Paul1968...Too late for me to reinstate Effexor?

[Paul1968]

Wow, what a great site, with a lot of knowledgeable and caring people. I've spent many hours just reading various threads, and the mutual support and concern is amazing.

 

I have a current predicament, that I would love to get feedback on from the group. My signature summarizes my basic history and current medications.

 

Basics: 47 year old married male with teenage children. Depression off and on with varying intensity since 1992. Many drugs tried: Wellbutrin, Lamictal, Serzone, Lexapro ending with Effexor.

 

Achieved partial response with the Effexor for 12 years @ 300mg. Did have high blood pressure, but almost no other side effects after start-up. I should note that I also drank alcohol pretty heavily for 6 of those years, but now have been 1.5 years sober.

 

Over the last 3 or 4 years, I had been feeling depressed and fatigued, or "wiped out" in the afternoons. I began taking long naps after work (2 hours, deep sleep). It bothered me because I was not participating in life very much, but I did always feel better after a nap. Dr. ordered sleep study and I got a CPAP and that helped a little, but I still took naps. The reason for the naps was really more than just being tired, I was depressed.

 

Long story short, August2014 my Dr. suggested tapering off Effexor and seeing where my base-line was. Was Effexor causing this fatigue? We tapered down to zero over 6 months. My withdrawal was very mild compared to many of the stories I've read on here: numb feet, flu-like body aches nearly every day, some dizziness and anxiety after each change in dose....and a gradual increase in irritability/anger/rumination about resentments...neither me, nor my Doctor attributed my irritability to Effexor withdrawal....and my Dr. claimed to not be aware of people experiencing all-over body aches as a withdrawal symptom.

 

After 3 months with no medications, I went back to him and requested that he give me prescription for something to try to ease my depression. We tried Sertraline and it was horrible. I lost 27 lbs in 30 days and quit.

 

Now we are trying 10mg Brintellix, 1mg Risperidone, and 1mg Clonazepam (as needed for anxiety) & 10mg Ambien. and I feel miserable still.

 

My general feeling is that my body is just not accepting any antidepressant and is fighting me. I've missed a lot of work, tried to work from home, tried to exercise, try to meditate...but I am stuck in limbo, feeling really bad and very scared about my future.

 

My main question to the group is: Is what I am experiencing, maybe less to do with "normal" depression and medication start-up side effects and more to do with Effexor withdrawal? Even after 5.5 months being completely off of Effexor, might that be what is causing my main problems? ....and If so, should I try to reinstate the Effexor? I have about 40 of the 37.5mg capsules left. Should I take a few beads and see what happens? I know my current cocktail of medications throws everything into disarray and disorder...but if Effexor withdrawal is my real problem, then I should feel some relief if I reinstate shouldn't I? Has anyone ever tried this under similar conditions? What was their result? I welcome any and all input.

 

Thanks, -Paul

 

 

[peggy]

Hi Paul, welcome to SA!

 

It is so hard for any of us to be able to ascertain the cause of your distress when you have so many variables going on.

• 300mg Effexor is a whopping big dose, and reducing it in 6 months was very quick.
• adding Sertraline to the mix - what dose were you on and how quickly did you go off?
• Brintillex, Risperidone, Clonidine and Ambien.... that is quite a cocktail

Seeing as it is over 6 months since you finished your Effexor taper and given that you have had a variety of other drugs on board since then, it might be risky trying to reinstate effexor.  

 

One of the moderators will be along to give you some guidance, but I would suspect commencing 10% taper off your current cocktail would be prudent.  At the same time, attending to good diet, gentle exercise and maybe supplementing with some fish oils to give you some support.

[Altostrata]

Welcome, Paul.

 

As peggy said, "quite a cocktail!" Can you figure exactly when you started each: 10mg Brintellix, 1mg Risperidone, and 1mg Clonazepam (as needed for anxiety) & 10mg Ambien.

 

How often do you take clonazepam? How often Ambien?

 

Yes, you could still be having withdrawal effects from going off Effexor.

 

If I were you, I would stop taking advice about psychiatric drugs from this doctor. My hunch is you also need a liver function test (blood tests).

[Petunia]

Welcome Paul,

 

Thank you for posting an introduction and for filling in your signature, I'm sorry you're not feeling well at the moment. As Peggy wrote, you have a lot going on, with many recent drug changes, its hard to know what's causing your current symptoms.

