hopealive: First post, restarting Effexor after post-withdrawal symptoms/relapse

[hopealive]

Hello, I came across this forum after searching for information on relapses of depression/anxiety after coming off antidepressants. It was this article about Antidepressant Withdrawal Symptoms published in Psychology Today that lead me here, and I'm really glad to see that there is support around this much-shrouded topic.

 

I'm experiencing the worst and most prolonged episode of depression and anxiety that I ever have before, and believe much of it has to do with stopping antidepressants earlier this year (150mg Effexor + 50mg Quetiapine/Seroquel for just over 3 years). I thought that tapering off over 4 months would mean that my life could return to 'normal' but discovered that only a few months after taking the last pill, anxiety and insomnia started to develop and worsen (which I hadn't felt prior to medication), and eventually led to full-blown depression. I tried 100mg Wellbutrin for a little over a month but found that it made me more anxious, so I've stopped and am now considering going back on Effexor, despite some really awful side effects like constant sweating and overheating around the head/neck area. The worst part is the constant negative, pessimistic thoughts that are so debilitating that I can't function like I used to, which has made the journey to recovery much harder.

 

It seems that my only choice now is to go back on the Effexor to ease these symptoms in the short-term, so that I can once again taper off in the longer term. Does anyone have experience with dealing with the relapses or prolonged withdrawal symptoms of depression/anxiety after stopping medication, and does it subside when you restart / reinstate antidepressants? If you experience worse symptoms after stopping, how do you ever come off these drugs for good? 

 

[Petunia]

Welcome hopealive,

I'm sorry you are having such a hard time getting off your medications, but you are not alone, this site is full of members going through exactly the same thing. Effexor is a particularly difficult drug to stop taking, but people do manage by tapering very slowly, 4 months is too fast. We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?

 

Reinstatement of a small amount of the drug can often work well to alleviate withdrawal symptoms. According to medical knowledge, reinstatement is the only way to alleviate withdrawal. Reinstatement is best done immediately upon appearance of symptoms. The more time that passes, the less likely it is to work. Once you have stabilized on a low dose of the drug, then a slower, safer taper can be started. Here is some information about reinstatement to help you decide if its something you would like to try:  About reinstating and stabilizing to stop withdrawal symptoms

 

You have been off Effexor for 6 months now, so there is no guarantee reinstating would work, but you could try a very small amount to see if it relieved your symptoms.

 

Here is a topic which explains how to take very small doses:

 

Tips for tapering off Effexor (venlafaxine)

 

What was the last dose of Effexor you were taking before you stopped completely?

 

Are you still taking 25mg of Quetiapine daily?

 

Also see:   What is withdrawal syndrome?

 

When we have a few more details, we will be in a better position to offer support and suggestions. I’m glad you found us, we’re here to support you.

 

Petunia.

[JanCarol]

Hey Hope - welcome to SA.  I'm sorry you had to come here, but as Petunia said, it's all too common.  I'm sorry you are suffering, this does indeed sound like withdrawal.

 

You were wise, and took your taper slower than the doctor would have - but you still went pretty fast.  The slower the taper, the more control you have over symptoms. 

 

I don't have anything to add to Petunia's wise words, just saying welcome.

 

And - you are not alone.

[nz11]

Hi Hopealive.

Just wanted to say how much i liked your intro title and name ...'Hopealive'

 

Thats a most wonderful and wonder-filled name and intro title. imo

welcome

 

nz11

4.30am

 

Ive never said that about someones name before.

[LJ2015]

I totally understand where you are coming from, i stopped taking citalopram 3 months ago, i didnt taper properly and have really suffered over the last three months, today I feel better physically but mentally I am a mess, I cant take it anymore so i went to my gp who suggested I go back on sertraline 50mg.  I think it will help mentally but not sure if I can take the physical side effects.   I havnt decided whether to take them or not as i feel incapable of making such an important decision.  Let me know what you decide.

