riclach: Reinstating Venlafaxine

[riclach]

Started 37.5mg of Venlafaxine xr 4 years ago after being on Fluoxetine 20mg for 20 years. Started tapering Venlafaxine 4 weeks and 4 days ago on August 14 by taking beads out of the capsules. The capsules contain about 39 beads.

For the first week of my taper, I took 25 beads and I was fine.

The second week, I took 13 beads and that’s when I started feeling emotional, having hot flushes, night sweats, brain zaps.

I completely stopped the drug 19 days ago yesterday and my symptoms became unbearable. Extreme anger/irritability, suicidal thoughts, anxiety and depression. I decided to reinstate and today I took 20 beads.

The anger/irritability/suicidal thoughts quickly subsided in a matter of hours. The depression is still there.

Please, I need to know if 20 beads is too big of a dosage.

Should I lower the dosage?

I bought the book “Maudsley Deprescribing Guidelines”, by Dr. Horowitz and plan on following the slow taper protocol. 

I just need to know whether I need to lower the dose or since I have already started taking 20 beads this morning, I need to go from there by following Dr. Horowitz’s protocol. 

Thank you so much!

Edited September 17 by Emonda
Name to title

[LotusRising]

Hi @riclach

 

Welcome to SA,

 

22 hours ago, riclach said:

The anger/irritability/suicidal thoughts quickly subsided in a matter of hours. The depression is still there.

Please, I need to know if 20 beads is too big of a dosage.

If you felt symptoms subside immediately, then the dose may be okay. Have you had another dose yet?

[riclach]

Yes, and feeling better, thank you and thank you so, so much to all of you volunteers for committing your precious time to this wonderful site.

Should I stick do taking 20 beads for the next 2-4 weeks or should I lower the quantity of the beads?

 

[riclach]

Hi, I hope you can answer me before I take my third dose today.

The reinstatement had caused my migraines to go off the roof.

I noticed that when I was tapering off the Venlafaxine, my migraines had lessened.

Shall I still take 20 beads or less today?

Thank you so very, very much!!!

[riclach]

Hi, I hope you can answer me before I take my third dose today.

The reinstatement had caused my migraines to go off the roof.

I noticed that when I was tapering off the Venlafaxine, my migraines had lessened.

Shall I still take 20 beads or less today?

Thank you so very, very much!!!

 

It is now noon and I had to take my third dose. I only took 5 beads (there are about 39 beads in a capsule, sometime 40, sometime 41. One capsule I counted 42 and one 38. But they are mostly 39-40). I figured that if you think I need to take more and get a message from you in the next few hours, I could take the remaining.

Thank you!!!

[riclach]

It has now been almost 9 hours since I took my third dose of 5 beads today and my anger/irritability have not come back. 
 

If it’s okay to taper down from 5 beads, what do I do? Do I taper one bead down every 4 weeks? I don’t know how many milligrams are in one bead. If I follow Dr. Horowitz’s slow taper protocol, then I would have to get compounded liquid Venlafaxine to taper under 1 mg. 
Do I forget about the beads and try to get the liquid now?

If so, at how many milligrams do I start?

 

Please, help!  Thank you!!!

[LotusRising]

On 9/16/2024 at 9:01 PM, riclach said:

The second week, I took 13 beads and that’s when I started feeling emotional, having hot flushes, night sweats, brain zaps.

How many days did you take 13 beads and what day did you stop?

[riclach]

August 21-27 for 7 days 

[LotusRising]

23 hours ago, riclach said:

If it’s okay to taper down from 5 beads, what do I do?

@riclach I would not start tapering until you know your symptoms have stabilized. 

 

Our general recommendation is to go back to the dose where your withdrawal symptoms started and then wait at least a week before making any further increases. Was that at 13 beads for you?

 

Edited September 20 by LotusRising
clarified communication about wait time

[riclach]

yes

[riclach]

So, tomorrow I go back to 13 beads?

[Emonda]

Dear riclach,

I saw your PM. Please post all questions here. I note LotusRising is responding to you.

 

By posting publicly, everyone has the chance to respond when they are able.

 

This site only has a handful of volunteers and more than 20,000 members....so we can't assist via PM.

 

Warm regards.

[LotusRising]

12 hours ago, riclach said:

So, tomorrow I go back to 13 beads?

This is what I would do.

[brassmonkey]

As LotusRising said 13 beads should work. It would be a good place to start. You may have to adjust upwards a bit but let's see what happens first.

 

You will need to stay at that dose for much longer than 2-4 weeks. You have given your system quite a shock with the fast taper and CT over the past weeks. The drug you are tapering has a reputation for being one of the hardest to taper off of and requires a long slow taper. I would stabilize for several months before starting a slow controlled taper.

[riclach]

Thank you for your reply!!!

 

I have modified my signature to make things more clear.

I was hesitant to take 13 beads because of my migraines.

Also, I read this on the website -

 

“Reinstatement at a higher dose. Sometimes reinstatement, especially shot after can provide some relief since our body will get some more ssri support. However, your CNS will be at risk for counter shock, since Effexor is a very potent drug. Reinstatement would in my opinion be in 1.5-2.5 mg range, perhaps around 2 mg.”

 

So, yesterday and today I took 5 beads and my migraines are better and I have not regressed to feeling suicidal.

However, if you still think I should take 13 beads, then that’s what I will do.

 

THANK YOU!!!!

 

 

[riclach]

I should probably add that the week I took 13 beads, I just had some brain zaps, hot flashes and was somewhat emotional. It wasn’t bad. I did wake up one night with panic but I was able to go back to sleep. That surprised me because I have a history of horrible panic attacks (not anymore) and terrifying depersonalization.