etphonehome: trying to get off venlafaxine and lamotrigine

[etphonehome]

Original topic title:  trying to get off of effexor/venlafaxine XR and lamictal/lamotrigine. which one first?

 

Hello everyone and thank you in advance for reading:

 

TLDR: I am a 31 year old woman who has been on various meds over the last 10 years. I want to get off of lamotrigine and venlafaxine, but I'm not sure where to begin. 

 

Unfortunately, my mental health history is long. I have struggled with anxiety and phobias since childhood, starting at about 10 years old when I developed a fear of getting sick to my stomach and of contaminated food. In hindsight, I think the stomach aches I had for many years were likely due to the stress and anxiety as I did elimination diets and had various tests performed that all came up negative. When I was 14 I was diagnosed with anorexia and I think my eating disorder was by and large a way for me to try and deal with anxiety. I was also diagnosed with ADD in 8th grade, but was not medicated. In high school I saw a few psychiatrists and was briefly prescribed prozac and effexor, but I was not compliant with medication and would refuse to take the pills or hide them. I don't remember any bad side effects when I did take meds, so I assume the refusal was my teenage way of asserting some control over my situation and treatment. 

 

During my freshman year of college I started taking adderall XR (don't remember the dose, sorry) which did help me focus and calmed some of my racing thoughts. I dropped out of school my sophomore year (2011) due to the eating disorder and out of control panic attacks and that was when my ~journey~ with medication really began. I began seeing a psychiatrist when I moved home, stopped taking adderall as I was so activated from panic, malnutrition, too much caffeine, not enough sleep etc, and was put on celexa, propranolol, and PRN ativan. 

 

In 2012 I entered an all day partial hospitalization program for the eating disorder. While I was there the psychiatrist on my treatment team had me go on olanzapine (zyprexa) because I had a "delusional body image". I went off that medication cold turkey a few months after leaving treatment because I couldn't stay awake during the day and because I was afraid of potential weight gain. I did not experience any withdrawal symptoms. 

 

I relapsed about 6 months after leaving treatment and then for the next four years I cycled in and out of various levels of care for the ED. As is the case with most facilities, ED treatment centers are pretty medication happy. From 2012-2015 I was on the following at different times and in different combinations: seroquel, prasozin, zoloft, abilify, klonopin, xanax, and probably a few more that I am not remembering. At one point before going inpatient I was prescribed 3-4 mg of klonopin/day AND xanax PRN. That's probably my most negligent experience with a psychiatrist as I was underweight at the time and no medication is going to really help the psychological fallout from malnutrition. I left that program in 2015 on 1 mg of klonopin for sleep. 

 

I left treatment for (hopefully) the last time at the end of 2016 on 175 mg effexor XR, 20 mg adderall XR, low dose abilify, 20 mg propranolol, 1 mg klonopin. 

 

In 2017 I went off abilify cold turkey when my insurance company decided I didn't need it anymore. Didn't have any problems with withdrawal. I also went on wellbutrin after a 6 month episode of depression.

 

In 2018 I started seeing a new psychiatrist because the outpatient program I had been going to no longer had a consistent psych and my dr did not feel comfortable managing my meds. At the time, I was going through a really rough spot as I had just chosen to move out of the apartment I had been sharing with my partner as we were not getting along and I was having a rough time with that choice and transition. The new psychiatrist took me off of the wellbutrin, suggested lamictal for "mood swings", and increased my effexor to 350 mg. I also wanted off the klonopin as I'd learned benzos can cause cognitive side effects if used for too long. As my dose was considered low, I went off klonopin cold turkey. After reading some horror stories here I know I am lucky I didn't experience any side effects other than a summer without much sleep. 

 

2019: my insurance company decided it was only going to pay for 175 mg effexor (why? who knows!) so my dose was cut in half overnight. I once again dodged withdrawal. 

 

2020: When the pandemic started, I started taking 0.5 mg lorazepam/ativan PRN for panic attacks. 

 

2021: At the beginning of the year I was feeling good, had gotten involved in legal advocacy, was feeling more confident in school etc and decided I wanted to try getting off of lamictal as I didn't feel like it did anything for me. In March, I made a plan with my psychiatrist to finish my bottle of 150 and then go down to 100 mg. About a week later I had a panic attack so bad I went to the ER, which I had not done since I started having panic attacks in 2011. I still wanted to go off meds so I went ahead and reduced the lamictal. It seems that after consistent luck with quitting meds without a proper taper my luck has run out. Within a few days I was dealing with fatigue, nightmares, horrible brain fog, brain zaps, and GI distress. I couldn't deal with the symptoms and complete homework and deal with the fallout of that panic attack so I went back up to 150 lamictal but declined to increase my effexor as suggested by my psychiatrist. 

