brokensafety: Assisting with a taper off Venlafaxine

[brokensafety]

My mother has been on various medications.  She was on Duloxetine for many years until about a month or so ago when her new psychiatrist switched her to Venlafaxine.  She is taking 150mg XR.  She missed a pill on Sunday and that evening experienced severe abdominal pain, nausea and vomiting.  She remembered to take her dose the following day, but the nausea and vomiting continued.  She has not taken any meds since then due to vomiting.  She went to the ER twice this week.  Today, the doctor confirmed that she is experiencing withdrawal symptoms and that she should continue taking her meds.  That's a bit difficult given her nausea and vomiting, but she is going to try doing that again.  Because of this experience, she has learned about the half-life of the new drug and that it's unforgiving with regard to missing a dose. 

 

Now she is certain that she wants to taper off Venlafaxine.  She has taken her dose today after returning from the ER.  She said that once she is stabilized and no longer experiencing abdominal pain and discomfort, that she wants to taper off.  I am looking for guidance to assist her in this process.  I have found the Tips for tapering off Effexor and Effexor XR post.

 

Unfortunately, her doctors have not been helpful when she communicated that she wants to make changes.  They only change the type of medication or add new medications, but they have not been receptive to her requests to wean off existing meds.

Edited July 12 by Emonda
Name to title

[brokensafety]

My mother was able to begin taking her medication again without throwing it up, so she is no longer experiencing withdrawal symptoms.  She told me again today that she would like to start tapering off Venlafaxine.  We've discussed the 10% method and she would like to try that to avoid the withdrawal symptoms she experienced this past week.  She will begin this coming week.

[Catwoman73]

Hi @brokensafety, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes.  As we do provide peer support, I would encourage your mom to create an account, so that she can take advantage of all the encouragement we can provide to our members.

 

That being said, how wonderful that you are so supportive of your mom.  A support system is critical in getting through this- I have no idea where I would be without my husband and daughter!

 

Can I ask why she was taken off of the Duloxetine?  Was it just a case of new psychiatrist, new drug?  Or was it no longer effective for her?  Or was she developing adverse reactions?  All of these are common scenarios.  Sadly, most psychiatrists do not realize that you can't just go switching from one SSRI to another without risking withdrawal effects from the original drug.  It is very early days for your mom on the Venlafaxine- how is she tolerating it in general?  When she is not having vomiting from a missed dose, how has she been feeling since making the switch?  Any symptoms of withdrawal and/or start up effects from the venlafaxine?

 

I am simply stunned that the ER doctor said that she is experiencing withdrawal, so just keep taking the meds!  That is like saying to someone who is quitting cigarettes that they should just keep smoking because they are experiencing withdrawal.  That's just crazy to me. 

 

It does NOT surprise me, however, that doctors are not receptive to her requests to taper medication.  Doctors are victims of pharmaceutical company propaganda as much as we are, and they still seem to believe that depression is like diabetes, and we need our medication for life.  This is NOT true, and most cases of depression- even severe depression- do pass on their own.  Read more about this here:

 

Again, chemical imbalance is a myth. Stop the lies, please.

 

Your mom has been on antidepressants for many years, so these meds have had plenty of time to make changes to the biochemistry of her body and brain, and undoubtedly, her gene expression has changed as the result of long term use.  That makes moving very slowly very important.  Read more about how these meds affect the brain and body here:

 

How Psychiatric Drugs Remodel Your Brain

 What is happening in your brain?

 

In any case, you are right, a slow, 10% taper is most definitely the way to go.  She may even wish to making even smaller cuts, if she is concerned about withdrawal effects.  However, I think it's a wise decision to hold for a while, and wait this episode out, to make sure she is as stable as she can be before proceeding.  Given the recent switch to venlafaxine, her body has likely not even adapted to the absence of the duloxetine and the presence of venlafaxine yet.  This can take time- even months.  I would strongly recommend that she start a symptom journal- noting any odd symptoms she experiences as she proceeds over the coming weeks.  If she is experiencing any withdrawal from the duloxetine, it will come in windows and waves- periods of feeling better, and periods of feeling worse.  This may or may not happen- some people make medication changes with little difficulty, but I want you both to be prepared if things get rough.  Read more about windows and waves in the following link.  I will also attach a link to a typical withdrawal symptom PDF, so she can recognize what is and is not withdrawal.

