FindPeace: tapering off 21 years of Effexor XR.

[Frogie]

 

@FindPeace

 

What time do you usually take your Ativan? 

 

This is an example of what you will need to do to get your dose in 1/2 and 12 hours apart.

 

For Example:

 

You take your dose at 8 pm. You would take 1/2 at 8 pm (normal time) and 1/2 at 7 pm. Then the next day 1/2 at 8 pm and 1/2 at 6 pm. Continue to move 1/2 the dose up until you reach 8 am.

 

Edited March 20, 2022 by Frogie

[FindPeace]

On 3/17/2022 at 8:15 PM, Altostrata said:

 

Over the last 2 weeks, how often have you used Ativan? If not taking it causes symptoms, you are physiologically dependent on it.

 

Some of your symptoms may be caused by irregularity in your dosing schedule. Are you a shift worker? Do your shifts move around?

@Altostratahey Alto, in the last two weeks if used it about 8 times. It’s day 10 today. I am aware now that taking it a variable times and as rescue doses is not advised. I always take my Effexor at 8 am. I have been given medical leave from work today. It very well may be that I am dependent on the ativan, although I was having symptoms (high anxiety, stomach cramping, diarrhea, no appetite  ) before I was prescribed the ativan.

 

My doctor is unwilling to prescribe more,  because he thinks going back to 75mg of Effexor will solve the problem (not going to do that!) so I am now in not so good position where I need to stop using it. Q: I was wondering if I should just stop or do a taper of a few days. 
 

Thank you @Frogiefor explaining split dosing, I was unaware you had to shift it by and hour earlier like that. I thought you can just take half AM and half PM.

 

Thank you guys.

[Altostrata]

3 minutes ago, FindPeace said:

Q: I was wondering if I should just stop or do a taper of a few days. 

 

I don't know. Are you getting withdrawal symptoms between doses?

[FindPeace]

10 hours ago, Altostrata said:

 

I don't know. Are you getting withdrawal symptoms between doses?

@AltostrataYes I am. I have the same symptoms as before I started ativan when my issue was confined to the Effexor. They were anxiety, stomach cramping, nausea, diarrhea, lack of appetite. But now the anxiety is worse and I have had insomnia the last 3 days and only got 3 hours of sleep each night. 

[FindPeace]

21 hours ago, Frogie said:

@Findingpeace

What time do you usually take your Ativan? 

 

@FrogieI highly regret it but I was all over the place. Now I’m freaking out because my doctor cut me off and I have only a 20 pill supply (1mg) which I gave to me brother to hold on to. Q: Could it be dangerous to stop like this if I’m kindled?

 

I really need to decide whether I would benefit from a short taper from the remaining pills, when and how much to take. Could you please advise. 🙏

 

P.S. I will also post a reply with a summary of the times I used it over the last 10 days. Thank you.

[FindPeace]

@FrogieI always take Effexor 25mg at 8:00a.

Below describes my ativan use over the last 10 days 😞

 

3/18

 

5:00a. 0.125mg 

7:00a 0.125mg

8:30a. 0.125mg

 

Notes:

10:00a - feeling better by 

11:00p anxiety resurfaces, insomnia

 

——-

3/17

 

6:30a. 0.25mg

9:00a. 0.25mg

 

Notes:

Anxiety in the morning and evening, insomnia

 

——-

3/16 

 

12:30a 0.5mg Ativan.

 

Notes:

No ativan taken in the morning

First night of insomnia so taken at that time

 

——-

3/15

 

10:30a 0.5mg

11:00a. 0.25mg 

2:20p. 0.25mg

 

Notes: feeling ok after 3:00p. Sleep normally.

 

——-

3/14

 

None taken 

 

Notes: high anxiety all day but abates on it own by 5:30p, stomach issues persist.

 

——-

3/13

 

None taken 

 

Notes: 

anxiety manageable today

1 bead updose of Effexor 

Day light savings

 

——-

3/12 

 

4:00p. 0.5mg

6:00p. 0.25mg

 

Notes: anxiety ramped up in the afternoon, calm by bedtime

 

——

3/11

 

6:00p. 0.25mg 

9:30p. 0.25mg

 

Notes: anxiety manageable until evening 

 

——-

3/10

 

12:15p. 0.5mg

5:30p. 0.5mg

8:00p. 0.5mg

 

Notes: 

anxiety so bad in the morning.

After 9p experiencing sedation

 

——-

3/9

 

None taken

 

Notes: anxiety mostly in Before noon

 

——

3/8 

 

5:00p. 0.5mg

7:30p. 0.5mg 

 

Notes: first day of having been prescribed ativan 1mg sublingual tablets

 

 

   

[FindPeace]

@Altostrata  @Frogie Help! I am in agony. I haven’t had any ativan since fri (3/17) and my insomnia and anxiety have persisted and gotten so much worse. It is now 5 nights which I’ve barely slept. 
 

I’m having intense waves of crippling anxiety all throughout the day. When I try to sleep I night, as soon as I start to fall asleep I feel a zap and am jolted awake. I think I am experiencing akathesia. 
 

I am deteriorating mentally, physically and spiritually from this. I am so worried about reaching out for help. I almost caved and got myself admitted for psychiatric help. I am scared and don’t know what to do, it’s hell to live like this and it frightening to imagine the hell I’ll be in if I reach out for help. 
 

i don’t know what to do, please help me!

[Frogie]

 

@FindPeace

 

It looks like you are having Ativan wd. I was so hoping you would be ok after only taking it 10 days. But your body got dependent on it quickly.

 

Is there anyway you can get some from your dr now that they have you dependent on it?

 

Do you have any left that you could take a really small rescue dose?

Edited March 20, 2022 by Frogie

[FindPeace]

@FrogieI have 20 left and I took a 1mg tablet, probably too much but I still feel nasty. Also I tried sleeping and I have these revolting brainzaps every time I move from wake-sleep. Not able to sleep because of it. 
 

I will try and get more or even diazepam from a different prescriber. I hope to take this 1mg twice a day 12 hours apart and hope it stabilizes me. Q: Is this wise?

 

Q: Now I’m wondering if it’s wise to try a few beads upside on the Effexor. The zaps while falling asleep sound like an Effexor issue. What do you think?

 

 

[Frogie]

 

@FindPeace

 

2 hours ago, FindPeace said:

Is this wise?

You could do a crossover to Diazepam and then hold a good long while as Diazepam stays in your system up to 200 hours. But you are most likely dependent on the Ativan by now. You should take the Ativan twice a day.

 

2 hours ago, FindPeace said:

Now I’m wondering if it’s wise to try a few beads upside on the Effexor. The zaps while falling asleep sound like an Effexor issue. What do you think?

You could try a 1-2 bead updose on the Effexor and see if that helps.

Edited March 20, 2022 by Frogie

[FindPeace]

@Frogie how do you do a cross over to diazepam from ativan? Is it better to do it sooner rather than later?

[Frogie]

@FindPeace

 

1 mg Ativan is equal to 10 mg Diazepam.

 

You would take 3/4 dose Ativan and 1/4 dose Diazepam for a week.

 

Then 1/2 dose Ativan and 1/2 dose Diazepam for a week.

