JackOK: 2 months off meds

[JackOK]

I’ve been on anxiety meds for countess years. I was on venlafaxine since 2018. It started to not with well and I switched to desvenlafaxine. I decided at the end of 22’ to quit meds. I was also on meds for high blood pressure as well. I spent several months coming off each med individually with Pristiq being my last to taper. I’ve currently been off meds approximately 8 weeks. Im still having waves of anxiety return. I suspect I have protracted withdrawal syndrome. I work from home most days but I have to go into the office once a week. On my in-office days I have a lot of dread and I wake up gagging and have tightness in my chest. I spend a lot time deep breathing to relieve the tension. 
 

I would say overall, things are getting better but waves of anxiety are still bad. Is this normal? 

[Altostrata]

Welcome, @JackOK

 

Yes, you probably have withdrawal symptoms from going off Pristiq. Please explain more about why you switched from Effexor to Pristiq. What problems arose with Effexor?

 

To help us out, follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

[JackOK]

The biggest reasons I switched from Effexor is because I felt like it wasn’t working well anymore. My doctor suggested Pristiq for the extended release properties. Midway through my transition, I decided in need to change course by making positive changes in my life. With all the meds I was on I had gained a max weight of 230lbs, I was extremely hot and overall just uncomfortable. Once I transitioned to Pristiq, i gave myself a month to stabilize. There was a failed tapering that occurred between January through March 23’. Immediately after, I started to taper off a BetaBlocker, Bystollic, and I had a massive meltdown. I returned to Pristiq to get me through the taper of Bystollic. After quitting bystollic, I began over a three month period tapering off Pristiq. My withdrawals were manageable during that time. But most recently I’m having a hard time sleeping. I fall asleep with little issues but now wake up every morning around 4am without fail and can’t fall back asleep and episodes of anxiety…typically at work. 
 

I’m currently walking 3 miles a day, practicing deep breathing and supplementing. I have a bottle of Xanax for when I have an episode of anxiety. 

[Altostrata]

How did you taper Pristiq?

 

You went off Pristiq 8 weeks ago? If I were you, I'd immediately reinstate 10 beads of Effexor XR. Venlafaxine is a sibling of desvenlafaxine (Pristiq). This probably will take the edge off your Pristiq withdrawal syndrome. You'd taper Effexor later. Please let us know how you're doing.

 

See

 

 

Tips for tapering off desvenlafaxine (Pristiq)

What is withdrawal syndrome? 
 
About reinstating and stabilizing to reduce withdrawal symptoms 
 
The Windows and Waves Pattern of Stabilization

 

Please summarize your drug and withdrawal history in your signature

[JackOK]

I tapered off Pristiq one step down every 3 weeks. I stayed at 25mg for 5 weeks and took the jump to zero. I have a prescription for Xanax .5mg for emergencies. 
 

Please forgive my ignorance but I’m not familiar with beads. Is this something my doctor should be familiar with? 

[Altostrata]

30 minutes ago, JackOK said:

I tapered off Pristiq one step down every 3 weeks.

 

How did you do this? From what dose to what dose?

 

See Tips for tapering off venlafaxine (Effexor)

 

Your doctor probably knows nothing about tapering antidepressants.

 

Please summarize your drug and withdrawal history in your signature

 

[JackOK]

100 to 50 to 25 every 3 weeks. I stayed on 25mg for 5 weeks. 

[Altostrata]

3 minutes ago, JackOK said:

100 to 50 to 25 every 3 weeks. I stayed on 25mg for 5 weeks. 

 

As we recommend a 10% taper per month for a gradual reduction, can you see why your method might have caused withdrawal symptoms?

 

Since it's difficult to take an amount of Pristiq smaller than 25mg (explained in Tips for tapering off desvenlafaxine (Pristiq)), we suggest reinstating with its sibling venlafaxine XR instead. Brand-name Effexor XR comes in capsules filled with tiny beads.

