BigCat So maybe I'm not the problem? After 20 years!!

[BigCat]

First off, I am a MH professional.  I remember "coming out" to a colleague in 1993 that I was on an antidepressant.  

"Yeah, not been on that one, but Gill has" was the response.  I was so relieved.  It turned out that half the team were on something. We swapped side effect stories. 

 

Depression and anxiety was, and still is, seen as an occupational hazard, like hearing impairment if you are in a noisy industry.  But for folk who care for others, and I mean genuinely care, there are no earplugs or headsets to reduce the volume.  Same in social work, teaching, nursing, social care, policing, emergency services, etc.  What makes you give a $h!t is what makes you good at what you do but leaves you vulnerable.

I also suspect that I have several ADHD traits that also make me vulnerable to feeling bad about myself, and not always good at managing my emotions.  But I also understand that others might not be either...

 

I have tried doing without ADs on numerous occasions since 1992 (age 30).  Every time, within a couple of months, it has led to an escalation onto a different medications.  I have trusted this to be the appropriate clinical judgement of some very genuine and caring GPs and psychiatrists. They have helped for a while...

I have gone with the view that some people (like me?) are better on an AD permanently rather than try without (an AD is a preventative/safety net for your faulty brain chemicals) I have recommended this for my own patients (I don't prescribe) in good faith.  I care about my patients and have gone with the recommendations of professional bodies and of my respected colleagues and (less?)employers. 

 

I find myself at a glass ceiling on a big dose of a heavyweight AD.  Venlafaxine, as you will all appreciate, is horrible even if you miss only one dose.  I am on 300mg having been on 225mg for many years.  Each increment has made me feel a little better but it soon wears off.  I am now 60 and venlafaxine has a really serious impact on my blood pressure and I have to take 2 meds to control that!  

 

( I had a horrendous experience, a living nightmare for a week on The California Rocket" prescribed by a trusted, well meaning and genuine psychiatrist)

 

I am no longer convinced that this AD is helping me because I doubt some of the claimed science.  I feel emotionally numb from many everyday experiences, and disproportionately sensitive to others.  I don't always feel present.  I feel like I am missing out.  I don't meet the criteria for clinical depression, but I am not living, or alive.  I function. 

 

And I am concerned, ethically, about what I am recommending to my patients. 

 

That is why I am here.  

[Altostrata]

Welcome, @BigCat

 

What we do here is help people taper off their psychiatric drugs slowly to avoid withdrawal symptoms.

 

On 6/29/2023 at 8:58 PM, BigCat said:

I have tried doing without ADs on numerous occasions since 1992 (age 30).  Every time, within a couple of months, it has led to an escalation onto a different medications.  I have trusted this to be the appropriate clinical judgement of some very genuine and caring GPs and psychiatrists.

 

We have 20,000 members here with similar stories. Most likely, what you felt after going off your antidepressant each time -- probably fairly quickly -- was withdrawal syndrome, not "relapse" or a new psychiatric disorder. Almost every one of our members was told they had "relapsed" by genuine and caring GPs and psychiatrists who were unable to recognize withdrawal symptoms.

 

Emotional numbing is a very common effect of long-term antidepressants. If you are feeling adverse effects from 300mg venlafaxine XR and you wish to gradually reduce the dose, see Tips for tapering off venlafaxine (Effexor)

 

Please be aware that your emotional numbing might persist for some time after you go off the drug, only very gradually fading over months, as your brain and nervous system are thoroughly adapted to the drug and this adaptation has to unwind.

[BigCat]

Many thanks for the welcome.

 

I will read the guidance.  I tried dropping back to 225mg last year, and was OK for a couple of months, then thought I was relapsing.  Time to try something a bit less radical. 

[Altostrata]

Please let us know how you're doing. 

[BigCat]

19 hours ago, Altostrata said:

Please let us know how you're doing. 

The plan is to go the 10% route, and I've saved the Reverse Psychiatry calculator in my tabs. If I manage to drop 25% it will help reduce my blood pressure at the very least.  I am optimistic and motivated to try this. 

I will keep you posted. 

[BigCat]

Just ordered a powder scale for weighing beads!

[Altostrata]

You had difficulty reducing from 300mg to 225mg before, but you intend to do it again anyway?

 

Strongly recommend you reduce by less than 25% this time.

[BigCat]

On 7/3/2023 at 10:28 AM, BigCat said:

The plan is to go the 10% route, and I've saved the Reverse Psychiatry calculator in my tabs. If I manage to drop 25% it will help reduce my blood pressure at the very least.  I am optimistic and motivated to try this. 

