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  1. Hi I am new to this forum and this is my first post . I am currently on 30mg mirtazapine and 200mg of pregablin , I have been on these mess for about 3 to 4 months . I have just cut my mirtazapine from 30mg to 15mg and in the space of 4 days I have have horrible side effects , anxiety through the roof , shaking , lack of appetite poor sleep crying spells and the general feeling of feeling crap . The reason I have started to withdraw from the mirtazapine is that after 3 months I feel no benefit only get awfull side effects . No help with my anxiety and depression if anything it's made me more depressed . I have gone through withdrawing from Effexor and that was really tough , however just the drop for a few days of the mirtazapine has left me crushed , my doctor told me that mirtazapine was a easy drug to withdraw from , but after 4 days it has left me house bound . Has anyone got any idea on how I get through this or any experience in mirtazapine withdrawals
  2. I have been on meds since I was around 18, I am now 33, I have been tapering off all my meds for the last year now, I have managed to get off venlafaxine xr 75mg which I tapered off for around 4 - 6 months, and quetiapine 50mg over the last 12 months, I was on 200mg at one point and also tapered off diazapam 10mg, and also propranolol 10mg, I have been off all meds now for nearly 3 months and have been fine, I have been at the gym most days and eating healthy, I was starting to look good again and becoming myself again, I have not been human while on meds for the last lots of years, I was finally starting to enjoy life and then the last few weeks my sleep has been getting very fractured and I have been waking up very early with extreme brain fog, it feels like my head is going to explode sometimes, now the last 2 nights I have not slept at all and feel like death, I even took 2 melatonin tablets and they did nothing, what on earth is going on? I am worried I have done some serious damage to my brain, I am too worried to go and get checked at the doctors as I could not handle news that I have some brain disease, I have read that meds can cause effects many months after, can anyone give any advice/peace of mind?
  3. Hi all— New here, obviously, and new to forums in general, not so obviously (or maybe so still, idk). Here because I've been unable to (unproblematically) leave bed for the last 48 hours and I can't concentrate on much meaningfully (there goes my work): as a result I've been viewing a lot of content about withdrawal online (against my psychiatrist's pleas—I wonder what he wouldn't want me to know. . .) and found this forum linked in an article. See my signature for my history, and please feel free to share any information you think might be helpful. An abridged account of my woes: -Since midday Wednesday (first day w/o any poison) I've been experiencing the unique blend of motion sickness/brain zaps/heart palpitations that seem to come in waves (anywhere from every 10-15 seconds to 10-15 minutes) and with increasing intensity have been accompanied by nausea and aural interference (it feels like there are broken subwoofers in my head that, with each heart flutter/kick, respond: like how loud music from within a car driving by sounds from the outside). Hands and feet are also involved in these spasms, with less frequency. -I'm sad. Very sad. Was still feeling OK enough Wednesday night to watch a movie, watched my favourite movie (have seen at least 10 times), and cried (like wept cried) through most of it (for the first time). I don't cry in response to art, news, etc., ever. Highly irregular. -I slept almost all of Thursday. I'm a 6am 7 days a week type of guy, so sleeping in til 11, then sleeping ~1-5, and barely moving for the rest of the day is troubling. Not being able to read more than a page of a book even moreso (since that is what I do, for work and for pleasure). -My appetite is nowhere and eating is hard. Were it not for the intervention of my partner, with whom I am lucky to live, I don't think I'd have eaten very much yesterday and today. She woke me up to eat breakfast this morning (Friday), and after doing so I felt slightly stronger: I even flirted with the idea of leaving the house for the library. But I crashed about an hour later, just after I'd gotten dressed, and have been in bed or shower or toilet since. What I'm thinking about/dwelling on: -I'm feeling really stupid for having done this to myself (by way of trusting this doctor, of overlooking my anxieties about psychmeds) -I'm obviously feeling fear about how long these symptoms might last: I'm supposed to board a flight and spend 10 days with her family this Tuesday. . . -I'm wondering if it would be too hasty to get the few caps I threw out out of the trash and try counting out beads for a much slower taper like I've read about some of you doing, or if I should stay this course -I'm desperate for suggestions/spells/tricks to minimize the way these feelings feel in the interim, especially the nausea and shocks: I've tried two different raw ginger cocktails thus far to no positive effect and am taking 3x the vitamin D, B12, and omega-3 I usually do -I'm grateful that the stripe of withdrawal I'm undergoing seems to be primarily embodied and not psychoemotional (my anomalous weepfest the other night notwithstanding): so far I've had no return of suicidal ideation (like what I suffered beginning the drug last summer) and i more or less feel like I recognize myself (knock on all the wood) -I'm hoping that, given all the information and knowledge collected here, it is possible to not be totally in the dark against this thing: by which I mean, that there might be a way to tell, with some certainty, based off certain signs or makers or clues, that this will be over in a week; might take a month; seems bad and requires a different strategy and soon; etc.. . In sum: is there anything I should be thinking about that it seems like I've missed? not noticed? should look out for? Thanks very much for reading and responding.
  4. Hi all I'm on day 3 of tapering off venlafaxine XL 37.5, only 2 beads out at a time,I will get a scales soon because It will only get harder the more I have to count out the beads .I am going to take it extremely slowly this time.I did a taper in march 2016 and it lasted till the june and i didn't go beyond 5 beads out each day before going back to 37,5. Its been a very tough time , I have extreme anxiety,extreme iratibillaty ,intrusive thoughts,. to name a few. What I have learned since that time is to have compassion for ones self and b very patient when doing the taper . My advice to everyone is don't ever believe u cant get through it .our nervous system and soul take time to heal Over the last 3 years I have learned and practice mindfulness ,it is amazing. It has helped me to calm down during a couple of flights to the UK when starting to panic. Today I had a bad anxiety attack but I was able to snap out of the attack fairly quickly because I have been practicing it and I recommend always getting out for a walk in the sun if u can and clear your mind. Please always keep your mind open to new ways to heal.We all now its hard but don't ever let anyone break your spirit. Total respect to everyone .