 

Then 1/4 dose Ativan and 3/4 dose Diazepam for a week.

 

Then all Diazepam.

 

Diazepam will be easier to taper off of than Ativan also.

[FindPeace]

@Frogie thank you, that makes sense. Is it reasonable to assume that the sooner I do that the more likely I will tolerate the cross over?

[Frogie]

@FindPeace

 

If you can do the crossover now, I think it would be a lot easier on you.

[FindPeace]

@Frogie

 

should the diazepam also be taken twice a day? I’m think I’m getting interdose withdrawals with the ativan.

 

yesterday I took 1mg at 10am and 1mg at 10pm. It was the first day were I felt functional and my first

night of semi normal sleep in 5 days. However, I woke up at 7 with bad anxiety. I am a bit leery 1mg is too much.

should I split the dose into 3 times a day (like every six hours) so

 

8am Effexor 

10am 0.5mg ativan

4pm .25mg ativan

10pm 0.5mg ativan

 

I updosed my Effexor this

morning (3/21) by 1mg (4 beads)

 

Im really frightened about my situation, and further guidance is much appreciated.

 

 

[Frogie]

@FindPeace

 

Yes, you can split the dose of Diazepam and take it twice a day just like the Ativan.

[FindPeace]

@Altostrata @Frogie

 

Hey, thank you in advance for any help you can provide. It’s been a while since I checked in here. The reason is because I ended up going into acute care at the hospital on March 24th until the 5th of April. I was in a really bad place with panic, anxiety, and SI. There I was switched to Clonazepam and given seroquel 6.25mg for sleep and my Effexor was raised to 75mg (my original dosage. To recap: I spent the previous year getting my dosage of Effexor down from 75mg to 25mg, when things fell apart (anxiety, nausea, insomnia).
 

When I got out, I stopped the seroquel on April 7th and started using melatonin time release 5mg. I was on the seroquel for 13 days total. I’ve been off benzos since April 2nd. My total length of use of the benzos was 24 days (from March 8 - April 2nd). 
 

So now I’ve been on 75mg of Effexor for about 6 weeks and nothing else besides the melatonin. Currently I don’t even take supplements. The anxiety has improved although I still have days when I can feel it in my chest and have some nausea/dry wretching. My worst symptom is a depressed mood. I am holding on and very loathe to change anything as I know I need time to stabilize, but I can’t seem to find joy in anything. I am very worried that aomehow

my brain is broken now and I will never be happy again. The doctors are urging me to increase the Effexor dosage to 112.5mg. As I said, I am holding on.

 

I was wondering what you guys would make of all this and if you could advise me how to proceed, because I really don’t trust the doctors at all.

 

Thank you

🙏

[Altostrata]

On 5/10/2022 at 7:31 PM, FindPeace said:

my brain is broken now and I will never be happy again.

 

If you believe this, it will undoubtedly be so.

 

On 5/10/2022 at 7:31 PM, FindPeace said:

The anxiety has improved although I still have days when I can feel it in my chest and have some nausea/dry wretching. My worst symptom is a depressed mood.

 

This is what we would expect if someone had withdrawal syndrome and reinstated the drug. We would not advise careful tapering again until all withdrawal symptoms go away. It's very common that after someone has been taking an antidepressant for many years, they experience emotional anesthesia for a long time even if they go off. That's the effect of the drug.

 

Not sure what else to add. It's your choice whether to take 75mg Effexor indefinitely. Please let us know if you want assistance tapering.

[FindPeace]

@Altostrata

 

thanks for your reply Alto. It does scare the crap out of me though, too think that depression won’t lift no matter what I do. I never had this “emotional anesthesia’ before I crashed in my taper, so I’m not sure what to make of it. Looking back on my symptom log my mood was worsening and I had some SI before I was reinstated in hospital  so my hope is that it will eventually resolve. 
 

I really wish they hadn’t raised my Effexor from 25mg to 75mg after I was committed, but I would very much like to try tapering again. I know it’s hard to say, but how long does it usually take to stabilize after such an upset?

[Altostrata]

20 hours ago, FindPeace said:

It does scare the crap out of me though, too think that depression won’t lift no matter what I do.

 

This is your belief about yourself. You might want to work with a psychotherapist to find out why you believe such things.

 

If you go to the hospital saying you're thinking of suicide, you can count on coming out on a drug cocktail.

 

It may take several months before you're back to a stable baseline. Please let us know when you feel up to tapering.

[Bindy]

On 3/3/2021 at 1:50 PM, H8FXR said:

TLDR: switched from 75mg/D Sandoz (generic) Effexor XR to 75mg/D Wyeth (brand-name and with beads) Effexor XR. Doctor did not support bead counting/wieghing; suggested alternating dose regime and then Pristiq. 

 

UPDATE: M36, 75mg/dEffexor XR. I saw my doctor after the two week period in which I was supposed to bridge to trintellex (which I didn't take) for the purpose of cross-tapering. For two weeks I steeled myself to go in there and succesfully switch from generic Effexor XR containing mini tablets to the Wyeth brand name Effexor XR with the beads so I could do the 10% taper. My hope was he would be on my side and support it.

 

I told my doctor I couldn't tolerate the Trintellex and right away we begin discussing tapering Effexor. I told him straight away I would like to switch to beads and proposed titrating the dosage 10% (hyperbolically) by compounding the capsules by weight in lower dosages. He was against it, saying that the time release mechanism would be compromised. I responded that I had looked at the patents and the the extended release was an enteric coating on the microspheres.

 

He quickly moved the conversation away from what I presume he thought was "tampering" with the medication. I acknowledge that he may not want to be liable for endorsing it.

 

He suggested I achieve a 10% reduction by filling my script with 37.5mg capsules and taking 2 37.5mg capsules for 3 days and then just one 37.5mg capsule for one day and then back to two or 3 days. I told him I don't follow how that would be a 10% reduction. He said that the medication "bioaccumilates" and that I wouldn't fell to much on the low dose day. I told him I would surely be a mess on the off day because of the short half-life of the medication and I feel this would be playing ping pong with my brain. He said I could dose a half-tablet twice a day because the 37.5mg capsules are immediate release. I asked him if he was sure, because afaik IR was discontinued. He looked it up and agreed and he had a chance to see that Pristiq was related to Effexor and also available.

 

So then he started exploring the possibility of switching to Pristiq. I told him I've looked into it and since it is also extended release and similar if not stronger than Effexor this would not help tapering. I promptly apologized for all the push-back, and explained that I had been researching this a lot and getting off Effexor was extremely important to me.

 

He then steered the conversation back to the alternating half-dose day and it began to look like that was my only option. Furthermore he was proposing I use the current generic caps with the mini-tablets. So as a last resort I asked him if I could switch to the brand name at the current 75mg/d dose and see how that goes. He said that's a good idea because they are not bioequivalent and I would need an adjustment period. Great - I feel like at that point he just wanted to get me out of there. So he filled the script and I got the beaded medication of my heart's desire.

 

I'm going to take it as prescribed at 75mg/D for 4 days or so while I wait for my jewellers scale to arrive and so that I can establish whether its effect is much different than the previous generic brand.