I will keep you posted. 

 

3 hours ago, Altostrata said:

You had difficulty reducing from 300mg to 225mg before, but you intend to do it again anyway?

 

Strongly recommend you reduce by less than 25% this time.

I am planning to reduce by 10% of each dose, each month, as recommended.  270, 243, 219 etc.

Edited July 4, 2023 by BigCat
additional info

[Altostrata]

Okay, good to hear.

[BigCat]

I have taken delivery of my Lee powder scale, lovely bit of kit.

 

I have discovered that my generic venlafaxine XL (Vensir in the UK) doesn't contain the small beads that I have seen in genuine Effexor. 

150mg capsule has 12 tiny "tablets", so each worth is 12.5mg.  At least they are easier to herd into the capsule!

For the time being I will have to initially tale 150mg + 125mg (10 beads) = 275mg instead of reducing by 10% of 300mg  to 270mg.  Still, that's erring on the side of caution at 8.3%.

 

Plan to start tomorrow. 

 

Plan is to adhere to 4 weekly intervals. 

 

The next reduction will be to 250mg (150mg plus 8 beads @ 12.5) or 9%, so still cautious. 

Then it will be 150 cap plus a 75 cap = 225mg...

It might get more awkward as the taper progresses depending on what is inside the 75mg capsules.

 

Good to know you are out there while I attempt this. 

[Altostrata]

57 minutes ago, BigCat said:

150mg capsule has 12 tiny "tablets", so each worth is 12.5mg.  At least they are easier to herd into the capsule!

For the time being I will have to initially tale 150mg + 125mg (10 beads) = 275mg instead of reducing by 10% of 300mg  to 270mg.  Still, that's erring on the side of caution at 8.3%.

 

This is a good plan. You'll probably be able to taper half-way down with the 12 tiny tablets.

[BigCat]

Six days in at 275mg, mostly OK. 

Slight increase in anxiety and the odd vivid dream (but no nightmares).  

 

[BigCat]

18 days at 275mg.  Anxiety increasing.  First doubts that I might be relapsing into a depression.  Couldn't go to work today.  Also suspect I have a virus (sore throat etc.)  Not been sleeping well. 

[Altostrata]

8 hours ago, BigCat said:

Anxiety increasing. ...

Not been sleeping well. 

 

Please describe more about this. What is the anxiety like? Is the anxiety worse at any times of day? What times o'clock do you take your drugs, with their dosages? How do you feel before and after each dose?

 

Since you reduced 18 days ago, how has your sleep pattern changed?

[BigCat]

13 hours ago, Altostrata said:

 

Please describe more about this. What is the anxiety like? Is the anxiety worse at any times of day? What times o'clock do you take your drugs, with their dosages? How do you feel before and after each dose?

 

Since you reduced 18 days ago, how has your sleep pattern changed?

These symptoms were not present in first 7-10 days...

Anxiety- restlessness, discomfort in pit of stomach (feels like dread), often worse in morning (when depressed mood would be classic diurnal), easily brought to tears (a few moments ago a friend was "kind/nice" to me on the phone and set me off)

Sleep- wake up exhausted, sometimes early and go back to sleep, keep regular bedtimes (11-7.30) and good sleep protocols

Take single dose 275 (150+125) mg XL roughly at same time as always have done (8.30am +/- depending if weekend), with breakfast. 

 

All of the symptoms remind me of being "depressed". 

 

Edited July 28, 2023 by BigCat
additional info

[BigCat]

Bit better than earlier. 

I had a slight tremor and that has gone, and I have lost some of the dread.  

Managed to go to see my kids and snoozed with the cats on the sofa.  

[Altostrata]

17 hours ago, BigCat said:

These symptoms were not present in first 7-10 days...

Anxiety- restlessness, discomfort in pit of stomach (feels like dread), often worse in morning (when depressed mood would be classic diurnal), easily brought to tears (a few moments ago a friend was "kind/nice" to me on the phone and set me off)

Sleep- wake up exhausted, sometimes early and go back to sleep, keep regular bedtimes (11-7.30) and good sleep protocols

Take single dose 275 (150+125) mg XL roughly at same time as always have done (8.30am +/- depending if weekend), with breakfast. 

 

This could be your withdrawal pattern, a few rocky days starting about a week after a reduction. Please continue to observe. If these symptoms continue beyond a few days, you might have to hold on your next reduction until they go away, then plan to reduce by smaller amounts.

 

We do not expect depression "relapse" while tapering. What we do expect is that you might get withdrawal symptoms that are worrisome or mimic "depression". These generally go away fairly soon, if you don't taper too fast.

