sibling citalopram and other SSRIs. Your doctor is a fool.

[CharlieBrown13]

5 hours ago, Altostrata said:

 

If I were you, I would not try to treat that hopelessness with increased dosages of antidepressants. Your nervous system has been through a lot. It's not unusual for people to have those kinds of symptoms after experiencing serotonin toxicity, your system needs to recover.So should I stay on the dosage of 25.5 mg and try to stabilize? Or should I reduce again a tiny bit? 

@Altostrata

Thanks again for taking the time to reply so quickly, that's very kind of you!

Since I started the antidepressants I never had a phase of more than 6 weeks without a reduction and the severe depression with anhedonia was there before taking the antidepressants. So I think I need an antidepressant medication for a certain period of time.

Though I really hate it, allegedly like everybody else on this site.

 

5 hours ago, Altostrata said:

There may be no way for you to reduce these drugs without brain fog, the tiredness and depressive symptoms, which appear to be your withdrawal symptoms. However, at your current drug mix, you are getting adverse effects of TOO MUCH serotonergic (muscle and joint pain, headache, diarrhea, tachycardia, tremor, muscle twitching, tinnitus, activation).

 

Yes, I’m afraid that will be the case. And it will take me years.

These symptoms have improved in the last few days, they were much stronger in the first ten days after the dose increase. The main problem now for me is anxiety.  The tinnitus doesn't bother me that much.

 

5 hours ago, Altostrata said:

You are still taking 50mg venlafaxine? Are you taking the type of venlafaxine that is a capsule filled with tiny beads?

Yes, I take four beads à 12.5 mg/d

 

5 hours ago, Altostrata said:

Your doctor is a fool.

Yes, I agree completely with that. 
When the depressive symptoms worsened, she wanted to increase venlafaxine to 150 mg again and give me additional olanzapine. Thank god I refused (she was not happy), I think I'd be more dead now than alive.

 

With all your knowledge, what would you do in my situation now?  What changes or not would you make?  

Thanks again for all the time you take. I know there are a lot of people here waiting for answers and they all are in bad shape. I think of each and every one of them and I wish all of them healing, even if it takes lots and lots of patience and strength.
I am so mad at the doctors who don't believe in this. They should only have to endure it for a single day.

[Altostrata]

It's not good for your body to remain in a state of overdrive from excessive serotonergics.

 

You are taking 4 capsules of 12.5mg venlafaxine XR per day? If I were you, I'd start reducing venlafaxine by taking one bead out of one capsule every 4 days. This will gradually reduce the interaction with escitalopram.

 

11 hours ago, CharlieBrown13 said:

So I think I need an antidepressant medication for a certain period of time.

 

Please reflect on how much this has helped you resolve your problems so far, and consider unpatienting yourself.

[CharlieBrown13]

@Altostrata

thank you again for your fast reply! 
Did I understand correctly, I should sneak off venlafaxine within 16 days?  Every 4th day 12.5 mg less? Currently I take one capsule with a total of 4 beads per day, all in all 50 mg ( 4 beads á 12.5 mg).
But I could also get another brand of venlafaxine with a lot more beads and reduce it in smaller steps ?! 
You're absolutely right, my path so far hasn't got me very far ...

I just think the initial dose was way too high and the combination of the two AD wasn't good at all. 
That's why I've actually been in permanent withdrawal from the start and maybe that's why I haven't been doing well for the past few months. 
I am so afraid now that I will get much more severe withdrawal symptoms by reducing venlafaxin next and that I will not be able to do anything any more. 
And why do you think that venlafaxine should be reduced first rather than escitalopram?  I thought that venlafaxine was even more difficult to reduce. I so wish I had taken only one of these AD, that would make it a little bit easier right now.
I'm sorry for having so many questions, I'm just so very insecure about all of this right now.  

Thanks again for taking the time and for your help!

[Altostrata]

Do your venlafaxine capsules contain only 4 mini-tablets?

 

The name-brand Effexor XR capsules contain tiny beads, each about the size of a pinhead.

[CharlieBrown13]

@Altostrata

Sorry, this text got much longer than I had intended…

I have 150 mg capsules (Venlafaxin Heumann, retarded) and they contain 12 mini tablets of 12.5 mg each (I still had it from the beginning)
I always take 8 out, the remaining 4 go back into the capsule I then take.