 

The bad part is that now I feel like I have to keep it hidden from my doctor that I'm self-titrating the medication. I'm pretty sure he will have figured out that this was the end-game of my visit anyway. It's now and awkward situation because if I need his support or any helper meds (god forbid) it will be difficult if I don't tell him what's actually going on. I'm prepared to do it alone but it sure would be nice if he was supportive of this unorthodox method of tapering. 

I am really proud of you. You can do this.

I was a t 150 mg and basically took 2 beads a day then 4 and 6 etc. It was tedious but I started in Nov 2022 and by Feb 2023 I was at zero mg. The first 2 to 3 weeks at zero were ruff but I honestly think there is no way around it. I took some great natural supplements but not sure if I am allowed to discuss on this forum. I luckily found an amazing doctor who supported me he was a MH and behavioral Physicians Assistant. I used some klonapin very sparingly and now very rarely. My biggest challenge is sleep these days. Although in my case I am currently officially in Menopause so some extra challenges.

Every person's experience and challenges going off antidepressants is different but I think Effexor is one of the worst. My Dad's wife is a Psychiatrist in Canada and she totally agrees with me on that.

 

A great resource is a lady on utube name Angie Peacock. I hired her for a 30 min consultation and she really validated me that I wasn't loosing my mind.

 

Your doing great keep strong and sending positive vibe your way H8fxr.

[FindPeace]

Oh man, its been over two years. I stabilized on 75mg Effexor, but I never went back to feeling as well as I did before tapering. For a long time I was upset that there isn't a disclaimer in these support groups stating that if you try and get off your drug, you may become destabilized and not be able to get back to the way you felt before. This has been my experience, but I'm not sour about it. The truth is I had to stay away from the Effexor Facebook groups (where I was a moderator), Reddit, and SA because I was traumatized by it all. I wanted to forget everything that happened and just focus on moving forward. 

 

All in all, I came out the end not too bad. My issues right now are anxiety, restlessness, fatigue, feeling flat and sometimes depressed, and fragile sleep. There comes a point in stabilization when you go from wondering if your still recovering from what happened to currently dealing with the drug's side-effects or tachyphylaxis.  I picked up Mark's Horowitz Book on Deprescribing (mostly to arm myself against future negotiations with doctors) and my mind has come back to a place where I'm contemplating tapering again. Mark is an remarkable man: calm, logical and reassuring. 

 

I'm scared of tolerance, tachyphylaxis, tardive dysphoria and emotional anaesthesia, and it seems going off the drug is the sensible approach to avoid them.   I'm equally or even more scared of the withdrawal syndrome and protracted withdrawal; and not only that but the murky backwaters of "destabilization" - states which cannot be readily explained and the advice is to do nothing and just bear the suffering. Nothing is certain, but I am quite sure 21 years of Effexor have taken their toll: I perceive no benefit from it (not that I ever did) and at best it's doing nothing. But there is the growing conviction that its causing tardive dysphoria, anxiety/agitation, mental fog and memory problems. The sexual side effects I've learned to live with. So tapering seems like a logical thing to do but the reality of it is that it will take many years, is unpredictable, and there may still be further years of protracted withdrawal at the end. In order to pursue this course (with no guarantees of success) I make-do with a sub-par life while I focus on coping with withdrawal (and put my partner through the same). And I know there is the possibility of crashing and burning into the worst suffering imaginable with no clear way out and no telling how long it will last. Sorry to sound glum, but I want to be sure there will be a day when I'm off Effexor and feel well, and that certainty just cannot be had. There's no reason to dress this up, psychiatric drug withdrawal ruins lives. It nearly ruined mine. 

 

So I've decided on a middle ground: I will attempt to taper from 75mg to 37.5mg. I am very curious to see if reducing the dose helps with some of the side effects - and I'm curious to see if I can. Unfortunately I've read (In Maudsley Deprescribing) that adverse effects (side effects) have an hyperbolic relationship to dosage just like the drug effect, which would mean 37.5mg likely gives as many side effects as 75mg because the dosage needs to get much lower before SERT occupancy (and side effects) are considerably lowered. But still there's a part of me that longs to be off this drug, which I cannot deny. 21 years of emotional blunting will do that. 

 

I have a couple things to do first. I'd like to stop using creatine, caffeine and nicotine as I know from my previous attempt that using and drugs concurrently can complicate the taper. I did things during my last year long taper from 75mg to 25mg which I think destabilized me: 1) I had a couple relapses on alcohol and marijuana 2) I used too many supplements and tried novel supplements often 3) I tapered in spite of withdrawal symptoms 4) I tried to change from weighing to counting 5) I tried to change from beads to minitabs 6) I received the covid vaccine 7) and when destabilized I panicked and returned to my original dose 8 ) Oh and one last thing: I turned my back on my support group after things fell apart (I interpreted the inquiries into how I was doing as prying and just thinking about the groups re-traumatized me). I desperately wanted to put it all behind me, to get back to how things were: "If it ain't broke, don't fix it." But it looks like I'm back here again, singing a different tune: "Its still broke, so let me fix it" and if that entails the long arduous process of tapering off, so be it. Do I regret ever tapering? Yes I DO. 

[FindPeace]

Through the thick teflon coating of two decades of emotional numbness I sense a feeling of genuine sadness. My eyes kind of seize for a second like there might actually be tears. If I could I would. 

 

I am mourning the loss of a friend. Someone I met in the groups and who genuinely touched me. More than a consultant or confidante. More than words…

 

Sont les mots qui vont tres bien ensemble…Tres bien ensemble

 

And I turned my back on them, because I panicked and ran away from it all. God, I feel real guilty about that. How idiotic of me - as if I could close the door on all this and just wake up as if from a bad dream. A curse it is to walk this road alone, but probably well deserved.
 

😪
 

 

[Ariel]

Hello again @FindPeace

 

Just moving your recent posts here to your intro topic so that it'll be easier for the mods to help you with your query. 

 

First post:

 

Looking for input from anyone with direct experience switching from brand name beaded Effexor XR to liquid venlafaxine? Any issues with the transition from a once a day dosing to twice a day? 
 

Thank you 😊 

 

Second post:

 

1 hour ago, FindPeace said:

 

The compounding pharmacy said they use extended release bead-version of venlafaxine, pulverize it, and make a suspension; but it begs the question, do they use the brand name stuff which I’m taking? Probably not, as it is more expensive. I will inquire/specify. 
 

I insisted on them using immediate IR because in the Maudsley guide it is listed as available in Canada. And I’m thoroughly sick of dealing with the extended release medication and its different sizes of beads and dubious dose. But I maybe need to rethink that in regards to it being a change. 
 

I am on 75mg. I also thought about introducing an intermediate step in the change over to liquid which involves taking a a regular 37.5mg capsule and two doses of liquid to make up the difference. Maybe going even slower is warranted, although then I’m forced to open the caps and deal with the inaccuracies involved with bead counting or weighing. 
 

Thank you for your reply, any additional input would be appreciated. What would you do?

 

FP 🙏 

 

I see that in the past you've been assisted by Frogie and Altostrata, neither of whom are currently active on SA. 

