AnaBanana: Mild mannered on the outside

[AnaBanana]

… but sometimes screaming or crying on the inside.    
 

(Sorry about the crazy font changes, I tried to fix but I’m having trackpad issues and can’t manage it)
 

I’m 59 and doing pretty good. I moved from a southern US state to Europe last summer (2022), retiring at the same time, and that has helped a lot. 

 

But certain things can really set me off into a spiral of anger or shame and feeling worthless.
 

Here is my entire drug and therapy history. I started when an episode of grief over a relationship ending lasted more than about 8 weeks. Lots of crying, feeling worthless, all while trying to pretend I was okay. I started therapy, she suggested going to a psychiatrist to get an SSRI, and to my regular doc for some Buspar just for a short while. But doc prescribed Xanax and I was too scared to insist on Buspar. Luckily I didn’t use the Xanax much. 
 

I was on SSRIs for 7 years starting about 1993 including Paxil, Celexa, and Effexor, for last few years with Wellbutrin added. Tried to get off with a taper but it wasn’t slow enough; failed and restarted the meds; a year later got back off with a very slow taper - more than a year. I was in therapy all or most of the time I was on meds on this go-round.

I went back to therapy in 2005 with a new therapist I trusted more. I remained off meds 

until 2009 when started getting s. ideation, had a failed business, and needed to get a job.
 

Got on 75mg Pristiq, was upped to 100mg about a month later. At some point, Gabapentin was added for anxiety, for a max of 400mg allowed (2 in morning and 2 at night), but I was usually just on 300mg (200 at night).

 

Pristiq is not available in my new country, so I did a cross-taper to Effexor XR, no change to Gabapentin, in late 2021, in preparation. Ended at 0 Pristiq and 75mg Effexor XR. . It was surprisingly easy symptom-wise. I kept a detailed chart of the plan and the actual, which was very close.
 

Got a psychiatrist here, and meds. So I am still on the same.  My psychiatrist wanted me to go down to 200 mg, which I did on 14 January. So that is 33% reduction. 
 

Things were going well, just a few minor headaches, insomnia, a nightmare. Then I attended a social thing this weekend which has someone that really bugs me. I had trouble going to sleep (up until 3 which is really rare for me), and was just so angry that day. But I took an outside bike ride and am back on an even keel. 
 

I know that is more than the 10% recommended, so I plan to stay there but don’t know how long.
 

So I look forward to this journey. Thanks for this forum!

 

Here it is in bullet form.

1993 - 2000 - various SSRIs plus later Wellbutrin added.
2000 - failed taper.
2002 - Successful taper to 0. 

2009 - 75mg Pristiq (desvenlafaxine)

2010 - 2015 100 mg Pristiq

2015 - 2019 100 mg Pristiq + 300mg Gabapentin

2019 -2023 taper/switch to 75mg Effexor XR (venlafaxine) + 300mg Gabapentin

2023 - 75mg Effexor XR + tapered to 200 mg per psychiatrist. 

 

 

[Gridley]

Welcome to SA, AnaBanana.  Thanks for doing your signature.  I hoping you're enjoying expat life.

 

I'm going to give you a few links regarding the protocols we recommend here at SA.  The first, as you're already aware, is that we recommend tapering by no more than 10% of your current dose every 4 months.

 

Why taper by 10% of my dosage?

 

The 10% rules would apply also to Gabapentin, so you're wise to hold where you are for some time before making any further changes.  The following link is specifically about tapering Gabapentin.  

 

Tips for tapering off gabapentin (Neurontin)

 

When you're taking more than one psychiatric drug, we recommend tapering the more activating (stimulating) drugs first, leaving sedating drugs in place to help with sleep to be tapered later.  In your case, all other things being equal, the more activating drug Effexor would be tapered first, followed by the more sedating Gabapentin.

 

Taking multiple psych drugs? Which drug to taper first?

 

The following link is specifically about tapering Effexor, including how to get the nonstandard doses needed for a 10% taper.

 

Tips for tapering off venlafaxine (Effexor)

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system.  Please note that Gabapentin limits the absorption of magnesium so you should take magnesium at least 2 hours separate fromGabapentin.

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited January 30, 2023 by Gridley

[AnaBanana]

Thank you, Gridley. I will read those topics.

 

 

[AnaBanana]

Checking in (later post) and a question. 
 

Reading about magnesium- nature’s calcium channel blockers. I hadn’t heard of these drugs before, and the only search results here are referencing that post, and on Google are about heart health.
 

I am supposed to be taking Calcium and Vit D3 for osteopenia* but haven’t been for some months (4-6 months), but would like to start again. 
 