 

Please read the links I've given you.

[JackOK]

Started 10 beads of Effexor XR today. We’ll see how it goes. 

[Altostrata]

Please do this before checking in again 

 

Please summarize your drug and withdrawal history in your signature

 

[JackOK]

So I tried 10 beads of Effexor XR 4 weeks ago and the next day I had a bad reaction so I discontinued immediately. Two weeks later I started to have a really bad wave that wouldn’t stop. Crying, tightness in chest, and panic attacks. So I decided to reinstate 37.5 and try to stabilize. I started 3 days ago I’m having terrible insomnia. What should I do? 

[Catina7]

2 hours ago, JackOK said:

So I tried 10 beads of Effexor XR 4 weeks ago and the next day I had a bad reaction so I discontinued immediately. Two weeks later I started to have a really bad wave that wouldn’t stop. Crying, tightness in chest, and panic attacks. So I decided to reinstate 37.5 and try to stabilize. I started 3 days ago I’m having terrible insomnia. What should I do? 

 

We will await to see what Altostrata says, but in the meantime what symptoms did you have when you had the bad reaction?

 

I'm not a mod or anything, but I do know that doing a lot of stops and starts of a drug and then eventually reinstating at 37.5 mg probably put your nervous system into a tailspin.  What your nervous system needs is stability.

 

I look forward to seeing what guidance Altostrata will give to you.

[LukeUK]

I'm sorry to hear you've had a hard time.

 

If your only withdrawal symptom is waves of anxiety, and it is slowly getting better after 8 weeks I would say you're probably better off not destabilising yourself further with more drugs and continuing on your path, especially as you're managing these symptoms (even though it's difficult).

 

Any reinstatement seems to cause a bad reaction and would potentially take weeks to stabilise you, whereas if your anxiety is improving over time perhaps a few more weeks means more improvement. 

 

Others may disagree, but that's my take. I'm not a mod nor an expert- just offering perspective. 

[JackOK]

It’s hard to gauge if my condition was better or worse pre reinstatement, more like different symptoms. The uncontrollable crying has subsided. I did have insomnia pre reinstatement and it was really bad before the day which was the what triggered me to go on 37.5 mg. I’ve been waking several times a night and having to urinate. Until this week it was maybe one or two times a night. My hope is if I just stay on this dose I can stabilize and then work down a micro taper. 

[Altostrata]

Thanks, @Catina7 @JackOK, what was this bad reaction after you tried "10 beads of Effexor XR 4 weeks ago"? 

 

We ask people to check in with us when they attempt reinstatement.

[JackOK]

Overall horrible malaise feeling and tightness in my chest the following day. What cause me to try again later was my withdrawals began to increase. My current thought is maybe to stay on 37.5 and see it through so I’m not yo-yoing, but I’m totally open to ideas. 

[JackOK]

The insomnia is bad but I could see a way to see it through, today in particular is bad, I’ve lost 3 pounds in the last few days from lack of appetite. I had to take a Xanax which is scared to take. That also lead my thoughts on reinstating to avoid taking the Xanax. I might take it once a week previously. 

[Altostrata]

8 hours ago, JackOK said:

So I tried 10 beads of Effexor XR 4 weeks ago and the next day I had a bad reaction so I discontinued immediately. Two weeks later I started to have a really bad wave that wouldn’t stop. Crying, tightness in chest, and panic attacks. So I decided to reinstate 37.5 and try to stabilize. I started 3 days ago I’m having terrible insomnia. What should I do? 

 

So you quit after you tried "10 beads of Effexor XR 4 weeks ago" but thought 37.5mg would be so much better?

 

Aside from insomnia, how did 37.5mg Effexor affect your other withdrawal symptoms?

 

 

[JackOK]

No more crying. Over the last two weeks my withdrawal symptoms were increasing. Tiredness, weakness, insomnia has severely imcreased. 
 