 

I'm not a moderator and do think it would be best to get staff to weigh in on this matter.

Are there any moderators whose work you particularly appreciate? You might tag the person in question to ask for hands-on guidance. 

 

You ask what I would do. 

I don't have any personal experience with proper tapering. I did a rapid taper/CT and am still recovering many years later.

(Incidentally, many years ago I took Effexor for a while and CT'ed off of that; it was truly atrocious.)

I so admire and respect the courage, patience, tenacity of you good taperers!

Give yourself so much credit for that hero's journey with its singular demands and challenges.

 

What I would do -- hypothetically, theoretically -- is I'd think it through by planning backwards from where I want to get to. Writing out all the steps in maximum detail and reverse engineering. 

 

For example, if the goal is to resume my taper, I would ask myself: how do I ideally want to taper when I begin to resume my taper? (my reasoning should be clear, written out)

-> if I want to taper using liquid (because I have decided that this will make my taper easier/more manageable), then the goal prior to resuming my taper is successfully completing the change to liquid

-> what are the steps necessary to arrive at being on all liquid? (incl. the process of switching over and holding for stability, factoring in contingency plan of not knowing how I will react to liquid, etc.) 

-> if the change to liquid involves switching brands, what is that process and what are the steps? 

-> if any of the above changes entail going from once-daily dose to twice-daily dose, what are the steps for achieving a twice-daily dosing schedule (map out the process) 

etc. 

 

Following these steps backwards will eventually lead you to what you need to do first. 

And you're already taking the first step by posting your questions and thinking about this and asking more questions. 

Ask all the questions, and let each question lead to an even better question, etc. 

 

Do you see what I mean? 
I would use a pencil and paper and map it all out by hand, the old-fashioned way. I would draw a kind of flow chart or some other sort of diagram (whatever makes sense to you) to clearly visualize it, and then I would pencil in estimated minimum time frames for each step of the process. 

 

Looking at your drug signature, it seems you have been holding at 75mg for 2 years and have achieved stability. Bravo, FP!!

Seriously, this is a huge achievement. That takes such hard work and faith and integrity. No small feat. 

 

So if I'm reading this correctly, you're now in a position of stability and interested in resuming your taper. Yes?

I would say the key here is to keep practicing patience, as you are clearly so good at doing, and invest the time to plan your next moves and set yourself up for success. 

An ounce of prevention is worth a ton of cure, and you're far better off doing thorough research, waiting to begin, and eventually going into this taper fully informed.

Slower is faster. 

 

Definitely consult with a moderator. 

 

In the meantime, have fun with some colored pencils, drawing as many charts and timelines and plans as you like! 

And there are members here who have successfully tapered off of venlafaxine in a variety of formulations, I think, if you want to look them up. 

 

I am celebrating you for your accomplishment thus far! Hats off, truly. 

 

On 5/27/2024 at 8:40 AM, FindPeace said:

I am mourning the loss of a friend. Someone I met in the groups and who genuinely touched me. More than a consultant or confidante. More than words…

 

And I'm very sorry for your recent loss. My heart goes out to you in your grief. 

Please be gentle with yourself and hold yourself with compassion and forgiveness. 

You deserve nothing less than unconditional acceptance and regard. 

 

Love to you,

Ariel

[Ariel]

Hi @FindPeace

 

It might also be helpful to connect with SA member and mentor @Alfred1977

Alfred has extensive personal experience with venlafaxine.

Based on his posts he also seems to be quite knowledgeable about the technical, theoretical aspects of tapering, incl. calculations, methods, strategies, etc. 

I see that he generously supports several other members in the venlafaxine club.

 

 

[FindPeace]

Hi @Ariel, thank you so much for your sounds advice and recommendations, I really appreciate it!

 

19 hours ago, Ariel said:

Are there any moderators whose work you particularly appreciate? You might tag the person in question to ask for hands-on guidance. 

It’s been a while, so I’m out of touch but I will keep an eye out and your recommendation to touch base with @Alfred1977 Is appreciated. 
 

19 hours ago, Ariel said:

I would use a pencil and paper and map it all out by hand, the old-fashioned way. I would draw a kind of flow chart or some other sort of diagram

I love your process, I agree I will have to work backwards, I am working with a former NP from Outro this time, I think she will be support the careful switch to liquid, should that be the way I go now or later. 
 

19 hours ago, Ariel said:

And there are members here who have successfully tapered off of venlafaxine in a variety of formulations, I think, if you want to look them up. 

I’ve read a few Effexor success stories but I’d say I found very little for people on as long as I have been (21 years) but I’m not discouraged!

 

19 hours ago, Ariel said:

Looking at your drug signature, it seems you have been holding at 75mg for 2 years and have achieved stability. Bravo, FP!!

Seriously, this is a huge achievement. That takes such hard work and faith and integrity. No small feat. 

Thank you! I have to admit I wasn’t holding intentionally - only that I was so traumatized from the crash in 2022 that I stepped away from everything in the hopes that I would heal completely. I don’t think that ever happened (back to how I was pre-taper) but it’s true I am more stable.
 

Current symptoms are interrupted sleep, memory and focus issues, restlessness and anxiety, depression. They are fairly constant: and I’d put them in that dubious category of “withdrawal normal”. Either the drug has turned on me somewhat or I’m forced to come to the conclusion that even crashes mid taper can create a protracted withdrawal injury that doesn’t fully remit with reinstatement. I’m inclined to believe the latter. 

 

19 hours ago, Ariel said:

I am celebrating you for your accomplishment thus far! Hats off, truly. 

Never the less, I am proud to where I’ve gotten to considering how severe my crash was. You are right, it did require extreme patience and a lot of courage in my convictions. 

 

19 hours ago, Ariel said:

And I'm very sorry for your recent loss.

I just want to be clear so no one get triggered that my tapering buddy did not lose their life; I only lost their friendship because at the time of my crash I chose to step away from all the groups for 2 years. Not too sure what set this person off but I no longer have their support. 
 

Thanks again and I wish you much continued healing in the coming Summer months 🙏

[FindPeace]

 

Effexor XR: does counting microspheres provide a more accurate modified dosage than weighing?

 

Overall process

• from U.S. patent 6,274,171

 

 

The encapsulated formulations of this invention may be produced in a uniform dosage for a specified dissolution profile upon oral administration by techniques understood in the art. For instance, the spheroid components may be blended for uniformity with a desired concentration of active ingredient, then spheronized and dried. The resulting spheroids can then be sifted through a mesh of appropriate pore size to obtain a spheroid batch of uniform and prescribed size.

The resulting spheroids can be coated and resifted to remove any agglomerates produced in the coating steps. During the coating process samples of the coated spheroids may be tested for their distribution profile. If the dissolution occurs too rapidly, additional coating may be applied until the spheroids present a desired dissolution rate.