 

I would think carefully tapering off your current cocktail and getting some counseling, to find the cause of your depression might be a good idea.  I'd highly recommend reading Anatomy of an Epidemic by Robert Whitaker. Psych meds can cause harmful side effects and long term, they can worsen health, increasing the risk of other illnesses. In my opinion they  should only be used for short times and very cautiously, if at all.

 

Here is some information you may find helpful:

 

Why taper by 10% of my dosage?

 

 

Taking multiple psych drugs? Which drug to taper first?

 

Please be careful with Clonazepam, if you take it more often than 1 - 2 times a week, you may become physically dependent and then that will also need to be tapered. Its possible to become addicted to a benzo in as little as 2 weeks if you take it regularly.

 

Please feel free to write whenever you want, you will find a lot of friendly help and support here.

 

Petunia.

[Paul1968]

Just wrote a long response but I lost it somehow...so now starting over. Thanks for the quick replies to my post!

 

sertraline was just 25 mg for 30 days in July.

 

All other drugs in current cocktail started about August 5.

 

Take ambien every night, but take 1mg Clonazepam only about twice per week for Brintellix start-up anxiety.

 

Have been seeing a good Therapist weekly for about 7 weeks.

[Altostrata]

Did your sleep problem start with Brintellix?

 

Your doctor is in error, prescribing a drug to mask adverse effects of the first drug.

 

If Brintellix has a negative effect on your sleep, that indicates Brintellix is the drug for you to go off first. As you've been taking it for more than a month, gradual tapering is called for.

[Paul1968]

My sleep problems definitely started with the Sertraline, and continued after I switched to Brintellix. I've also added Benadryl to help with my sleep....so now Benadryl and Ambien to help me get a good nights sleep.

 

So, No-one thinks it could be a valuable experiment for me to take say a 37.5 mg Effexor (or part of one)for a week and see if I improve? If I improve, then I'd have a hunch that my real problem is Effexor withdrawal...if nothing happens, then I guess I'm just depressed and should hope for Brintellix to start working, or start to formulate a new plan for trying something different, or going off everything again....or?

[peggy]

personally, I think you need to not look to a drug to fix the depression....after all the drug changes i would be very hesitant to restart effexor - especially if you intended to take it along with the rest of the drugs you are on..

 

Antidepressants can relieve depression in some people, but not all and with them come a whole host of other problems.  It's a bit like using a sledgehammer to break an ice cube - overkill.  You have been on medication for a lot of years and it is quite possible that you will not find one to relieve your depression at this point.  They are not drugs that only do one thing, they have a lot of knock on effects and they do change the architecture of your brain.

 

There are other non pharmaceutical ways of dealing with depression; exercise, meditation, CBT, healthy lifestyle...it's not easy, but possible - if the drugs are causing you problems then taper off them

[Paul1968]

Thank you for your response, Peggy, and everyone. I understand where you are coming from. I have struggled myself with the question: if these drugs are making me sick/anxious/sleepless then why on earth would I keep trying to take them? My only answer is desperation and the belief that the "bad" side effects should dissipate soon and then the beneficial effects should kick in...that is my reasoning from my research. But it really strains common sense to keep taking something that you think is making you ill.

 

As far as Effexor reinstatement goes, I hear you there too. My whole system is currently in flux from all these new medications...the whole subject is just too confusing for me to come to grips with...I guess my original hope was that one of you would come along and say "just take x beads of Effexor every day for a week and then re-evaluate, we've seen many people have these same problems and this can really help" ...or something like that...I guess I could still try that, the risk should be very low I would think...but I understand the wisdom of your saying that maybe a medication free existence is what I should consider aiming for.... I guess I'm just really confused and fearful about the whole situation. I just want to feel "ok". Thanks for all of the input from everyone...and the caring. It means a lot to me.

[peggy]

I feel from your posts that you are ambivalent about being drug free. Whilst you still have belief that a pharmaceutical will help you then you will continue to search for the elusive wonder drug.  