  5. Hello to all, just found this site and I thought it might be helpful in my case. For a little more than a week I'm experiencing insomnia (wake up after 5 hours, today only slept few hours..), headache, lack of concentration, lack of appetite appeared yesterday. Times of crying, when I think about something emotional. I quit drugs in May this year, under supervising, but I think it's a relapse happening right now, right? Can you please give any comments on my situation according to the drug story? I feel very scared about what to do next. Don't want to go back to medication, but afraid that it could get worse the symptoms... Appreciate for any help! Sincerely
  6. Hello, I'm new to this forum and I'm working toward tapering off of 225 mg of venlafaxine. I am a 70 year old male, that has been very active and health conscious. My weakness has been depression. I previously had two periods of feeling depressed that involved obtaining an antidepressant from my general practice doctor. I would get to the point of feeling spacey and or lethargic, then do talk therapy to get back off of the drug. These where phase one antidepressants, and I would taper off slow over say 4 to 6 months without noticeable side effects. These events occurred between 2005 to 2008 per notes I still have. I retired from Highway Engineering March 1, 2014. Many emotional events piled upon me during the next five months. The stressors where; retiring and adjustment period, daughter coming home to live with us and get a divorce, a vicious son in law (being divorced), one or two other more minor stressors that I do not recall, and a huge spiritual crisis in which I felt I had not lived as graciously as God would have wanted me to. In July 2014 I became fixated on thinking about all these things. I sat in a stupor for days, lost 15 pounds, thought the devil was speaking and accusing me of my wrongs and tempted me to deny God and just die. My wife asked me If I had thought of suicide and I admitted that I had. She called 911 and got help. They took me to a hospital and put me on suicide watch till they could transfer me to a psych ward for treatment. I was confined for a week and given many medications. I also had a physical problem that they dealt with. I was released to an out-patient psychiatrist. The psychiatrist told me he would take me off all the previous medications except for increasing my dose of venlafaxine to 225 mg. I have been on venlafaxine for four (4) years. In May 2018 I stopped drinking all alcohol and also stopped experimenting with legalized cannabis. I quickly felt a bit more energy. I put this energy toward searching the internet for information about venlafaxine and antidepressants. I have learned much, but still want to keep learning. My Psychiatris agreed to allow me to get off Venlafaxine October 4, 2017, after telling him repeatedly about my desire to and why. He reduced my venlafaxine from 225 mg to 150 mg. The short of it is that I did not make it, and went back to the full dose. After learning more about how to decrease slowly, I am ready to try again. I have sought the help of my general practice doctor, who is supportive and has reduced me to 187.5 mg. Since I know that a 10% reduction is better, I cut open a 37.5 mg capsule, counted the beads, and took 40% of those beads, 15, and added them to the 187.5 mg, for a new total of 202.5 mg. I'm also taking daily notes of my physical and mental state, and dosage. I will see my general practice doctor monthly. I will be also talking to my Psychiatrist about my plans. I plan to start talk therapy also. Does anyone have any advise or comments?
  7. Hi everyone! Finally got round to creating an account after months of just reading posts. Anyway, I'm currently on 18.75mg immediate release Venlaflaxine. Since The beginning of 2016. I was on the prolonged release tablet for many years ,the highest dose being 150mg for 3 years. I gradually reduced this down to 37.5mg ,with long holds in between ,the longest being 2 years. However since I went onto the immediate release I have felt a significant difference. I feel low in the morning and get better towards the evening, I've found this has impacted my decision making. Despite this I continued making reductions to where I'm at half a tablet at present. I've had a lot of ups and downs in this period eg relationship ended ,although I'm able to exercise and have managed to work, but not consistently. My sleep has not been the same since I changed over to the immediate release , which is very frustrating. I also feel any change to a routine I get into has a big effect on me physically and mentally. I'm also wondering if I could be in continual withdrawal because of the short half-life of the immediate release tablet? I really feel like I'm not getting better. I feel very depressed at times. I'm starting to think I should go back on the prolonged release tablet.perhaps it would restore some balance. Anyway I'd like to get some feedback, and I very much value having people to share my experience with. I
  8. Hi all,[/size] My name is Lisa, I am a 30 year old female and I believe I've experienced protracted withdrawal. I plan on starting to taper off Effexor XR in July. Here is some of my history: [/size] Starting in 2005, I began taking Lexapro after my father got cancer and passed away 4 months later as I started having panic attacks. I am not sure when I went off Lexapro, but I know I was put on Celexa for a while as Lexapro stopped working and I have now been on Effexor XR for 6 years. In the past, when I go off an SSRI/SNRI, I end up going back on after some time because my panic attacks come back. After 6 months of therapy, I went off Effexor XR in March 2014 with a week of a half dose (37.5 mg) and then completely off, by the advice of a psychiatrist. Actually, the book she referred to recommended 2 days of a half dose and then completely off, but she extended it.[/size] Withdrawal was horrendous. Insomnia, nausea, diarrhea, dizzy, not able to concentrate, felt just SO out of it. Finally it was over in a week or so. But in late May 2015 (3 months later, thinking it was all out of my system and I was good), I had just gotten home from vacation and was about to get into the shower when BAM, I was suddenly so dizzy that I couldn't tell which way was up or down. This remained for 3 months day in and out and after a ton of tests (took meclizine (anti-dizziness pill) which did nothing, ENT looked at my sinuses/ears which were clear, inner ear tests which were normal, brain MRI which was normal), until I went back on Effexor XR in August 2014 by recommendation of a neurologist who said it was my anxiety coming back. During what I'm thinking was protracted withdrawal, I was dizzy constantly. I'd wake up from a deep sleep completely dizzy, it did not go away. I also had excruciating headaches at night and could barely sleep 2-3 hours a night because of this (I NEVER get headaches). I was also severely exhausted because of the dizziness - everything was harder, and the low amounts of sleep due to headaches. I did not understand because other than being upset of my state of being constantly dizzy, I really was not anxious. I was meditating, exercising (as much as I could - it was a feat with being dizzy), nothing significant going on in my life. I had also been going to therapy and made huge strides.. I still continue to go to therapy weekly and it's been about a year and a half now. I was so confused as to how this could be anxiety. Now I'm reading this site and I'm learning this was probably protracted withdrawal. After I started taking the Effexor XR again, within 2 weeks I felt totally better. Now that I have been back on Effexor XR since August 2014, and after learning what I've read on this site, I want to start a slow taper in July after my next vacation. My therapist believes I am ready and now I know I am after having a great suspicion that those symptoms were not due to my anxiety. I have read the advice boards and will be doing the 10% per month taper. I also will be going to the recommended doctor in Farmington, MI and have an appt with him at the end of this month.[/size] Has anyone else experienced the protracted withdrawal symptoms that I had? Any other advice or tips that you can share? I will be coming here often and hoping to make friends [/size] Thanks![/size]