 

Uniformity of Venlafaxine and Ingredients

 

(Image is at bottom of post )

 

• from the FDA submission: caption explains that the actual quantities of excipients and rate-controlling polymers may vary but the weight of AI is the same
• E.g. 42.43mg of venlafaxine HCL (88.4% freebase as indicated in the patent literature) in a 37.5mg capsule:
• 42.43 X 0.884 = 37.508 (ie 37.5mg)

 

Dissolution testing and modification 

 

• from U.S. patent 6,274,171

 

TABLE 1

Acceptable Coated Spheroid Dissolution Rates

	Time (hours)	Average % Venlafaxine HCl released
	2	<30
	4	30-55
	8	55-80
	12	65-90
	24	>30

 

• Conformance with the dissolution rate given in Table 1 provides the twenty-four hour therapeutic blood levels for the drug component of the extended release capsules of this invention in capsule form. Where a given batch of coated spheroids releases drug too slowly to comply with the desired dissolution rate study, a portion of uncoated spheroids or spheroids with a lower coating level may be added to the batch to provide, after thorough mixing, a loading dose for rapid increase of blood drug levels. A batch of coated spheroids that releases the drug too rapidly can receive additional film-coating to give the desired dissolution profile.

 

• From the patents: further evidence that the core spheroid varies in size in only in extent of XR coating to ensure proper dissolution, and not in composition. 

 

Batches of the coated venlafaxine hydrochloride containing spheroids which have a dissolution rate corresponding to that of Table 1 are filled into pharmaceutically acceptable capsules in an amount needed to provide the unit dosage level desired. The standard unit dosage immediate release (IR) tablet used presently provides amounts of venlafaxine hydrochloride equivalent to 25 mg, 37.5 mg, 50 mg, 75 mg and 100 mg venlafaxine. The capsules of this invention are filled to provide an amount of venlafaxine hydrochloride equivalent to that presently used in tablet form and also up to about 150 mg venlafaxine hydrochloride.

 

• the question is how are capsules filled, by level, volume, weight, or another measurement? Is it possible that there are multiple filling stations?
• There’s ample evidence that the capsules are filled “conventionally” and by weight.

 

Further considerations from withdrawn patent EP1778208A1

 

Abstract

 

A capsule comprising venlafaxine hydrochloride wherein part of the drug content is in the form of delayed-release coated spheroids and a second part of the drug content is in a prompt-release form.

 

Background

 

Venlafaxine hydrochloride is now also sold in the United States and elsewhere, under the tradename Effexor XR™, as extended-release capsules in strengths of 37.5, 75 and 150 mg. These capsules provide gradual release of venlafaxine hydrochloride over a 24-hour period after ingestion, thus enabling a dosing schedule of once daily, while at the same time providing a lower incidence of nausea and vomiting.

™- Trademark. Effexor XR™ capsules are made in accordance with the disclosure of U.S. patent 6,274,171. Each capsule contains a multitude of small granules or beads, referred to as "spheroids". Each spheroid is comprised of a core, and a coating applied to the core. The core is comprised of venlafaxine hydrochloride, microcrystalline cellulose, and hydroxypropylmethylcellulose. The cores are coated with a mixture of ethylcellulose and hydroxypropylmethylcellulose. The ethylcellulose makes the film water- insoluble, while the hydroxypropylmethylcellulose makes the film water- permeable. The result is slow release by permeation through the film, with the release rate dependent on the ratio of hydroxypropylmethylcellulose to ethylcellulose and the thickness of the coat.

 

• taking different sizes of beads at random alters the pharmacokinetics of the drug in as far as the dissolution rate of the overall dose is altered. 

 

The cores are made by a process of mixing the venlafaxine hydrochloride, microcrystalline cellulose, and hydroxypropylmethylcellulose with water to produce a wet plastic mass, which is then extruded, spheronized and dried.

The film coating is then applied by dissolving the ethylcellulose and hydroxypropylmethylcellulose in solvent, and spraying the solution onto the cores in a fluid bed drying system.

 

While capsules according to U.S. patent 6,274,171 provide a satisfactory extended release product, coating all of the spheroids to reduce the dissolution to below 30% at two hours is costly.

In light of the foregoing, an objective of the present invention is to provide a formulation of extended-release capsules comprising venlafaxine hydrochloride, which does not require coating all of the spheroids to the extent necessary to reduce dissolution of all of the spheroids to below 30% in two hours. 

 

• if cost is there primary concern, would they really be producing core spheres which vary API content? I think not. Here they are even concerned that about the cost of coating all of the spheroids. 

 

Description of the Invention

 

The present invention is an extended-release formulation of venlafaxine hydrochloride in the form a capsule characterized as follows:

1. From 40% to 70% of the venlafaxine hydrochloride is in the form of coated spheroids, referred to as delayed-release spheroids, which exhibit average dissolution of less than 30% at 2 hours;

2. From 30% to 60% of the venlafaxine hydrochloride is in another form, referred to as a prompt-release form, which exhibits average dissolution of more than 60% at 2 hours. This prompt-release form may be in any of a number of physical forms including, for example, uncoated spheroids, coated spheroids, tablets, or powder; and

3. As a result of containing venlafaxine hydrochloride in both forms, the average dissolution of the capsules exceeds 30% but is less than 60% at 2 hours.

For purposes of this specification, the dissolution testing is done in USP Apparatus 1 at 100 rpm in 900 ml_ of phosphate buffer of pH6.8 at 37°C. The reason for maintaining dissolution of the capsule below 60% at two hours is to reduce the side effects of nausea and vomiting, just as is achieved by compositions of U.S. patent 6,274,171. The average dissolution of the mixture at two hours will preferably be between 35 and 55%, and will most preferably be about 45%.

As aforesaid, the delayed-release spheroids will be coated spheroids, which will be comprised of core spheroids, to which a coating is applied to delay release. The core spheroids will comprise venlafaxine hydrochloride along with one or more excipients (inactive ingredients). For example, the core spheroids may be made as in U.S. patent 6,274,171 by mixing venlafaxine hydrochloride with microcrystalline cellulose, hydroxypropylmethylcellulose and water to form a wet plastic mass, extruding, spheronizing, and drying.

A preferred method of making the core spheroids is to use, as an excipient, a water insoluble polymer, such as, for example, ethylcellulose. This enables the core spheroids themselves to exhibit somewhat extended dissolution, so as to reduce the amount of coating required on the core spheroids.

Such core spheroids can be made, for example, by preparing a solution of ethylcellulose in an organic solvent, such as methanol or methylene chloride, mixing the solution into the venlafaxine hydrochloride, drying the wet mass, milling the dried material into granules (i.e. spheroids), and selecting granules of the desired size by sieving. The coating that is applied to the core spheroids will be a film-coating comprising a water-insoluble polymer, such as, for example, ethylcellulose.

As aforesaid, in addition to containing delayed-release spheroids, the capsules will contain additional vehlafaxine hydrochloride in a prompt-release form, which may be in any of a number of physical forms, including, for example, uncoated spheroids, coated spheroids, tablets, or powder.

For example, the core spheroids that are used to make delayed-release coated spheroids may be used, uncoated, as the prompt-release form.

Alternatively, the prompt-release form may consist of the same core spheroids, which, instead of being uncoated, may be coated, but with a lesser amount of coating than the delayed-release spheroids, so as to only slightly delay release.