Since I am a doctor myself 🙈 I can buy the medication without prescription, so I could try another brand, where each capsule contains 70 or more beads (eg venlafaxin hexal), then I could take much smaller reduction steps. That was my plan for "after escitalopram", I thought towards the end of this year. I can’t believe how naive I’ve been.

I still have to say I’ve never prescribed AD to my patients, they had already so much toxicity to cope with (chemotherapy) and because I was not a friend of it.
But never in my life would I have believed that these devastating symptoms could occur upon discontinuation. Not one word about it in medical school or in the 25 years I practiced. Nobody talks about that, every psychiatrist I talked to in the last months (and there were a few) denied it exists.

Now I've learned the hard way and I see everything with completely different eyes…

 

 

[Altostrata]

Now I understand better. You're taking 50mg venlafaxine XR per day, in mini-tablets. If you cut one mini-tablet into quarters (half short way, half through the tablet thickness), you would have 4 pieces of 3.125mg each, which would be faster release, the XR glue matrix having been compromised.

 

You could reduce your 50mg/day to 46.875mg by taking 3 12.5mg XR mini-tablets and 3/4 of one of the mini-tablets. The complication is that  9.375mg of this dose would be more or less immediate-release, which could exacerbate your activation from the 2 drugs.

 

You are taking venlafaxine and escitalopram almost at the same time, about 8 a.m. Ordinarily, we guide people in separating their drugs by some hours, so we can see the effects of the individual drugs. In your case, though, to avoid additional activation from the 9.375mg of immediate-release venlafaxine, I might take only that portion 5 hours later, when you are clear of peak plasma from the 8 a.m. venlafaxine dose.

 

(This is very approximate, because the escitalopram and venlafaxine may be interacting in a way that delays metabolism of one or the other drug.)

 

So, maintaining your current schedule to hold factors constant, you might take 37.5mg venlafaxine XR at 8:00 a.m. (in 3 mini-tablets) and 25.5 mg escitalopram at 8:15 a.m., and 9.375mg in venlafaxine pieces at 1 p.m.

 

Hopefully, this will not be so late in the day that the 9.375mg venlafaxine disturbs your sleep. Also hopefully, a lower dose of venlafaxine will relieve some of the activation from the drug combination without bringing on withdrawal symptoms, the 3.125mg reduction well within a 10% reduction on the total daily dose.

 

You'd have to see how this goes. You might feel some bumps, but it is a way to reduce your dose quickly. If it goes relatively smoothly, you might look forward to another reduction of 3.125mg in a week or so, until you are down to 37.5mg. Even with a lower amount of venlafaxine, the combination of antidepressants may still maintain SERT saturation (per Horowitz & Taylor, 2019), which would make reducing venlafaxine easier than reducing escitalopram, which binds more powerfully to SERT.

 

Other ways to do it is to either get your prescription filled with venlafaxin hexal or similar and use a very gradual bead-counting method, or find a compounding pharmacy that would encapsulate custom dosages of venlafaxin hexal or similar for you -- which you might have to do at 37.5mg anyway, because you will want to control the rate of taper.

 

This is a fairly complex process. Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can help track the result of the dosage reduction.

 

 

 

 

 

 

[CharlieBrown13]

@Altostrata

Thanks for the detailed answer and your patience with me!  
I think I'm trying to get the Venlafaxin Hexal tablets today with more beads per capsule.  I think, dividing the small tablets of the current preparation so that it is always the same dose, is extremely difficult, they are so tiny.
In addition, I am a bit afraid of the immediate release, which I felt so strongly at 0.3 mg of the liquid escitalopram (I take the 25 mg as tablets).

However,  I am really afraid of withdrawal symptoms, which I have had very badly in the last few weeks, with depression and hopelessness and brain fog etc. Unfortunately, I often notice the psychological withdrawal symptoms only  weeks after a dose reduction. And, on top of all, I’m supposed to start working again in December. For known reasons, I can't talk to my psychiatrist about it and she's the one who puts me on sick leave.
Forgive me for the question - wouldn't it perhaps be better to slowly reverse the increase in escitalopram first?  Maybe on 25.4 mg?  
In any case, today is not a good morning, I woke up at 4.30 am, with severe neck headaches and nausea, I usually sleep at least until 6.00 am.  

