George234: Long term and aged Effexor user stuck on taper and is it worth it

[George234]

I am 74 yrs old and really tired of dealing with this issue. Been on venlafaxine IR generic for 25 yrs, since 1999. In 2007 had a major industrial accident, then began other medications  - pain medications (I have had 20+ major surgeries) back surgery, shoulder surgery, wrists surgery (broke both) and a few more. Not going to name them all. My lifelong issue with depression became worse after the accident when I became disabled and unable to work. I began taking psychiatric meds - SSRIs, SSNIs, benzodiazepines, different ones for mostly short periods of time since they did not work. But always on the venlafaxine. Dosed up to 200 mg the first few years. About 2010 decided the venlafaxine was absolutely no help and found ways to reduce it to 50mg (1 25mg IR tablets, 2Xs day) over 10 years. When I had a major surgery I used that situation as an opportunity to reduce the venlafaxine since I was on heavy painkillers. Don't recommend as a protocol!

 

The last 2 years dealt with getting off of 16 years of Tramadol use for pain. Titrated off that finally as of May 2024. I get by badly with OTC pain killers- acetiminphin, ibuprofen, naproxen. Some days use opiates but not more than once or 2Xs a week. I also will take a valium once or twice a week when I am so burned out from anxiety, depression and insomnia to get some relief and sleep. I survive but cry throughout the day. That has been a fairly regular occurrence but since I have begun this last attempt at decreasing the venlafaxine, it is much worse. In Aug 2024 went from 50mg to 47.5mg for 2 months. It was rough but kept going. At 45mg I became exceedingly depressed, suicidal, and constantly crying. Went back to 46mg. That's where I am now. Not in great shape. Still very depressed, reduced cognitive function, lethargic, gloomy, and not functioning well. Not that I was before I began this latest taper but it was not quite as severe.

 

This is the question I have been struggling with. At this rate, it will take 3 - Given my age, 

Edited November 12, 2024 by Emonda
Name to title

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  Congratulations for getting off of the Tramadol! It certainly sounds like you have had a lot of challenges to deal with throughout your life -  my heart goes out to you.  

 

Can you please give us specific information in your signature about your drug history for all drugs and supplements you are on and have been on, especially for the past 18-24 months?  Only give us drug names, dosages, and dates, as best you can remember, in a list format.  Read the link below for instructions.  

 

How to List Your Drug History in Your Signature

 

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

 

 

This helps you understand what withdrawal syndrome is: 

 

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.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Venlafaxine

 

When I see your drug signature with more detailed information, I will be able to give you more specific help.  

[getofflex]

I would like to ask you if you have any kind of support system in your life - family members, friends, a spiritual faith community, therapy, or support groups?  

[Emonda]

Hi @George234

I saw the message you sent me.

 

Immediately below where you read this message, you will see an empty white box. You start typing your response there, and then press "Submit Reply" in the bottom right corner. GetoffLex, myself or someone else will see it and respond.

 

Don't worry about not being on top of the site just yet. It took me a little time...and I am still learning! I'm always asking another Admin how to do things behind the scenes (thanks, KenA ☺️).

 

A wise lady on this site told me that "every drop in dose is a win". The fact that you might be a little older than some is not an issue. You just chip away slowly...progress is progress....but I think you need a nice long hold in dose for the time being until things improve.

 

The idea behind tapering is to go slow enough so that you can keep you functioning. If you don't feel like you can go about your usual day, that tells me you've previously tapered too fast. Slow is the way to go with tapering....very slow...as in as slow as a garden snail.

 

Why taper by 10% of my dosage? The reductions should get smaller and smaller each month, for example: 10mg, 9mg, 8.1mg, 7.3mg etc. This process involves a degree of trial and error, as there is no way of predicting how an individual will respond. Importantly, if you develop unpleasant side effects from tapering, halt the taper, give yourself time to settle, and once stable, taper more slowly and by smaller amounts moving forward. The experience of others suggests that the lower you go in dose, the slower you need to go with tapering.

 

Can you give getofflex and I a little information about how you got down to 47.5mg of your AD? Can you tell us about the frequency and size of your drops? Did you notice withdrawal (WD) symptoms at the time and just push on? Those that taper too quickly often develop very unpleasant withdrawal symptoms. This Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) is a helpful summary of what many experience.

 

Have you changed the manufacturer of your AD? Do you take it exactly the same time each day? Have you missed dosses? Do you drink alcohol?

 

Looking forward to your reply.

 

Emonda

[George234]

Started tapering from 50mg venlafaxine IR (25m in AM, 25mg in PM) shaving tablets then weighing on micro scale Aug 6, 2024. I tapered down to a total of 45 mg in a  month around Sept 15 but then experienced increased severe withdrawal symptoms. The symptoms are always there but intensified to a point where I couldn't function. Very depressed, could not focus, reduced cognitive function and anxious with insomnia. Increased dose to 46 mg total. November 11, 2024. Symptoms are basically the same. Additionally I have a very bad case of seasonal affective disorder that kicks in this time of year so that compounds things. Have not found a very successful method to deal with that. Light therapy is not very effective for me. The winter here increases my physical pain.

 

So it's a spin and overwhelm. Difficult to interact with my family and be effective within the household because I am overwhelmed with symptoms and having no real success with the taper, just more difficulty, makes me feel like it's wasted effort. And if I just settled on the 50 mg of venlafaxine IR for the rest of my life it would be one less issue to deal with. Depression has been an issue my entire life. If I do get off the venlafaxine IR I still have the issue. I have very limited energy and time for that matter. That's why I came to this site. To get some advice as to where to direct my energies.  The other reason for getting off of this nasty drug is that I am dependent upon one generic manufacturer and if they go away, I'm in trouble. It's the only one that seems to work. But if that happened, I just have to find a way around it. Again, thank you for your continued attention.