The capsules of the present invention not only have a lower cost of production than capsules according to U.S. patent 6,274,171 , but also enable greater flexibility of absorption profile, as a result of having the drug present in two forms instead of only one form. The capsules of U.S. patent 6,274,171 provide a peak venlafaxine blood level at from about 4 to about 8 hours after ingestion. The present invention enables capsules for which the peak venlafaxine blood level is reached in less than 4hours, but for which the peak level is still no higher than, or not significantly higher than, that obtained with capsules according to U.S. patent 6,274,171.

The invention will be better understood from the following illustrative examples.

 

Example 1 - Core Spheroids

 

Core spheroids were made as follows: ,

A quantity of venlafaxine hydrochloride was granulated by adding an equal quantity of ethylcellulose dissolved in methylene chloride, mixing and evaporating the methylene chloride. The resultant dried mass comprised 50% venlafaxine hydrochloride and 50% ethylcellulose. This dried mass was then milled through a #10 screen (10 wires per inch). The milled material was then sifted on a #20 screen. The granules that remained on the #20 screen, having a size from about 850 to about 2000 microns, were then retained for use as core spheroids. As aforesaid, such core spheroids may be used directly, in uncoated form, as the prompt-release form; or they may be coated with a film coat comprising a water insoluble polymer to form delayed-release spheroids. The average dissolution of these core spheroids was found to exceed 90% at 2 hours when tested in USP Apparatus 1 at 100 rpm in 900 mL of phosphate buffer of pH6.8 at 37°C.

 

Example 2 - Delaved-Release Spheroids

 

600 grams of core spheroids of example 1 were spray-coated with the following coating solution in a fluid bed coating system:

Ethylcellulose 200.0 g

Dibulyl Sebeate 30.0 g

Methanol ' 1800.Q q

2030.0 g

Total Dry 230.0 g

The content of venlafaxine hydrochloride in these delayed-release coated spheroids was 50% x 600/830 = 36.1 %. The average dissolution of these delayed-release spheroids was found to be about 15% at 2 hours, when tested in USP Apparatus 1 at 100 rpm in 900 mL of phosphate buffer of pH6.8 at 37°C. 

 

Example 3

 

Size 0 two-piece hard gelatin capsules were filled with spheroids as follows:

Venlafaxine

Quantity Per Hydrochloride

Capsule Content Per Capsule Core spheroids of example 1 120.0 mg 60.0 mg

Delayed-release spheroids of example 2 249.0 mg 90.0 mg

369.0 mg 150.0 mg

 

• see picture below for proper formatting for Example 3 
• Example 1: these core spheroids contain 50% API and 50% ethylcellulose
• Example 2: the dry weight of the coating is added to the core spheroid weight and the API weight is now a lesser percentage of the total weight. 
• Example 3: a mixture of uncoated core spheroids and coated spheroids in a capsule. The total fill weight (369mg) of the capsule can be broken down: 120mg of core spheroids and 249mg of coated spheroids. The API weight is calculated by using the percentages for each type of spheroid: 60mg for the uncoated (50% of their weight) and 90mg for the coated (36.1% of their weight). Added together the API weight is 150mg

 

The average dissolution of these capsules is about 40% to 45% at 2 hours when tested in USP Apparatus 1 at 100 rpm in 900 mL of phosphate buffer of pH6.8 at 37°C.

 

 

 

Discussion 

 

The above patent (although was withdrawn) sheds light on the fact that core spheroids - which are subsequently coated - are produced with a consistent amount of API.

 

Since the core spheroids are sifted for uniformity, the differing weights of the encapsulated microspheres is due to the thickness of the extended-release coating. The reasons for varying thickness of coating is explained in patent US6274171B1: batches of microspheres are adjusted for proper dissolution by adding 

microspheres which contain either more or less coating. 

 

Then encapsulation takes place. And that is where there are still some unknown on my part. The capsules must be filled to contain the “capsule claim” ie amount of API in mg stayed on the capsule. How do they fill them if the microspheres are weigh different amounts? 

 

Regardless, if the core spheroids have a consistent amount of API, there are important implications for suggesting counting spheroids is more accurate in terms of modified dosages for tapering - rather than weighing. 

 

Weighing is inaccurate due to the different weights/sizes of microspheres. It may be alright the beginning when a large sample size ensures dasage may average out. But I still believe counting to be superior. The additional

step of taking a precise number of different sizes is also a good idea, since the capsule contents are formulated that way to ensure continuous dissolution and stable blood plasma concentration over 24 hours.  In order to do that the capsule contents must be sieved. Averages of microsphere sizes in 10 or more capsules can be taken as a reference point for a proper ratio. 

 

—-

 

%# 49/41/10

 

 

Let’s say I am going to make a batch of spheroids which contains 50% small, 40% medium and 10% large in order to provide the proper dissolution. The last batch I made had to be adjusted to the above ratio to get the proper dissolution of the spheroids over 24 hours. 

 

The core spheroids are all the same and consist of 50% venlafaxine hcl and 50% microcrystalized cellulose.  

 

Final dosage: 75mg venlafaxine HCL

Fill weight: 246mg

Core spheroid weight at 50%Ven/50%MCC: 150g

XR coating weight: 96g

 

%# 50/40/10

 

Small spheroids: 

Combined weight of core spheroids: 75mg 

Coating: 9.6mg

Total weight: 84.6

 

Medium spheroids:

Core spheroid weight 60mg

Coating: 38.4mg

Total weight: 98.4 mg

 

Large spheroids: 

Core spheroid weight: 15mg 

Coating: 48mg 

Total weight: 63mg

 

Total coating weight: 96mg

Total core weight: 150g

Total capsule (fill) weight: 246mg

Venlaxine content: 75mg

 

 Number of spheroids in average capsule: 244

# of small: 122

# of medium: 98

# of large: 24

 

Small spheroid weight: 0.69 mg ea

Medium spheroid weight: 1.00 mg ea

Large spheroid weight: 2.63 mg ea 

 

Venlafaxine content of each spheroid: 0.3mg 

 

[FindPeace]

 

What’s up with the tips on tapering Effexor section? There are many errors. Someone hasn’t researched this enough. Well I did. Here’s what I’d change:

 

1. Half-life of ‘regular’ Effexor is stated up to 15 hours. Incorrect. It’s approximately 5±2 hours for immediate-release. 
 

2. “At the very end of your taper, you may wish to switch to immediate-release venlafaxine, if available, and make a liquid from it so you may reduce by fractions of a milligram.” 

 

Why anyone would want to risk this at the end of a taper is beyond me, better to do this well before tiny variations in dosage account for huge variations in SERT occupancy. 
 

3. “Opening the XR capsule and taking out the beads to gradually reduce the dosage is an established tapering method”

As the number of beads per capsules varies, removing a set number of beads leads to taking an inconsistent number, and a variable dose. One should count beads and ingest that amount rather than removing beads and ingesting the remainder. 
 

4.  “The number of beads in a capsule varies from dosage to dosage, e.g. the number of beads in 75mg Effexor XR capsules from Pfizer is NOT half the number of beads in 150mg Effexor XR capsules from Pfizer.”

 

Not true. At least for Effexor XR. The capsules of different strengths are “compositionally proportional” as stated in the FDA new drug application. Statistical analysis of  the capsules will show that a capsule of twice the strength does roughly contain twice the spheroids. 
 