  9. Hello Surviving Antidepressant friends Around 18 months ago I posted this thread desperately seeking help for tapering gone wrong. I had been on a treatment dose of 300mg of Effexor, which I had reduced around 80%. I went to a psychiatrist to seek advice on tapering and bridging and he told me the amount I was on was almost nothing and there would be no issue if I tapered off over a couple of weeks. That caused the worst withdrawal I have ever had, including what felt like 48 hours of suicidal panic attacks and inability to sleep. My memory from that time is blurry. Anyway. After that I tapered back on to Effexor until the worst of the discontinuation syndrome subsided, which ended up being back up to 10mg, or 30 beads. I stayed that way for around 8 months before trying to go off again. I would take my dose every morning in the same place, around the same time, by pouring out the little beads onto my hand, counting them, taking them, then brushing my teeth. The next time I started going off I reduced by 1-3 beads every 3-4 days (more at the beginning, fewer at the end). I also conducted a little placebo conditioning experiment with myself, where I replaced the lost beads with white 100s and 1000s (I think Americans call them sprinkles?). I figured, after reading up on the classical conditioning mechanism in the placebo effect, that the eight months of "ritual" around taking the drug might be sufficient to allow the placebo sugar beads to have the same effect as the drug on my brain. Once there were no more drug beads I continued "taking" the 100s and 1000s each morning for a few weeks. I'm not going to recommend the placebo approach outright for obvious reasons (I am not a doctor or scientist; my understanding of the placebo effect is probably rudimentary). However, in my specific case, the experience of going from 30 beads to 0 beads, was a million times better the second time than the first. Other factors that likely helped: It was about 5 times slower than the first time; I had adjusted to the 30 bead dose before I started; I took even longer gaps between reductions of the last beads; I was not working as much as I went through this process. Now. While it was easier than the first time, it was still not easy. I felt churned up emotionally and was super irritable, I had rage flashes, my anxiety increased hugely, anhedonia returned, I had nausea, and my muscles, particularly in my legs, spasmed and twitched, often violently. I could, however, sleep for the most part, and none of these symptoms got too much in the way of life (granted I was not working very much and I work for myself anyway; it would have interfered if I worked for someone else). It helped to know that if I could just get through those few weeks then things would probably get better. These symptoms lasted around 2 weeks after the final drug dose, which was early April 2017. And things did get better. For me, most of the side effects of the drugs have now gone. Most significantly, my sense of self and my creativity have returned. It had felt like they were being numbed or muted by the drugs, and I couldn't access them. Off the drugs I now have access to them. Similarly, my ability to enjoy sex has improved, and I don't feel like that side of me is muted either. The above is really tremendous; feeling like yourself again instead of a weird muted robot alien is a big relief. However, while I consider the drug withdrawal to be 100% successful and 100% the right decision for me, I should caveat that with the following context: The drugs appeared to be muting extreme unresolved emotional distress, both from childhood stuff and from rape and sexual assault from a few years ago. The pain from this sort of exploded when the drugs went away. My primary diagnoses are anxiety and major depression, but it appears even those were symptoms of childhood stuff. When I came off the drugs it was the first time I had been drug free in around 13 years. I am highly sensitive and have a big emotional world, but I never learned how to regulate stimulation and emotion, and then had it muted by drugs. When I came off the drugs the emotions and stimulation were pretty extreme and often overwhelming. I took from that that I should learn skills of emotion regulation though, rather than that I should go back on the drugs. Even with only 3-4 months of practice, I am hugely improved and the emotions and stimulation overwhelm me much less frequently. (Now they inform my creative work and my service work, and are real positive assets for me, albeit ones that require sensitivity and management.) I have the great privilege of being able not to work for a while while I recover fully, which is lucky because I cannot currently work. I put that down to unresolved trauma that has now come to the fore rather than drug withdrawal. I am doing deep dive work with my psychologist that is helping more than any other talk therapy I've done, and I think that work will be sufficient to return me to work eventually. I see her weekly. That work is also subsidised by the government because it is about recovery from sexual trauma, meaning for now I do not pay anything for it (another enormous privilege). I have a partner who is extraordinarily supportive and gets what is happening for me. He judges fair contribution to the relationship by reference to each partner's capacity, and thinks that because he has more capacity right now it is fair that he do more housework, financial contribution etc than me. This has allowed me not to push myself beyond capacity, which has meant I have recovered more quickly. In conclusion, while I am currently not working and my capacity to do a lot of things is severely restricted, I could not be happier that I am off the drugs. I feel like I have real issues (childhood trauma and sexual trauma) that require serious work, but now I feel like I am actually properly addressing them, instead of having them be muted yet just as destructive. I also no longer have the drug side effects interfering with my ability to enjoy things, make music and comedy, have intimacy with my partner, meaning recovery feels more authentic and there is more joy in it. Things still hurt a lot, but my world feels real in a way it wasn't on the drugs. It's hard to explain to anyone who hasn't come off these drugs before. In simple terms: I have hope. I can experience joy and enjoyment. I am excited about what the rest of my life might bring. Even while I know that I am in the middle of pretty extreme emotional upheaval and trauma processing, life is better than it has ever been. I am finally able to be fully, authentically myself, in ways that the drugs (and the trauma and mental health issues) got in the way of. I am optimistic.
