Merlin123: Advice needed on reinstating venlafaxine

[Merlin123]

Hi everyone

 

Firstly thank you for all of the resources and support available on this website. I really wish I would have found this site sooner as it would have likely helped to avoid the situation I'm in currently.

 

To cut a long story short, the last couple of years have been very difficult. I've been tried on multiple antidepressants alongside various forms of therapy. In the last year, I've had 2 episodes of serotonin syndrome (requiring A&E care), both as a result of altering medication under the supervision of a psychiatrist. Fortunately, things have improved significantly over recent months, mostly attributed to the progress I've made in therapy and various self-help methods.

 

My most recent episode of serotonin syndrome happened in June this year, shortly after increasing my venlafaxine from 75mg to 150mg. Following from this my dosage was quickly reduced back to 75mg and then to 37.5. I'm not sure on the exact timing but this must have been over a few weeks as I was honestly in a rush to get off the drug. Up until this point I hadn't experienced any withdrawal symptoms and continued by trying to stop the 37.5mg. I think I tried to stop completely around 5-6 weeks ago, however, almost immediately started getting the typical withdrawal (brain zaps, emotional liability, tinnitus, etc). Initially, I wasn't able to last more than a couple of days so I took another tablet and followed this pattern for 1-2 weeks taking a table once every 2-3 days. In hindsight, I know this was a poor option, but at the time I honestly thought I was doing the best thing. More recently, I haven't taken venlafaxine for 2-3 weeks and it's been a horrible rollercoaster. I've just had the mindset that I need to ride this thing out, not knowing the potential harm I've been doing. Bizarrely, after a week I thought I was over the worst of it. However, in the last few days, I've had new symptoms including severe agitation and anger outbursts which are totally out of character. The most distressing symptom is just this strange feeling of dread and everything around me just feeling altered in some way. Saying this, these symptoms come in fairly significant waves. I can wake up and generally feel ok, but then suddenly feel very agitated which might last a few hours. Additionally, some of the other symptoms have stopped. For example, I haven't had any brain zaps for a few days and haven't experienced any periods of uncontrollable crying which I had during days 7-14.

 

This is where I decided to do more research and came across this website. After spending many hours looking through the content, I feel like I'm in a difficult situation to determine my next steps. I know there is a window in which it is possible to reinstate the venlafaxine and I am potentially still in that window, though it's difficult to be certain. I think I'm willing to try and reinstate the drug, though my question is what dose would be best to restart on. I've read the post on reinstating and how it might be better to try a very small dosage. I believe the example it gives suggests trying 0.5-1mg if you were previously on 20mg.

 

In summary, it would be great to get some advice and guidance and how to move forward. The options which are available from what I can see include 1) Remain off venlafaxine and hope that the symptoms continue to subside or 2) Reinstate venlafaxine at a lower dose (need help determining this), take time to see if this helps then consider a very gradual tapering off as recommended on this site.

[Altostrata]

Welcome, @Merlin123

 

How have your symptoms changed in the last 2 weeks? What effect does mirtazapine have on you?

[Merlin123]

Hi Altostrata,

 

Shortly after writing this post, I decided reinstate venlafaxine. The venlafaxine I'm prescribed is prolonged release and is in capsule form with the 'mini tablets', each containing 12.5mg. After reading a post on this website, I learned that dividing these 'min tablets' further can make them immediate release. I ultimately decided to restart on one of these tablets at 12.5mg. Ideally, I would have preferred to try a smaller amount, but I didn't feel comfortable breaking up tablets.

Within a few hours, the symptoms I've described above pretty much disappeared. Over the next few days my partner told me that I seem much more like my usual self, and I was feeling a lot better. The sense of dread/anxiety faded away and I no longer felt agitated or excessively emotional. I was also experiencing a persistent tension headache previously, which also stopped after I reinstated the meds.

 

I was feeling positive that reinstating the medication had worked and I hadn’t missed the window in which restarting the drug would still work.