 

Windows and waves pattern of stabilization

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

If she is having any difficulty adjusting to the venlafaxine, it is not too late to consider returning to the duloxetine, though there is risk with switching the meds around.  It could destabilize her further, and we certainly don't want that.  In her case, I would only recommend this if she was having intolerable side effects from the venlafaxine, or severe withdrawal symptoms from the duloxetine. 

 

Is your mom on the immediate release or the extended release version of venlafaxine?  Capsule or tablet?  What she is currently taking and how prepared she is to do the tedious work of bead counting will affect the method of tapering.  Venlafaxine is notoriously challenging to taper, both because of the short half life, and most members here are on the capsules, which adds to challenge.  We can certainly help along the way, though!

 

In summary, I do think holding for a while is wise, as long as your mom is not having severe side effects from the venlafaxine, or severe withdrawal from the duloxetine. Of course, it is up to her, and I understand wanting desperately to get this medication out of her system.  I'm only concerned that she may become unstable very quickly, given the recent medication change, and the dramatic effect that missing one dose has had one her.  Once she is sure that she is as stable as she can be, then proceeding with a hyperbolic taper is a great decision.  Start with a 10% drop, but be prepared to slow it down if she has severe withdrawal symptoms. 

 

Other good advice- avoid alcohol, nicotine, caffeine, recreational drugs, and using other psychiatric medications while tapering.  Doctors will always try to prescribe more medications when withdrawal symptoms happen, but this is creating further instability, and will create a situation where you have to taper a different drug once the one causing the withdrawal is stopped.  And they will often prescribed benzos, which are extremely habit forming.  When withdrawal symptoms happen, it is best to use non-drug methods of coping.  I will link a few here, but she may find some of her own.  Personally, I love swimming- I feel perfectly normal in the water!

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

 

I would also recommend finding a good trauma informed therapist if possible, to help deal with the issues that caused her to go on antidepressants in the first place.  That would give her the best shot of never returning to using them again. 

 

Overall, I know it seems daunting, but there's lots of support here!  We can help walk you through the difficult days, and celebrate the victories along the way!  So keep us in the loop- keep posting, asking questions.  And don't hesitate to engage with other members by reading others' threads, commenting, etc.  It's so nice to have a community of people who understand, and can provide support along the way.

 

Most of all, remember that any symptoms that come up are temporary.  We are all healing, all the time, whether we feel like we are or not! ❤️

[brokensafety]

@Catwoman73

 

Thank you for your response!  My mother is "old-school" and unlikely to join this community, but I will encourage her to do so.

 

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Can I ask why she was taken off of the Duloxetine?  Was it just a case of new psychiatrist, new drug?  

 

Yes, she was taken off Duloxetine because her previous psychiatrist prescribed her an anti-psychotic drug for 'anger' without telling my mother anything about it.  My mother had a seizure shortly after taking that medication and was hospitalized for several days.  She switched psychiatrists after that.  Her new psychiatrist told her that she couldn't prescribe Duloxetine, but that she could prescribe Venlafaxine instead.  Her psychiatrist told her "it was in the same family, so there was no problem switching."

 

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It is very early days for your mom on the Venlafaxine- how is she tolerating it in general?

 

She has not mentioned any other problems to me. 

 

Thank you for all the resources!  I have printed the checklist of withdrawal symptoms for my mother.  She did not mention any issues switching from Duloxetine to Venlafaxine.  However, about a week or two into Venlafaxine, she did miss a dose early on and experienced abdominal discomfort and diarrhea.  It quickly resolved since she continued to take her medication (I assume).  Other than the issues after missing doses, I don't believe she's experienced any problems from the transition from Duloxetine to Venlafaxine.

 

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Is your mom on the immediate release or the extended release version of venlafaxine?  Capsule or tablet?

 

She is on the extended release version of Venlafaxine in capsule form.  I intend to assist her with the bead removal, as I live nearby.

 

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I would also recommend finding a good trauma informed therapist if possible, to help deal with the issues that caused her to go on antidepressants in the first place.  That would give her the best shot of never returning to using them again.

 

Yes, after she switched psychiatrists, she began speaking with a therapist as well.  I don't know much about their discussions or the therapy she receives, but I know that she is getting more support than she was with her previous psychiatrist.

 

Thank you very much for your insight and the resources you provided.  I agree that proceeding with the 10% taper after my mother feels completely stabilized is the best approach.  I will continue to post here as she progresses.