Greenowala: Withdrawal - Trintellix (Vortioxetine)

[Greenowala]

Hello, 

 

I am new here, I discovered this website through being part of the Trintellix subgroup on reddit. 

I recently tapered off Trintellix and have now discontinued for a total of 7 days. I was on the 20mg dosage for 6 years. 

I wasn't able to taper off with a doctor as family doctors are difficult to find right now in Toronto, Canada. I had an appointment with a walk in doctor who suggested that I taper off 5mg every couple of weeks and that is what I did.

I started tapering off Nov 25th. Tapering down 5mg every couple weeks was not too bad. My main side effects were headaches, and fatigue. The main withdrawal symptoms have hit me in the last 7 days when I completely discontinued use. 

I'm feeling highly irritable, have snapped at a couple people this week :(, sad, feelings of hopelessness, and mood swings.

 

I cant tell if I had tapered too quickly or if these are normal feelings and I should continue to ride the withdrawal symptoms out. 

 

Thank you for listening! Any guidance would be appreciated! 

[LotusRising]

Hi @Greenowala

 

Welcome to SA,

 

We are a peer-run volunteer site dedicated to a harm reduction tapering approach in an effort to minimize withdrawal symptoms. We suggest tapering by no more than 10% of your most recent dose each month, so this was indeed a quick taper. See  Why taper by 10%.

 

Thank you for creating a signature.

 

This is your introduction thread. Please post any updates or questions related to your specific situation right here in your thread. It's helpful to keep everything related to your tapering journey in one spot.

 

These two links will help you to understand withdrawal syndrome:

 

What is Withdrawal Syndrome?

 

Video on Recovery from Psych Drugs

 

When we take medication, the CNS responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS must then undo all the changes that were made. As the changes are undone, symptoms may occur. You can expect that they will follow 

The Windows and Waves Pattern of Stabilization  and since the CNS likes stability, we suggest to Keep it simple, slow and stable.

 

5 hours ago, Greenowala said:

I wasn't able to taper off with a doctor as family doctors are difficult to find right now in Toronto, Canada.

 

I feel like this is a common theme across much of Canada right now. I'm sorry your care has suffered because of it. 

 

Have you read our topic on reinstatement? See Reinstating and Stabilizing

 

Reinstatement of a very small dose of the original drug can sometimes help to alleviate withdrawal syndrome. The only other alternative is to wait out the symptoms and manage the best you can while your CNS returns to homeostasis. Unfortunately, no one can give you an exact timeline as to when you'll start to feel better, or if it will even work. While some notice immediate improvement, for others it can take many months or longer.

 

Reinstatement isn't a guarantee for everyone, but it's the best tactic available, aside from waiting it out. You're in the time period where reinstatement predictably works, up to 3 months since your last dose. If you decide that reinstatement is an option for you, we would recommend a much smaller reinstatement dose than your last dose. These drugs are strong and your system has become sensitized and if you take too high a dosage, it may be too much for your brain.

 

If reinstatement is something you have an interest in, please let us know and we can suggest a reinstatement dosage. 

 

I've given you lots of information here so please take some time to digest it. 

 

Let us know if you have any questions, and again welcome  

 

[Greenowala]

Hi @LotusRising

 

Thank you so much for responding to me. I really appreciate your msg and providing me with resources to get started with, it means a lot. 

 

I would like to follow up on my situation. Ive been experienced the negative side effects during this 7/8 day period where ive completely discontinued use.  

I am in the middle of a mental breakdown right now, I feel like ive hit my limit on how much withdrawal I can endure. I cannot stop crying. My back seized up last night, I couldnt sleep and I just had a dreadful chiro appointment where the doctor was extremely unpleasant and mean. I feel completely unstable right now and cannot endure it any longer. 

 

I think I definitely need to reinstate medication. Do you have any suggestions on how much I should start with? I was at 20mg which is the max dosage. 

Do you recommend I go up to 5 or 10?

 

 

Thank you!!!!!! 

 

 

[LotusRising]

@Greenowala

 

At what dose did withdrawal symptoms start? Was it 5mg?

