MaYuLa: Effexor withdrawal rate - help wanted

[MaYuLa]

Hi wise fellow withdrawallers,

 

In November 2024 I will be celebrating my first year of tapering off of 150 XR mg of Effexor.

With the guidance and support of a psychiatrist - I am now on 57 mg, and till a week ago, besides s little nausea in the first couple of months, it has passed symptom free.

 

The doc told me to reduce 10% per month and after 5 months he said I could slowly go up to 15% per month, by adding 1% every two months to see how it goes.

I reached 13% two months ago and 2 weeks ago I started to feel a bit off. I was PMSing so doc said to wait and see, it could be hormonal. But things got worse. I could feel my heart beat faster and stronger. My jaws tight and my mind, of dear, my mind. What a bully. I was in a nightmare. Crying, anxious, non functioning. Of course I didn't do any reduction and I am "parking" on my current dose. I feel now that I am recovering from a bad trip and a beating to my head.

 

Doc said to stay steady on 57, and to wait as much as I need to feel strong and stable before going back to tapering, but this time start with 5% reduction for at least 3 months, see how it goes and if all is well I can slowly go up to 10% but not more than that.

 

So three main things come up for me:

 

1. I am bummed that my tapering will take longer and that the excel sheet of the withdrawal plan is lengthening.

 

2. I am afraid that this will happen again. That if this happened at 57 mg - what will happen at the lower dosages that have much more effect on the body/mind?

 

3. How can I know what is the safest tapering plan for me? I prefer quality of life than getting off quickly and suffering as I did last week,

 

I must share that I tried to taper 8 years ago, before knowing about this website, or any other support groups. The psychiatrist then told me to taper in 6 months, which I thought was slow (Ha!) and I suffered from nausea, dizziness, brain zaps and in the end crippling anxiety and suicidal thoughts. I went back on the pill after 3-4 months being off it feeling like a failure and thinking I will go to the grave with this pill. Till I read an article 2 years ago with Dr. Mark Horowitz which gave me hope and another perspective.

 

Thanks for reading and looking forward to any pearls of wisdom.

 

All my appreciation to my antidepressant survivors.

 

Maya

 

Edited September 22 by Emonda
Name to title

[MaYuLa]

Dear fellow withdrawalers,

 

I began withdrawing from Effexor 150 mg XR in November 2023 with the consultation of Dr. Mark Horowitz. (After trying to withdraw 8 years ago within 6 months, without the knowledge and support there is today, needless to say, it was a disaster - physically and emotionally - started taking it again)

I have been hyperbolically reducing 10% each month, besides a wee bit of nausea for the first few months, it went smoothly.

After 5 months Mark suggested I could slowly increase to 15% by reducing another 1% every 2 months. Meaning - One month of 11% reduction followed by staying on it for an additional month, and so on. Last month I was on the second month of 13% reduction, 57.42 mg, and I started to feel my heartbeat, my jaws clench, anxiety entered the building big time. It really freaked me out. I met with Mark who said perhaps he wasn't cautious enough or too optimistic since it went so well. If memory serves (and that is hard to tell since I feel like I have brain injury) he said that if I don't feel like I need to go to the hospital tomorrow, to wait it out and stay on my current dose till I feel strong. Then I can withdraw, but this time only 5% for 3 months to see how it goes, and if it goes well, I can go up 1% every month till 10% maximum.

 

I have to admit that I am a bit confused. Of course I will not do anything till I feel confident - but A. I am scared shitless this will happen again B. My confidence and trust in myself and the process has been tossed out the window C. I am bummed that the tapering will take so much longer D. Geez Louise - when the anxiety hits - it's not a wave it's a bloody tzunami and nobody can understand (people who haven't experienced withdrawal that is) how it plays with your mind and nothing helps and it's scary as hell.

 

I would so much appreciate any words of wisdom, practical, experiential, anything.

 

In the meantime reading all of your pearls of wisdom.

 

Thanks,

 

[LotusRising]

Hi @MaYuLa

 

Welcome to SA,

 

First, I want to say that your psychiatrist seems to be reasonable with your tapering plan. But I want to point out that the effects of the drug on the brain become greater as you lower your dose, so ideally, you would maintain a reduction rate of 10% or less each month.

 

It sounds like your taper got a little out from under you when you increased the rate of reduction.