 

Which brings me to 2022 (sorry, this is long!!!!). The panic attack I had in March 2021 set off the panic cycle and the physical symptoms of anxiety I experience continue to be frightening and debilitating. I struggle to go anywhere other than a limited number of places with a limited number of people without taking ativan because my body just freaks out and I start feeling extremely ill. I ended my relationship of seven years in January and that on top of that, the relentless physical anxiety made it nearly impossible for me to finish spring semester and my summer class. Over spring break (March 2022) I gave in and increased my effexor XR to 225 mg and felt some relief from the panic symptoms and obsessive thoughts/phobias. During the summer I basically did nothing but hang out and try to give my nervous system a break by getting enough sleep and enough food and that break also helped. Over the summer I went off trazodone cold turkey because it was making me dizzy. That was fine except for a week of extra vivid and messed up dreams. 

 

Four weeks ago I tried again to reduce my dose of lamictal, going down to 125 mg this time. That (very unsuccessful) attempt is what brought me to this website and some fb support groups for people trying to get off meds. For the first week of the lower dose I actually felt better--more alert, fewer issues with finding words, better memory. Maybe it was a placebo effect. I was tempted to cut my dose again since I felt great, but thankfully I checked myself before wrecking myself because during the second week things went awry. One morning I went outside to walk the dog and some of the worst anxiety of my life hit me over the head. It was horrible, like someone reached inside my diaphragm and twisted my organs. I was thinking about things that are hard to deal with and real fears like the break-up, uncertainty over where the relationship would go in the future, what to do and where to live when I graduate this semester, applying for post-grad programs that I find intimidating, but all those things hit me at a 20 out of 10 and all at once. Of course I wondered whether this is the "me" the meds numbed or whether it was withdrawal. I feel it may have been withdrawal because it's not how my experience with anxiety and depression usually is. I was having really insane thoughts that didn't feel like they came from me and scary suicidal impulses that, again, didn't feel like anything I've ever experienced. 

 

After maybe three days of trying to ride these feelings and thoughts out I went back to 150 mg and started looking up other resources for tapering. I'm so glad I found this site because after doing some reading I see I was trying to taper way too quickly. For the last few days I have felt more "normal", but am still I think worn out from the roller-coaster my nervous system just went on. 

 

My plan was to go off lamictal first because I think it is causing cognitive side effects like having trouble finding words and trouble with short term memory and focus. I am also not good at math and trying to figure out how to reduce effexor feels more intimidating. But I saw a post saying that it can be better to taper off of more activating meds like effexor first, so I am definitely looking for some advice. 

 

I'm also wondering when I should start trying to taper. It is my last semester of undergrad and, while I would like to taper ASAP, I need to do well this semester to make up for less than amazing grades last year while I was in constant crisis. I know getting off of these meds is a long process that I need to be patient with, so I am trying very hard to be zen about the timeline. 

 

Currently my meds are as follows: 225 mg effexor XR (one 150 mg pill and one 75 mg), 10 mg Adderall XR, 20 mg propranolol, 150 mg lamictal (currently taking one 100 mg tablet and two 25 mg tablets), and PRN 0.5 ativan. For supplements I take vit D, beef liver, iron, magnesium, fish oil, and cbd gummies with melatonin for sleep. I will have a drink maybe once every two months and I do not smoke weed or do other drugs. I have not been taking adderall recently as I have felt too activated and only in the last few days have I been able to have about a 1/2 cup of coffee in the morning. 

 

I see a therapist about twice per month. She does somatic experiencing which I hear can be helpful for the nervous system. I was doing it for awhile and it helped, but then her office became a place that felt too overwhelming to go to so I have been seeing her virtually, but I am considering giving the touch therapy another try. I started using my meditation app again and I walk the dog every day. Thanks to all the treatment I've had, I do have skills I rely on to get through crisis without hurting myself and I try to use things like ACT and DBT. My ex and I are still friends and I stayed with her when it was not safe for me to be alone. 

