Longleaf: introduction and checking in - Trintellix / Brintellix / vortioxetine

[Longleaf]

Hi everyone. I am amazed and thankful for everyone's stories and hard work. Feel free to skip the too long backstory and scroll down to my questions and concerns. 

 

After decades of depression and much anxiety / panic attacks, and years of therapy, I decided to see what psychiatry could do for me. After a few tests, my psychiatrist diagnosed me with long term major depression and we decided to start Buproprion. I immediately felt motivated and more interested in life (but this faded over time).

 

Over the next three years, I tried various brain drugs. Nothing really helped with the depression (although my psychiatrist believes it did). In 2021 June we decided to look more into ADHD, with comorbid depression. I am 65 years old and never formally diagnosed with ADHD in the past, but it is pretty obvious in me and the psychiatrist did diagnose it. She started me on Dexmethylphenidate ER 10mg / day.

 

The lights went on immediately. I had energy, interest, I felt better than I had for a very long time. Based on this, we decided to taper the Trintellix.

 

The psychiatrist instructed me to start by cutting from 10mg to 5mg / day beginning 2021 July 15. I began to have very strong anxiety and other symptoms. I didn't know what was happening to me; I thought it was situational. I did not connect it to possible WD symptoms.

 

At our next appointment on 2021 August 19, I was instructed to reduce to 5mg on Mondays, Wednesdays, and Fridays (I assume long half-life influenced this). Anxiety and other symptoms continued and got worse, and I began to suspect it might be WD. 

 

At the next psychiatrist appointment on 2021.09.30 I complained about the anxiety. I was told to keep on 5mg M/W/F and increase Buspirone to 30mg / day. My other WD symptoms continued, but anxiety improved somewhat. 

 

At the psychiatrist appointment on 2021.10.28 I was told to continue taper, reducing to 5mg on Monday and Friday for two weeks, then stop, and keep Buspirone the same.

 

My symptoms increased and new ones appeared. I won't list them all, but they include many many PVCs, increased heart rate, hot flashes / chills, loss of exercise tolerance, fatigue, muscle pain, inner trembling, anxiety, brain fog, tinnitus, increased sadness, etc. etc. I wondered whether this might be related to flu vaccine and my first Shingrix vaccine, both on 12 October (and Covid booster on 5 November). Then I though I might be returning to hypothyroidism (incident in 2014). Yet I wasn't losing weight like last time.

 

I started researching and found this wonderful website. I began to realize that all these symptoms could be related to withdrawing from Trintellix. I had thought "not me, I never had problems withdrawing from other brain drugs," but the other withdrawals had overlapped with me taking other brain drugs, so any WD effect was likely blunted.

 

As of today, 2021 December 11, I continue to have symptoms. My windows / waves are day to day. For example, one day I wake up with PVCs happening every other heartbeat, the next day I have very few. Or I will feel dizzy and lightheaded, and the next day steady. I am in no way feeling like myself.

 

Questions / concerns: Of course I came to this website too late, and I see that my taper was much too fast. I can handle my current symptoms and I can be patient with them for some time. Yet I see the problems others have reported here, and I wonder whether I should restart a low dose (maybe 2.5mg / day) and then taper properly.

I also fear feeling better soon, then crashing in six months or later. 

 

My instincts (likely self-pride) say to just ride it out, but I don't want to make a huge mistake that I will regret later.

 

I would be grateful for any thoughts, and thanks again for a wonderful resource for those of us who ate the antidepressant candy. Thank you!

[Kiasofia]

Welcome @Longleaf

Thank you for your introduction and creating your signature. We have members who have gone on and off their drug/s multiple times in the past with no issues and then suddenly they get issues. This is because the effect is cumulative and one day it catches up with them. Your taper from Trintellix was faster than we recommend and skipping doses to taper can worsen withdrawal symptoms. So it is possible that this is the cause of your symptoms now. However, when more than one drug is involved it is harder to know what is withdrawal and what is side effects. Have you checked what side effects Dexmethylphenidate, Buspirone and Levothyroxine can have?

https://www.drugs.com/sfx/

 

And of course you can be reacting to various vaccines or have other medical issues.

It is therefore hard to advise on reinstatement in this case. Have you read this post?

About reinstating and stabilizing to stop withdrawal symptoms

 

About withdrawal:

What is withdrawal syndrome?

Dr. Joseph Glenmullen's withdrawal symptom checklist

The Windows and Waves Pattern of Stabilization  

 

Aside from a high quality fish oil and magnesium, be careful with supplements. Your central nervous system (CNS) has become sensitized from psychiatric drug use and can react unpredictably. Alcohol, caffeine, nicotine and other mind altering substances can make the condition worse.

Important topics about tests, supplements, treatments, diet

 

Here is our symptoms and self care section, you may find some useful ideas to help manage symptoms as you recover. 