[Comfyquilt]

Hi @Greenowala if you are looking for someone to help you in Ontario maybe try Monica! 
 

https://www.mindfulmedicinebymonica.ca
 

she’s helped me a lot! 

[Emonda]

Hey @Greenowala

I feel for you. I did the same with the same AD. I dropped from 15mg to around 5mg over, say, 4-6 weeks. I can't recall exactly.

 

At 5mg, I felt like an elephant was sitting on my chest, as well as the other symptoms you mentioned.

 

For me, I increased from 5mg to 7.5mg (the last dose I felt ok) and found stability....and held there for maybe 5 months.

 

As LotusRising asked, how did you feel at 5mg? Was that the last dose you took before you jumped to 0mg 8 days ago? If so, that might be a reasonable starting point. It's best to start low and see how you go, rather than jump straight back to a higher dose. You need to be mindful of Kindling.

 

I hope this is helpful.

 

Emonda

[Greenowala]

@LotusRising

Withdrawal started as soon as I dropped to 15mg. But the withdrawal wasn't too bad - mainly headaches and fatigue. Because it wasn't too bad, I continued to taper.

Withdrawal started to get bad around December 5/6 after being on 0 for a few days. (I updated my signature to be a bit more detailed btw) I think the fast taper and complete discontinue coupled together all just hit me hard. 

The symptoms that I find more challenging lately that make me want to start back up are the mood swings, high irritability, my back seizing up, focus/concentration/poor cognition, and just overall hopeless feelings.

Thank you for your guidance! 

 

 

@Emonda

Thank you so much for sharing! Thats a great point - maybe I should hold at a certain dosage until I feel stable and then considering a taper again. When I moved from 20>15>10>5 - I never really waited until I felt stable, I just continued to taper because I didn't find the withdrawal too bad. And now its all just hitting me, feels like its all catching up to me - the fast taper + discontinued. 

Thank you for your help and input - I'm going to read up on kindling! 

[Greenowala]

@ComfyquiltThank you so much! Setting up a consult with her now - really appreciate it! 

[Comfyquilt]

@Greenowala she’s fantastic! I’m glad I could help a little. Hang in there ❤️

[Greenowala]

@ComfyquiltDefinitely helped ❤️ its giving me something to look forward to - speaking to her friday.  

Do you know if her sessions are covered by ohip or insurance at all? When creating a profile it asked for my ohip number.  Thank you! 

[Comfyquilt]

@Greenowala I think it’s out of pocket. It is for me in BC but I find it worth it 

[Greenowala]

@LotusRising @Emonda Hi both! I'm hoping you can advise me with a reinstated dosage for Trintellix. I am still on 0. Its been a total of 10 days on 0 and I need to get back on something asap but not sure what dosage. Trintellix only comes in 5,10,15,20 tablets. 

What do you think if I crush up the 5mg tablets and take half so 2.5 daily starting today and see how I feel? and assess from there?

I just spent the last 2 hours calling every single family doctor in Toronto to see if they would accept me, because it would've been ideal to get some sort of compounded dosages so I dont need to be crushing up pills... but it looks like this is what I have to do. 

 

Please let me know ! 

[manymoretodays]

Hey there Greenowala,

If it was me and just 10 days off completely, last dose 5 mg every other day, I too, might try a 2.5 mg reinstatement dose.

Take it at the same time EACH and every day after carefully reading through:

About reinstating and stabilizing to reduce withdrawal symptoms

 

Pill cutters are cheap and generally easily obtained to get started.......  assuming you have 5 mg pill/tablets right now.

Liquid is also an option, even making your own suspension or solution I see:

Tips for tapering vortioxetine(Trintellix/Brintellix)

(another topic to get thoroughly familiar with)

 

And then keep us posted daily as well.  Always nice to see a couple days of daily notes, in the simple list format, once you get going.

 

Real good chance you'll get some reduction in symptoms in these early days since off.

 

Welcome and best for further stabilization for you.

Love, peace, healing, and growth,

manymoretodays(mmt)

[Emonda]

1 hour ago, manymoretodays said:

2.5 mg reinstatement dose.

 

I'm with manymoretodays. 2.5mg sounds reasonable.

[Greenowala]

@manymoretodays @Emonda  Thank you very much both! I have started 2.5mg tonight. Really hoping I feel some relief in the coming week.