[hopealive]

Thanks all for the replies, and the helpful links Petunia. nz11 - thanks, I created my handle in a rush while registering and all I could think about was ‘keeping the hope alive’ and not giving up on this battle with mental illness.

 

I have restarted my Effexor at 37.5mg 3 days ago and I already feel a tiny bit better, possibly due to the placebo effect. Feeling some slight nausea and dizziness but otherwise no side effects so far, I hope my old side effects (sweating around head/neck/chest) don’t come back on this low dose.

 

Petunia, to answer your questions:

 

My last dose of Effexor was 37.5mg in late April 2015. I basically tapered down with the standard dosage pills of 150mg > 112.5mg > 75mg > 37.5mg monthly, which I realize now was too fast. I had no idea you could split the beads and there is very little information out there about proper withdrawal while supplementing with vitamins, minerals, herbs, etc. 

 

During this time I was working with an experienced acupuncturist (who I still see) who has helped many patients come off chronic medication including antidepressants, so I was taking herbal supplements and getting the needles weekly for a few months. I felt fine the entire time until the last pill of Effexor, after which I got a really bad flurry of head zaps, headaches, nausea, etc for about a week. [side note: there’s some studies out there that say acupuncture can work effectively to ease depression http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782410/

any thoughts on this?] I took some detox herbs for that week and then the withdrawal effects eventually dissipated on its own… I felt great for about 2 months and then the anxiety slowly crept it, first worrisome thoughts and then insomnia, mini panic attacks, social withdrawal, avoidance, and now full-blown depression for over 3 months. It’s been hell trying to find the right medication combo and I wish I knew about reinstating the Effexor earlier instead of trying Wellbutrin and going back on Seroquel.

 

I am still taking 25mg Seroquel now and am wondering if I should stop soon, now that I’m back on 37.5mg Effexor. I was on both at higher doses before because I am mildly bipolar 2 and antidepressants caused slight mania, but it may not be necessary now at a lower dose of Effexor. My acupuncturist says I should quit Seroquel as it’s making my heart rate and blood pressure low, giving me low energy/numbness but my doctor says I should stay on it, which feels like generic advice. Maybe I should continue until the Effexor stabilizes, then try and quit?

 

Last point, I just started reading a book my acupuncturist recommended called "Nutrient Power" by William J. Walsh. It’s a good resource for anyone interested into understanding more about natural supplements to replace psychiatric drugs in the long term. 

[peggy]

Hi hopealive...

 

welcome!

 

from my experience you should settle within a couple of weeks on the 37.5mg effexor.  Once stabilised, wait a good 3 months and then commence your 10% taper.  

 

Regarding seroquel - you will need to consider a 10% taper of that as well.  Some people here have done multiple drug tapers together - alternating drugs and going very slow, others have tapered off one completely and then commenced the other.  I will let someone with more knowledge advise you on that one.

[hopealive]

I totally understand where you are coming from, i stopped taking citalopram 3 months ago, i didnt taper properly and have really suffered over the last three months, today I feel better physically but mentally I am a mess, I cant take it anymore so i went to my gp who suggested I go back on sertraline 50mg.  I think it will help mentally but not sure if I can take the physical side effects.   I havnt decided whether to take them or not as i feel incapable of making such an important decision.  Let me know what you decide.

 

Hi hopealive...

 

welcome!

 

from my experience you should settle within a couple of weeks on the 37.5mg effexor.  Once stabilised, wait a good 3 months and then commence your 10% taper.  

 

Regarding seroquel - you will need to consider a 10% taper of that as well.  Some people here have done multiple drug tapers together - alternating drugs and going very slow, others have tapered off one completely and then commenced the other.  I will let someone with more knowledge advise you on that one.

 

Thanks peggy, I guess I wonder if I actually need to be on Seroquel again as I only started that ~4 weeks ago?

