zenpug: zenpug

[zenpug]

I have a longterm history of antidepressant use, which I am only coming to terms with even after many years of understanding that the chemical imbalance theory is a myth. Getting to a place in my life where I feel stable and supported enough to slowly taper off has been a journey which I cannot disentangle from choices I made that have been shaped by the drugs themselves and the ways they have affected my outlook, decision-making and beliefs about myself. I have struggled to shift my outlook and take responsibility for my dependence/addiction to these drugs, especially in light of a family member’s addiction to alcohol and heroin. It’s been a difficult paradigm shift for me to change from being the one who is doing the ‘right’ thing for their ‘illness’ to understanding my own drug use as an addiction.

 

I was first prescribed SSRIs when I was 20 years old and suffering from a bought of depression following a slow physical recovery from anorexia. The psychologist I saw at my point of desperation saw me for one session before offering Prozac, and telling me that she thought I had a chemical imbalance that needed to be corrected. I was extremely unhappy in myself at the time, and though initially I refused the drugs, she had enough of an argument for them and I trusted her as a psychologist. I felt immediate relief in taking my first dose of Prozac, and was told that was proof that I had ‘depression’. I was given various escalating doses and additional drugs to combat the drowsiness I felt as result of the Prozac. I also admit responsibility for my part in these escalating doses, as I knew that the effects of them were making me feel elevated and they also initially made me feel nauseous which enabled me to go back to starving myself. I knew at some level that these effects were not truly healthy. 

 

It was not until 2005 when I moved to the UK from the US that I began to confront the complexities of my drug dependence. I came into a health care system that was less condoning of these drugs, or at least not marketing them as aggressively. At first I was confused as to why my GP was not sending me to a psychiatrist to oversee my doses and offer me new options when I was starting to feel signs of depression returning, and I sought a private psychiatrist (at no small expense). I was convinced I was looking after my mental heath and that depression was just something that was a lifelong condition. When I became pregnant in 2006, my GP said to stop taking the drugs, with no advice about tapering. I felt awful because of withdrawal and was not offered information or support through this process. The medical advice was unclear about SSRI use in pregnancy, so I went back onto an SSRI that was deemed safest to use. I reasoned that being depressed would be worse for me and my unborn child than being not depressed but on the drugs, though my understanding of what depression was had begun to be mixed up with the feelings caused by being on the drugs as well as the discomfort and pain of withdrawal. I think many of difficulties I had with a colicky baby may have been caused by the baby withdrawing from the drugs I was on, which is almost too heartbreaking to write about, but which I imagine many other mother’s have experience of.

 

When my child started school, I decided it was a good time to try to come off the drugs, but I tapered very quickly without any support and had extreme and debilitating withdrawal followed by suicidal depression after the physical part subsided. Luckily my partner was sane and supportive through this process. I was completely off the drugs for about 2 months before going back to my GP in tears asking for the drugs.

 

The trauma of the withdrawal (alongside the trauma of realising the lies I had been told about the nature of depression) kept me from trying to come off the drugs again until more recently when I began a new journey of realisation; this time through beginning to understand the effect of my emotional numbness on those I most love. Through family therapy in which I began to learn about the ways to support my child’s intense emotional expressions, I started to realise that I had been responding to my own intense emotions by numbing them rather than learning to sit calmly and openly with all my emotions (easier said than done, but a much better path!). This realisation has coincided with a yoga practice that has taught me the value being present in my body more than striving to numb myself. I had a breakthrough moment where I realised that attuning with my child’s emotions in a calming way was the key to my relationship with my child. This was the same element that I had not developed in relationship to my own inner self, and which the drugs were getting in the way of. I began to lower my dose slowly, and could see the results first hand in my interactions as a parent when I was able to connect with this part of myself- my calm centred self, not my medicated numbed-out self.

 

This turning point has meant I am now ready to steadily lower my dose, though I understand that because of the nature of my longterm use I may need to continue on a small dose if I cannot tolerate completely stopping. I am going to explore what is possible, and part of that means reaching out to this forum. The stories I have read on here have made me realise how many other people are going through similar situations, and has also given me hope that it is possible to be free of the drugs even after so many years. 

Edited June 16 by Emonda
Name to title

[zenpug]

I also wanted to add a question here:

I’m just starting the stage of dividing up my tablets into smaller amounts- so cutting up a 37.5mg tablet of regular release Venlafaxine to create a 10% decrease which you cannot buy.

 

When you divide up the tablet, if it crumbles or splits, and you need to use some of the crumbled parts to create the correct dosage, then do you just swallow these crumbled parts or do you need to crush up all the parts and scoop into a gelatine capsule? I saw a post about using a pill-crusher, but wasn’t clear about whether this is required or you can just swallow the little chipped of bits of the tablet. 

 

Thank you for any advice about this!