[BigCat]

 

On 7/29/2023 at 4:42 AM, Altostrata said:

 

This could be your withdrawal pattern, a few rocky days starting about a week after a reduction. Please continue to observe. If these symptoms continue beyond a few days, you might have to hold on your next reduction until they go away, then plan to reduce by smaller amounts.

 

We do not expect depression "relapse" while tapering. What we do expect is that you might get withdrawal symptoms that are worrisome or mimic "depression". These generally go away fairly soon, if you don't taper too fast.

 

Reduced from 275mg to 250mg a week ago. No issues initially. 

Having the same experience as before- 7-8 days in, feeling tearful, fearful/agitated, ruminating and low in mood. 

Complicated by having Covid just over 2 weeks ago and still recovering.  Very, very fatigued as a result.  No doubt this will have affected my mood. 

Persevering.

[pinkfairy]

On 8/15/2023 at 11:10 AM, BigCat said:

 

 

Reduced from 275mg to 250mg a week ago. No issues initially. 

Having the same experience as before- 7-8 days in, feeling tearful, fearful/agitated, ruminating and low in mood. 

Complicated by having Covid just over 2 weeks ago and still recovering.  Very, very fatigued as a result.  No doubt this will have affected my mood. 

Persevering.

Just stopping by to say keep going. everything will pass, i always say it will pass,maybe like a kidney stone but it will pass. Keep on keeping on.

[Altostrata]

@BigCat since you're still recovering from covid, suggest you not taper again for a month or two. Make sure you feel pretty good first.

[BigCat]

22 hours ago, pinkfairy said:

Just stopping by to say keep going. everything will pass, i always say it will pass,maybe like a kidney stone but it will pass. Keep on keeping on.

Kidney stone?  🙀

You are funny. 

Appreciate the black humour.  Right up my poorly lit, faeces strewn, rat infested street...  Watch out for the puddles, no one knows how deep some of them are.  BTW I can say faeces but not $H1t 🤪

[BigCat]

13 hours ago, Altostrata said:

@BigCat since you're still recovering from covid, suggest you not taper again for a month or two. Make sure you feel pretty good first.

Thanks for that.  I'm feeling a bit fragile and will take that on board.  

[NotQuiteMyself]

Hello BigCat.

I thought I’d look at your Introduction after reading your post elsewhere.

 

It’s astonishing how many people are on ADs. We don’t mention it obviously if we don’t know someone very well, but the second anyone opens up it’s ‘me too’.

 

On 7/28/2023 at 11:03 AM, BigCat said:

easily brought to tears (a few moments ago a friend was "kind/nice" to me on the phone and set me off)

I had to comment on this as I am EXACTLY the same. You get so used to people being baffled or dismissive. When a lovely friend of mine rang up a while ago and was really kind I just dissolved on the spot.

 

Good luck with your onward taper. I feel lucky that I was only on Venlafaxine for a bit over 2 years and my highest dose was 75mg, but it caused me so much misery and I thought my other ADs were bad enough. Slow and steady will get you there.

[BigCat]

I have delayed tapering from 250mg to 225mg.  @Altostrata had suggested a month or two following Covid, but I was feeling pretty good after a month so cautiously went down to 230mg last week. 

 

Noticed I've been randomly slightly elated/anxious/irritable/tearful.  Now, I've realised this has been the case since I started tapering.  

 

 

[Altostrata]

12 hours ago, BigCat said:

Noticed I've been randomly slightly elated/anxious/irritable/tearful. 

 

When did this start?

[BigCat]

16 hours ago, Altostrata said:

 

When did this start?

I suspect around two weeks after beginning tapering, initially tearful/anxious, then in the last month additionally slightly elated/irritable at times. 

These symptoms are occasional and don't appear to be related to external events.  

[BigCat]

I find my self laughing at times, especially talking with my daughter, and enjoying things, so perhaps the barrier between me and my life is finally breaking down, and that is all the other stuff is just evidence of that?  So far from bad. 

[BigCat]

Doing well on 225mg.  Usual shaky episode 7-10 days after last reduction that passed within 48 hours.  I am posting this as encouragement that cautious tapering works, at least for me.  I am certainly enjoying life a little bit more and feel more connected already.  I am trying to be patient...

 

On the negative side, I have noticed that my alcohol intake has gradually increased since starting this tapering.  I suspect that I have been "self medicating"  my evening anxiety symptoms, although not every evening.  I have reduced it again since realising.  Just a point to note for me and maybe for others.  

