onlyhope - Need advice for tapering off Vortioxetine/Brintellix

[onlyhope]

Help! I am needing advice for my taper off Vortioxetine/Brintellix.

 

My story so far: Was put on Escitalopram at age 21 in 2014 for generalised anxiety. Sure it helped me with my anxiety however the side effects were significant (severe emotional blunting, no libido, amongst others), however doctors always recommended I stay on them. So I did. Many years later I finally woke up to the fact that the medication wasn't helping much anymore, and that along with the side effects made me decide I wanted to come off it. I tapered down over 6 weeks (which was even slower than what the doctor had recommended), and suffered severe anxiety, emotional ups and downs, low mood. I had put those symptoms down to a resurgence of my original anxiety exacerbated by a poorly timed job change, but now the more I read I know it was withdrawal symptoms. I then started Brintellix as recommended by my doctor and have been on that for approximately the last year. I saw no additional benefit compared to the Escitalopram however the thought of going through the process of changing medications again was too overwhelming so I just stayed on it because I didn't know what to do.

 

I desperately want to come off the medication but after the last time I have been too scared. I am now at the point in my life where my husband and I want to conceive, so have started the taper as recommended by my psychiatrist. I was taking 20mg every second day (to be honest I don't even know why, probably because I would occasionally forget to take it, it didn't seem to have any negative effect, and my psychiatrist didn't seem to see a problem with that so I just continued). 3 days ago I dropped down to 10mg every second day as instructed. However since I did that I have stumbled across this site and now realise this is far too quick, and my planned 3 month taper is also way too fast given how long I have been on medication. I haven't had any withdrawal symptoms so far. I know that it is recommended to drop down 10% per month, however my question is now what do I do at this point to give me the best chance for success? Do I carry on with 10mg every second day as recommended? Or do I change to take 10mg daily? Or do I go back up to closer to my original dose and restart the taper from there?

 

Side note, over the last year I have also been diagnosed with ADHD, and have discovered a lot of, if not most of my anxiety is due to symptoms from that. I have trialled a couple of stimulants (ritalin, dexamfetamine, vyvanse), with mild benefit, but am scared to start another psychiatric medication after this ordeal with SSRIs. The theory my psychiatrist is working with is that ADHD medication will help with my anxiety (as most of my anxiety stems from symptoms of ADHD), and can be used as a tool to help get off the Brintellix. This made sense to me however I am now scared introducing another medication will confuse my system even more.... or will it help? I am just so unsure about what to do. 

 

I greatly appreciate any help/advice 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  Let me give you some basic information and links, and then advice specific to your situation.  

 

Thank you for giving us a clear and concise drug history.  

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Brintellix

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

Firstly, we strongly suggest you do not take the tablets only every other day.  This tends to destabilize the nervous system, and will make it quite hard to taper.  Your doctor has given you bad advice by telling you to do this. Unfortunately, many doctors suggest this to their patients.  Please read 

 

Never Skip Doses

 

Secondly, you dropped your dose by 50%, which is way too steep of a drop. You might feel OK right now, but these things have a way of sneaking up on us in the future.  My suggestion to you is switch to taking 10 mg every day for a while.  (This is assuming prior to 2/16/23, you were taking 20 mg every other day).  Do this for several months, I would say 6 months.  Then, if you feel stable, you can start to taper your drug by 10%, so you would then take 9 mg.  During this hold period, you might consider gradually switching to liquid, which makes it very easy to taper.  I don't know if there is commercial liquid available in Australia.  There are other ways of measuring the nonstandard doses, such as crushing the tablets and weighing them with a digital scale.  The link above on tapering brintellix goes into all this.  

 

 

[onlyhope]

Thanks so much for your reply. I will definitely follow your advice and hold on 10mg daily for a while before changing anything. It's a struggle coming to terms with the fact this is all going to take so much longer than planned. My husband and I were planning on trying to conceive in June of this year but this is clearly now going to be pushed back quite a lot, as I definitely don't want to be on this medication while pregnant. I had stupidly thought 5 months would be long enough to taper off (considering the doctor was saying even 6 weeks was more than enough...). We had already left it quite late as it is and are getting older so this is a difficult change of plans to process. But of course I'd rather do the right thing and taper properly, I just need to get over the impatience!

 

Thanks again

[getofflex]

On 2/20/2023 at 7:24 PM, onlyhope said:

I will definitely follow your advice and hold on 10mg daily for a while before changing anything.

That's good.  It is very important to take the same dose at the same time each and every day, whether tapering or not.  The important thing here is stability.  Our nervous system needs stability in everything in order to find its own stability.  Many people here tried to taper too fast, and in the long run, it took longer to get off the drugs, because they destabilized their nervous systems, and had to updose or reinstate, etc.  It's best to taper carefully and properly, and avoid major WD, so that you can be healthy physically and mentally when you have the child, and be able to give the child the care they need.  A destabilized nervous system can take years to recover from.  Good luck, and let us know how you are doing. 

Edited February 22, 2023 by getofflex

[Altostrata]

Hello, @onlyhope, how are you doing?

[Emonda]

On 2/20/2023 at 12:09 AM, onlyhope said:

I am needing advice for my taper off Vortioxetine/Brintellix.

 

Hi there @onlyhope,

Same country and the same AD. How's the stabilisation going?

 

On 2/20/2023 at 12:09 AM, onlyhope said:

I desperately want to come off the medication but after the last time I have been too scared.

 

That's a completely normal response. I reckon we are all scared/fearful of the journey. Fortunately, plenty of people in this community can encourage you along the way.

 

On 2/20/2023 at 12:09 AM, onlyhope said:

what do I do at this point to give me the best chance for success?

 

Same comments as from getofflex. Stabilise and go slow. I took a few months to stabilise after dropping too quickly, then held for a total of 5 or 6 months out of fear. My most recent reduction was only 2%, and I still feel mild irritability, restlessness, dizziness and anxiety.

 

It's taken me 18 months to drop from 15mg to 3.58mg. The reductions are fiddly, given the smallest pill in AUS is 5mg. Sing out if you have any questions....although getofflex and Altostrata are the experts.