 

I believe there are very few people that medication helps.  On one hand I was actually one of them, but I have always been resistant to stay on them. I have always had a deep set aversion to being on anything for the long term.  When i first went on medication I had an amazing response - I would sort of be the poster girl for SSRI's.  Maybe if I had only stayed on them for 3months and then done a 10% taper I wouldn't still be on them 15 years later.  I periodically went off as my Dr prescribed - halving my dose every 2 weeks.  Way too fast and so a few months later i would be hit with a wall of depression and anxiety so intense i couldn't move/breathe - i just wanted to die.  I always had an inkling that the medication was actually to the cause - my depressive cycles premedication were 3 or 4 years apart, post medication I couldn't stay off.

 

So, fast forward 15 years and i am now down to about 25mg effexor and feeling great. I just have to keep it slow and steady.  

 

Depression does 'run in my family' - my grandmother used to have these periods every few years where she would disappear for months on end, that was what my depression was like - it came on, stayed a while and then went.  I would feel perfectly fine in between episodes - that kind of depression is in my opinion harder to deal with in therapy etc, I could never work out the trigger.  In the episode that i had when I went on Effexor I was also in a stressful job that no doubt made it worse. In previous episodes I wasn't working and used strategies such as intense exercise to get through, that time it wasn't enough.  I should have left the job.

 

But, getting back to your beliefs about the drugs - I believed in Effexor for 10 years, so kept going back on it.  Once I started to shift my paradigm beliefs I could accept that the drug was actually making it worse.  It is understandable to be confused and fearful - we are taught to believe in medicine.  

 

I once told my Dr that I have a love/hate relationship with effexor - I do believe I have sold my self efficacy to a drug. 

[Altostrata]

After a person has been on and off a number of psychiatric drugs, particularly if there were adverse reactions along the way, the nervous system can become sensitized to the drugs.

 

It sounds like your sleep problems started as an adverse reaction to sertraline or possibly from Effexor withdrawal syndrome, which included irritability/anger/dysphoria -- very common in withdrawal.

 

It's quite common for withdrawal syndrome to be misdiagnosed and mistreated as "relapse" or emergence of a new psychiatric disorder.

 

My guess is you have Effexor withdrawal syndrome with subsequent adverse reactions to drugs because of a sensitized nervous system.

 

My guess is the Brintellix isn't doing any good, but you've been taking it a little too long to simply quit. If I were you, I might try cutting the dosage by 25%, see what it does for a week, then decide what to do from there.

 

(Read Brintellix side effects here http://www.fda.gov/downloads/Drugs/DrugSafety/UCM370633.pdfThis is not a good drug to give to someone suffering from sleeplessness.)

 

It's possible that 10 beads of Effexor might help. Hard to tell with the cocktail you're taking. When the nervous system is sensitized by going on and off drugs, effects of drugs are very unpredictable. Adding Effexor to Brintellix is likely to exacerbate the sleep issue.

 

My own personal, non-medical opinion is that you will no longer be able to count on taking antidepressants to deal with your "depression."

[Paul1968]

Thank you so much Peggy and Altostrata. Your patient and thorough explanations and insight have really helped me. I have decided to begin tapering tomorrow. I just had an awful depressed day today, I just can't seem to shake it. Even took the dog for a long walk, which normally helps. I talked to my wife and sister, which normally helps (and it did a little bit) now I am going to pick up a self help book my therapist suggested and try to get my mind off of things. My plan is to carefully cut off 25% from my Brintellix tomorrow and do that for a week and see where things are. I'm also going to try to avoid the Clonazepam like the plague....it lists depression as a possible side effect, and I swear it makes my depression worse after about 5 hours after taking it. Once again, thank you for your caring support. I will try to update this thread with my progress and use it as a kind of log to track my progress. After the Brintellix is gone, I'll probably be interested in how to taper the Risperidone...those pills are tiny. I will also ask my pdoc about what he thinks. Thanks again for all the support and caring words. -Paul

[Altostrata]

Just try this first reduction of Brintellix before making any other reductions.

[Paul1968]

Ok. That's exactly what I'm going to do. Thanks again.

[KarenB]

Hello Paul,

 

Just dropping in to say welcome, and that we'll all be here to listen as you taper.  I am tapering Effexor and know how the withdrawal feels - I truly wouldn't wish it on my worst enemy.  There's lots of things you can do to help with the emotional side of things - check out http://survivingantidepressants.org/index.php?/forum/8-symptoms-and-self-care/

 

Hot baths with epsom salts, gentle yoga, telling a close friend and asking them to check in on you - I like having a whole raft of ideas to pick and choose from - it stops me from getting so stuck in the fearful places.  Friends are the best, so if there's no-one you could share this with in 'real' life, then keep posting here.  Strength in numbers . 

