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KaBa: Tapering Venlafaxin - third time is a charm?


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Hello, this is my introduction - English is my second language so please excuse any mistakes. I´m desperate, my psychiatrist thinks I´m bipolar and refuses to help with withdrawal. But let´s start from the beginning:

I think I have been depressed all my life, but got diagnosed in 2015 with depression and social anxiety. I was almost constantly in therapy and two times in a hospital for longer treatment, which all helped a little bit, but not much. Over the years chronic back pain was added to the diagnoses (which was at least favored by Venlafaxine, but more on that below), and in 2022 finally a cPTSD diagnosis with an according change in therapeutic strategy really made some improvement. Including an almost healing of the back pain, fortunately I only get it in high stress phases anymore. Also the anxiety is gone I would say, ans I also only face it in very high stress phases, but can handle it well. What persisted was the depression and frequent testing confirms that it even got worse over the years. I had two periods of being unable to work, happily I´m working part-time now since spring last year. But currently my symptoms are getting worse again and I fear to be unable to work again. I don´t want to loose my job and I don´t want to admit, how bad I am really feeling right now. I think this is mainly since I cannot find help with my medication. From a therapeutic point of view I feel like I´m well educated by now and can handle most of my challenges on my own. What I desperately wish for is a stabilization of my mood and energy, which was like the key problem or red line through my medication history.

 

My mediation history as far as I can remember:

  • First psychiatrist prescribed Escitalopram in 2015, slow ramping up to 20mg daily - only slight improvement of depression
    • in 2017 circa, Bupropion ("Elontril") was added daily first 150mg, then 300mg - still only slight improvement of depression
    • switched Bupropion from daily to on-and-off medication as recommednet by psychiatrist: when depression got really bad, I took 150-300mg Bupropion to buffer the worst
  • I moved, so I switched to psychiatrist number 2 in 2021
    • since I still complained about the depresseion, we switched to Venlafaxin end of 2021
    • I think it was an abrupt stop from Escitalopram & Bupropion
    • slowly ramping up (don´t recall the inital dose) Venlafaxin
    • still no improvement of depression and side effectes started: severe fatigue, nightmares, backpain, heavy sweating, no sexual desire, general numb feeling/indifferent to almost everything, brain fog
    • in spring 2022 addition of Venlafaxin retard, in Summer 2022 dose was 150 mg Venlafaxin retard and 150 mg Venlafaxin direct
    • doses varied, but highest was 350 mg Venlafaxin retard and 150 mg Venlafaxin direct in fall 2022
    • depression still persisted/got worse, psychiatrist number 2 told me that "this is the way it is going to be for the rest of your life, so better start accepting your symptoms now"
    • self-directed withdrawal from 350 mg Venlafaxin retard and 150 mg Venlafaxin direct within 6 weeks --> developed severe withdrawal symptoms (hypomania, insomnia, cyring spells, mood swings, irritability, no apptetite, flu-like symptoms)
    • re-instated Venlafaxin retard 150mg in January 2023 and withdrawal symptoms vanished within 36h
  • psychiatrist number 3
    • after reporting my withdrawal experience she went for screening of bipolar disorder, which came back negative (I never experience myself maniac before, it was the scariest thing I ever experienced, since you know, I know how to handle depression, panic attacks and suicidal thoughts, but hypomania was completely new and scary) - still she is convinced that I´m bipolar, since "there is no such thing as withdrawal symptomes from Venlafaxine"
    • depression and fatigue increase, so we increase the dose to 225mg Venlafaxin retard in summer 2023
    • no improvement, switch to Desvenlafaxin in summer 2023 100 mg - again, I developed severe withdrawal symptoms and after one week of Desvenlafaxin we switched back to 150 mg Venlafaxin retard (again, within 36 h withdrawal symptomes vanished)
    • self-education and self-administered tapering started in August 2023, since still no help from psychiatrist ("your symptomes are too heavy, you need to go to a hospital" - hospital basically laughed at me and told me, deprescribing is the job of the psychiatrist)
      • plan developed with my therapist: I lower the dose by 12,5mg (since my Venlafaxin retard had those mini-tablets each 12.5mg inside) when I feel the depression and fatigue coming in, since then my nervous system seems to be on a stable level of Venlafaxin
      • it was mostly 2-3 weeks with only mild withdrawal symptomes (brain-zaps, brain fog, flu-likle symptoms and general higher energy/drive which made withdrawal quite nice, since I finally felt energy coming back to my life. Also I started feeling more again, like a wider spectrum of emotions, which was tiring, but nice a the same time. Like feeling alive again after a very long period of sleep walking :D), then depression and fatigue started to rise and I knew I could lower again
      • I was at 0 mg mid march 2024, which was fine in the beginning (I felt neutral-good, which I absolutely loved, normal drive & energy, just... living) - but depression hit very, very hard and I got suicidal thoughts after 3 weeks at 0
      • the depression got so intense, that I reinstated Venlafaxin retard in May 2024, first 12,5 mg and after 2 weeks 25mg
      • In this time had inexplicable anxiety and was agiteted every morning and early noon, in the afternoon and evening I felt better, also mild GI symptoms were present
      • with a vanishing of the anxiety, depression and fatigue returned and got again unbearable, so I increased my dose today to 37,5 mg - still not sure if this was the right decision.
  • currently on the search for a new psychiatrist since number 3 is even not helpful in finding Venlafaxin retard products with tiny beads instead of those 12,5 mg tablets
    • so far I only could find two hospitals (in Bremen and Berlin) in Germany which list deprescribing antidepressants and withdrawal symptomes as their area of treatment - unfortunately they only offer their service to locals
    • does anyone know any professionals which can support in deprescribing? My therapist is supportive, but not experienced and she also is not allowed to prescribe anything...
    • I did some research and can offer help in finding Venlafaxcin with micro beads :) I emailed some of the producing companies here in Germany and I have now Venlafaxin retard 37,5 mg with mirco beads inside
    • my plan currently:
      • find stability - I wanted to give my nervous system a break to rest and settle, befor I start a new taper
      • next taper according to the recopmmendations here, I want to start with 10% reduction every 4 weeks