 

I am trying to make more lifestyle changes as I need to work on exercising more, getting consistent nutrition, and sleeping, I walk pretty much every day, but I'd like to do something else like lifting weights or taking up hiking again. I know I need to be much more consistent about challenging the anxiety and agoraphobic tendencies so I can return to doing the things I know I enjoy and things that are good for me. I am looking into functional nutrition as I have been mostly stable with the eating disorder for years, but choosing what to eat continues to be a struggle. I am sleeping better than I was last year, but it still takes me a long time to fall asleep and it's not uncommon for me to wake up during the night. I also have very vivid nightmares so I often wake up feeling unrested. I am constantly exhausted and struggle to find the motivation and energy to attend to my responsibilities. 

 

All of my meds are generic, if that matters. I can go back and change the names in the post if necessary. I'd obviously like to be completely off medication at some point, but the effexor and the lamictal feel the most urgent. I don't think I can handle getting off more than one at a time. I am scared to start this journey again, but I still want to keep trying. I have several physical symptoms that I have long attributed to anxiety and am now wondering if some of them are actually medication side effects. My hope for myself is that someday I can feel physically better and just more at peace. I'm in my early 30s and I feel like this is the time in my life where I should be feeling my most vibrant and healthy but, to quote Martha Wainwright, "I'm young and I'm strong, but I feel old and tired". 

 

Thank you all for reading, whoever is reading all of this!!!! I know this post is super long and for that I am sorry. I am trying to give as much info as I can and my history is long.

 

Edited October 7, 2022 by ChessieCat
added original intro title before shortening

[Altostrata]

Welcome, @etphonehome

 

As I understand it, you're currently under the care of a psychiatrist? What plan does this person have for you to go off your drugs?

[etphonehome]

hi @Altostrata,

 

thank you for responding to my literal novel (sorry again about that...i did not proofread). yes, i am currently seeing a psychiatrist. when I emailed her regarding withdrawal she suggested I try splitting a 25 mg pill in half or quarters to taper more slowly (i am currently taking one 100 mg pill and two 25 mgs). she didn't really give me any other information. 

[Altostrata]

You're taking a lot of drugs.

 

If you've been taking Adderall only occasionally and not getting withdrawal from that, if I were you, I'd stop taking it. It complicates your cocktail. 

 

How often are you taking Ativan?

 

What times o'clock do you take your drugs, with their dosages? Have there been times when you've forgotten to take a dose of any of the daily drugs?

[etphonehome]

Hi--

 

I'd say I take ativan about 2-3x/month. 

 

Today my med schedule has looked something like this:

 

8 AM: wake up, take propranolol (20 mg)

9 AM: 225 mg venlafaxine, 150 mg lamotrigine, 5,000 IU vit D with breakfast

 

This evening around 9 I will take two CBD gummies that are total 10 mg CBD.

 

I take my prescription meds and vit D every day, but am less consistent with supplements. I think I may need to revisit my supplement schedule. For the last year or so I have been so desperate to feel better that I've been adding supplements probably without enough understanding of what they do and how they may interact with my medication/system in general. 

[Altostrata]

41 minutes ago, etphonehome said:

9 AM: 225 mg venlafaxine, 150 mg lamotrigine, 5,000 IU vit D with breakfast

 

Why are you taking these 2 drugs together? How do you feel before you take them? How do you feel after you take them?

[etphonehome]

Sorry, do you mean why did my psychiatrist prescribe them together or why take them together in the AM? 

 

This morning I woke up feeling anxious and unsettled, a feeling which got worse after I took my meds and got ready for my day. I had a cathartic cry in my car and felt more relaxed after that ha ha. Do you think it would maybe be helpful for me to keep some kind of mood journal for a few days to see if there are any patterns with med timing? 

[Altostrata]

Why do you take the 2 drugs together in the morning?

 

Good question! 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 show if your symptoms are adverse effects from one of your drugs.

[etphonehome]

Thanks @Altostrata. I will take some notes and report back. 

 

My psych told me to take the venlafaxine in the AM. On the occasions that I've had to take it after about 3 PM I have noticed I have a more difficult time sleeping. I don't believe I was told to take the lamotrigine at a certain time of day so I take it in the AM for convenience. 