  10. Hi all , I am 8 months off reinstated sertraline for a month ( by doc) and Aripropazole. History Its around 4 years back when i passed out my college and not get placed even after making to finals in many interviews .. that i decided to write competitive exam for PG. I had taken coaching but just before exam I came back and found myself unable to recall things. My brain is just like nothing in it. I found myself in despair and stopped studying. This fog is happening all the time since my engineering but I managed to get average marks sometimes and sometimes very good . There is more in back history but I ll get to it later. So, my parents took me to a psychiatrist ( family known) and he put me to Olanzapine and one more thing. He diganosed me bipolar2. I got about 10 pounds on it but its not help . Meanwhile after 4 months, with the help of a relative , I got intern in a company and I moved out with fog to a distant city. TThere in a hospital, they put me on floxetine and Amisulpride for 3 months . Then i moved to a private psychiatrist ... where it starts getting haywire . He stopped fluoxetine and Amisulpride . And put me on Venlafaxine and Seroquel... As i was interning, i get usual heat racing in between job times but my doctor convinced me to stay with it . 4 months and I just started feeling agitated due to stress. It happened that I slapped a senior on abusing me and there I left a job I never happened to get physical in my school or college .. but it happened. Doctor told me to scrap the prescription he wrote of raising Venlafaxine. And he put me paroxetine + Oxcarbazepine. In his words , it is best tolerable and has lesser side effects. I managed to get a job by my own and cracking first time. But this time there is lot of work and culture pressure. Its a startup with full of politics . Boss and his boss .. all keep on putting things. Let office aside, I started feeling some well .. overly casual ... excited .. raged .. Iits about 25 mg Paroxetine and 300/600 mg Oxcarbazepine. I had unusual violent acts .. had hit a school friend .. insomnia.. I decided to leave the paxil by asking the doctor . He said half in a week and then other half a week to off. Thats when it all started , i cannot sleep whole night and with day light i start getting a nap. I left going office with fear of state i was in . I cannot wake and even if I .. i was too tired and angry . Doctor then gave me Mirtazapine which didn't help . I resigned job telling muly boss about all and came back home. It was Nov,2015. I start getting yhese uncontrollable rage that I locked myself in a room. Parents took to a local shrink who put me on Venlafaxine+ Mirtazapine(CRF), lamotrigine, resperidal, Seroquel. The NEXT Day I woke up so fresh .. all calm like 12 yrs back .. i was smiling happy.. but it lasted only 4 hrs .. and i am doomed again . I took those meds 10 days and i decided to go off. Physical Damage. I got brain zaps as sounds with eye movement .. While on Paxil I got severe neck stiffness and movement pains - which came out as Osteophytes. Anger , heart race , memory, fog , chest pains , fatigue ... All I beared for 4 months. Reinstatement after 4 months. Father took me to another psych who put me on Sertraline+ Aripropazole+ Seroquel. I started having increases restless legs than before and the doctor asked me not to go over net. After 2 visits and when he said it wslas Aripropazole for restlessness all time.. and he is cutting it . I stopped all meds . Withdrawals in 8 months. All first symptoms with some new like utter sensitivity in teeth. It is while breathe in most of the teeth . Muscles gone from forearms .. My left hands gone ulnar neuropathy and i got surgery done when no hope lived. Right hand has stiffness too . MAnger I am living with .. I have stopped talking .. I have decided to go sit on my Shop but I was unable to understand the talk . In spite anger biuts and memory makes it difficult to adjust. I keep forgetting people faces .. important talks . So i stopped . Now I am muted all the time with burst inside . Read success stories and play CoC. This is the most I can write now.
  11. New here, so will hope to fill in fuller history later. I am 71 and have had depression to varying degrees 1977 to date. Managed to work full time 1964-2001, though. 12 years on irregular shift pattern 1964-1977. Last month, went to new younger GP who arranged blood tests, (after I had given him my list of ill-health symptoms!) Blood, mostly OK, but indicated low folic acid, he said. I am on 5mg daily folic acid tab for last 5 weeks. I do feel better (carrying out lots of small projects in my retirement). Had so many ups and downs in last 40 years, though, that I think this may be a placebo effect. However, a more positive side of me thinks I may be on the way to breaking through the wall where "the drugs don't work anymore" at 225mg Venlafaxine slow release. I have been on Losec (Omeprazole 10mg) for decades, too. I read that it can spoil your absorption of certain vital items in the vitamin B family, at least? Thanks for reading, all.
  12. Hello. I first took venlafaxine (immediate release) in late 1998 at the lowest dose (75mg, i.e. 37.5mg x2 daily) I continued on that dose until July 2003 when (without consulting anyone, I'm now ashamed to say) I started to omit every other morning dose. I continued doing this until the beginning of 2006 (unfortunately I have lost the diary for that year so cannot be precise as to by how much and over exactly what period I further reduced the dose) when I began reducing the dose until by March or April 2006 I was not taking any venlafaxine. I do not recall any problematic symptoms, but during that time I did have access to diazepam, so perhaps that may have masked them. I had also started psychotherapy at the beginning of 2005. I felt fine for the rest of 2006, including coping with the sudden death of my father and the stress of dealing with his estate. Toward the end of January 2007, I started experiencing a return of the symptoms that led me to be given venlafaxine in the first place. In February 2007 I went back on to the original dose (75mg, i.e 37.5mg x2 daily). Within 6 weeks or so I felt fine. I continued on that dose until October 2017 (I wish I'd found this site a year ago!) when I reinstated the omission of every other morning dose ( I told my GP I was doing this). Everything seemed to go okay until the middle of May when I began to feel the returning symptoms of depression, anxiety and tension until at the end of June I just seemed to cross a line where nothing could reach me. I went to my GP and started taking 37.5mg x2 daily again, hoping for a similar effect as in 2007. After 8 weeks of no improvement the GP put me on 150mg of venlafaxine (75mg x2 daily). I stuck it for 4 weeks and went back to the original lower dose while I try to figure out what to do. As a result of searching the internet I discovered the phenomenon of “poop out” or tachyphylaxis, which made me think that perhaps I should give venlafaxine up altogether (and not replace it with sertraline,as my GP has suggested), which is how I ended up at this site. Certainly the venlafaxine has not restored me to feeling “normal” by the standards of 2007 to 2017. In fact I feel worse than I have ever felt. The worst symptom is a continuous tension in my neck/head/ upper spine that does not respond to anything (massage/valium/hitting a punchball/stretching) and feels like a mixture of physical and emotional tension. Anybody recognise that? I have discussed with my GP getting a liquid version of venlafaxine (available in the UK from this company: http://ipsspecials.com/) but he said he cannot prescribe it (even though I offered to pay for it myself) because it is unlicensed. Disappointing, to say the least. I told him about this site and the 10% taper method, and, while he didn't say it was rubbish, I could tell he thought it was unnecessarily cautious. The methods used here (making a liquid or weighing powder) do seem daunting. The dilemma I have at the moment is whether I ought to start tapering or whether to continue taking 75mg daily to see if any “improvement” happens before deciding to taper. I should also state that I have been taking diazepam 5mg (“as required”) for the last 20 years. My usage probably averaged out about 5mg daily for the last 10 years, but recently, because of the state I'm in it has increased. I have also had two acupuncture treatments recently, in the hope that it might make me feel a bit more like my old self, but perhaps acupuncture isn't appropriate at this stage.