 

On 9/22/2024 at 11:33 AM, MaYuLa said:

1. I am bummed that my tapering will take longer and that the excel sheet of the withdrawal plan is lengthening.

Yep, I get that. I remember feeling the same way. But truthfully, it's more important to remain functional. It is what it is and the best way forward is to keep going at a rate that you can tolerate.

 

On 9/22/2024 at 11:33 AM, MaYuLa said:

2. I am afraid that this will happen again. That if this happened at 57 mg - what will happen at the lower dosages that have much more effect on the body/mind?

If you're concerned about recurrence, you might want to stick with a slower taper.

 

 

22 hours ago, MaYuLa said:

but this time only 5% for 3 months to see how it goes, and if it goes well, I can go up 1% every month till 10% maximum.

Per my above comment, slower might be better. This sounds like a good idea. You mentioned tapering at 10% per month - was this rate tolerable?

[Jane318]

@MaYuLa, Just piping in to share my experience tapering off Effexor.   Concur with @LotusRising above - It has definitely gotten harder as my dose got lower.  I did okay early in the game, but WD worsened as I got to low doses and and I crashed hard this past summer due to tapering too much / too quickly.  It snuck on me because I wasn't monitoring my symptoms or paying close enough attention to how I was feeling.  After the hard crash and with advice/support from SA, I updosed slightly in mid-July.  I noticed improvement almost immediately so chose to not updose further.  After two months, I am off the ledge.  I am doing okay - not great, but slowly progressing towards stabilization I think.  I plan to hold at current dose through the end of this year to stabilize, then, as long as I am sure I am stable, start tapering again following the BrassMonkey micro-tapering protocol (see below).  Below are some posts you might want to read.  Best of luck!

 

 

 

 

 

[MaYuLa]

@LotusRising Thanks so much for your reply.

As for your question - on 10% it was fine, that's why the doc suggested going higher, an additional 1% every 2 months. I hit the rocks at the 2nd month of 13%.

 

I am wondering if, when I feel stable and confident, to go down to 5% tapering or is it safe to go back down to 10%?

 

I know there are no rules, but would love to discuss this with someone besides myself : )

 

Thanks again

[MaYuLa]

@Jane318

Thanks for sharing Jane, sorry to hear about your summer crash.

 

May I ask what you felt? And what dose are you on? 

 

Thanks for the posts, I read most of them in the past week.... a couple of times ; )

[Emonda]

28 minutes ago, MaYuLa said:

on 10% it was fine, that's why the doc suggested going higher, an additional 1% every 2 months. I hit the rocks at the 2nd month of 13%.

 

It seems like such a small increase, doesn't it, but it doesn't surprise me at all.

 

I can taper comfortably (as comfortable as tapering can be) at 8% per month...at 10% per month, I find it difficult, so back to 8% per month I go.

 

30 minutes ago, MaYuLa said:

I am wondering if, when I feel stable and confident, to go down to 5% tapering or is it safe to go back down to 10%?

 

Listen to your body. Once stable, it sounds very prudent to slow down to what has previously worked.

 

If it's still unpleasant at 10% per month, slow down even more. It's not a race. The tortoise beats the hare.

[Jane318]

4 hours ago, MaYuLa said:

@Jane318

Thanks for sharing Jane, sorry to hear about your summer crash.

 

May I ask what you felt? And what dose are you on? 

 

Thanks for the posts, I read most of them in the past week.... a couple of times ; )

I am glad you are reading the posts.  There is so much information here, it can be overwhelming, especially when you are feeling rotten.  I haven't read everything, for sure, and have to go back and re-read as I am able to absorb.

 

I started out with tapers around 11% and sometimes higher.  And I wasn't necessarily consistent in the size of the cut nor interval between cuts, which was sometimes only 7 - 10 days when I first started.  For me, those were mistakes.  There is a whole lot of experiential data to support 10% or less.

 

My intro topic describes my symptoms / progress.  Jane318: Tapering off Effexor - Struggling at the End  At the worst, I was thinking a LOT about ending my life. It was a very dark place, and will do all I know how, with God's help, to avoid going there again.  That said, it seems everyone's symptoms differ and they can differ over time in the same person.  I now use the checklist to monitor the symptoms I am having as well as keep an eye out for others that may pop up at some point.   I am grateful that so far I haven't had to deal with the extreme anxiety so many others experience, nor many of the physical symptoms.  Currently I am at 1.44 mg/day.  This is below the threshold that some would say is okay for jumping to 0.  I know I need to go much, much lower.  I am not going to set a target this time, just follow the BrassMonkey micro-taper (which includes two weeks minimum hold every 4 weeks of cuts) until I don't notice a change.