I see the warning about taking calcium 2 hours apart,  but are there any warnings against taking it at all while doing a withdrawal? 

 

* osteopenia was shown in left hip from first age-based scan about 5 years ago. Got the recommendation for Calcium +D3 but forgot about it until my next scan about 2 years ago and started taking. Haven’t bought new supplements here yet. Osteopenia is precursor to osteoporosis. 

 

[AnaBanana]

Check in: 

I am doing well 3 weeks in to reducing my Gabapentin. A few minor headaches, which I rarely get otherwise. Sinus issues are annoying, but I can’t say that is WD as I was having them before. Bad enough so I needed to rest a day each week. Also having obsessive thoughts.
 

I talk to my therapist back in the States tomorrow. I don’t know how she will react to me following my psychiatrist’s suggestion to get off the Gabapentin. She’s aware that I have a love/hate relationship with psych meds: I like that they helped when I was down. But finding out about withdrawal made me so mad and I have some shame about needing them.

 

The biggest thing is if I am 3 hours late with a dose of Pristiq or Effexor, I figure it out because I start feeling fuzzy/dizzy in my head. It makes me scared to drive. I have no idea if that is perception or truth (like being drunk with bad reaction time or time/space calculations). And that I guess makes me feel vulnerable - not particularly about the driving but about not having physical control.  
 

One of the things that makes it hard to talk about is that my side effect symptoms from being ON meds are either mild or unable to really credit to the drugs. They are: being overweight, getting dizzy and sweating profusely when I do aerobic exercise, loss of libido (which started way before menopause). Being tired /low energy /low motivation (sometimes) even when I get enough sleep. I can enjoy myself but often I need someone else to make the suggestion. 
I’ve always talked in my sleep and had nightmares, so not that.

 

[AnaBanana]

Check in.
 

It has been 5 weeks since I went from 300 mg Gabapentin to 200. I am doing fairly well, some days of irritability and/or obsession. I think I turned a corner in some realizations about the situation to help me leave it in the past. 
 

I still need to pick up Calcium for my osteopenia and the proper form of magnesium, and omega 3 and to plan so I take them properly, and I have the links to do that.

 

[AnaBanana]

Check in and request for help. I hope it is okay to tag you, @Gridley
 

Question: Should I taper just the morning first, then when at zero and ready, taper the nighttime dose? 

 

Situation 

It has been 9 months since I went from 300 mg gabapentin (100 morning, 200 at night) to 200 mg (100 in morning, 100 at night). No WD symptoms for many months. Good in general. 

 

Currently:

• mood good, anxiety under control.
• Sinus issues off and on (stuffy nose, post-nasal drip, minor headache), most likely due to allergies 🤧 and we are coming into rainy/cold season here and that change often brings it on. Caring for it with daily Zyrtec, prescription nose spray (non-steroidal) and occasional sinus rinse.
• Stressors: Started foreign language class and while difficult, I’m doing fine. Also bought a house and are having it renovated. I’m retired so that helps.
• I tend to have nightmares occasionally, when I go down on gabapentin, they worsen. But they don’t cause insomnia or anxiety during the day. 

 

So I am starting a new taper of gabapentin. I’m preferring that over tapering the venlafaxine because I’ve been on it a shorter time, have an easier time going off it than an SNRI, and my anxiety is easier to handle than the depression. I’ve never been on more than 400mg gabapentin total a day. 

 

I take 100mg gabapentin, 75 mg venlafaxine, Zyrtec in morning.
100 mg gabapentin at night.

 

Thank you.

 

[Gridley]

1 hour ago, AnaBanana said:

Should I taper just the morning first, then when at zero and ready, taper the nighttime dose? 

AnaBanana, I'm taking a break from moderating for health reasons.  I suggest you check recent posts to see which moderators are active right now and tag one of them.

[AnaBanana]

Thanks for letting me know, Gridley.

[Gridley]

@AnaBanana

I got to thinking about your situation and remembered I had something in my notes that was applicable to your situation of tapering split doses of Gabapentin (Neurontin).  I don't remember who wrote the following on the site a while back:

I would like to suggest that the 10-percent method should be used with a keen awareness of the half-life of the medication. Tapering off valium using the Ashton Method, for example, allows one to take the meds three times per day, taper down and eliminate the morning and afternoon dosage one at a time - but this is because valium has an extremely long half life and the drug stays in the system for days. On the other hand, tapering to eliminate a morning or afternoon dose of a short half-life drug, such as Neurontin, can be disastrous, as I discovered recently. The person I care for is tapering off this drug (generic name, gabapentin) and got all the way down to the last taper, only an evening dose, when disaster struck and she had off-the-wall withdrawal reactions. We had to kick her back to three doses a day and then taper each dose using water titration. 