Thanks again so much for your effort!

[Altostrata]

2 hours ago, CharlieBrown13 said:

wouldn't it perhaps be better to slowly reverse the increase in escitalopram first?

 

You could reduce either of the 2 antidepressants, they are interacting. Because of the increased SERT binding of escitalopram, at this point, you might find reduction of the comparatively weaker venlafaxine to be more tolerable. If so, it would be a less risky way of reducing the drug burden.

[CharlieBrown13]

@Altostrata

Thank you for your kind reply!
I'll get the venlafaxin hexal.  I will try to reduce escitalopram again in 2 steps to 25 mg, which is easier to take, since I don’t have to measure the one drop in water then.
And then I'll start reducing venlafaxine like you suggested. I will keep you up-to-date.  Thanks again for your help, I appreciate that very much!!

I wish you a hopefully good day! 

[Altostrata]

Please let us know how you're doing after each drug change.

[CharlieBrown13]

@Altostrata

Yes, of course I will. Thank you very much!

[CharlieBrown13]

@Altostrata

Is it actually ok, if I tag you or should I not do that?

I reduced escitalopram to 25.35 mg (from 35.5) yesterday.  
The day was terrible yesterday, I woke up at 4.30 am with massive feelings of fear, hopelessness, restlessness, drowsiness, muscle twitching, severe tinnitus, brain zaps.  Somewhat improvement in the evening.  
Woke up again at 4.30 today, tinnitus and muscle twitching better, again very strong feelings of fear (in this form only for 4 days), other symptoms as well.  Escitalopram reduced to 25.25 mg today. Are you ok with that?

I am so very desperate.  I don't want to complain here but somehow I don't see any light at the end of the tunnel.  I feel so damaged…

[ChessieCat]

Alto is following your topic so will get notification when you post.

[CharlieBrown13]

@ChessieCat

Thank you for your reply!

[Altostrata]

On 10/11/2021 at 10:29 PM, CharlieBrown13 said:

Currently I take 50 mg venlafaxine at 8:00 am and 25.5 mg escitalopram at 8:15 am.  Due to the increasingly severe withdrawal symptoms in the last two months, I increased escitalopram by 0.3 mg three weeks ago and again by 0.2 mg 10 days ago ....

 

I am confused. On Monday, you said you were taking 25.5mg escitalopram. When did you increase it to 35.5mg?

 

11 minutes ago, CharlieBrown13 said:

Escitalopram reduced to 25.25 mg today. Are you ok with that?

 

I'm okay with it. I hope your symptoms reduce in the evening again (that would indicate a drug-drug reaction occurring after you take the 2 drugs together) and gradually improve over the next 4 days.

[CharlieBrown13]

@Altostrata

No, I didn’t increase to 35.5 that was a typo then, sorry!

[CharlieBrown13]

@Altostrata

One last question and sorry for taking up so much of your time: should I try to move escitalopram very slowly into the afternoon or is that too much change all at once?  Thank you so much again!

[Altostrata]

One change at a time! Let's see how the reduction of escitalopram plays out over a week.

[CharlieBrown13]

@Altostrata

Thank you! I already thought so, but wanted to have it confirmed.

[CharlieBrown13]

Dear @Altostrata,

I thought about the whole situation again.  Do you think it is possible that I am overdosed (so to say) in the morning while taking both drugs at the same time (maximum plasma level venlafaxine after 2 hours, escitalopram after 3 hours), in the afternoon / evening the plasma level fits and I’m doing relatively ok and early in the morning I am practically in withdrawal?  Every day, and maybe even from the beginning?  And that's why I never really felt better?!  
And even worse after the dose increase because it worsened the symptoms of the too high morning dose and the early morning withdrawal symptoms as well?

I went down to 25.35 mg escitalopram on the 15th, now to 25.25 mg on the 16th and 17th October. The symptoms (severe anxiety in the morning, diarrhea, stomach cramps, muscle twitching, tinnitus, restlessness) have not changed so far, but it's only been three days.  Should I stay at this dose for a few more days or reduce it further?  
By the way, my psychiatrist would like to give me a third antidepressant because of the anxiety attacks.  And I just won't take it.