 

My questions: would you start tapering now? Or do I need to increase first to a dose where I can just "rest" for some weeks? Since I never was really stable under Venlafaxin, I don´t know which way to go. After ready around here a bit, I thought maybe I was in withdrawal all the time from my abrupt Escitalopram withdrawal? Maybe I need to reinstate that and wait for stabiliyt and then taper that?

I´m so confused, with the heavy depression currently and the lack of professional help I´m so desperate...

 

Any help and tips appreciated.

 

Best wishes an I hope you all out there are safe!

Started Escitalopram in 2015 (20mg) - only slight improvement of depression
Added Bupropion ("Elontril") in 2017 (150mg-300mg)
Switched to Venlafaxin XR end of 2021 (150mg)

Added Venlafaxin XR spring 2022 (150mg)

Withdrawal from Venlafaxin XR (350mg) + Venlafaxin (150mg) in fall 2022 - heavy withdrawal symptomes

Reinstating Venlafaxin XR in 2023 225mg
Switch to Desvenlafaxin in summer 2023 (100 mg) - heavy withdrawal symptomes

Switch back to Venlafaxin XR in summer 2023 (150mg)

Tapering August 2023 to mid March 2024 (150mg --> 0mg)
Severe rebound depression, suicidal - reinstated Venlafaxin XR May 2024 (currently 37.5mg)

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  • Erimus changed the title to KaBa: Tapering Venlafaxin - third time is a charm?
  • Moderator

Hello, and welcome to Surviving Antidepressants. We are a peer support forum to assist in tapering off psychiatric drugs safely, or recovering from psychiatric drug withdrawal.

 

This topic is for anything relating to you, and any questions you have. Please do not start another topic.

