Mando: Coming off 10 years of Trintellix

[Mando]

Hi Everybody! My name is Armando. It’s nice to meet you all!
 

I’ll try to keep my introduction as short as possible.

 

I’ve always been an anxious person and now I realize I was raised by an overly protected mother. Fast forward to the age of 23 and I have a nervous breakdown/burnout. I fell into deep depression along with panic attacks and extreme pure OCD. 
 

Growing up in a Hispanic environment, family and friends tried to get me to take natural supplements. I now understand these take a while to work so we gave up on these. 
 

My friend recommended me to see a neurologist. At the time, trintellix was fairly new and the neurologist gave me some samples to try at first. I started with 10mg and slowly went up to 20mg. I felt better after a couple of months of taking them. 

 

I would continue to see him for my trintellix prescription for the next couple of years. I would say I tried coming off trintellix 3 times from 2016-2018 with NO knowledge. My neurologist recommended one of those attempts and it was unsuccessful.

 

Fast forward to 2022 and I decided to come off trintellix a fourth attempt with “point of return” organization using some of their supplements and doing a liquid base suspension taper. I finished the taper in 9 months. It was a slow taper. To my surprise, I felt completely fine for the next 3 months. I would say I still hadn’t learn how to handle stress at this point, leading me to feel like I was burning out again. 
 

Well, I started feeling bad on the fourth month. Now at this point, I didn’t know about reinstating trintellix on a short dose and worse, I was clueless that my habits were causing me to burnout.

 

Unfortunately my neurologist had retired and I ended up seeing a psychiatrist who prescribed me Prozac and after taking it for 1 month, i literally was going crazy.

This was by far the worst time of my life. I feel bad for the stress I put my wife and family.

 

I went to taking trintellix and kind of normalize after 3 months. During this time, I received CBT with anxiety centre and finally made sense as to why I was prone to burning out.

 

Simply put, a combination of overprotective parents, not having a work life balance and not learning how to relax.

 

That was early 2023 and now we’re in 2024. I feel with the CBT therapy, lifestyle changes and a non stressful job that aligns to my personality, I’m ready to come off trintellix for good. Now due to insurance, I might not qualify for the liquid base suspension taper so I am considering a pill crusher and tapering off slowly.
 

As many know, Trintellix is hard to cut into two equal pieces since it is oval. I would like to crush the pill and do a slow taper but I have no clue how to do it or what to purchase.

 

i would really appreciate any insight, suggestions or advice this community can offer. Thank you so much in advance!
 

 

[Carmie]

Welcome @Mando

 

You may have tapered too quickly with your attempts of trying to get off trintellix in the past. How fast did you taper? It’s recommended to taper no more than 10% of the last dose every month or so. Some people, myself included, are tapering by much less than this.

You can crush and weigh the Trintellix on a scale and taper it that way. I’ve never used a scale before. I’m tapering Seroquel and I water titrate it, I make my own mixture. I can’t share links, I’m on a phone, but there’s a thread in the tapering section entitled: “ Tips for tapering vortioxetine/ Trintellix/ Brintellix.” As well as weighing your meds, it also mentions making your own liquid formula. Check it out, if you like.

Could you please put in your drug signature. Just go to the top of the Introductions page. There’s a thread on starting a topic about yourself. In the first paragraph you’ll see a link showing you how to do your signature. Thanks💛

[Emonda]

Hi @Mando

 

As requested by Carmie, please complete your drug signature by following these instructions. Adding a signature ensures your drug history appears at the bottom of every post, making it more efficient for those trying to assist. 

 

17 hours ago, Mando said:

As many know, Trintellix is hard to cut into two equal pieces since it is oval. I would like to crush the pill and do a slow taper but I have no clue how to do it or what to purchase.

 

I take the same AD as you and face the same challenge. Here's what is working for me (I've gone from 15mg to 1.99mg over two years or so):

1. Crush a tablet into fine powder, so it looks like flour,
2. Add the contents into a large syringe,
3. Add 10ml of water and shake until it looks like a consistent solution,
4. Extract what I don't need with a combination of syringes (buy them online and remove the needle),
5. Drink the remaining liquid from the large syringe, then fill it with water again and drink that too, just in case something was left behind.

You need to be accurate and consistent. If you aren't confident in your accuracy, use a compounding pharmacy. I know others here use a scale to weigh the pill and shave bits off.

 

A few links that helped me:

 

Why taper by 10% of my dosage?

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Windows and waves pattern of stabilization

 

Emotional Spirals

 

Non-drug coping strategies

 

Melatonin for sleep

 

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

Magnesium

 

Omega-3 fatty acids (fish oil)

 

Avoid alcohol. 

 

This is your own Introduction topic.  Each member has only ONE Introduction topic.  Your own Introduction topic is the best place to ask questions and the place to journal your progress.  This keeps your history in one place and means you do not have to repeat your story. 

