SleepyCynic: A decade of ssri/snri usage into venlafaxine ct withdrawal

[SleepyCynic]

Hello SA community, I've really appreciated the content here to come to some sense of what has been happening to me and seeing the ways others have been able to help each other and themselves improve.

 

I'm a 28 year old male who has been taking antidepressants since approximately early 2015 because of depressive and anxious symptoms I've had most of my life. In that period of 4-5 years I was prescribed fluoxetine, sertraline, escitalopram and paroxetine. I apologize for the poor history of these but I can only recall the medications, but not the order and duration. I just remember that I only took paroxetine for a very short period, which gave me flu like symptoms (probably adverse effects in retrospect). For the remaining years until now I've been on venlafaxine xr. I believe i ramped all the way up to 150mg xr towards the beginning, but I'm confident that the last 3-4 years i was on 75mg xr.

 

Basically, all the problems emerged when I made the very bright decision to taper myself off my venlafaxine between jobs in late July 2024. I went down at a pace of 10 beads a day which I calculate to only be barely over two weeks. I was used to all the acute withdrawal symptoms so I let them happen, but symptoms of lethargy, slowness, and brain fog got worse over the following months. Following this more concerning symptoms of tremors, palpitations, and hearing sensitivity emerged, but where sporadic so I didn't really piece it together. Everything came to a head when I got sudden insomnia in mid December. I took some time off work to deal with it and my supposed seasonal depression, and then my nervous system crashed (Dec 22). For about 5 days I was in sheer terror and panic with akathisia and intrusive thoughts. since then symptoms let up reasonably and major symptom waves have come on the periods of days, with many small waves between. I've just seen a doctor who I tried to convey my thoughts considering what I've researched and lines up with my symptoms but he, reliably thinks its just depressive relapse. With my suggestion of low dose, he prescribed me 37.5 mg. I've not touched it yet and am still making up my mind and observing my symptoms.

 

Thank you much in advance to anyone reading this.

[Jane318]

Greetings @SleepyCynic, and welcome to SA.  We are a community of volunteers providing peer support in the tapering of psychiatric medications and their associated withdrawal syndromes. 

 

Thank you for providing your drug history.

 

8 hours ago, SleepyCynic said:

...symptoms of lethargy, slowness, and brain fog got worse over the following months. Following this more concerning symptoms of tremors, palpitations, and hearing sensitivity emerged, but where sporadic so I didn't really piece it together. Everything came to a head when I got sudden insomnia in mid December. I took some time off work to deal with it and my supposed seasonal depression, and then my nervous system crashed (Dec 22). For about 5 days I was in sheer terror and panic with akathisia and intrusive thoughts. since then symptoms let up reasonably and major symptom waves have come on the periods of days, with many small waves between.

I am sorry for all you are suffering right now.  I believe you are experiencing severe withdrawal from a much too-fast taper off Effexor xr last July.  It is not unusual for symptoms to become severe several months after stopping.

 

8 hours ago, SleepyCynic said:

I've just seen a doctor who I tried to convey my thoughts considering what I've researched and lines up with my symptoms but he, reliably thinks its just depressive relapse. With my suggestion of low dose, he prescribed me 37.5 mg. I've not touched it yet and am still making up my mind and observing my symptoms.

Most doctors are woefully uninformed about AD withdrawal and often conclude that symptoms are relapse and so you need to go back on the drug.  I would advise going back on 37.5 mg.   However, you might want to consider reinstating a much smaller dose to try and stabilize before beginning a much slower taper back to zero.

 

Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  It isn’t a guarantee of diminished symptoms but it’s the best tactic available. The only alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  Your narrative suggest you are seeing some improvement, which is a good sign.  So you will need to decide if you can wait it out or whether you want to try reinstatement.  Here's some more information about that.

 

REINSTATEMENT - It is best to reinstate as soon as possible after withdrawal symptoms occur and predictably works up to 3 months after last dose.  In your case you more than five months out, when reinstatement becomes less sure and the risk of kindling increases.  Nonetheless, we have see reinstatement work outside the three-month window.

 

If you wish to try it, I would recommend trying about 4 or 5 mg, no more.  If symptoms worsen right after taking the drug, stop.  Otherwise, wait a week or so to see if symptoms improve.  If they do, hold at at that dose.  If no improvement, increase by another 0.5 or 1 mg and repeat.  I takes about 4 days for blood levels to stabilize at the new dose, a few days longer for the brain.   The goal is to find the lowest dose at which symptoms start to improve - going too high can induce kindling, which can be quite difficult to recover from.  Once you find a dose that helps alleviate symptoms, you will want to hold at that dose for as long as it takes to stabilize - it will likely take several months.  Then you can begin a slow taper back to zero.

 

Please read:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

How long does it take to stabilize after reinstating or updosing?

Hypersensitivity and kindling

It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.

 

Here is information about tapering Effexor, which includes how to prepare low doses:  Tips for tapering off Effexor and Effexor XR (venlafaxine)

 

Once you stabilize, you can begin a slow taper down to zero.  We can send you information about safely tapering later.

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, in this thread.

 

Let us know what you decide and if you have any questions.  Best wishes.