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Vick: Request for help to start taper journey


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Hi. I joined a few months ago but this is first time posting. I want to start toward coming off Venlafaxine 150 XR. Been on since 2018. Proir to that had come off 7 years Paroxatine (with GP not slow enough) and became REALLY ill, more than ever. I felt strongly it was discontinuation synd but gp said no and I felt i had no choice but to start again or do something final and was put on venlafaxine. I originally started a.d just before I got clean from drugs/alcohol and don't think I actually need anti deps (clean sober 12 years) or have serious depression.... mild was present throughout using,  but only really bad when I came off paroxatine.  Question is, how do I find a gp who will support in v slow taper. I live in Dorset. Mine were very dismissive and deniers. I'm a mental health professional and have knowledge, and lots of support from others,  but struggling to advise self. Thank you

2009 - 2017 Paroxatine

Nov 2017 - Feb 2018 Reduced Paroxatine

May 2018 - Present Venlafaxine XR 150 mg 

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  • ChessieCat changed the title to Vick: Request for help to start taper journey
  • Moderator

Hi Vick, 

welcome to SA. Sorry your taper from paroxetine was so difficult. It is a very difficult drug to come off of. So is Venlafaxine. It is great that you are looking for support ahead of starting this time. It is also hard to find a GP who understands this though this is changing in the UK. You could give them sources such as this video. Or you could see our tips here - the other two threads have links to academic articles that help. 

 

https://www.survivingantidepressants.org/topic/20161-how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect/

Why taper by 10% of my dosage? - Tapering - Surviving Antidepressants

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration - Tapering - Surviving Antidepressants

  

But strictly speaking, you don't need your doctor's approval to taper. As long as they keep prescribing you your regular dosage, you can keep taking lower amounts of it.

 

Here we recommend tapering by no more than 10% of your previous dosage every 4 weeks. Since you have had trouble with this before and have a longer drug history, it may be wise to start even lower - maybe 5%. You would lower your dose by 5% of your current dose and then wait for 4 weeks to see what symptoms emerge and how they change. If the symptoms are bearable, then you can try a bigger cut the next time, until you get to 10%. If not, you just do a very slow taper. You could also start by 10% and see how that changes. 

 

Can you please create a drug signature so in the future we can advise you better if changes need to be made. 

How to List Drug History in Signature - Introductions and updates - Surviving Antidepressants

 

Here are also links to tips for tapering off venlafaxine: 

https://www.survivingantidepressants.org/topic/272-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine/ and FAQ on tapering in general. 

Important topics in the Tapering forum and FAQ - Tapering - Surviving Antidepressants

 

Good luck with your taper and do let us know if you have any other questions. 

 

OMW

 

Edited by Onmyway
Mistakenly wrote 10% every 4 months - corrected to every 4 weeks

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

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Thank you this is so helpful. I'm a bit baffled and overwhelmed with the logistics, especially as I'm on prolonged release. Also I'm always being given different brands, which having read the articles may be problematic? In my case would you suggest very sensitive scales? Though maybe different coatings weigh different amounts. It feels very confusing and I haven't even started!! Nevertheless your response was extremely helpful, thank you

2009 - 2017 Paroxatine

Nov 2017 - Feb 2018 Reduced Paroxatine

May 2018 - Present Venlafaxine XR 150 mg 

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  • Moderator

Hi @Vick

Have asked someone with venlafaxine experience to advise here. Please note - I've written 10% every 4 months in my earlier message above. That's a typo. It's 10% every 4 weeks. 

 

sorry about that -will edit message to have it correct.

 

omw

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

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  • Administrator

Hello, @Vick In what form is your venlafaxine XR? Is it a capsule filled with tiny beads?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 4 weeks later...

Hello, yes it is in tiny beads. But im worried about how to manage it, as the make is always being changed.  Though I guess as it's proportional I can rework it out with each brand...or should I use micrograms scales? I'm probably overcomplicating this as I got so seriously ill when I tried to come off (paroxatine) before. Hence my very long delay in replying...everyone's help is truly appreciated.  Are there people here who have come off venlafaxine and been ok?  Thanks 

2009 - 2017 Paroxatine

Nov 2017 - Feb 2018 Reduced Paroxatine

May 2018 - Present Venlafaxine XR 150 mg 

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  • Administrator

You might request that your prescription be filled with the same brand of venlafaxine XR consistently. Failing that, you'd have to get a digital scale and taper by weight, calculating dosage per milligram for each different brand.

 

Is immediate-release venlafaxine available?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thank you Altostrata, thats what I will do if they don't stick to same brand. 

 I expect i could ask for IR...is that for down the line when dose gets low to make liquid?  

Has anyone bought taper strips from Holland? And what about bridging with prozac...thats also near end too right?

Or maybe I just need to get underway....the end part is a long way off and I'm procrastinating through fear 🙄

2009 - 2017 Paroxatine

Nov 2017 - Feb 2018 Reduced Paroxatine

May 2018 - Present Venlafaxine XR 150 mg 

Link to comment
  • Moderator

Hello @Vick. I’m based in the UK as well and have had similar issues with changing brands in the past.

 

When you collect your prescription make sure you go to the same pharmacy. Ask your pharmacy which brands they stock and how long they they expect to be able to receive this brand. You can get a note put on your script by the GP requesting you receive the same brand (once you’ve decided which brand you want). The pharmacy will order this brand for you as long as it’s available.

 

My recommendation would be to stabilise on a brand that you will consistently be able to get every month, that way you don’t have to factor in brand changes whilst tapering.
 

Like others have said regarding tapering, I would utilise the bead counting method. Once you’ve settled on a consistent brand, count the number of beads in a capsule. Do this for 5-10 capsules and take an average. When making your dose make sure you count the number of beads taken, not the number of beads removed (as the count can fluctuate per capsule). 

Active Monday-Friday UK time

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021; 55mg - 23 Feb 2024; 60mg - 20 March 2024; Start tapering - 24 April 2024

Current dose: 57.93mg  (15 May 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

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Thank you Erimus and everyone here. Joining this group has given me the confidence to try again to come off AD, with your knowledge and support if feels possible. 

2009 - 2017 Paroxatine

Nov 2017 - Feb 2018 Reduced Paroxatine

May 2018 - Present Venlafaxine XR 150 mg 

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  • 10 months later...
  • Administrator

Hello, @Vick, how are you doing?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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