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF)

 

[MaYuLa]

@Jane318

Thank you so much for sharing and caring, Really.

 

Since my brain is a bit mushy - may I double check with you if I understand correctly what the 

 BrassMonkey micro-taper is?

 

 For example - if every month I taper 10% (from my previous dose of course) in 9 micro steps (meaning the 10% is divided into 9 steps, each one 1.1111111, 3 days each step, (last step 4 days to make 28 days) - is that agreeable with the method?

 

And not sure if the "holding" means after doing the 10% reduction in 9 micro steps over 4 weeks- should I stay on the last step for an additional 2 weeks?

 

Thanks so much again for your support.

 

What a mysterious journey into the unknown.

 

It's the most direct and harsh invitation to not believe my thoughts, to not identify with what my mind is telling me. A beautiful practice, but not easy.

 

Just thought today to write myself a letter for the next crash - to remind me of all this, cause a week ago, when friends and fellow survivors said repeatedly that "This will pass" I couldn't not believe them and wanted to scream at them "You don't understand! It's different! It's not a regular "wave" It's a Tsunami and I won't make it!"

 

A skull sized hell.

 

Thanks for reading me.

 

X

 

 

[Jane318]

@MaYuLa

 

6 hours ago, MaYuLa said:

may I double check with you if I understand correctly what the   BrassMonkey micro-taper is?

 

I should have given you the link to this information!  It is https://www.survivingantidepressants.org/forums/topic/27883-the-brassmonkey-slide-method-of-micro-tapering/#comment-412439.   There is a lot of information here, and you'll want to read it carefully, but it is a bit easier than you are thinking, weekly, not daily.  Note that the page above includes links to spreadsheets and other tools to help you calculate all this out, including the flexibility go to another tapering rate.  For example, Emonda uses 8% instead of 10% to avoid severe withdrawal.  Everyone needs to decide what works best for them, and the spreadsheet makes the calcs easier.

 

To start with, here is a summary, extracted from this forum:  "The idea behind the Brassmonkey Slide Method is to maintain the speed of a standard 10% taper while reducing the symptom load by taking the reductions in smaller bits.  When I was researching my taper, I observed that there was a large hit of symptoms that occurred several days after the reduction was made.  These symptoms would then peak and decrease over the next several weeks until the person would return to an average state of feeling bad.  My idea was that if the reduction were taken in smaller pieces fairly close together you would experience reduced symptoms for a shorter period of time and by doing reductions back to back, as the symptoms resolved, a person could maintain a 10% reduction and experience reduced symptoms."

 

So what this looks like, is if you are doing a 10% taper (meaning, reducing by 10% of the prior dose), instead of doing the cut all at once, you would divide it into four equal amounts, which you would implement over four consecutive weeks.  Then you would maintain that final dose for two additional weeks before cutting again.

 

As an example, since you are currently at 57 mg / day XR, and once you felt stable and ready to start tapering again and if you choose 10% - your next 10% reduction would be by 5.7 mg to 51.3 mg/day.  But you are not going to do this all at once.  You are going to go down by 1.425 mg per week (5.7 / 4 = 1.425 mg) for four consecutive weeks, then hold at 51.3 mg/day for two weeks.  So would look like this:

 

Week 1 (7 days) - dose is (57 - 1.425) mg = 55.575 mg

Week 2 (7 days) - dose is (55.575 - 1.425) mg = 54.15 mg

Week 3 (7 days) - dose is (54.15 mg - 1.425) mg = 52.725 mg

Week 4 (7 days) - dose is (52.725 - 1.425) mg - 51.3 mg.

Weeks 5 and 6 (14 days) - Hold dose at 51.3 mg / day.

 

If after this two week holding period, you feel ready to continue, then you would begin again.  Now your 10% reduction would by 5.13 mg / day, spread in even decrements over four weeks as before.

 

I hope this makes sense - I know how confusing it is when our brains are mush.  Please let me know.

[Jane318]

6 hours ago, MaYuLa said:

It's the most direct and harsh invitation to not believe my thoughts, to not identify with what my mind is telling me. A beautiful practice, but not easy.

 

I agree, so difficult, but does get a bit easier with time, learning more about withdrawal, understanding your own body's responses better, and learning that others are going through the same thing.  Now your goal is stabilization.  Time and patience and all the things you are doing to manage your thoughts and promote healing, as hard as it is, will get you through this!