 

When I came off Effexor + Seroquel I only tapered Seroquel from 50mg > 25mg over the span of a few weeks, then stopped altogether while tapering off Effexor. I didn't notice any withdrawal effects of the Seroquel possibly because I was on a higher dosage of 150mg Effexor. This time around for reasons I won't bore everyone with, I've started Seroquel first, which only made me feel numb, flat, and low energy HOWEVER it did help with the insomnia and anxiety. But after restarting Effexor very recently, I have hope that 37.5mg might help me stabilize after a few weeks.

 

Your story of tapering in your signature makes it seem like Effexor is an incredibly hard drug to come off of, since withdrawal effects may not appear for months after stopping. I am experiencing the same thing now and had never imagined that getting off these pills would cause worse symptoms than what I started them for! Have you been off Effexor since Sept 2013, and how was the slow tapering process?

[Altostrata]

Welcome, hopealive.

 

If you do get those symptoms from 37.5mg Effexor, it is because the dosage is too much for you. I would have suggested a lower dosage, perhaps 10mg.

 

It may take you some months to stabilize.

 

Acupuncture might help some withdrawal symptoms. It's important to understand that withdrawal syndrome is not the same as "depression" and is not a psychiatric illness. Rather, it is an adverse drug reaction, "depression" and all.

 

Many people do better with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

See our Symptoms and Self-care forum  http://survivingantidepressants.org/index.php?/forum/8-symptoms-and-self-care/for suggestions about how to cope with symptoms.

[hopealive]

Welcome, hopealive.

 

If you do get those symptoms from 37.5mg Effexor, it is because the dosage is too much for you. I would have suggested a lower dosage, perhaps 10mg.

 

It may take you some months to stabilize.

 

Acupuncture might help some withdrawal symptoms. It's important to understand that withdrawal syndrome is not the same as "depression" and is not a psychiatric illness. Rather, it is an adverse drug reaction, "depression" and all.

 

Many people do better with fish oil and magnesium supplements, see

http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

See our Symptoms and Self-care forum  http://survivingantidepressants.org/index.php?/forum/8-symptoms-and-self-care/for suggestions about how to cope with symptoms.

 

Thanks Altostrata, it seems that it may be too late to start at 10mg as it has already been day 4 back on 37.5mg Effexor.

 

I hate being back on the drugs but it was literally my last resort, as the anxiety, insomnia, social avoidance / neuro-emotions of shame, guilt, fear, and iatrogenic 'depression' became all too much to bear. As they say, sometimes it takes two steps back to take a step forward, so I really hope that reinstatement, stabilizing, then a very slow taper will help me get off for good.

 

I'm currently also taking multivitamins (the expensive brands with less filler), fish oil, and some herbs my acupuncturist prepared to help me sleep. Stopped taking the seroquel for 2 nights now after cutting down to 12.5mg for a week and it seems ok for now... seroquel made my heartbeat too slow and irregular and I already have a history of some heart issues.

[hopealive]

*moved from symptoms forum

 

The worst side effects I have always experienced with Effexor are sweating (profusely around the head, neck, and chest area) and itchy skin, specifically dermatographia or skin writing, which is a tingly/itchy sensation that causes slight red bumps in the skin, and then becomes raised once I scratch it but goes away within 20 minutes or so.

 

The sweating is particularly bad as it seems that my body 'overheats' very easily and I sweat about 5x more than I used to once my heart rate or temperature increases. Apparently there is medication that alleviates the sweating (http://asp.cumc.columbia.edu/psych/asktheexperts/ask_the_experts_inquiry.asp?SI=583) but I really don't want to add another drug to the mix.

 

Does anyone else experience these symptoms, and how to you manage it? Have you found anything that helps ease these symptoms?

Edited November 12, 2015 by Petunia
added note

[Petunia]

Hopealive, there's some information and discussion about temperature and sweating related to withdrawal in this topic: 

Body Temperature Dysregulation: fever, chills, too hot, too cold

Itching is also a common withdrawal symptom and can sometimes be relieved with medicated powder, especially if its caused by sweating.