Symptoms and self care topics  

 

I highly recommend reading  Anatomy of an Epidemic by Robert Whitaker as well as A straight talking introduction to psychiatric drugs by Joanna Moncrieff to better understand these drugs and their effects. The Council for Evidence based Psychiatry also has a lot of good information.

 

Take some time to read the information I have provided and then we can take it from there. This is your Introductory topic, where you can ask questions and connect with other members.  We're glad you found your way here.

Edited December 13, 2021 by Kiasofia

[Longleaf]

@Kiasofia

 

Thanks so much for your helpful reply. I have been lurking and reading many of SA's resources in the past few weeks. Slowly I'm getting better educated.

 

A couple of quick developments: I was able get an appt with my psychiatrist for this Wed 15 Dec. I'll discuss options including reinstatement, and I'll come prepared! Second, my 2d Shingrix vaccine was scheduled for tomorrow 14 Dec. I canceled it. I think my nervous system is under enough stress for now.

 

I'll have to study more about exercise. Each week I cycle, do stairs, and lift weights, reaching heart rates in zone 4 sometimes 5. I understand this can be a further stressor. Damn.

 

About drug side effects, you are right, it will be hard to isolate. The thyroid hormone (Levo) has been a constant and I doubt has much impact. Buspirone does impact serotonin, and can increase the impact of Trintellix (I read somewhere that 10mg of Trintellix is like 20mg if also taking Buspirone). I do know that I attempted to taper Buspirone back in March 2021 (with psychiatrist schedule) and it sent me into a depressive spiral. I didn't realize it was likely WD.

 

Dexmethylphenidate is a psycho-stimulant and works on both dopamine and norepinephrine, and can significantly impact SSRIs. I suspect in my case it, combined with Trintellix, had a strong effect on me.

 

I'll add supplements to my signature.

 

Take care!

[Longleaf]

Another question. I’ve been studying brassmonkey’s thread (linked below) and see at section 10: 

 

Quote

Once the interaction has started, fixing the situation is not as simple as just stopping one or more of the drugs.  Each drug must be tapered over time or withdrawal symptoms may occur.

Does this mean that I should be starting to taper my other brain drugs while I am dealing with Trintellix?

 

[Kiasofia]

This can be a good post to read before meeting your psychiatrist: How do you talk to a doctor about tapering and withdrawal?

 

And to learn more about Trintellix: Tips for tapering off vortioxetine (Trintellix, previously called Brintellix)

 

I also recommend reading  A straight talking introduction to psychiatric drugs by Joanna Moncrieff to better understand these drugs and their effects. The Council for Evidence based Psychiatry also has a lot of good information.

9 hours ago, Longleaf said:

 

Quote

Once the interaction has started, fixing the situation is not as simple as just stopping one or more of the drugs.  Each drug must be tapered over time or withdrawal symptoms may occur.

Does this mean that I should be starting to taper my other brain drugs while I am dealing with Trintellix?

 

I think he is referring to when people try adding drugs or supplements to deal with withdrawal and think: "if I react badly I'll just quit". Our general advice is to not taper any more drugs until one has felt stable for at least a month, unless serious side effects mean that getting off the drug fast is more important than preventing withdrawal.

[Longleaf]

Update after a longish pause. In mid-December I met with my psychiatrist to discuss likely WD symptoms and possible reinstatement. She was very open to my concerns and reinstatement. Although she wanted me to start with a higher dose, we agreed on 1mg / day (original dose 10mg / day). I decided to cheat and start at only .5mg / day.

 

I had purchased a milligram scale from Amazon but found it to be inaccurate. My daughter is a scientist and explained that when they weigh small amounts of chemicals, they always do it in a plexiglass box. Otherwise, slight air movement can affect weight. I decided to make a solution: 10mg tablet crushed, added to 20ml water, sit overnight, and after shaking I had a pretty good solution. I take 1ml of the solution daily.

 

It seems to have eased some of my physical symptoms. Heart rate is lower and PVCs are much less. My "jelly legs" are somewhat better; this comes and goes. It can be a challenge to keep track of symptoms because they are a moving target and change often.

 

My mind has been all over the place. The holidays are always a time of overwhelm for me, and I often cycled between anxiety and melancholy. I began to doubt whether reinstatement was doing any good, but remembered the windows and waves pattern.

 

Now, my physical symptoms are primarily fatigue, nausea (with watering mouth, some possible reflux), on and off muscle weakness throughout the day, underlying anxiety, and deep mood drops that typically diminish the same day.

 

I guess I'm on the right track. I'm not great, but hanging in.

 

Hoping everyone is on an upward trend!

[Kiasofia]

Good to hear reinstatement seems to be easing some symptoms. I'd wait another few weeks before making any changes. It can take a while for the full effect and you want to stay at the lowest dose possible.