 

 

 

I would suggest a period of stability, where you remain on your current dose of 37.5mg for a period of 3-6 months. The symptoms you have experienced are either caused by rapid withdrawal, or are adverse effects of the medication you use. Venlafaxine has to be tapered extremely cautiously because of its short half-life, even when you're taking the XR/retard version. When you swap one drug for another the withdrawal symptoms are usually masked by the new drug, you are probably not still suffering from escitalopram withdrawal, but your recent drug changes have complicated things.

 

These two threads will be critical for you moving forward:

Counting beads in a capsule versus weighing

 

Tips for tapering off venlafaxine (Effexor)

 

 

 

We recommend tapering by no more than 10% of your CURRENT dose each month, to limit withdrawal symptoms. E.g. 10mg --> 9mg --> 8.1mg --> 7.29mg

 

All the answers you are looking for regarding tapering and antidepressant withdrawal are on this site. Please search around and continue to read as much as you can manage. Use the site search function to search for specific words or phrases, such as drugs or symptoms.

 

Here are a few of the most useful links:

 

--------Important topics in the Tapering forum and FAQ--------

 

Micro tapering

 

Why taper by 10% of my dosage?

 

Using a scale to weigh and measure doses

 

--------From the Symptoms and Self-Care Forums--------
 
What is withdrawal syndrome?
 
About reinstating and stabilizing to reduce withdrawal symptoms
 
The Windows and Waves Pattern of Stabilization

 

Hypersensitivity and Kindling

 

We only recommend two supplements. Omega 3 Fish Oil and Magnesium. Both should be introduced separately and increased slowly.

 

Regards

Erimus

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

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  • Moderator

We have another German member dealing with venlafaxine, who you might like to converse with. .@Alfred1977

 

 

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment
  • Mentor

Hey @KaBa,

you can tag me like this @Alfred1977 if you have any questions or simply want to chat.

Viele Grüße

Earlier drug history:

Paroxetine  2001 until 2003, quit cold turkey, don't remember dose; Venlafaxine 2005 until Dez. 2023, mostly 75mg xr per day, for about 4 years 37.5mg xr; quite a lot of Antihistamines because of allergy; there were other drugs that I don't remember all, but nothing what I consistently took over a longer period of time, for example Lorazepam 0.5mg prn.

Recent developments:

Dez 2023 - 03/13/2024 quitting Venlafaxine 75mg (skipping doses); 04/07/2024 reinstating Venlafaxine 12,5mg; 04/17/2024 Venlafaxine 25mg; 4/29/24 until 5/4/24 Trimipramine, 5mg going down to zero over 5 days

Drugs right now:

Venlafaxine 25mg; supplements: 500mg magnesium, 100mg aspirin and melatonin spray

 

I am no medical expert. I am dependent on Venlafaxine, trying to find and give peer support in this community and simply giving my opinion. Double check any information before you take action, for example with your doctor.

 

First they sell addictive drugs as harmless and then they leave you alone dosing fractions of a mg correctly or plunging into the abyss.

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Thanks so much for your replies @Erimus and @Alfred1977. It feels very good to be heard and not be alone with the struggles.

 

I understand that a phase of stability is now the best what I can do for my nervous system, but I´m still not sure how to achieve this. With the latest increase from 25 to 37.5mg I felt quite ok for the first few days, but on Friday the Depression returned. I can handle it for a few days, but it´s very tough to sit through. I experienced the same when I started Venlafaxine, after some weeks, the current dose didn´t do anything for me besides fatigue and severe depressions returned. This led my psychiatrist then to steadily increase dose until I was basically at max dose. Now I experience the same in even faster "cycles", a dose is finde for a few days but then I´m stuck in hell again. Is this kindling what I experience now?

 

I have severe doubts on further increasing the dose. Staying at the current dose and suffering through the depression is a very tough challenge which I don´t know how long I can conquer. Lowering the dose is also not a good idea I guess with regard to "giving my nervous system a break with a stable phase".

Any tips, experiences on where to go from here?