 

Because this is a support site for tapering and withdrawal, we don't encourage discussion about various side effects caused by taking drugs and how to manage them. All psychiatric drugs have long lists of potential unpleasant and dangerous effects which can be found by using google. Unwanted side effects from psychiatric drugs are best dealt with by carefully tapering from the offending drug, not adding another drug or substance, this is how people end up on a cocktail of drugs while their health continues to deteriorate.

[KarenB]

Hello Hopealive,

 

I love your strong wish to keep that hope alive - it's the most important thing.  Just wanted to say that I'm tapering Effexor too, and with my experiences and after reading on this site for nearly a year now, I feel more hope than ever about getting drug-free and being okay too.  Yes it's horribly hard, and yes it can take a long time, but it can be done and we will find ourselves in much better places.  

 

Just take the time needed to get really stable, then go really gently in the tapering with good holds along the way. 

 

Oh, and multi-vitamins can sometimes be too activating for people in withdrawal.

 

Best wishes,

KarenB   

[hopealive]

Hello Hopealive,

 

I love your strong wish to keep that hope alive - it's the most important thing.  Just wanted to say that I'm tapering Effexor too, and with my experiences and after reading on this site for nearly a year now, I feel more hope than ever about getting drug-free and being okay too.  Yes it's horribly hard, and yes it can take a long time, but it can be done and we will find ourselves in much better places.  

 

Just take the time needed to get really stable, then go really gently in the tapering with good holds along the way. 

 

Oh, and multi-vitamins can sometimes be too activating for people in withdrawal.

 

Best wishes,

KarenB   

 

Thank you KarenB for the support. 

 

It's been a week since reinstating Effexor and I've started to feel a bit better, although the hopeless feelings are still there as well as the minor headaches. I've been feeling really lonely and realize there are underlying issues that I still need to work on and heal. I've started to feel really lonely at times over the past week and wonder how much of my symptoms are withdrawal related, and how much is my relapse of depression. I just hope this low dose will stabilize and make it easier to function again, so that I can start rebuilding my life again. 

 

I'll keep this thread updated to track my progress over the next little while.

[KarenB]

Hello Hope,

 

I'm sorry you are feeling lonely - is it possible it's because you are feeling a bit more these days, and so are actually noticing the lonliness?  I got like that after a couple of months of tapering Effexor, and I realised I needed to get some close friends more involved in my life again.  Nothing too stressful, just a gentle visit or something. 

 

The fact that you have started to feel a bit better indicates that you will continue to stabilise - just keep giving it time.  And you have already started to re-build your life because these are the first steps - making a strong and stable foundation for everything that will come after. 

 

It is very common to find our underlying issues still there waiting for us to heal them.  SSRIs don't heal, they just mask.  Do you have any instincts on what might help you with these?   Maybe face-to-face therapy could be a start?  There are many non-drug approaches to managing depression.  Have a look at http://survivingantidepressants.org/index.php?/topic/1112-non-drug-techniques-to-cope-with-emotional-symptoms/ for some ideas.  

 

It can be hard to separate out whether it's withdrawal or the underlying condition, (probably a bit of both) but either way you can manage it with the same nurturing techniques.  I believe depression is a perfectly normal response to trauma and/or a harsh, mixed-up world.  It comes in waves, and we don't need to panic about it - we can learn to manage it, and we can heal.

 

You're going to be fine Hopealive, just keep stabilising for now and start some real nurturing practises.

KarenB 

[hopealive]

Hi Karen, thank you for your kind words of encouragement, I really appreciate it.

 

I think you're right about the loneliness - I've been able to feel more and cry again, which is a relief from feeling the numbness when on Seroquel and going through the 'merry-go-round' of finding the right medication to stabilize. I only wish that I reinstated the Effexor sooner so I could find the physical and mental strength to cope with rebuilding again. I've started to see a new therapist and more regularly again and trying to be kind to myself throughout this process, as it feels like I've taken 2 steps backwards since coming off the drugs.

 

Reaching out to people when feeling depressed is like a double-edged sword sometimes: I want to relieve the loneliness, but I'm also aware of being very withdrawn, awkward, drawing blanks and finding it difficult to make conversation, feeling worse about myself when I hear about how great other people's lives are... the negative self-talk is hard cycle to break.