 

 

[Altostrata]

11 minutes ago, BigCat said:

I have noticed that my alcohol intake has gradually increased since starting this tapering.

 

Be warned -- drinking alcohol can set you back quite a bit if you are sensitized by withdrawal. We don't have any fixes for this.

[Emonda]

10 hours ago, BigCat said:

I have reduced it again since realising

 

I'd go one step further and eliminate alcohol. I eliminated it ~6 months ago.

 

I had always been okay with one or two drinks once or twice a week, but something changed during my taper. I found my anxiety would ramp up the day after an alcoholic drink.

 

Tapering & WD symptoms can be challenging enough at times...no need to make it any harder.

 

You're doing great 👍

[BigCat]

On 9/29/2023 at 8:27 PM, Altostrata said:

 

Be warned -- drinking alcohol can set you back quite a bit if you are sensitized by withdrawal. We don't have any fixes for this.

 

On 9/30/2023 at 6:48 AM, Emonda said:

 

I had always been okay with one or two drinks once or twice a week, but something changed during my taper. I found my anxiety would ramp up the day after an alcoholic drink.

 

 My anxiety the day after a couple of drinks is now noticeable, it wasn't before.  Perhaps the time to stop.  Thanks both.  

[BigCat]

Struggling in the past week...

Restless, inconsistent mood, easily startled and irritable, little joy in much, feeling very anxious when driving. 

Have taken this week off sick from work as don't feel able to offer my best. 

Very close to tears a lot of the time/easily "knocked off my perch". 

Keeping on 225mg for time being, perhaps hold for a couple of months more.  Guess I need to be patient, I've been on this 15 years!

[pinkfairy]

You are doing amazing and everything you are enduring is healing you, the tears, the anxiety every symptom is you recovering on the way down.

you are being forged in the fire of this journey and it’s painful.

 

Go gentle with yourself and just allow yourself to feel it all and let it move through you.

 

This journey is the most potent journey you’ll ever embark on ever again.

 

Treat self so very kindly and become your own best friend.

 

You’re doing awesome.

 

Pink.

 

[Emonda]

Hi BigCat,

15 hours ago, BigCat said:

Restless, inconsistent mood, easily startled and irritable, little joy in much, feeling very anxious when driving. 

 

15 hours ago, BigCat said:

Very close to tears a lot of the time/easily "knocked off my perch". 

 

I know the feeling. It's not nice, but it is temporary. The things you list are all on the WD symptom checklist. That may not make you feel better immediately, but for me, it's good to be reminded it's the pills, not me. 

 

I dropped 2% yesterday and have felt very fragile today, but I remind myself by reading my mood diary, that it is temporary.

 

15 hours ago, BigCat said:

Keeping on 225mg for time being, perhaps hold for a couple of months more.  Guess I need to be patient,

 

Good idea, there's no rush. Time and continued patience. 

 

Emonda

 

 

[Motherdragon]

Hello!! I’m new but our stories are so similar I thought I would reach out. If you check out my introduction you will see my story. I too am on two BP medications due to the Venlafaxine. 

 

I’m on “California rocket fuel” - I’m tapering the Venlafaxine first, Will tackle the mirtazapine later. I started at 375mg and am now on 112mg.

 

 

On 7/28/2023 at 11:03 AM, BigCat said:

Anxiety- restlessness, discomfort in pit of stomach (feels like dread), often worse in morning (when depressed mood would be classic diurnal),

This is exactly how my anxiety manifests, I call it “a sense of impending doom”. It’s markedly worse in the morning and tends to get better as the day wears on. Yesterday, I read the article here about increased morning cortisol levels being related to sunlight so I’m keeping our blackout blind shut properly and am hoping the darker mornings of winter might help.

 

Are you taking any supplements?

If you’d like a “buddy” I’d be happy to volunteer as someone on a similar path to you. I too have ADHD.

 

‘sending {{{{healingvibes}}}} and ((((hugs)))) 

[BigCat]

Good luck @Motherdragon and thanks for your good vibes. Not taking any supplements as things have only taken a turn for the worse recently.  There's evidence out there about the higher instance of MH issues for the neurodivergent, as you will probably know.  And a high level of undiagnosed ND conditions, let alone folk who have several ND traits that they struggle with...  The world is a difficult place for many people and the simple solution is to medicate the non-conformists. 

 

Thanks @pinkfairy @Emonda your kind encouragement is much appreciated. 

 

Things sound good in French - I have held on to my dark sense of humour, just... Made this up, it's not an "actual" quote.

"L'exposition du merde est temporaire".