  13. Hi All, My 16yo vivacious daughter ran into a bout with serious depression when she was 14. After a failed trial with Zoloft, her MD put her on Effexor (venlafaxine) 75mg ER. While a relatively modest dose, she took this medication for two years. She also took Lutera (birth control) during this time to help with PMS/menstrual issues. This past May we decided to discontinue the venlafaxine with doctor/psychologist's approval. Doctor gave us a very drastic and probably unrealistic taper program. We opted to taper more slowly than what doctor prescribed -- alternating between 75mg and 37.5mg, daily, every other day, etc then dropping to just 37.5mg. We hovered at 37.5 for a period of time, and then tried to taper from there without success. Since she was miserable even while tapering, and since from what I was reading (I hadn't yet found this site...) it seemed like even more modest tapering would not avoid the misery of withdrawal, we dropped from 37.5 to 0. She took her last 37.5mg venlafaxine pill sometime in late July. (She also discontinued the Lutera at some point over the summer, although I do not remember exactly when.) She was miserable for 8 days. Her biggest symptoms were nausea, headache, dizziness/vertigo, occasional vomiting (flu-like symptoms). She decidedly did not have anger, anxiety, or any other emotional/mood-type symptoms and only a few brain zaps toward the very end. After day 8, she was good for about 10 days, after which the dizziness, headache, vertigo returned -- this time for 3 days. After the third day of misery, she again was fine. Repeat this pattern, and we are now in what I call our fourth "episode" (I guess, the correct term is a "wave"?) of withdrawal symptoms returning -- again, no mood/emotional issues, but vertigo, queasiness, stomach pain, headache. We have tried to treat her symptoms with very little success -- dramamine, ginger, meclizine, tylenol, ibuprofen, Excedrin migraine, promethazine, pepto bismol. MD has been willing to consider possibility symptoms have been withdrawal-related, but seeds were sown at our last visit that we were getting close to the end of that window. In addition to anti-nausea medications, at last check-in (after 3d "wave") MD prescribed 10mg fluoxetine to use as a "boost." That worked one time, and since then hasn't made much of a difference. She has taken the fluoxetine 3x, and I would say all it did was serve to push off the inevitable. My daughter is home from school today, again, probably her 9th absence already this year (not even 2 months into school). I am at a loss at this point as to what to do to help her. The last "wave" lasted 5 days, and it looks like this current one is heading in that same direction (this is longer than previous 2 waves -- those were 3-4 day experiences). I will note that the onset of the "waves" seems to correlate to when her estrogen level would be at its lowest during her menstrual cycle. Curious? Does that suggest anything? Thinking that there had to be a physiological reason for what she was experiencing, I focused on boosting her seratonin/norepinephrine production (to replicate what the SNRI had been doing?) -- starting her on 5HTP and L-Tyrosine, along with magnesium and fish oil. Even when reduced to just the 5HTP along with the magnesium and fish oil, anxiety was starting to become a problem. Switched to adaptogens (Rhodiola and Holy Basil) and the anxiety has disappeared and she seemed quite well-balanced until this latest "wave" where, again, it is the vertigo/nausea/headache trifecta that we cannot seem to remedy. Looking at working with a functional doctor at this point but very frustrated with what I am running into --- first available new patient appointments months out? (First place I called, could not get her in until March!!?) Wondering if a functional doctor can help? Any ideas, suggestions, hope? So scary to read of such long and painful experiences of others and the possible life-long consequences from these drugs. Realize we are probably paying the price for a poor taper (?) -- wish I had found this site sooner -- any helpful place to go from here? Thank you for reading.
  14. I joined this site a couple of weeks ago. After finding that paxilprogress was no more. I was devastated. That site may have truly saved my life in some of my darkest moments. What is one to do? When essentially you've self-destructed in front of everyone you love; because of a nasty little "non-habit-forming" pill that's been shoved down your throat for decades. So here I am. Time (weeks really) has eluded me. I meant to reach out sooner. I'm just hoping I'm not reaching out too late. I feel like such a horrible failure. I know better than that at some level, know that maybe I failed but that I just have to pick up the broken pieces and keep moving forward. But I'm so I'll. I'm so weak. I'm so alone. And I feel so helpless. My life may not have been a picnic before the introduction of SSRIs. But this is one situation in which the grass was truly greener on the side of which I was already standing. Before popping that first "innocent" little pink pill, prescribed by a doctor who had seen me only once and only spent 10 minutes "getting to know me". I couldn't tell you who that doctor was, I never saw him again. Nevertheless he was the first in probably nearly a hundred who have insisted upon continuing the saga. And what better did I know? I was unhappy before the meds. I was often unstable on them. And I was clueless as to why I was saying and doing psychotic things (that I often didn't remember, or just have "snippets" of memory after the fact) and so violently ill when I decided I simply no longer wanted to take the pills. Or was even 12 hours late on a dose. (More about that and my travels down genetic testing road and CYP450 mutations later.) All that being said; Hello to all in these forums. I'm the antisocial one. The antisocial one that sometimes doesn't know when it's appropriate to shut up. Or how to appropriately ask for help. But if you've been through it (psych med-wise), I probably have too. And vice versa.
  15. I am posting this on behalf of my husband who is quite unwell. I am in a very vunerable place watching my husband deteriorate so please be kind. We are in our 60's and have never experienced anything like this. My husband was administered antidepressants for depression over 30 years ago and has remained on antidepressants all this time. I cannot recall what they started him on but maybe 8 years ago he was moved to Effexor XR 75mg. When it was increased to 150mg - we noticed a lack of feeling and low libido. We discussed the idea of coming off the Effexor XR and did this with the aid of high quality supplements - tapering by reducing the beads over a year. There were horrible side effects - nausea, high anxiety and then the concentration started to be impacted. After six months of being off the Effexor XR he deteriorated very quickly to the point where he became Psychotic and he couldn't get his brain to think how to get himself into the shower. It was like his brain had frozen. He kept saying I am losing it! Unfortunately he was admitted to the Psychiatric Ward where they administered 10mg Olanzepine and 75mg Effexor XR then increased it up to 150mg. He was released after three weeks. He was on Olazepine for about three months and the Psychiatrist reduced him off that. Because he is still not stable the Psychiatrist was not sure whether to increase or reduce his medication. He has gone for the latter and we are administering 112mg every other day at around 10am this is our 3rd day (eg 150mg one day 112mg the next and so on). I am monitoring him closely and notice that he is so much more responsive in the morning and quite normal, although says he feels really tired. His memory and concentration has been affected. He has blurred vision. After his medication is given I notice he begins pacing, not as responsive to talking and becomes quite anxious. The Psychiatrist says he has had a relapse and has major depression. I don't know who to believe anymore but I just want my husband well again. Please help?