 

I started to read your blog and can relate to a lot of things you wrote about - I too suffer from childhood trauma and the pain / healing feels never-ending sometimes. It's inspiring to see the hope and tenacity in your words, and thank you again for your support.

[KarenB]

I think reaching out to friends when we are in these really hard places needs to be done in a different way than when we are 'well.'  I don't know how close you are to your friends so it may or may not work for you, but here's what I've done over this past year.

 

Even before I started tapering I explained to my closest friends what was going to be happening in terms of withdrawal.  I talked about how (due to adverse reactions) I was finding it increasingly difficult to either talk on the phone or make conversation or have the energy to sit up when they visited.  I said they may need to let themselves in, make their own cup of tea, and maybe just sit with me.  I said just having someone around when I was struggling was what I needed, and that knowing I didn't need to talk took a huge weight off me. 

 

Two of my friends were particularly understanding.  Each of them has either popped in or phoned weekly for most of this year to check I'm okay.  Sometimes when they've come over all I've done is cry, and they've just sat on the couch, neither of us saying anything.  It's very comforting and supportive.

 

It made me realise that people might be more able to step outside of the 'norm' of friendships and visiting etc, if only we explain what is really needed and why.  If we don't try to keep up the pretense, then they too are able to leave it behind.   

 

Of course, it's important to choose people you really trust.  

 

It's good to hear you are being kind to yourself, and seeing a therapist more often.  You are on a good path now.

 

KarenB 

[ChessieCat]

Hi Hopealive,

 

Just wanted to drop in and say hello.

 

I also suffer from loneliness.  I don't mind my own company but at times the loneliness is very deep.

 

When I go out (whether volunteer work, shopping or an outing) I put off going home.  It is something that I have done for at least 30 years.  Eighteen months ago I started talking to another lady when we were both having lunch in a food court and when I mentioned that I had had a great day (I had been to a local city festival and spent time with a good friend) and I didn't want to go home because I knew I would start to feel down.  She gave me a really good tip:

 

Think about something that I could do when I went home, eg watch a DVD or movie or plan to do a puzzle.  This particular time I chose to watch a DVD and was reminding myself on the 1/2 hour drive home that I had a plan to do something.  As it was, when I got home I didn't end up watching the DVD but I had overcome the dread I usually felt.  Since then I have used this regularly and found it very helpful.

 

This idea may not be relevant to you at the moment, but might help in the future.

 

Best wishes,

CC

[hopealive]

KarenB and ChessieCat - thanks for the support, and apologies for this delayed response.

 

It's been a while since I've visited the forum and I wanted to update my progress so far. Doing a lot better and feeling less depressed now, although I've had to bump up my dose to 75mg Effexor. I'm not sure how much of this persistent low mood is depression or withdrawal effects; guess I'll never really know but all I know is that the meds do help me, as much as I hate the thought of being on them long-term.

[JanCarol]

Hey Hope - welcome to SA!  I'm glad you found us when you did - when you had time to reinstate, before it got really, really bad.  I know - it got really bad - but the thing about these drugs is:  they can always be worse than you think.

 

I don't mean that to discourage you - instead, to remind you that they are powerful mind (and body!) changing drugs that are challenging, at best, to deal with.  They can be helpful, but we are rarely given the complete information, especially from doctors.

 

Rhi's description of healing the brain

 

You write:

 

I am mildly bipolar 2 and antidepressants caused slight mania

 

Looking at your history, it seems that what happened to me, happened to you.

 

The antidepressants are accelerators - and when a healthy body (notice I'm not saying emotions or mind, here) is given antidepressants, it can throw the whole system into overdrive.

 

It's carefully documented in Robert Whitaker's excellent book, "Anatomy of an Epidemic" - how many "bipolar" diagnoses are because of antidepressants and "ADHD" drugs (also major stimulants).