[etphonehome]

October 22, 2022:

 

8:30 AM: got woken up suddenly by dog barking, so felt a little unsettled

9 AM: fish oil + propranolol, feeling ok

9:30: breakfast + 225 mg venlafaxine xr + 150 mg lamotrigine + 5,000 IU vit D
10:30 AM: go for a walk. feeling kind of blah

12:30 PM: lunch, a little anxiety but i was able to calm down

2: headache, feeling sort of irritated and short tempered

3: lack of motivation 

5: went for another walk and felt better

7: dinner

8: still feeling ok, took 200 mg magnesium

 

At 10 PM I'll take 10 mg of cbd

 

It's the second day of my period and it's not unusual for me to feel really tired and unmotivated for the first two days of my cycle

 

 

[Altostrata]

On 10/17/2022 at 1:50 PM, etphonehome said:

Thanks @Altostrata. I will take some notes and report back. 

 

My psych told me to take the venlafaxine in the AM. On the occasions that I've had to take it after about 3 PM I have noticed I have a more difficult time sleeping. I don't believe I was told to take the lamotrigine at a certain time of day so I take it in the AM for convenience. 

 

When and why do you have to change the timing of your venlafaxine dose?

[etphonehome]

On 10/23/2022 at 1:35 AM, Altostrata said:

 

When and why do you have to change the timing of your venlafaxine dose?

Oh, there have been a few times where I haven't been able to pick up a new prescription until later in the day or if I've forgotten to take AM meds

 

I have been traveling so I'm sure that has impacted my mood but here we go:

 

October 30th, 2022:

9 AM: wake up, feeling ok

9:30: breakfast + 150 mg lamotrigine + 225 mg venlafaxine xr+ 5000 IU vit d

10:30: feeling fine

12:30 headache, took excedrin migraine, drank water

1 PM: lunch, feeling better (probably dehydration + hunger headache)

5 PM: 1 hour before going out to dinner, stomach hurts, heart palpitations. took .5 mg ativan

5:30: feeling better

6 PM: dinner out, had fun, drank one cocktail 

10 PM: 10 mg CBD 

11:30: bed 

 

 

[etphonehome]

October 31, 2022:

 

9 AM: wake up, feeling ok but tired

9:30: 20 mg propranolol + 1/2 cup of coffee

10:30: breakfast + 225 mg venlafaxine xr + 150 mg lamotrigine + 5000 IU vit d

11:30: feeling ok, shower, getting ready for airport

1 PM: feeling overheated, dizzy, heart palpitations

1:15: lunch, start feeling better

2:30: dizziness, heart palpitations, nausea, sweating. i have to leave for the airport at 3 so I assume these are anxiety symptoms. take .5 mg ativan 

3 PM: feeling less activated

5-7:30: flying, feeling calmer. had one cocktail on plane*

8:30: arrive at home, eat dinner

11 PM: 10 mg cbd

1130: bed

 

*yes, i know drinking is not recommended w/ these meds. i don't do it very often but was on vacation etc etc

 

I notice that going too long without eating has started triggering physical anxiety symptoms...I assume because drops in blood sugar can mimic panic symptoms. I definitely need to work on eating on a better schedule. 

[etphonehome]

November 1, 2022:

 

8 AM: not a pleasant start to the day as I woke up to the dog being sick.

 

I didn't keep an hourly log past that but I basically felt fatigued and really low all day. I have not been noticing that the persistent fatigue I have been feeling has not been altered by my medication one way or another. I feel that traveling + taking depressants that I don't have very often likely contributed to the low mood/energy. 

[Altostrata]

On 11/2/2022 at 12:42 PM, etphonehome said:

Oh, there have been a few times where I haven't been able to pick up a new prescription until later in the day or if I've forgotten to take AM meds

 

And what happened when you did not take your dose on time? How often did this happen?

 

Taking lamotrigine at the same time as venlafaxine doesn't make any sense. Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

Why are you taking beef liver? Are you taking glandulars?

 

Please post notes 24 hours at a time. We cannot interpret fragments.

[etphonehome]

--Re taking venlafaxine late: only a handful of times. the only thing i've noticed is more trouble sleeping if i've taken it late

 

--re beef liver: i read good things about liver supplements helping people with their energy and hair/skin. i've never heard of glandulars

 

here is the report. i'd never heard of this website before, thank you. maybe i will send it to my psychiatrist. 

https://www.drugs.com/interactions-check.php?drug_list=2296-1523,1430-0,1956-0,1548-0

https://www.drugs.com/interactions-check.php?drug_list=646-5790,3906-0,1081-13328

 

i attached a screenshot of the major interaction. yet another thing i wish i'd known before going on lamotrigine.