  16. I've been taking Pristiq 100mg (plus 5mg Somit to sleep and 100mg Activigil to wake up) for the past 3 years more or less. I've been trying to quit Pristiq for many months due to HORRIBLE withdrawals whenever I forgot even one pill. I got to down the dose to Pristiq 50mg after enduring two weeks of those horrible withrawals and then they were gone, luckily. Now I'm trying to figure out my next step. There's no Pristiq 25mg where I am from. My psych told me to switch to venlafaxine 75mg three days ago, not the XR, the regular. It has such a short half life that I'm having horrible symptoms as well, even though I'm taking 37,5mg in the morning and 37,5mg in the afternoon. I'm trying to figure out if this is the best way to quit Pristiq. She says I should stay with venlafaxine and taper down from it. I'm worried about feeling awful. I can't function. Should I stay with the venlafaxine or switch back to Pristiq 50mg and figure out something else? Should I bridge with Prozac form Pristiq? Should I stay with venlafaxine and THEN bridge with Prozac? Should I just taper down from venlafaxine? By the way, thank you all for describing so accurately all the discontinuations sympotms of the Pristq- the brain zaps, the headaches, the dizziness, the confusion. What has this done to us? I want out.
  17. Hello everyone, It feels good to discover this site - thank you all for being here. Right now I've run out of everything, my depression has swamped me, I'm exhausted. Doc queried increasing meds, I said no. I realise this would be a silly time to start coming off them, and I'm not thinking of doing that, but the need to stop meds is always in my head. I want to know everything I can about it, especially how to know when to start decreasing. My husband, who is beautifully supportive of me in every other way, is sure that the possible upheaval would be too much for our family. I worry about that too.
  18. https://metro.co.uk/2018/01/24/woman-shares-coming-off-antidepressant-ruined-life-7255570/ See link for images that accompany article By Ellen Scott, Lifestyle editor Wednesday 24 Jan 2018 10:36 am When Tabitha Dow was six, she had her first migraine. Now and again she’d be stuck with headaches, but when she hit 29 they became more regular and more severe. Soon her migraines were debilitating, so she sought out medical support at the National Migraine Centre in London. There, Tabitha was advised to ask her doctor for the antidepressant Venlafaxine at a maximum dose of 150mg. She was told that this would help not only with her migraines, but also with her persistent low moods. ‘This was the start of my downfall,’ Tabitha tells Metro.co.uk. ‘Neither the neurologist, nor the GP who subsequently prescribed the drug, explained that it was extremely chemically addictive. ‘I was not told how long to take it for, it was prescribed indefinitely, and there was no mention that coming off the drug would likely result in severe withdrawal symptoms and a need to taper off like you would heroin. ‘Neither mentioned that one of the common withdrawal effects of Venlafaxine are migraines.’ Venlafaxine didn’t work to help Tabitha’s mood, so after a year, she decided she wanted to come off it. Asking her GP about a plan to taper off the antidepressant, Tabitha was told that the medical professional had ‘no idea’ how to proceed. ‘I was completely by myself,’ says Tabitha. She followed the instructions recommended by her GP, but was quickly confront with severe and debilitating withdrawal symptoms. The plan the doctor recommended was fast and drastic, and Tabitha feels she was left completely unprepared for what she was about to face. Tabitha before withdrawal. Picture: Tabitha Dow) ‘The migraines increased dramatically and on top of these I developed intense crushing pressure in my forehead which was constant and unbearable for months,’ Tabitha remembers. ‘I also experienced chronic fatigue, internal tremors, startling easily, sensitivity to light and sound, sensory overload, anger, brain zaps, pressure behind my eyes, tired eyes, extreme fear, panic, confusion, being unable to speak, being unable to move, my brain feeling sick, my heart beating fast when I stood up, mental turmoil, night terrors, hypnagogic hallucinations, night sweats, gasping in my sleep, feeling unwell after a bath/shower, severe difficulty waking up in the morning, feeling drowsy and stuck until several hours after waking, feeling drugged and toxic after napping and sleeping, a sensation of my brain moving from side-to-side, squeezing/tight sensation inside my head, right eye-brow pulling upwards, a chemical “metally” sensation in my forehead, vibrating and electrical sensation in my head, being unable to cope with everyday tasks, deterioration in mood, agitation, feeling like my brain was shutting down, light-headed when I stood up, feeling like my body was rocking as if on a boat, feeling catatonic, scrambled thinking, feeling as if there was a block in my thinking, difficulty planning, difficulty carrying out sequential tasks, and feeling detached from my environment.’ Having found out that she has a lesion in the frontal lobe in her brain, Tabitha believes she may have even had a seizure during this time. ‘I’ve had two episodes where I couldn’t speak,’ she says. ‘It felt like an electrical storm in my head, which I’ve read is what a seizure feels like.’ Tabitha during withdrawal. (Picture: Tabitha Dow) At first Tabitha didn’t realise that her symptoms were the direct result of withdrawal from Venlafaxine. When she asked her doctor for help and her test results came back normal, she was offered no further support. ‘I was left to cope alone,’ she says. NICE's current guidelines on Venlafaxine, and what Tabitha wants to change: ‘Associated with a higher risk of withdrawal effects compared with other antidepressants. ‘Gastro-intestinal disturbances, headache, anxiety, dizziness, paraesthesia, tremor, sleep disturbances, and sweating are most common features of withdrawal if treatment stopped abruptly or if dose reduced markedly; dose should be reduced over several weeks.’ Tabitha suggests that the recommendation to reduce the dose over several weeks isn’t accurate. It takes months to come off the antidepressant safely, and two years later she’s still experiencing debilitating symptoms. She notes that NICE’s guidelines also fail to mention that Venlafaxine can cause withdrawal symptoms even when not stopped abruptly, and tapered off in accordance with GP’s tapering guidelines. Unable to work, Tabitha had to quit her job and leave her flat in West London to move home with her parents, so they could look after her. She lost everything – her job, her health, her home, and yet, she says, doctors still refuse to listen to her struggles. The doctors Tabitha has seen don’t believe that withdrawal can cause the severe symptoms Tabitha listed. The only psychiatrist she could find to back up her claims is Dr Healy, who’s dedicated his time to researching the effects of Venlafaxine’s withdrawal symptoms. Dr Healy wrote a letter to Tabitha’s GP confirming that she was experiencing intense withdrawal symptoms, but Tabitha says she’s still not receiving any help. It was only when Tabitha found a Facebook group dedicated to Venlafaxine withdrawal that she learned she wasn’t alone in experiencing her symptoms. Scrolling through the group, Tabitha found comment after comment repeating her experience, listing a ‘crushing pressure in their foreheads every single day’, that feels like your head is ‘in a vice’ or you’re being ‘smashed in the head with a brick’. ‘It’s ruined my life’ (Picture: Tabitha Dow) ‘It wasn’t until I joined this group and saw that there were hundreds of people in the group all experiencing the same symptoms as me,’ Tabitha tells us, ‘and that I realised that my symptoms were caused by Venlafaxine withdrawal. ‘I told two GPs that I was experiencing withdrawal symptoms from Venlafaxine. One didn’t comment but agreed to refer me to see Dr Healy, the other disagreed even once I had written evidence from Dr Healy.’ Doctors Tabitha has seen believe that the symptoms she’s experiencing are not the result of coming off Venlafaxine, but are simply her original condition returning. We spoke to a psychiatrist with experience in Venlafaxine, Dr Cosmo Hallstrom, who told us that it’s one of the most popular antidepressants out there, and is generally regarded as the most effective. While legally, GPs are required to give patients all the information regarding drugs they prescribe, Dr Hallstrom says that the reality is quite different. ‘A doctor’s interest is to get patients treated, and to persuade them to take medication that will help,’ Dr Hallstrom tells Metro.co.uk. ‘So maybe they don’t start listing off all the possible side effects.’ He notes that a GP’s perception of risk is different to that of a patient, and doctors may be reluctant to note all the possible risks in case it puts a patient off getting help. Two years later, Tabitha is still experiencing withdrawal symptoms. (Picture: Tabitha Dow) SSRIs do have withdrawal symptoms, Dr Hallstrom explains, but these tend to be short-lived. He states that data shows that in the majority of patients who believe they’re having withdrawal symptoms, what they’re actually experiencing is the return of their initial condition. He does admit, however, that there’s a chance some people may experience genuine withdrawal – but recommends a simple ‘test, retest’ as a way to check it out. ‘I understand that a lot of patients might not want to take the medication again, having been through a bad experience,’ Dr Hallstrom says. ‘They say “that stuff’s poison”. ‘But if it is withdrawal, when they start taking the drug again their symptoms should disappear within 24 or 48 hours. That’s a simple test.’ But having been ‘traumatised’ by her experience, Tabitha is reluctant to go near medication again – especially as Venlafaxine didn’t work to remedy her depression in the first place, and she doesn’t want to be tied to taking medication for the rest of her life. Two years on, she’s still debilitated by withdrawal symptoms. She’s unable to work, relies on PIP and ESA benefits, and is now trying to raise money to fund alternative therapies to help her cope – not only with her side effects, but with her thyroid cancer, which she was diagnosed with in the last few years. It’s the withdrawal symptoms that concern her most. MORE: HEALTH These are the 20 most painful illnesses, according to the NHS Women take to Twitter to vent over how they are treated by doctors Mums over 35 should wait at least a year between pregnancies, says study Women are more likely to be addicted to cannabis than men, suggests study ‘I’d rather have thyroid cancer than go through coming off Venlafaxine,’ Tabitha tells her. ‘Thyroid cancer doesn’t cause any symptoms. Withdrawal ruins my life every thirty seconds. ‘I have really bad cognitive symptoms. It was like my brain had been drugged. ‘I feel like my intelligence has gone, along with my memory.’ Naturally, the experience has put Tabitha off taking medication. She now relies on alternative therapies, but as this is a huge financial burden, she’s taken to GoFundMe to ask for help. Now, by sharing her story, Tabitha hopes she can affect change. ‘It’s too late for me,’ she tells us. ‘Taking Venlafaxine has ruined my life; I’ve lost my income, my social life and my independence. ‘But I would like doctors to believe me. I’d like them to listen. ‘I want there to be better information about coming off antidepressants and I want there to be a change to the NICE guidelines, so no one has to go through this again.’ Read more: https://metro.co.uk/2018/01/24/woman-shares-coming-off-antidepressant-ruined-life-7255570/?ito=cbshare Twitter: https://twitter.com/MetroUK | Facebook: https://www.facebook.com/MetroUK/
  19. Hi all! Finally had the time and courage to start to tell my story. I'm thirty-something year old woman from Finland. This forum has been really important to me on this dreadful journey. It's crucial to hear that you're not just imagining things and not alone in this. When my withdrawal really hit me the first time, I was so scared. I had heard of AD whitdrawal but didn't really know what to expect. I've never felt so deeply depressed and utterly hopeless than in some waves I've had during this whithdrawal. That really puts you in to the darkest place ever I have a wide range of symptoms, most of the Glenmullen's withdrawal symptom checklist I have been under a serious stress on this past month and I have noticed that it has possibly made my symptoms worse again. But fortunately I have noticed some progress too. I also have been able to sleep almost the entire time. That's HUGE! Well, that's probably all I can write now. It's really tough to write in a foreign language with this braindamage, it has made me so slow..
  20. Caspur

    Caspur: history

    I have been taking Venlafaxine at 75mg per day for about 6 years. The side effects were becoming too annoying to contiune - mainly flat, blunt unemotional mood, drowsineess during the day (i would fall asleep at my desk whilst working (at home)) and frequent urination, especially at night, which interrupted sleep too much. I have successfully tappered off venlafaxine once before after about 10 months treatment. I did it over 9 months without any issues. Buoyed by that success, i thought i could do it again and embarked on a taper using broken pills and liquid preparations prescribed by my doctor on the UK NHS. I only took 4 months this time which wasnt that sensible , as i now know. The taper ended 5 weeks ago today (24/11/17). Since then i have experienced many and varied discontinuation symptoms both physical and emotional: - physical - nausea, diarrhea, flatulence, dizziness and swimmy feeling in the head; mild visual disturbances; mild but constant headache; mild tingling sensation in the face - emotional - depression, anxiety like i've never experiened before for no aparent reason, irritability, poor concentration; mood swings over a very short time period for no apparent reason etc The semotional symptoms come and go. I will have one or two good days followed by 2-4 days of feeling depresed, anxious, etc On the up side i do feel like im experiencing real emotions like i havent felt for year I have mananegd to control some of the symptoms with supplements such as tryptophan. i also take fish oil, B vits, vitamin C and D I exercise a lot - run 5-6 km per day and try very hard to eat well; lots of fruit and vegetables etc Any suggestions for help would be gratefully received!