 

Hope this helps.

 

Emonda

[Mando]

@Carmie @Emonda I just finished my signature, thank you for your assistance in this! I have the link to "Tips for tapering vortioxetine/ Trintellix/ Brintellix" saved. I did feel a little overwhelmed with the ways on how to taper off. I'm waiting to see if my insurance will cover going to a compound pharmacy to get the pill crushed into a powder or liquid taper, but I highly doubt my insurance will cover it.

 

What you mentioned @Emonda hit it right on the dot with the 5 steps. I'm ok doing the crushing process myself since doing the liquid taper 2 years ago was something similar. I think my questions now refer to specifics like, "What did you use to crush the pill?" "What syringe do you have?" "If I'm supposed to taper 10% a month or so, am I using a specific weight scale?" "The residue powder that remains after I crush it, how do I consume that?" "How do I add the contents to the syringe" I apologize to be very picky. I just know from personal experience that when trying to taper off these medications, EVERYTHING needs to be accounted for. Thank you so much for your patience and in considering my questions

[Emonda]

9 hours ago, Mando said:

What did you use to crush the pill

 

I use two metal dinner-sized spoons and that works just fine for me. You can buy something fancy from a pharmacist if you want. 

 

9 hours ago, Mando said:

How do I add the contents to the syringe"

 

Getting the power into the large syringe can be made easier with a piece of paper folded down the middle to sort of make a funnel.

 

9 hours ago, Mando said:

What syringe do you have?

 

I use a combination of 10ml (for adding the water), plus 3ml, 1ml and 0.5ml syringes to taper as required. I make sure I have heaps of identical syringes on hand for when they break so I know I am being as consistent as possible along the way. Put sticky tape over the numbers, as the numbers tend to rub off.

 

9 hours ago, Mando said:

If I'm supposed to taper 10% a month or so, am I using a specific weight scale?

 

I just stick with the syringe measurement. 10ml of water added... the first month, 1ml removed and disposed of, and you'd consumer 9ml.

 

The next month, you want to take 9ml * 90% = 8.1ml. So, 10ml of water added and remove/dispose of 1.9ml, and consume the balance of 8.1ml etc.

 

Now that I am at 1.99mg, I add 20ml of water as it was getting too hard to make small reductions with only 10ml of water.

 

9 hours ago, Mando said:

The residue powder that remains after I crush it, how do I consume that?

 

Do you mean liquid? I make a liquid to taper. Others use a scale. I figured at lower doses, a scale that is affordable won't be accurate enough for me. I dispose of the liquid I don't use.

 

9 hours ago, Mando said:

I apologize to be very picky. I just know from personal experience that when trying to taper off these medications, EVERYTHING needs to be accounted for.

 

No apology is required at all. You are correct; consistency and accuracy is vital. The above works for me...I hope it gives you something to consider.

 

For anyone else reading this, not all ADs can be turned into a liquid solution. Read about your own AD before working out how you should proceed for yourself.

 

Emonda

 

[Mando]

@Emonda Thank you! Your answers are very precise and specific, which is what I am looking for! I know Trintellix pill goes off milligrams (mg) and the syringes go off milliliters (ml). So, for example, I buy a 20 ml syringe. I get the 20 mg pill, crush it, put it in the syringe, put 20ml of water and shake it. If I'm doing a 10% taper reduction, I take away 1ml off the 20ml syringe leaving me with the 19ml and take that? 

I also included links of a pill crusher, a scale and the syringes. Not sure if I'm overdoing it by getting these items. Thank you in advance!

 

Amazon.com: B&C Home Goods Pill Crusher - Stainless Steel Pill Grinder - Large Capacity Pill Crusher - Grind Pills into Fine Powder - Mills for Feeding Tube, Pets & Kids : Health & Household

Amazon.com: Gemini 20 - Portable Precision Modern Stainless Steel Digital Milligram Scale 20g x 0.001g (Silver) - AMERICAN WEIGH SCALES: Digital Kitchen Scales: Home & Kitchen

Amazon.com: BSTEAN 30 Pack - 1ml, 3ml, 5ml,10ml, 20ml Syringes with 14ga, 16ga,18ga, 20ga, 22ga and 25ga Blunt Tip Needles and Caps for Refilling and Measuring Liquids, Oil or Glue Applicator : Industrial & Scientific

[Mando]

trying to understand if 1mg of Trintellix powder is equal to 1ml of water...

[Emonda]

On 4/13/2024 at 8:50 AM, Mando said:

If I'm doing a 10% taper reduction, I take away 1ml off the 20ml syringe leaving me with the 19ml and take that?

 

If you have 20ml of water * 90% = 18ml that you would consume this month.