[getofflex]

20 hours ago, George234 said:

Increased dose to 46 mg total. November 11, 2024.

Your signature indicates that you are currently taking 47.5 mg venlafaxine.  Please let us know which is correct, and if it is 46, please change your signature to indicate this.  Please also type in your signature about your occasional valium and opiate use 1x to 2x weekly, thank you.  

 

I agree with Emonda, it sounds like you need a nice long hold period, where you do not make any changes to your psychiatric drugs.  You have been through a lot of drug changes recently, and with these drugs, even one small dosage change can take your brain 4-6 weeks to adjust to.  Also, it is very important to completely avoid alcohol, and other mind altering substances.  Also, I'm not sure, but it is possible that taking Valium and opiates 1 - 2 times per week may be confusing your nervous system, and making it hard to stabilize.  Do lots of natural self care. I don't know if you are physically able to take walks or swim, but it you are, I would do some gentle exercise in this vein.  Eat healthy, get plenty of fluids, and find activities that you enjoy and that are soothing to the nervous system.  Arts and crafts are great for this.  I believe that if you do these things, very gradually you will improve.  Please keep in touch and let us know how you are doing. 

 

 

[George234]

Problem is this time of year I fall into a deep depression. And I struggle with depression all year as it is. Winter compounds the chronic pain I have. Results of multiple surgeries, multiple broken bones for which I have no effective treatment. Done with opioids. Get by with Tylenol, ibuprofen which does not help much but better than nothing. The tapering adds to the negative psychic load. Really difficult to function. Forget any kind of decent mood. Life is very difficult, been that way most of my life. No, no real support system. Some friends. A wife. But do not want to talk or deal with anyone. I isolate a lot. So, the consideration is to give up on tapering since it could be too much at this point in my life.

 

[getofflex]

George, my heart goes out to you.  You have a difficult set of circumstances, and I feel for you.  It is very understandable you would be depressed.  Having chronic pain and health issues, combined with no support system is enough to depress anybody. My suggestion to you is to develop a strong spiritual life. My own faith and spiritual life is my main source of inner strength and support.  I spend time in prayer every day, at least 2-3 times day, and it makes a profound and huge difference. You could also try and find a faith community, a support group, and/or a sympathetic supportive person to talk to.  Isolating a lot will tend to worsen the depression, and could lead to despair - I would try and resist this urge. It may be a good idea to stay on your current dose of venlafaxine for a while, or even permanently.  It's up to you.  You are in my thoughts and prayers.  

Edited December 14, 2024 by getofflex

[George234]

The reason I became a member here was to get "expert" (non-psychiatric) advice my situation. It's a fairly complicated one given my age (74), constant chronic pain from multiple accidents, and the life-long depression, anxiety that becomes overwhelming this time of year. To deal with a taper on top of all this is too much, especially since my reduction has been only 4mg down off of 50mg per day (now 46mg) and feeling horrible. I hate the idea of being on venlafaxine for the rest of my life but, even if I did get off it, I would still have the previously mentioned lifelong issues to contend with. So I am thinking that, as much as I resist it, my psychiatrist's suggestion that I just live with it at 50mg per day from here on might be the most practical action. This comes from a place of overwhelm. I know going back to the regular dose won't make my life any better, just a little less complicated. I need to accept the fact that I am on this stuff for the rest of my life. 

 

I have been taking benzodiazepines, Tramadol and other painkillers sporadically, as well as OTC meds. Take different ones on different days. I've been through the addiction thing so I am trying to be as cautious as possible while achieving some sort of a productive life for myself and be able to interact with my family instead of isolating from them. The only time I feel OK is when I have taken something. I had stopped a lot of this but found I could not function and family life was really bad. It is still a challenge, but I don't give up if I can get some relief and I don't hate myself as much.

 

From what I have read on the site, it would not be a good idea to immediately revert to the original baseline of 50mg venlafaxine. What would be the best way to get there?

 

I really appreciate your feedback and thank you so much for answering my post 

[getofflex]

If it were me, I would slowly titrate back up to 50 mg, or perhaps you could just stay at the 46 mg.  I would slowly increase it by 1 mg at a time.  46 mg, 47 mg, 48 mg, 49 mg, 50 mg.  I wish you the best of luck.  

[George234]

I am going back to the 50mg. Too much to battle regarding depression, anxiety, physical pain, cognitive issues, OCD and other age-related challenges. It has taken almost 4 months to get to this point (46mg) and symptoms have only become more intense. That is after having to up-dose from 45mg because of overwhelming symptoms. If I was in my 60s I would probably continue. Question is, I am currently at 46mg for 2 weeks. How long here and how long at the next up-doses? A month on each up-dose to 50mg? 

 

You guys are great. I have a lot of admiration for what you do. Thanks again.

[Catina7]

Hi @George234,  while you're awaiting specific direction from your moderator, you might want to read over this topic thread.  Hope it helps, and I wish you all the best.  The most important thing is for us remain as stable and functional as possible, so do whatever you need to do to attain that.  

 

 

[getofflex]

8 hours ago, George234 said:

Question is, I am currently at 46mg for 2 weeks. How long here and how long at the next up-doses? A month on each up-dose to 50mg? 

I would suggest titrating up very gradually.  If it were me, I would stay at the 46 mg another 2 weeks, then go up to 47 mg.  Stay at this for at least 4 weeks, or longer, then go up to 48, etc. until you reach 50 mg.  You want to wait until you stabilize after each dose change.  Here is a link that explains what we mean by stability. 

 

Stability