  21. My introductory post. I have a sleep disorder associated with Fibromyalgia. Fibro also is associated with anxiety and depression and inability to relax the muscles. So, Venlafaxine has been a real help for me to live a normal life for 20 years. But I'm 68 and want to get off. Today is the 6th day following a failed tapering, my second. My first tapering was a year ago. I have a terrible sleep disturbance: I have a panic attack while falling asleep. My husband is helping me find a better psychiatrist, one who is experienced with both a sleep disorder and tapering. But this time around as I tried to fall asleep a loud buzzing sound and vibrating sensation occurred inside my right nasal passage. As I type this I am aware it sounds unbelievable. It's so embarrassing. "Doctor, I have a bee in my nose." Well, I googled "my own snoring wakes me up" and found Sleep-Doctor http://sleep-doctor.com/blog/does-your-own-snoring-wake-you-up-from-sleep/ . Anyone have a similar weird sleep disorder? I bet it was due to tapering - some kind of neurological trauma. I'm exhausted. Last night I finally slept through the night.
  22. On Effexor (Venlafaxine) since Fall 2016; taking 200 mg for the past 6 months or so. I've decided to stop the effexor, as I feel that it is no longer working. I picked up a prescription for 25 mg effexor yesterday, in order to taper by 25 mg every 3-4 days (as recommended by my psychiatrist). 9/26/18 was my first night of 175 mg; I felt okay the next morning, if not a bit dehydrated. However, over the course of the day, particularly in the evening, I began to feel out of it, naseous, and just weird (for lack of a better description). That being said, I also had not eaten much that day; however, I've never felt "weird" while not having eaten, as I did 9/27. I will continue with the 175 mg dose for the next few days to determine whether the symptoms were due to lack of food or effexor. I’m terrified to taper off it it. I’ve been reading about it, and the stories of tapering off are terrifying! However, I still read them just so I know the possibilities. What kind of tapering experience have you had? Was it good or bad? Has anyone tapered off with zero side effects? Thanks!
  23. Hey all! This is my first post here and I'm so glad I found this forum. I've been feeling desperate for months. My question is about drug-induced derealization. I took the combo of Effexor + Valdoxan and only felt good for a month while being on them. In hindsight I almost seemed manic. Then, suddenly, I got very strong derealization that lasted for weeks. It lifted a bit for a few feeks and then came about again when I had a drink one night. I have now tapered off Effexor, I took my last pill about three weeks ago. Three days ago I also started tapering off Valdoxan. I take Oxazepam to cope with the symptoms. I feel like I broke my brain for good. The only other time I've felt derealization was when I ate a hash brownie and clearly it was too much for me. I used to be a caring and fun person before going on the antidepressants. Right now I feel like I'm just completely empty inside. I do and feel things because I know I have to, but I seriously don't care about anything at all. When I do feel emotion, it's mostly fear or worry. Has anyone else expierienced drug-induced DR? Did it go away when you started to withdraw from the drug? How do you cope with this?
  24. I have been on antidepressants 3 times in the last 14 years. Usually would take them for 6-8 months and then taper off with no problems. The last time I took them (2011), I needed the maximum dose of sertraline (200mg) to get an effect. After a year on it, I felt it was time to stop. The nurse insisted I had to keep taking or risked relapsing into severe depression. I tried several times to bring up the topic to no avail. After about 1.5 years on it, I cut the dose on my own to 150mg and felt ok for 2 weeks. But after I started having a dull headache that lasted hours, dizziness, serious cognitive difficulties and severe fatigue. I could not function and needed excessive sleep (12-14 hours/day). Tried increasing it again and the more severe symptoms got better, but the headache and flu-like malaise persisted for at least a week. I consulted with a psychiatrist. We tried effexor and cut on zoloft. Had no withdrawal symptoms, as I was cross-tapering. I was completely off the zoloft. Only took Effexor for about a month on a low dose (never past 150 mg) because it never helped with the symptoms of Atypical Depression I had. When I started tapering down the effexor, I got the dizziness and extreme fatigue again. When I would fall asleep, I found it extremely hard to get up. Literally felt pinned to the bed. Woke up more tired than I went to bed, even after 12 hours of sleep. Woke up dizzy and with a headache. I increased dose again and we're doing a slower taper over 21 days. The starting dose is 37.5mg. I experience dull headache that lasts hours, flu-like malaise, muscle tension, fatigue every day (with the occassional good day of no symptoms and the occassional day of much worse symptoms). I have learned to cope the best I can with these symptoms, but the fatigue gets unbearable at times. I sleep 12 hours at night and still feel tired and even drowsy during the day. I'm in grad school and it's hard and often impossible to study or even make it to class. I was supposed to decrease dose to 25 mg after 10 days on 37.5mg, but since I still have symptoms, I'll ask dr if I can postpone the decreasing... Im also concerned that the increasing apathy Ive had over the last 7 years might be due to antidepressant use. It could also be depression, but if it is SSRI use, its a very scary symptom that is not going away (has not gone away for more than 3 months in over 14 years since I started having depression/taking SSRIs). The only reason I can semi-function today is because I take nuvigil (a stimulant) 3 or 4 times/week. Without that, I can't do homework or clean or shower. Im extremely dysfunctional. I don't rely only on the stimulant though. I use it to give me energy and motivation and alertness that I use to do positive things, which improve my mood and further help with apathy.
  25. Hi, I tapered down from 75mg (already down from 150mg a year ago) in the last few months. Took my last pill last saturday. The symptoms are ok to handle, but the worst thing is the itching pain in my legs and arms. It feels like there is not enough blood circulation. I have to keep moving them, mostly at night. As soon as I lay down it is unbearable and I can’t sleep. Does anyone have tips or knows what this is? I tried taking asperine, tiger balm, massage, sauna... I also have very low muscle strenght and endurance. I can only walk for about ten minutes and then exhausted. Maybe also related to blood circulation and O2 in the blood? thanks,
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