[manymoretodays]

What size pill are you working with?

If it's still a 20 mg size, you'll have to quarter it, and then slice the quarter in half. 

Not ideal, but okay to get your reinstate started.

 

I think your vortioxetine topic will further link you to methods of getting smaller doses than are made, and some of the properties of your medication.

Do searches on site too, OR post here in your topic rather than start new topics.  I just moved your post on weighing, into that topic.

 

You can easily find alot in this topics index post:  Important topics in the Tapering Forum and FAQ's

 

And......just be real consistent for tomorrows dose, same time, same method to get to a 2.5 mg approximation.

Try some notes too.....I gave you a hyperlink to best method to present a couple days of those to us.

 

Here is hoping, some initial improvement, at least by the end of the week. 

 

 

 

[Greenowala]

@manymoretodays Hi there!

 

Im working with a 5mg pill. Thank you for moving the post over, still new on here and learning how the forum is organized. 

Thank you for the encouraging words!!

[Emonda]

Is the 5mg tablet a tear-shaped pill, @Greenowala

 

If so, I found it hard to cut it accurately with my pill cutter. It never looked even despite my best efforts. Too much one day and too little the next.

 

I ended up crushing the tablet into a very fine powder between two spoons, tipping the power into a 20ml syringe, adding 10ml of water, shaking well, and then removing 5ml to get 2.5mg. 

 

Thought I'd share if of interest.

 

Emonda

[manymoretodays]

Perfect!  Any early improvements in your WD(withdrawal) symptoms?  

Here is a screenshot of the symptom checklist link I(Emonda did the screenshot not me)  from Dr Glenmullen.  And of course there are even more.

 

I did suspension in water too, for my last drug(trileptal/oxcarbazapine), so do consider that option.  Worked out fine. 

 

 

 

[Greenowala]

@manymoretodays Thank you for checking in!!!

Yes I feel very relieved and happy to say my withdrawal has improved. Im feeling much less irritated, mood has improved as I have had severe mood swings, less suicidal ideations, and less disequilibrium sensation of floating. 

Thank you for this screenshot - I just used it to journal all my withdrawals I was experiencing and it really helped me put a word to this bizarre sensation I've been feeling like I was floating and I wasn't able to put the feeling into words until I looked up what disequilibrium entailed. 

 

[Greenowala]

@EmondaThank you for the suggestions Emonda!! Thats genius I would've never thought of that - I did manage to get my hands on a scale and Ive been using that so far  

[Greenowala]

@Emonda @manymoretodays

 

Hello, Im looking for some tapering advice as I plan for what the next year will look like.

Ive been reading about this 10% tapering guideline - exponential. If I follow this guideline that will take me well into mid next year 2025...

It makes me wonder if this taper guideline is a bit too conservative for me, since I was able to taper from 20-2.5mg within 7/8weeks. 

 

Once I feel stable on the 2.5mg dosage, hopefully after 3 more weeks. Im wondering if I should start with  a linear taper every 3 weeks. This plan would take me to July/August this year - about 5 months to taper off of 2.5mg. 

It sounds a bit more reasonable to me, what do you guys think?

 

[Emonda]

I would be sticking to the recommendations on this site. Yes, it takes a while, but it's not a race.

 

It seems that at smaller doses, the reductions can be more challenging for some. Once you destabilise yourself, it can take a while to recover.

 

Today, I dropped to 2.33mg. I'd love to be a 0mg, but it's just not worth the risk for me.

[manymoretodays]

On 1/18/2024 at 2:27 PM, Greenowala said:

Once I feel stable on the 2.5mg dosage, hopefully after 3 more weeks. Im wondering if I should start with  a linear taper every 3 weeks. This plan would take me to July/August this year - about 5 months to taper off of 2.5mg. 

It sounds a bit more reasonable to me, what do you guys think?

 

No.  Linear tapers are not the way, if you mean dropping by a set amount each and every taper.  Not reasonable at all.  No one every regrets taking the time to taper right.

Just do today, each day..........you'd be surprised how quick time goes.

 

What one day look like now?  Try 1 note, 1 day.  I gave you a link above.