 

since melatonin interacts with my meds i guess it's best that i stop using the cbd gummies for sleep since they contain melatonin. i'll keep a better symptom log this week. 

 

 

[Altostrata]

How many is a handful? When was the last time you took your drugs off-schedule?

 

I would not worry about melatonin. I would worry about taking lamotrigine at the same time as venlafaxine. Why do you take propanolol in the morning? How long have you been taking your drugs on this schedule? Your signature says you are also taking Adderall and Ativan, when do you take them?

 

Please continue to post daily notes.

 

 

[etphonehome]

On 11/5/2022 at 12:02 AM, Altostrata said:

How many is a handful? When was the last time you took your drugs off-schedule?

 

 

 

Maybe 2-3 times within the past year? I last took them off schedule about two weeks ago as my pharmacy got behind on refills

 

On 11/5/2022 at 12:02 AM, Altostrata said:

I would not worry about melatonin. I would worry about taking lamotrigine at the same time as venlafaxine. Why do you take propanolol in the morning? How long have you been taking your drugs on this schedule? Your signature says you are also taking Adderall and Ativan, when do you take them?

Should I maybe try taking the lamotrigine at night? Now that I see using the two together can cause dizziness I wonder if the combination is what has been causing the dizziness I attribute to anxiety. I have been taking propranolol in the AM because that is when the anxiety symptoms are the worst. I've been taking the drugs on this schedule for about four years (when I was prescribed lamotrigine).

I haven't been taking the adderall so I'll update my signature!

The last time I took ativan was on October 31st. I take it 2-3 times/month. 

 

November 13, 2022:

9 AM: wake up, feeling ok despite restless sleep and bad dreams, take fish oil

10: breakfast + 20 mg propranolol + 150 lamotrigine + 225 mg venlafaxine xr + 5000 IU vit D

11: in a decent mood, physically feeling ok

12 PM: some fatigue

1: lunch

2: feeling tired but anxious. muscle tension. 

3: ate a snack, heart pounding, dizzy

4-5: went for a walk, feeling better

6: feeling ok--just sort of emotionally blank

730: dinner, feeling fine

9: nothing to report

10: magnesium, feeling fine 

11:  bed

 

[Altostrata]

How are you taking lamotrigine? Is it a 150mg tablet? Is it extended-release?

[etphonehome]

November 15, 2022

 

12 AM: fell asleep

3 AM: woke up after a bad dream, fell asleep quickly

6: woke up briefly but fell back to sleep

830: wake up, feeling ok but really tired

9: breakfast + fish oil + 20 mg propranolol + 150 lamotrigine + 225 venlafaxine XR + 5000 IU vit d

9:30: feeling more energized

1030: panic symptoms on way to class (dizzy, muscle weakness, heart pounding, shaky, trouble breathing)

1115: take .5 mg ativan

1145: feel more calm, able to engage w the material

1 PM: lunch

230: reading, feeling fatigue 

330: walk, am in a better mood

8: dinner

10: 10 mg CBD + 200 mg magnesium

1130: bed

 

[etphonehome]

9 hours ago, Altostrata said:

How are you taking lamotrigine? Is it a 150mg tablet? Is it extended-release?

yep, the 150 mg tablet. it's not extended release. 

[Altostrata]

How often have you taken Ativan in the last month?

 

It appears the 150mg dose of lamotrigine is too much for you, or it is interacting with the venlafaxine.

 

If I were you, I might cut the lamotrigine tablet in half. Take 75mg at the usual time of 9 a.m., move the other 75mg an hour later each day until you are taking it at 9 p.m. 

 

Please continue to post your notes during this process.

[etphonehome]

Thank you for all your help so far @Altostrata. I will try cutting the pills in half and see how it goes. 

 

I've taken ativan once so far this month (November).

[etphonehome]

First day cutting the lamotrigine in half.

 

Took the first half (75 mg) at 9 AM, the second half (75 mg) at 11. I had a little bit of that weird combination of slight headache/brain fog, but it went away after taking the rest of the tablet. 

[Altostrata]

I had suggested moving the timing of the second half by an hour each day for that very reason. Recommend you don't borrow trouble, go the gradual route.