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I applaud you for all of the insight and perception you have on the issues of drug dependency.  You sound like a very good mother to your child.  I just want to say that I, too, was unfortunately on Paxil while I was pregnant with my second son, and I understand feeling bad about it.  I sat in the psychiatrist's office while he called my Ob-gyn, who said it was safe during pregnancy, and I trusted them.  I regret it now.  However, the past is past, and cannot be changed.  My younger son didn't appear to have withdrawal, but I was nursing him, so I think that gave him a natural taper when I weaned him.  

 

Thank you for your drug history.  How is your taper going so far?  Are you having any withdrawal symptoms?  If so, what are they? 

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

Just in case you are having some withdrawal, this helps you understand it:

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.  The other option is a micro taper.  This is a very wise choice, and is gentler on the nervous system. 

 

 Why Taper by 10% of my Dosage  

 

Micro-Taper Instead of 10 or 5 Percent Decreases

 

You asked about splitting the pills and measuring the doses.  I personally think using the liquid is the easiest way to measure non standard doses.  If you switch to liquid, do it gradually, and don't reduce your dose at the same time.  Your nervous system needs some time to adjust to the liquid.  This link will explain exactly how to switch from tablet to liquid.  You can make your own liquid from the tablets. 

 

Cross Over from Tablet to Liquid

 

The other option is to grind the tablets into a powder, and weigh that with a scale.   It's important to get a precise dose each day, to help your nervous system have stability.  This link will go into how to do that, as well as how to make a liquid from your tablets, should you choose that route. 

 

Tips for Tapering Effexor

 

Please keep in touch, and let us know how you are doing.

[zenpug]

Thank you for your reply gettoflex. I agree with you about the topic of pregnancy that you can only move forward. I appreciate your supportive words.

 

I have had symptoms while reducing my dose down to 75mg from 150mg- tingling in my head, depressed mood, irritability, fatigue- but I’ve stabilised now at this dose and actually feel a lot less anxious than when I was at the higher doses, which gives me encouragement about continuing the taper. 

 

I am waiting for my doctor to prescribe the 37.5 tablets before I begin the next stage of tapering, but will keep you updated. 

[getofflex]

Thanks.  What did your reductions look like? Do you remember which specific doses you were at when you were reducing? If you do that would help if you could put it in the drug signature thank you.  

[zenpug]

I just went straight from 150mg to 75mg, which was a big reduction, but I had not come to this site yet and discovered all this information about slow tapering. So I wasn’t as organised in keeping track or having a method. Now that I have more information I will be keeping track and noting my symptoms. 

[getofflex]

Thanks.  Hopefully you will use our harm reduction approach of only cutting 10% or less at each reduction.  This gets especially important at the lower dosages, because at the lower dosages, these drugs have a disproportionately larger effect on us.  

[zenpug]

Yes, I am planning to begin with a 10% reduction, waiting at least 4 weeks between each reduction. I will let you know how it goes. 

[zenpug]

Hello @getofflex

I am working out my taper- can you please advise?

 

I am currently on a dose of 75mg/day Effexor immediate release (tablets not beads as I’m in the UK)

My tablets are 37.5mg, so two of these each day

 

I’ve taken the average weight of 5 of the tablets, which came out to 181mg

I want to make a 10% reduction 

181mg x 2 (2 tablets) = 362mg

362mg x .10 = 36.2mg

So my dose at a 10% reduction should be 

362mg - 36.2mg = 325.8mg

 

Is this right?

From my understanding, I then make the liquid formulation, but I’m getting confused about how exactly to do this in my situation. How much of the tablet would you make into a liquid (and store in a jar) at this point? Then, I need to translate the amount of the dissolved tablet in each ml of liquid to calculate my dose?  

 

I’m sure this is explained elsewhere, but I’m getting mixed up with all the different options in various explanations.

 

I know you said you found liquid to be the easiest way to measure your doses. I’d really appreciate some specific guidance from here! Thank you so much!

[getofflex]

8 hours ago, zenpug said:

I’ve taken the average weight of 5 of the tablets, which came out to 181mg

I want to make a 10% reduction 

181mg x 2 (2 tablets) = 362mg

362mg x .10 = 36.2mg

So my dose at a 10% reduction should be 

362mg - 36.2mg = 325.8mg

 

Is this right

Yes, this is correct. 

 

 I would actually round off 325.8 to 326.  To simplify matters, mix your drug into water in a 1:1 ration.  This would mean mixing 326 mg of the drug into 326 ml of liquid (water).  You will probably want to make several doses at a time. I would use distilled water. So, if you want to make 4 doses at a time: 

 

326 x 4 = 1304 mg of ground up tablets

 

Add the ground up tablets to 1304 ml of water, mix this up, and store it in the refrigerator.  To take a dose, just take 326 ml of this liquid after you mix it up.  

 

If this is still confusing, I suggest you have a chemist/pharmacist make a liquid or capsules in the specific dose for you.  

[zenpug]

Thanks you for your advice. I think this will work for me.