However, over the last 5-6 days things seem to have taken a turn. For what seems like no reason I started to feel that mind is 'busier' than normal and I'm struggling with negative thoughts. I feel much more forgetful, and I've had this tension headache which is similar to what I had in the weeks after stopping venlafaxine. Instead of being overly emotional like when I initially stopped the drug, my mood has been very flat. This is despite practising all of the self-care techniques including mindfulness, regular exercise, healthy eating, etc.

The last couple of days I've felt the symptoms of depression which I haven't felt for many months. Today for example, I just couldn't get myself out of bed. I feel physically exhausted and can feel the desire to withdraw from people. I'm finding it hard to figure out if what I'm experiencing is connected to the venlafaxine or something else entirely. I know this could be a reoccurrence of depression, but I'm just not sure. A part of me thinks that this has to be connected to the venlafaxine, but I know I need to consider all possibilities.

Going forward, I'm not sure how best to proceed. I was wondering if it is worth increasing my current dosage of venlafaxine by a small amount and revaluating. Alternatively, do I go the other way and stop the medication again. It’s confusing as I initially had a very good reaction to restarting the medication and it’s hard to work out what the cause of my recent symptoms are.

Regarding mirtazapine, I believe this helped my symptoms, especially in the months following starting it. Currently though, it’s difficult to really know how much of an effect it’s having on my mental health. Especially as I’ve put lots of work into therapy and other self-help strategies, it's hard to know what's helping what if that makes sense.

 

[Altostrata]

On 8/19/2023 at 6:35 AM, Merlin123 said:

Within a few hours, the symptoms I've described above pretty much disappeared.

 

This is a hallmark of withdrawal syndrome -- symptoms largely go away upon reinstatement of the drug.

 

A 12.5mg daily dose of extended-release venlafaxine will build up over about a week. How do you feel before you take your dose compared to after you take your dose?

[Merlin123]

Update: I increased my venlafaxine from 12.5 to 25mg and again saw rapid improvements. This continued for the next couple of days. however, I then found myself struggling again. My mind has been very busy and much more negative, despite there not being any changes in my life. I've had this constant feeling of being overwhelmed with heightened background anxiety. This is unusual for me as even when my mental health was at its worst, my main symptom was depression.

 

I'm not sure if it was the correct decision, but I decided to increase the dosage to 37.5mg, which is the dose I was before I initially stopped taking them. This time, however, I haven't experienced the same degree of improvement in my symptoms. I did feel slightly better, but the last few days have been difficult. The symptoms described above are back and I've had a persistent headache and just don't feel myself at all. I honestly don't know what to do from here. My mood is low and I feel stuck in this situation. I suspect that this is still related to the venlafaxine, as it feels different to the mental health struggles I've faced previously.

[Catina7]

17 minutes ago, Merlin123 said:

Update: I increased my venlafaxine from 12.5 to 25mg and again saw rapid improvements. This continued for the next couple of days. however, I then found myself struggling again. My mind has been very busy and much more negative, despite there not being any changes in my life. I've had this constant feeling of being overwhelmed with heightened background anxiety. This is unusual for me as even when my mental health was at its worst, my main symptom was depression.

 

I'm not sure if it was the correct decision, but I decided to increase the dosage to 37.5mg, which is the dose I was before I initially stopped taking them. This time, however, I haven't experienced the same degree of improvement in my symptoms. I did feel slightly better, but the last few days have been difficult. The symptoms described above are back and I've had a persistent headache and just don't feel myself at all. I honestly don't know what to do from here. My mood is low and I feel stuck in this situation. I suspect that this is still related to the venlafaxine, as it feels different to the mental health struggles I've faced previously.

 

Hey @Merlin123, I'm sorry you've found yourself in this situation.  It's so hard when you feel trapped and don't know what the best thing to do is.  

 

I'm sure the mods will be able to give you more specific guidance, but I can tell you that too many frequent dose changes can further disrupt our nervous system.  

 

Hang in there, I'm sure you'll get things straightened around soon.  

 

Catina 🙂

Edited August 31, 2023 by Catina7

[Altostrata]

On 8/31/2023 at 10:59 AM, Merlin123 said:

The symptoms described above are back

 

Hello, which symptoms are back? How do you feel before you take your dose compared to afterward?

 

Did you ever feel well while taking venlafaxine? What was the dosage then?