[etphonehome]

Thank you, I like the phrase "Don't borrow trouble". I set a timer after taking the first dose so the time between doses doesn't get away from me and today I didn't have any problems. 

[etphonehome]

I've continued pushing back the time of my second dose without issue. I feel pretty physically and emotionally low but those feelings haven't been getting worse or better with changing the dose time so I think I'm just responding to my life lol. 

 

On Monday I need to call and make an appointment with my psychiatrist as I see her every three months. I would ideally like to try tapering again in the new year. Should I ask her to refill the 150 mg tablets or would it be better to get the 100 mg tablets and the 25 mg tablets like I did last time I tried to taper? Would love to hear your thoughts! 

[etphonehome]

I spoke with my psychiatrist today and told her about my withdrawal experience. She said she was surprised I had such a difficult time with lowering lamotrigine by a small amount. I don't think she is fully on board with me getting off medication, but she expressed a willingness to help and mentioned using a compounding (?) pharmacy if necessary, which I took to be a positive sign. I had her refill the 150 mg tablets for the time being. 

 

 

[etphonehome]

ETA: when I met with my psychiatrist she brought up spravato/esketamine nasal spray for treatment resistant depression. I'm not flat-out opposed to the idea and my therapist and I have talked about psychedelic therapy and ketamine in the past, but it's not something I plan on doing anytime soon. I hope to never take another drug without doing extensive research first. 

[Altostrata]

On 12/1/2022 at 10:54 PM, etphonehome said:

ETA: when I met with my psychiatrist she brought up spravato/esketamine nasal spray for treatment resistant depression. I'm not flat-out opposed to the idea and my therapist and I have talked about psychedelic therapy and ketamine in the past, but it's not something I plan on doing anytime soon. I hope to never take another drug without doing extensive research first. 

 

Many doctors think withdrawal syndrome is equivalent to a "relapse" of depression. It is not.

 

On 11/26/2022 at 10:50 PM, etphonehome said:

100 mg tablets and the 25 mg tablets

 

This might have been more useful for tapering. You'll have to cut a 150mg immediate release tablet. Are your tablets immediate-release or extended-release?

[etphonehome]

I take the immediate release. I was thinking I could fill the 100 mg and 25 mg tablets instead of the 150 when I get refills next (early January) and start tapering then. I don't want to mess with any of my meds over the holidays ha ha. 

[Altostrata]

On 12/9/2022 at 4:24 PM, etphonehome said:

I take the immediate release. I was thinking I could fill the 100 mg and 25 mg tablets instead of the 150 when I get refills next (early January) and start tapering then. I don't want to mess with any of my meds over the holidays ha ha. 

 

Good idea.

[etphonehome]

Noting this as part of my medication journey/so others can learn from my mistakes:

 

Yesterday I traveled for the holidays. In the midst of travel delays, taking my PM dose of lamictal totally slipped my mind, but this morning I took my 1/2 tablet as usual. In the early afternoon I felt the sudden onset of extreme anxiety, guilt, and general emotional agony I felt last time I tapered too fast. I took the rest of my tablet and within two hours I was no longer sick or thinking about hurting myself, so I assume I experienced withdrawal just from missing 1/2 a dose. I hate this medication and how dependent on it I am. Still determined to taper in the new year, but I have to admit I'm scared. 

 

Anyway, next time I travel I'll just take the whole thing at once instead of trying to stagger it. Lesson learned. 

 

Happy holidays to anyone reading this ❤️ 

[j1290]

Hi ETphonehome!

 

I can relate.  In fact, the main reason I got off of the Effexor so long ago was because I was always running out on vacation or missing doses and paying the price.   Now I take wellbutrin and I have a somewhat elaborate way to track my 3 x daily doses with failsafes built in.  It took me long enough, but I finally realized how important it is to be very meticulous about dosing.  

 

Happy Holidays to you too!!

[etphonehome]

thanks @j1290 ❤️ 

 

yeah, i hate this medication leash! glad you have found a system that works for you. effexor is such a rough medication. i've always leaned towards being on a rather flexible schedule when it comes to taking my meds so this process has been an """exciting"""" lesson on punctuality. 

[j1290]

1 hour ago, etphonehome said:

i've always leaned towards being on a rather flexible schedule

Same.  Its mildly annoying but worth it.  I get stubborn because I resent being stuck on these pills.