 

I already do take the Venlafaxin at the same time every day (8 am) and I do stick to a daily routine (pay attention to good sleep hygiene, so to bed/get up every day the same time), I do have a job currently (desk job) and have daily physical workout (3-4 hours, I have a horse which I take care of, so good combo of routine/physical work/sports). I pay attention to nutrition, which is working on most days to ear fresh and healthy (but not always, I guess I could improve here). Don´t do drugs or drink alcohol, 2 cups of coffee in the morning. 

I did weekly therapy, but since I feel I´m kind of done with the current method/therapist, I switched to monthly sessions. Any ideas on improvement/where I can do additional helpful things?

 

Best wishes to all you out there and stay stong

Started Escitalopram in 2015 (20mg) - only slight improvement of depression
Added Bupropion ("Elontril") in 2017 (150mg-300mg)
Switched to Venlafaxin XR end of 2021 (150mg)

Added Venlafaxin XR spring 2022 (150mg)

Withdrawal from Venlafaxin XR (350mg) + Venlafaxin (150mg) in fall 2022 - heavy withdrawal symptomes

Reinstating Venlafaxin XR in 2023 225mg
Switch to Desvenlafaxin in summer 2023 (100 mg) - heavy withdrawal symptomes

Switch back to Venlafaxin XR in summer 2023 (150mg)

Tapering August 2023 to mid March 2024 (150mg --> 0mg)
Severe rebound depression, suicidal - reinstated Venlafaxin XR May 2024 (currently 37.5mg)

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  • Moderator
On 6/9/2024 at 9:06 AM, KaBa said:

Thanks so much for your replies @Erimus and @Alfred1977. It feels very good to be heard and not be alone with the struggles.

 

I understand that a phase of stability is now the best what I can do for my nervous system, but I´m still not sure how to achieve this. With the latest increase from 25 to 37.5mg I felt quite ok for the first few days, but on Friday the Depression returned. I can handle it for a few days, but it´s very tough to sit through. I experienced the same when I started Venlafaxine, after some weeks, the current dose didn´t do anything for me besides fatigue and severe depressions returned. This led my psychiatrist then to steadily increase dose until I was basically at max dose. Now I experience the same in even faster "cycles", a dose is finde for a few days but then I´m stuck in hell again. Is this kindling what I experience now?

 

I have severe doubts on further increasing the dose. Staying at the current dose and suffering through the depression is a very tough challenge which I don´t know how long I can conquer. Lowering the dose is also not a good idea I guess with regard to "giving my nervous system a break with a stable phase".

Any tips, experiences on where to go from here?

 

I already do take the Venlafaxin at the same time every day (8 am) and I do stick to a daily routine (pay attention to good sleep hygiene, so to bed/get up every day the same time), I do have a job currently (desk job) and have daily physical workout (3-4 hours, I have a horse which I take care of, so good combo of routine/physical work/sports). I pay attention to nutrition, which is working on most days to ear fresh and healthy (but not always, I guess I could improve here). Don´t do drugs or drink alcohol, 2 cups of coffee in the morning. 

I did weekly therapy, but since I feel I´m kind of done with the current method/therapist, I switched to monthly sessions. Any ideas on improvement/where I can do additional helpful things?

 

Best wishes to all you out there and stay stong

With your drug history it is difficult to tell if the depression is a symptom of withdrawal, or an adverse effect of the medication. Either way, you need a period of stability before you proceed to taper off. To me it seems like you have experienced depression as both a result of tapering too quickly, and as a side effect of the medication.

Active Monday-Friday UK time

 

Taper calculator spreadsheet

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021, 55mg - 23 Feb 2024, 60mg - 20 March 2024, Start tapering - 24 April 2024

Current dose: 55.09mg  (1 July 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment

Hi @KaBa I am also in a tough spot reinstating venlafaxine. I don’t have a lot of advice, just sharing my experience.