Based on this, I'd recommend you taper all three doses simultaneously, with the total reduction totaling no more than 10% every four weeks.  That is to say, something like 3.33% off dose #1, 3.33% off dose #2 and 3.33% off dose #3.

 

You can tag me if you have questions.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[AnaBanana]

Thank you, Gridley! I will lower both doses at the same rate.

[Terry]

@Gridley @AnaBanana  I'm doing a liquid taper of alprazolam which has a short half life.  Since I take 3 doses per day, I do a 10% taper of the first dose and hold for 9 or 10 days, then taper the second and third doses accordingly.  This amounts to a 3.33% reduction every 9 or 10 days.  This seems to be a bit gentler on my system than a straight 10% across the board.

[AnaBanana]

@Terry, sorry I missed this. I'm glad you found something gentler for you.

[AnaBanana]

Update: 

I am completely off gabapentin. I followed Gridley's advice and reduced both doses at the same time. Thank you for your help. I don't have an exact date, but it was about March of 2024.

 

[AnaBanana]

Effexor XR and other drugs.

I updated my signature today with the most recent changes. 

 

Question: Any thing to be concerned about with taking Atorvastatin 10mg, Metformin 500 mg, or a supplement with Omega 3, Magnesium, Folic Acid, and Vitamin E (detailed below). Also while reducing Effexor XR.  I've started research and will continuing as able (I've been off and on this site and drugs.com for hours today). 

 

Summary:

My primary care doc wants me on a statin and metformin due to high cholesterol and pre-diabetes. I started the statin (Atorvastatin 10mg) in July, she prescribed Metformin this month as expected but I haven't started it yet.

 

I just now ran the drug interaction checker, including metformin, and it indicates that only drug interactions are venlafaxine and Zyrtec (cetirizine). https://www.drugs.com/interactions-check.php?drug_list=2296-0,276-0,569-286,1573-0 

 

PDoc also wants me on a specific supplement with Omega 3 (375 mg EPA, 174 mg DHA), Magnesium 110 mg, Folic Acid 200 ug, and Vitamin E 2,5 mg).

 

My psychiatrist wants me to reduce or get off of Effexor XR (venlafaxine), to reduce side effects.

 

Details:

In early July I started Atorvastatin 10mg, brought my total cholesterol from 265 to 170 in 3 months. Minor aches, now gone.

 

On September 1st, I reduced my 75mg venlafaxine to 90% by weight of beads and continued with that for a month. Have to pre-order the brand with beads in it because it is rarely available at the pharmacy. Was measuring by weight.

 

Minor headaches and irritability the first 2 weeks, afterwards the anxiety kicked in. Note that we started unofficially fostering a dog in August (bad decision) and school started in September. I am 61 yrs old but moved from US to Portugal and taking 3rd semester of Portuguese language.

 

I made the very bad choice to reduce venlafaxine further after the 4 weeks, and also was late on one dose and missed another. I couldn't get the brand with the beads, instead there are two mini-pills in the one 75mg dosage capsule. So I am doing 1 mini-pull plus part of a crushed pill, enough to get it to 75% of my original dosage. Yes, bad idea. Too quick.

 

Anxiety and rumination through the roof. Yesterday I couldn't finish making dinner because getting all the spices together for a curry or sauce for a stir fry (really, 5 ingredients) was too overwhelming.

 

So I think I will suck it up and redo my pills to 90% of original dosage. I recall Omega 3 and magnesium are recommended here but I seem to recall it was a specific form. So I am going to hold off on the metformin and the supplements for now.

 

Back to the other medications: 

 

I've had high cholesterol for decades (my mid-30s) but avoided statins due to hearing about side effects and also that cholesterol is an easy metric to measure and may not reflect actual bodily needs. My doc says that the risk of dementia from statins should be balanced against the risk of dementia from lowered blood flow to the brain, so I started taking it 3 months ago in July 2024. I wasn't aware of this meta analysis saying that cholesterol is important in the serotonin system, but don't know what to think of it. https://pubmed.ncbi.nlm.nih.gov/23767773/

Introduction: Statins have been widely used in clinical practice; however, the association between statin use and depression is complex as research findings have been mixed. We know that cholesterol plays an important role in the serotonin system, so statins used to lower cholesterol may lead to the occurrence of depression.

 

I've tried diet to reduce my cholesterol, and it basically requires a very, very restrictive diet that I'm not able to maintain.

 

Interactions between your drugs

Moderate. (Note I don't have these symptoms normally, only get dizzy if am late on my venlafaxine)

venlafaxine  cetirizine

Applies to: venlafaxine, Zyrtec (cetirizine)

Using cetirizine together with venlafaxine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.