 

 Thank you again for your great help!

[Altostrata]

23 hours ago, CharlieBrown13 said:

Do you think it is possible that I am overdosed (so to say) in the morning while taking both drugs at the same time (maximum plasma level venlafaxine after 2 hours, escitalopram after 3 hours), in the afternoon / evening the plasma level fits and I’m doing relatively ok and early in the morning I am practically in withdrawal?

 

Yes, you are overdosing both drugs in the morning. But in the morning, your symptoms are probably related to the normal surge in cortisol, the activating hormone, in the morning. Many of our members have this pattern in the morning.

 

On Thursday, I had proposed a way to reduce your drug burden by moving some of your venlafaxine dose to later in the day, in preparation for other schedule changes and more reductions, but you chose to reduce escitalopram instead.

 

How do you feel on slightly less escitalopram? Better, worse, the same?

[CharlieBrown13]

@Altostrata

4 minutes ago, Altostrata said:

On Thursday, I had proposed a way to reduce your drug burden by moving some of your venlafaxine dose to later in the day, in preparation for other schedule changes and more reductions, but you chose to reduce escitalopram instead.

Yes, I know, I first had to buy the other brand with more globules. I‘ve already prepared some capsules with 2.5 mg and with 47.5 mg. So Im ready to start with splitting.

 

I‘m not better, its getting worse, this morning was and is horrible. I woke up at 3.30 with such severe fear sitting in my stomach, I’m shivering hot and cold, trembling. The muscle twitching is maybe a bit less. The tinnitus unchanged. I feel very unwell.

Yesterday afternoon I was very agitated, for three days now I have a facial flush in the afternoon. My RR and pulse spiked to  150/100  and 110 (normal 115/80 and 65). I agree with you, I think, the serotonin level is too high, at least in the afternoon.

What would you do now? I already took the Venlafaxin for today, the Escitalopram in 5 minutes. Should I stop the 0.25 mg now and take only 25 mg?

Do you think, the morning symptoms, especially the fear and anxiety are withdrawal? How can I cope with that, it’s the worst thing I ever had?!

 

Thank you for your advise! 

[MirandaN]

Dear @CharlieBrown13,

I hope you feel somewhat better soon. Will be following you. Warm greetings! 

[Altostrata]

8 minutes ago, CharlieBrown13 said:

Should I stop the 0.25 mg now and take only 25 mg?

 

Yes, you might as well reduce to 25mg.

 

We really need to separate those 2 drugs.

[CharlieBrown13]

Thank you, and I think you’re absolutely right.

Should I start with 2.5 mg venlafaxine in the afternoon tomorrow?

 

[CharlieBrown13]

@MirandaN

Thank you for your kind words!

 

Warm greetings back!

[Memphisto]

Dear Charlie,

 

I wish you a fast recovery and pray for you. Please hang in there, you will recover and it will get better.

 

healing greetings
Memphisto

[CharlieBrown13]

Dear Memphisto,

 

thank you so much for your great help and your kind words! I wish you the same!

 

Warm greetings 

 

Charlie

[CharlieBrown13]

I'm so angry with my psychiatrist right now (I have to go, she's giving me the sick leave).  
Obviously, all of my current symptoms are just depression, because my dose of antidepressants is far too low.  I should take escitalopram again with 40 mg, possibly even 50 mg, plus olanzapine and lorazepam.  And of course venlafaxine.  Olanzapine because I seem to have a psychosis that antidepressants can be harmful.  I said I'd like to lend her my symptoms and side effects for a few days… 

[MirandaN]

Dear CharlieBrown13, 

Oh no... your psychiatrist sounds so unprofessional and mean.

 

I have also been thinking a lot about the question about sick leave. I am also on sick leave. But we really  must not let anyone force us to take these horrible drugs if we strongly feel they are harmful to us! If one takes any drugs, it should be one's own choice. It must be better to fall outside of the sick leave system (and possibly be unemployed etc. etc.) than let them further damage one's health. For us it is our life and our health, while for them it is just a job (that they do rather poorly). I am so sorry you are in this situation. I am thinking of you.