 

i tapered slowly yet not slow enough, I took my last dose in January 2024. Last month I began reinstating tiny amounts after withdrawal symptoms became unbearable. I’ve been taking around 2.8mg for the last 2-3 weeks. Initially I felt a slight decrease in symptoms but they ramped up again. I’m holding steady at 2.8mg and living with a lot of SI, depression, anxiety that cycles every week, usually the worst on Mondays. I usually feel more ‘stability’ or relief in the afternoons and later in the week. I suppose the idea is leaving the nervous system alone from changes, and letting it get used to wherever you are at. It’s not easy. 

 

With help from @Alfred1977 and @Onmyway I’m holding at this dose for 4-6 weeks. 

Sounds like you are doing a lot to try to keep the symptoms at bay. I have noticed that I often have to introduce a change to my routine— from doing yoga everyday as my physical activity, to walking a few miles a day. Or spending time at my parents or partners instead of spending all on my evenings around my apartment. After a while it feels like my routine doesn’t ‘work’ anymore, and I try to make a small change to mix it up. It helps a bit. It’s also tough because of the panic and anxiety.

 

I’m also working part time and understand how hard it is to try to heal, while worrying about keeping a job/routine/paycheck. I’m sorry you’re going through this, you’re not alone. Here if you need to chat/vent.
 

 

Venlafaxine, 150 mg, 2015-2018 abrupt discontinuance from 150mg>75mg>0mg in 2 months
Venlafaxine, 150mg, 2018- Jan 2024 7-8 month taper, 4-6 weeks 112.5mg, 4-6 weeks 75mg, 4 weeks 37.5mg, removed 5 beads a week (from 100 ish beads per 37.5mg capsule, 7 doses of the same amount), stopped and held at about 18mg for a month when symptoms became intense, then continued to take 3 beads out a day until January 24, I took a capsule with 1 single bead

Spironolactone, 100mg, march 2024, acne

Sertraline, 25mg, May 7, 2024 (two doses in when I found this forum) discontinued May 9 after extreme anxiety and insomnia

Venlafaxine, .94mg, May 13, Reinstating to try and mitigate withdrawal symptoms

Supplements:

2023- Present 400mg Magnesium Glycinate

2023- Present 4800mg fish oil 1728 EPA, 1152 DHA

2023- May 8 B50 complex vitamin 

2023- May 8 5000 ID Vitamin D3

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  • Mentor
On 6/9/2024 at 10:06 AM, KaBa said:

I understand that a phase of stability is now the best what I can do for my nervous system, but I´m still not sure how to achieve this. With the latest increase from 25 to 37.5mg I felt quite ok for the first few days, but on Friday the Depression returned. I can handle it for a few days, but it´s very tough to sit through. I experienced the same when I started Venlafaxine, after some weeks, the current dose didn´t do anything for me besides fatigue and severe depressions returned. This led my psychiatrist then to steadily increase dose until I was basically at max dose. Now I experience the same in even faster "cycles", a dose is finde for a few days but then I´m stuck in hell again. Is this kindling what I experience now?

 

I have severe doubts on further increasing the dose. Staying at the current dose and suffering through the depression is a very tough challenge which I don´t know how long I can conquer. Lowering the dose is also not a good idea I guess with regard to "giving my nervous system a break with a stable phase".

Any tips, experiences on where to go from here?

Personally I believe that it is justified to slowly, carefully and gradually increase the dose if it helps to stabilize and you notice improvements. It is normal to experience ups and downs during withdrawal ("windows and waves"). However, if I understand you correctly Venlafaxine never really helped you to resolve those depressions in the first place (and so they have always been there?) and therefore you are wondering now whether your depressions are caused by withdrawal or are an underlying condition. This is really a difficult question since depression can be caused by a lot of factors that don't exclude each other. Somehow we have to carefully observe ourselves in order to find out what drug changes are doing with us. Do you experience any other symptoms apart from depression? Maybe they can help you to get a feeling for the drug.