5. “The number of beads in capsules may vary because the manufacturer, particularly generic manufacturers, have sloppy quality control and the capsules vary in weight”

 

No. The capsules vary in bead number because the batch of spheroids is adjusted for dissolution prior to encapsulation by adding various sizes, then filled by weight. If the capsule varies in weight then the quality of our scale is likely the culprit. Re: QC, yes there are fused-beads (dumbbells) and fragments but in a multi-unit pellet system the effect is negligible given most of the spheroids are of good quality. 
 

6. “When you're down to 9 beads, you won't be able to taper by 10% any more”

 

Then why do it? 
 

“Some people sort the beads by size and take the largest ones first, then the medium ones, and finally the smallest ones to go off gradually at the end.”

 

No. Bead size doesn’t make a difference in dosage but only in pharmacokinetics. The assumption that larger spheroids contain more venlafaxine is not supported. The literature supports the fact that they all contain the same amount regardless of size. Core spheroids (which contain a mixture of venlafaxine and ethyl cellulose) are produced to all have the same size and then subsequently receive varying coatings of extended release polymers such as hypromellose (HPMC) to ensure 24 hour dissolution of the drug. 
 

“…sometimes find one bead is too great a reduction. In that situation, longer holds are necessary”

 

A long hold is not commensurate with a small tolerable reduction. A large drop in SERT occupancy can severely destabilize someone and we all know what can happen. 
 

 

7. “Tapering by removing beads from Effexor XR can be tricky. Eventually, as you remove more and more beads, it may become too confusing and time-consuming to count them out. If you are very sensitive to dosage variations, you may wish to weigh the beads with a digital scale to get precise dosages.”

 

Again with removing beads. Don’t do it. Count beads and take that amount.  Switching to weighing when it becomes too tedious to remove beads makes no sense. 
 

“You may find weighing the beads will better enable you to control your dosage”
 

Wrong. If each spheroid has the same amount of venlafaxine, weighing them is sure to be less accurate than counting them since they vary so much in weight of XR coating. Either counting or weighing has to be more accurate, it can’t be both. I suggest counting, or better yet liquid. 
 

8. “Extended-release venlafaxine capsules: Open and count out mini-tablets. Depending on the manufacturer and dosage, there may be 3-12 tablets in a capsule, for example Vanlalupen XL”

 

If someone needs a hyperbolic taper with 40 or more steps, how are 3-12 tablets going to be of any use? What is needed here is a different formulation. 
 

“ingredients such as povidone and microcrystalline cellulose are integrated into the core of each mini-tablet (not the tablet coatings).”

 

I’m not sure about this. Probably a misinterpretation of the process of drug layering onto inert non-pareil cores (sugar). 
 

“Remember that doses in immediate-release tablet form have much shorter half-lives than those made from extended-release venlafaxine.”

 

They differ in absorption half-life not true half-life. Missing is the indication that it should be dosed q12h.  
 

 

“You cannot make a liquid from these mini-tablets, they contain a glue that will create a gel in liquid”

 

I haven’t tried it but it’s probably wrong unless it’s talking about mixing of fragments of mini tablets in liquid. If you turn them into a powder first, then the venlafaxine should pass into the liquid phase just fine. 
 

“If the extended-release tablets are cut, the extended-release quality is compromised.”

Fragments are not the same as powder. They may still have some XR properties depending on how they are formulated. 
 

9. Bridging with Prozac 

 

This is risky and should not be recommended. Who would want to count beads for 5 years if it was as simply as switching to liquid Prozac: the self-tapering marvel drug that is the solution to all our tapering woes. Mark Horowitz’s research shows that these drugs are not as similar to each other as physicians think, and switching from one to another can induce withdrawal confounded by adverse effects. A bridge from a SNRI to a SSRI is further dangerous in that they have different receptor targets; in this case, norepinephrine. 

 

Please consider revising this section. 

 

[manymoretodays]

@FindPeace, I've shared your concerns, and the above post with active staff and administration.

Someone will contact you regarding your concerns as soon as possible.

 

Did you thoughtfully read through the whole first post, and go to the quotes and links there as well?  Just asking as sometimes what you are reading as fact, or black and white isn't, there is room for interpretation, and decision making by each member.  And often the links go to what resources were tapped, and quoted.

Tips for tapering off Effexor and EffexorXR(venlafaxine)

 

I've got a ton of respect for Altostrata, who put together most of the tapering topics, gathering resources to share, and I think did a darn decent job of.

Last revision August of 2022.

 

Each member gets to empower themselves, with information and resources, and then can carefully guide their own tapers.......at least that's the way I've always seen it.   With some support, and experienced support.  I don't think there will ever be a complete one size fits all tapering manual or specific topic.  Hoping you get what I mean.  I love what is happening in the field, and the Maudsley guidelines, don't get me wrong.

Do I see a budding moderator in you?  I don't know.  Or technical writer?

 

Anyway.  Hope you are doing well enough.

 

L, P, H, and G,

mmt

Edited July 3 by manymoretodays

[FindPeace]

Hi mmt, 

 

Thanks for your reply. I apologize if my post is too brusque, but I feel frustrated by this. I did read the first post with all its twists and turns, including all the quotes and their sources.
 

I strongly believe that when guiding people with tapering their medication using off-label options, there shouldn’t be room for interpretation, rather a prescription for how it is done in as precise a manner as possible.
 

I’m sure you can appreciate that not everyone visiting the site is the position to make good decisions when they know next to nothing about how the medication works and how to taper safely. It is not prudent to choose what is convenient over what is safest, but many will if they don’t understand the difference. It is therefore useful to give them full disclosure as to the options which will give them the best chance of success, and those which will potentially cause problems for them. 
 

I also have lots of respect for Alto, but believe that the source of the information is irrelevant and what matters is its accuracy and usefulness. A revision could be considered, the first bridging link doesn’t work for example. 
 

I suppose there is some truth to the fact that each member has to decide what’s best for them. We don’t have clear guidance from medical professionals. But that is changing. At the very least, we have the Maudsley Guide, which is probably the best source of information on how to safely taper. Liquid formulations are the gold standard and for good reason. 
 

I guess that someone will respond that none of what I’ve said matters: ‘that it all averages out; that unless someone is extraordinarily sensitive, close enough is good enough.’ I’m not satisfied with that answer personally. Considering what’s at stake, dosage accuracy is as important as the speed and size of reductions.  
 

Certain members - such as myself - have invested a lot of time researching drug patents and the FDA submission and have discovered new information which can inform tapering. Why disregard it? Let’s open a discussion about it and - if appropriate - integrate it.  
 

Hope you are also well, 

 

FP
 

 

 

 

 

 

 

[Ariel]

Hi @FindPeace

 

1 hour ago, FindPeace said:

the first bridging link doesn’t work for example. 

 

FYI, regarding technical issues in a post --

 

It's great to notice defunct/obsolete links in posts and report them!

This is how we collaborate to co-create a smoothly functioning, up-to-date site. 

 

Do you know about the Report function?

 

In the top right-hand corner of any post "box"/window there are 3 little dots. 