 

Hugs,

Karen

[Paul1968]

Thanks for the support, Karen. I'm going to pick up some Epsom salts on the way home from work today...and try to review the self help links...

[bubble]

I don't know how long and how often you have been taking clonazepam but benzos are very addictive and notorious for causing rebound anxiety. The wors ething is to take drugs irregularly because it destabilises the CNS. If you were taking it often, it's less harm to start taking it regularly than on and off.

 

You have a good approach to this process and I'm sure you will succeed. The best of luck!

[Paul1968]

Thanks for the tip, bubble. I've only taken maybe 22 0.5mg pills total sporadically over the last 45 days...and I think I've noticed bad emotional effects from taking them then stopping for a few days...my plan is to take them only if situation is dire...I do agree, I was wondering if maybe I should just take 0.5mg every day just to stabilize...but then I would really set myself up for dependence on them...kind of a catch 22 I guess. Thanks for your comment. -Paul

[Paul1968]

I've been thinking a lot more about Bubble's comment about the Clonazepam. I opened my Pill bottle and counted out how many I have left versus what I started out with to get an accurate measure.

 

I've taken 20 of the 0.5 mg Clonazepam pills basically randomly over the last 49 days. So an average of 0.2 mg of Clonazepam/day over the course of 49 days. Of course, some days I had 1mg (max prescribed), some days 0.5mg and many days none at all.

 

I've definitely noticed that I think they make me slightly depressed, but they do seem to take the edge off my anxiety when It's really bothering me.

 

Does anyone think I should try to stabilize on 0.2mg/day and take it every day and do a careful taper....or should I just try to never take any more of them and see if I can do it? I've never experienced anxiety like I have over the last two months of Sertraline and Brintellix start-up failure....and it has been a comfort, at least until now, to be able to have 2 of the 0.5 Clonazepam pills in my pocket "just in case"....

 

Now, after bubble's comment has had a chance to sink in, I'm wondering if by sporadically taking the Clonazepam "only when I felt I really needed it" was actually a recipe for more agony because I was jerking my brain chemical around...

 

by the way...today was my first day at 25% reduction on the Brintellix and it was more or less fine...just some afternoon anxiety. Thanks for listening.

 

-Paul

[Altostrata]

No, I would not take the clonazepam regularly. Your cocktail is complicated enough.

 

Try to take clonazepam as infrequently as possible, and at the lowest effective dosage.

[Mort81]

Hey Paul welcome to the forum and Im sorry you have to go through this process. The good news is that the people on hear know and understand whats going on and unfortunately most doctors just complicate the process by throwing more drugs at the problem that was caused by drugs.It can be a vicious cycle. Your system definitely just needs to settle down and it will. Taper very slowly and don't be too hard on yourself. It will take some time but you will heal. Check out the recovery stories on the site. We all get better It just takes time and we all heal at a different rate so sometimes we have to exercise alot of patience. Hang in there buddy everything will be okay.

[Paul1968]

Ok...that is going to be my plan. Thanks for the support.

[Help777]

Thank you so much Peggy and Altostrata. Your patient and thorough explanations and insight have really helped me. I have decided to begin tapering tomorrow. I just had an awful depressed day today, I just can't seem to shake it. Even took the dog for a long walk, which normally helps. I talked to my wife and sister, which normally helps (and it did a little bit) now I am going to pick up a self help book my therapist suggested and try to get my mind off of things. My plan is to carefully cut off 25% from my Brintellix tomorrow and do that for a week and see where things are. I'm also going to try to avoid the Clonazepam like the plague....it lists depression as a possible side effect, and I swear it makes my depression worse after about 5 hours after taking it. Once again, thank you for your caring support. I will try to update this thread with my progress and use it as a kind of log to track my progress. After the Brintellix is gone, I'll probably be interested in how to taper the Risperidone...those pills are tiny. I will also ask my pdoc about what he thinks. Thanks again for all the support and caring words. -Paul

Hi Paul,

What is the self help book you are referring to? I would be interested in it. Thanks!