 

I also believe that withdrawal and /or quitting psychotropic drugs can take a real long time. I am still struggling to accept this...but I guess it will take at least 3 years for me to stabilize and to taper down from the 25mg where I am now. You went down from 150mg to zero in about 6 month and this is insanely fast for most people in this community. Some (and maybe not a few) nervous systems need a considerable amount of time to adapt to dose changes or otherwise run amok. If you do the recommended 10% taper, then as a rule of thumb you half your dose every 6 months. So coming from 150mg you would be around 75mg right now. This does not mean you should jump to 75mg but I think it is plausible that this is causing a lot of suffering.

Earlier drug history:

Paroxetine  2001 until 2003, quit cold turkey, don't remember dose; Venlafaxine 2005 until Dez. 2023, mostly 75mg xr per day, for about 4 years 37.5mg xr; quite a lot of Antihistamines because of allergy; there were other drugs that I don't remember all, but nothing what I consistently took over a longer period of time, for example Lorazepam 0.5mg prn.

Recent developments:

Dez 2023 - 03/13/2024 quitting Venlafaxine 75mg (skipping doses); 04/07/2024 reinstating Venlafaxine 12,5mg; 04/17/2024 Venlafaxine 25mg; 4/29/24 until 5/4/24 Trimipramine, 5mg going down to zero over 5 days

Drugs right now:

Venlafaxine 25mg; supplements: 500mg magnesium, 100mg aspirin and melatonin spray

 

I am no medical expert. I am dependent on Venlafaxine, trying to find and give peer support in this community and simply giving my opinion. Double check any information before you take action, for example with your doctor.

 

First they sell addictive drugs as harmless and then they leave you alone dosing fractions of a mg correctly or plunging into the abyss.

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Thanks for all of your replies. I really appreciate it, it´s sad to read that you are in similar places, on the other hand it helps to have allies in this battle. 

 

I stayed st 37.5mg and it is slowly getting better. Currently I think I´m in a window, since my mood is decently neutral and so is my energy. I think @Alfred1977 and @Erimus you´re right, Venlafaxine never really helped me and it is doing currently a mix of withdrawal symptomes and adverse effects. I take track of my symptoms and since I had severe symptoms from my first withdrawal (from 350mg XR + 150mg direct to 0 in 6 weeks or so), I think I can usually distinguish quite good between withdrawal/adverse effects - the depression as withdrawal response was new, which confused me. But with the accompanying symptoms the picture gets clearer. Thanks for that hint!

 

The "window" now gives me faith and strength to pull through whatever might come in the next week. I plan to keep the dose stable at the current 37.5mg and when my fatigue hits again, I will start slowly shifting my medication time towards the evening as @Erimus suggested. If Depression becomes unbearable, I will dose up as @Alfred1977 suggested.

 

Also thanks @Mushaboom for sharing your experience. I´m highly routine-driven, so very interesting idea with the small changes in routines. I will try that out! What I noticed, when I get adverse effects from the medication, I instantly become a couch potato. I love sports and moving in any shape or form, I´m usually very active. Under Venlafaxine I had no desire to move at all. During my withdrawals, the joy of moving came back (currently stalled again...) - so there´s another indicator for me for where I´m at. I´ll try to introduce "softer" stuff when I´m feeling down again, yoga or maybe just lying on my accupressure mat.

 

I wish a nice and calm Sunday to everyone!

 

Started Escitalopram in 2015 (20mg) - only slight improvement of depression
Added Bupropion ("Elontril") in 2017 (150mg-300mg)
Switched to Venlafaxin XR end of 2021 (150mg)

Added Venlafaxin XR spring 2022 (150mg)

Withdrawal from Venlafaxin XR (350mg) + Venlafaxin (150mg) in fall 2022 - heavy withdrawal symptomes

Reinstating Venlafaxin XR in 2023 225mg
Switch to Desvenlafaxin in summer 2023 (100 mg) - heavy withdrawal symptomes

Switch back to Venlafaxin XR in summer 2023 (150mg)

Tapering August 2023 to mid March 2024 (150mg --> 0mg)
Severe rebound depression, suicidal - reinstated Venlafaxin XR May 2024 (currently 37.5mg)

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