When you click on these you'll see two options pop up, Report and Share. 

Choose Report and you'll get a message box where you can write specific comments/concerns regarding that particular post and send directly to SA staff. 

 

When I come across inactive links this is what i do:

First I try to search the internet for a working link -- preferably a direct replacement of the original, or, if that can't be found, something equivalent or as similar as possible, matching the content and context of the post in question.

I then use the Report function of the post in question to notify staff of the erroneous link in said post, and I include any suggestions for replacement link(s). 

The staff are very busy, they are all unpaid volunteers, and there are very few staff members in proportion to many members. 
Anything we can do to help save staff time is helpful, so if we can do the legwork ourselves, e.g. searching and finding replacement links, it allows staff to spend their precious time directly assisting members in need, and minimizes any additional (extraneous) admin overtime. 

 

Thank you for your attention and dedication. 

SA works best when we all work together to co-create the best possible community resource(s). 

It is beautiful to behold. 

 

Healing vibes <3

Ariel 

[FindPeace]

Hi Ariel, 

 

Thank you for your message, I had no idea! I thought the report feature was to flag inappropriate content. I will be sure to do that in the future. 
 

All the best,

FP

[manymoretodays]

15 hours ago, FindPeace said:

Thanks for your reply. I apologize if my post is too brusque, but I feel frustrated by this. I did read the first post with all its twists and turns, including all the quotes and their sources.
 

I strongly believe that when guiding people with tapering their medication using off-label options, there shouldn’t be room for interpretation, rather a prescription for how it is done in as precise a manner as possible.
 

I’m sure you can appreciate that not everyone visiting the site is the position to make good decisions when they know next to nothing about how the medication works and how to taper safely. It is not prudent to choose what is convenient over what is safest, but many will if they don’t understand the difference. It is therefore useful to give them full disclosure as to the options which will give them the best chance of success, and those which will potentially cause problems for them. 
 

I also have lots of respect for Alto, but believe that the source of the information is irrelevant and what matters is its accuracy and usefulness. A revision could be considered, the first bridging link doesn’t work for example. 
 

I suppose there is some truth to the fact that each member has to decide what’s best for them. We don’t have clear guidance from medical professionals. But that is changing. At the very least, we have the Maudsley Guide, which is probably the best source of information on how to safely taper. Liquid formulations are the gold standard and for good reason. 
 

I guess that someone will respond that none of what I’ve said matters: ‘that it all averages out; that unless someone is extraordinarily sensitive, close enough is good enough.’ I’m not satisfied with that answer personally. Considering what’s at stake, dosage accuracy is as important as the speed and size of reductions.  
 

Certain members - such as myself - have invested a lot of time researching drug patents and the FDA submission and have discovered new information which can inform tapering. Why disregard it? Let’s open a discussion about it and - if appropriate - integrate it.  

 

Hey there.  Yes, I think it was the tone I responded to.  And yes, I think that we've opened a discussion about it now.   I'm not disregarding your information or your time invested.  It was the brusque tone is all.  I think we likely agree on more than you might think.

 

You bet I am more than aware that not everyone visiting the site is in a spot to make best decisions, and we are all vastly different with our strengths.  Gosh, I was one, and it took me literally years to figure out what I now know.   To read through, to understand.   And perhaps even more importantly, figure out what I don't know.   I'm glad you are a stickler for knowing the dose accuracy. 

 

We agree on dose accuracy is important!  I think we agree on harm reduction or NOT taking any chances that might lead to more harm than not.  And we really do try to back up our support, and methods, and suggests with references, and sometimes personal experience.

 

"close enough is good enough.’ I’m not satisfied with that answer personally"  I hope you did not read into what I typed, that was what I was saying.  I don't think I said that or conveyed that.

 

"I suppose there is some truth to the fact that each member has to decide what’s best for them."  I think my point was, we each, if not in the beginning, later, become our own experts on ourselves, and how we respond to given tapering or drug changes.  And keep in mind, many of us, me for one, have been gaslit by providers NOT recognizing when a drug or drugs effect is at play, and even sometimes going so far as to say it's "my or our illness".  So I'm all for grabbing the reins as soon as possible, or did so in my own case, with as much knowledge as I could gain and soldiered through, and got off my last drugs.   For some yes,  the best scenario is having a professional of some kind that allows for give and take discussions and respect.  And knowing where to look to find decent information that backs up what any of us are doing or suggesting.  I don't think there will ever be a one size fits all to de-prescribing, but there are principles that have been studied and measured and thank goodness for that.  Like I said I'm all for this becoming more of a respected science.  I too, appreciated the simple/concise suggests that I got early on, and had to learn to trust and did, those who made them.  I had to get off my drugs and save my life.  I'll never regret it, and tend to go with more open gratitude for what I got here when I really needed it.  It was no where else to be found. 

 

15 hours ago, FindPeace said:

the first bridging link doesn’t work for example. 

I can work on that.  I'll take a look now.

 

We do our best to work together, like Ariel put so well.  I'm starting to think I'm more of an analytical artist at heart and soul, and mind and spirit.  Forever learning, growing too I hope.  Not always the clearest, but caring counts for something I'm sure.

 

Alrighty.  Thank you for your reply as well.  Appreciate the discussion. 

 

Love, peace, healing, and growth,

 

mmt

 

 

Edited July 3 by manymoretodays
spelling

[manymoretodays]

 

 

-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine

 

"Bridging" with Prozac
Attributed to Joseph Glenmullen, the "bridging" technique is described by a doctor here http://www.bipolarworld.net/Phelps/ph_2005/ph1354.htm

 

Is this ^ the link you referred to @FindPeace  Sometimes when they are that old, looks to be 2005, they just disappear.  I do like sleuthing about searching the net though and will see what I can find.  I'll have to get back to this and will!  There's another response in the tapering topic to you as well.

 

Respectfully, mmt

 

[Schmeg82]

Hello FP!

 

I read your comment on scareddads thread about holding your dose after updosing and feeling better, I just want to say that gives me hope! I updosed from 5mg Paxil to 10mg Paxil and have actually gotten worse recently, it’s been 4 months since updosing and 6.5 months since withdrawal symptoms started.  I’ve been losing hope and thinking about starting a small taper again but I think it’s too soon.  I know Paxil and Effexor are very hard to come off of so I’m glad you finally got some stability!  Can I ask what your worst symptoms were and when you started to feel some relief?  Thanks again and hope you’re doing well! 

[Schmeg82]

22 minutes ago, Schmeg82 said:

Hello FP!

 

I read your comment on scareddads thread about holding your dose after updosing and feeling better, I just want to say that gives me hope! I updosed from 5mg Paxil to 10mg Paxil and have actually gotten worse recently, it’s been 4 months since updosing and 6.5 months since withdrawal symptoms started.  I’ve been losing hope and thinking about starting a small taper again but I think it’s too soon.  I know Paxil and Effexor are very hard to come off of so I’m glad you finally got some stability!  Can I ask what your worst symptoms were and when you started to feel some relief?  Thanks again and hope you’re doing well! 

I read most of your symptoms, you don’t have to tell me! I’m glad you stabilized again, that gives me hope.