I reinstated at 37.5mg because I felt like I was in danger of starting a Xanax dependency. I only try to use it once a week. I know that probably wasn’t the best idea, but it’s complicated. 
 

Should I stay the course since I’m four days in on 37.5 or do something different? 

[Altostrata]

Is this insomnia new since you started 37.5mg?

[JackOK]

I’ve had insomnia through my entire withdrawal. The night before I reinstated it was severe. I took a Xanax in the middle of the night and it did nothing. So I decided at that point to go to 37.5 hoping to avoid taking Xanax anymore, stabilize and work a very slow taper. The severe insomnia has not stopped since Tuesday night. 

[Altostrata]

12 minutes ago, JackOK said:

The severe insomnia has not stopped since Tuesday night. 

 

Just guessing here -- did you start taking 37.5mg Tuesday? This would be much easier if you gave dates for actions. 

 

So your insomnia prior to Tuesday night was not as bad as your insomnia since Tuesday night? How is it different?

 

Out of curiosity, if you didn't like the effect of 10 beads, why did you take 37.5mg, which is probably more like 200 beads?

 

 

[JackOK]

I took the 37.5 the following day after the Tuesday night of severe insomnia. My withdrawals were massively increasing tests why I was going reinstate at 37.5 and to avoid over using Xanax. I previously put 9/13 in my signature.

 

I was trying to avoid a Xanax dependency. How should I proceed? Should I reduce the beads? Stay where I’m at? 

[Altostrata]

@JackOK

 

Please answer these questions:

 

- What date did you start 37.5mg Effexor? Please put this in your signature.

- You say you've had insomnia since you went off Pristiq (?) in July (?), correct?

- On average, how much sleep per night did you get from when you went off Pristiq in July to when you started 37.5mg Effexor?

- How is the insomnia different since you've been taking 37.5mg Effexor? What is your sleep pattern?

 

You cannot become dependent on Xanax if you are taking it once a week. However, you have found that it doesn't work, so why would you continue it?

 

[JackOK]

@Altostrata

I started Effexor XR 37.5 9/13/23. I edited my signature but it’s grayed out. 
 

I have had mild insomnia since July when I ended my taper of Pristiq. Since off Pristiq I was averaging 5 - 6 hours s night. 
 

in the past to weeks I’ve had a significant increase in crying, chest tension and panic attacks. I try to only take a Xanax once a week but I felt as though I was getting to the point I was gong to have to rely on it more. Tuesday 9/12/23, Xanax did not help but that was an isolated incident. 
 

9/12 and to today, my insomnia has become more severe. Waking I might get a couple of hours of sleep. I’m up by 12am and then I’m struggling the rest of the night. I might briefly fall asleep but I can’t be sure. I’m getting up multiple times a night to go to the bathroom. 

[Altostrata]

Since you got withdrawal syndrome from it, was your taper off desvenlafaxine successful?

 

If your sleep got worse after reinstating 37.5mg Effexor, it's very possible you're taking too much Effexor and it's interfering with your sleep. If you want to sleep better, you may wish to take less Effexor, such as remove 10 beads from the 37.5mg Effexor capsule so you're taking a little less.

 

You'll have to wait about a week to see the full effect of a reduced dosage. It may be that you'll have to reduce further to get your sleep back to baseline (prior to 37.5mg Effexor).

[JackOK]

@Altostrata

 

So I’m hoping you could guide me on something. The pills i have only contain 34 beads for a 37.5mg capsule. Would you still recommend removing 10 beads with so few total in a capsule? 

[Altostrata]

On 9/18/2023 at 3:22 PM, JackOK said:

The pills i have only contain 34 beads for a 37.5mg

 

They must be larger beads. What is the average number in 6 capsules?

[JackOK]

@Altostrata
I checked and each were exactly 34. 

[Altostrata]

If I were you, I might take 5 out, see what that does.