 

Next month would be 18ml * 90% = 16.2ml to consume....etc

 

There is nothing wrong with going slower than this of course 😊

 

[Mando]

Thank you @Emonda!

I ended up ordering some 30 ml cup (could not find a 20ml cup) with a lid so I can shake the Trintellix powder with water. I spent about an hour looking a pill crushers but none convinced me. I will use the two-spoon method and using the paper as a funnel. And with the syringes I purchased, I will either fill the syringe from the cup with the mix of water and the medication or extract the mix from the cup using the needle the syringe comes with. I did do a practice run with crushing the pill. I did notice the outside shell of the pill does not like to be crushed so hopefully when I shake it in the cup, it dissolves completely.

 

[Emonda]

1 hour ago, Mando said:

I did notice the outside shell of the pill does not like to be crushed so hopefully when I shake it in the cup, it dissolves completely.

 

Yes, it is quite stubborn. I reckon I take ~60 seconds and do the best that I can.

 

1 hour ago, Mando said:

I spent about an hour looking a pill crushers but none convinced me. I will use the two-spoon method

 

Same. With dessert spoons, you can easily see how fine you've managed to get the powder.

[Mando]

@Emonda Thank you!

[Mando]

Hi @Emonda I decided to start with 5% reduction today. I got a small post it note, got my two dessert spoons and did my best to crush the 20mg pill. I then created a funnel of the post it note and proceeded to put the powder in a small cup. I then filled it with 20ml of water and shook the powder and water until it mixed. I did notice I did get some foam on top after I stopped shaking it, but that foam did seem to disappear. Then I got a 20ml syringe and only got sucked out 19ml off the 20ml mixed cup and drank that. I just squirted the 19ml mix with the syringe into my mouth and then I refilled it with water in case I missed anything. 

 

I decided it to do this around 5 or 6pm every day. I was taking the pill every night around 10pm but I know myself and since it now takes 5 minutes to do the crushing and mixing, I'm afraid that I will be too tired to do that at 10pm. My wife suggested I do it first thing in the morning when I wake up. 
 

Not sure if you have had the same experience but when I drank that 19ml liquid, I definitely felt something that I don't normally feel when I take it in a pill form. Like an extra boost of energy and anxiety. It might be because I'm taking it in liquid form so it's hitting me faster and more direct or simply my mind playing games on me lol. Should I eat something before?

 

Thank you in advance!!

[Emonda]

5 hours ago, Mando said:

Then I got a 20ml syringe and only got sucked out 19ml off the 20ml mixed cup and drank that.

 

I'd do it the other way around: use a 1ml syringe to remove 1ml, then drink the remaining 19ml. I find it is easier to be accurate with a 1ml syringe than a 20ml syringe.

 

5 hours ago, Mando said:

I decided it to do this around 5 or 6pm every day. I was taking the pill every night around 10pm

 

It's generally best to move the dose by no more than 1 hour per day so the change is slowly adjusted to. I'd set an alarm for the exact same time each day, rather than "between 5 or 6pm".

 

5 hours ago, Mando said:

My wife suggested I do it first thing in the morning when I wake up. 

 

I get up at the same time each day, so I do this. But again, you'd only move the dose by an hour a day.

 

5 hours ago, Mando said:

I definitely felt something that I don't normally feel when I take it in a pill form. Like an extra boost of energy and anxiety. It might be because I'm taking it in liquid form so it's hitting me faster and more direct or simply my mind playing games on me lol.

 

Another member pointed out to me that this AD has a long half-life (66 hours), so it's not likely you'd notice anything immediately...maybe you do, but more likely it's the mind playing games.

 

5 hours ago, Mando said:

Should I eat something before?

 

I haven't read anywhere that this is necessary.

 

Hope this helps.

[Mando]

Thank you @Emonda! I can’t express enough the gratitude for this valuable knowledge. There’s so much information out there but it’s hard to know if it’s truthful and accurate! Thanks again!

 

Now I will work my way to taking it in the morning by doing the 1 hour change you mentioned. It will probably take me two weeks until I can start taking it at 6 am since I’m currently taking it at 8pm. Once I start taking it first thing in the morning, is it possible to crush the pill in powder form the night before and have the powder form ready in the morning so all I have to do is simply mix it with water?

 

I don’t want to be rushed crushing the pill in the morning 😬
 

I know trintellix is not refrigerated so Im assuming I can also have the water and powder mix ready the night before and simply drink it in the morning?

 

Realistically, I would prefer to crush it the night before and just mix it with water in the morning, if possible.

[Emonda]

7 hours ago, Mando said:

is it possible to crush the pill in powder form the night before and have the powder form ready in the morning so all I have to do is simply mix it with water?

 

The batch I make lasts me two days. I just keep the remaining liquid in a dark cool room. Hasn't caused me any issues. 

 

[Mando]

@Emonda thank you! 🙏🏼