 

"Bipolar" used to be rare.  Bipolar 2 was non-existent before the DSM3.  Now, everybody and their dog is "bipolar" or "ADHD" or even "schizoaffective" and "schizophrenic".  What used to be a fraction of a percent of the population, has become widespread.  The p-docs tell us it's because "diagnosis" is better. 

 

I believe it is, as Whitaker says, "medicalizing normal emotions." - or worse, "medicalizing side effects."  Challenge your diagnosis.  Learn to describe your symptoms in terms of emotions and feeling words.  Feeling Vocabulary Wheel

 

Additionally, there are no "mood stabilizers."  Seroquel is a neuroleptic (called "anti-psychotic by Pharma but really, it's anti-brain), most of the mood stabilizers are anti-seizure drugs.  These drugs are used because they flatten emotion, brain function, and so much more.  This "stabilize the mood" as a side effect - but the whole person is affected - not just the brain.

 

Fortunately, you were on a small dose for a short time.  But the hooey about "you are bipolar = you need a mood stabilizer" is just that:  hooey.  You are having symptoms, side effect ("manic") - it wouldn't occur to them that you need OFF the drug that they so "caringly" prescribed for you?

 

You wrote:

 

although I've had to bump up my dose to 75

I must remind you what Alto said:

 

If you do get those symptoms from 37.5mg Effexor, it is because the dosage is too much for you. I would have suggested a lower dosage, perhaps 10mg.

 

Please do not make any more changes.  Please hold where you are unless the 75 mg is too stimulating.  

 

How is it going, the 75 mg?  Did it improve things?

 

Also, please put in your signature, your updated dose so that we can see it everywhere you post.

 

Last, you mused:

 

I'm not sure how much of this persistent low mood is depression or withdrawal effects; guess I'll never really know but all I know is that the meds do help me, as much as I hate the thought of being on them long-term.

 

Please see:

Is It Withdrawal or Relapse? Or Something Else?

 

Your "bipolar" was likely from the Citalopram and Effexor.  This "worst depression" - it's worse than the original depression that started you on the drugs, isn't it?  That's a sign that it is from withdrawal, as the drugs intensify and amplify emotions.  See what others have said about these emotional symptoms:

 

Neuro-emotion

 

and look to use:  Non-drug techniques to cope with emotional symptoms

 

I hope you see the sun today, and I look forward to hearing how you are doing.

[SquirrellyGirl]

Hi Hope, 

 

I wanted to drop by and say hi.  I wanted to share that I also had horrific anxiety and depression in protracted withdrawal, far worse than I had ever had before, as well as severe insomnia. My doctor reinstated 37.5 mg after Remeron up to 37.5 mg didn't work.  This was all before I knew about protracted WD and just thought I was going insane, pretty much.  I had been off for 10 months or so.  When I took that first reinstatement dose, I had a total turn-around within an hour!  I was really lucky that reinstatement worked. 

 

I don't know what part the Remeron might have played.  The Remeron seemed to help at 7.5 mg but then didn't and so I kept upping the dose until at 37.5 mg I was totally non-functional and desperate.  When my p-doc suggested going back on Effexor because I had "tolerated it well" in the past, he said that the two together are known as California Rocket Fuel, that they have a synergistic effect.  Maybe that was true.  Either the Remeron pooped out real fast or it just couldn't hold its own against the Effexor WD.   I guess I'll never know. 

 

I do want to say that at about 6.5 mo post reinstatement, I am now at about 29 mg Effexor (below the minimum effective therapeutic dose) and 16 mg Remeron, and I feel better now than when I reinstated.  We shall see as I get down into the lower end of things where things seem to go wonky for people.  I don't know if that gives you any hope.  

 

I was on Effexor for 12 years, and on others including Prozac and Wellbutrin for another eight years prior, so I have a long history of AD use.  I hold out hope that you and I will be more examples of life feeling better than it ever has since before or during drugs!

 

SG

[ang]

Hello hopealive 

if you are on effexor, you need the seroquel,  effexor causes sleep disturbances, counteracted by the sedative qualities of seroquel.   

 

Effexor is the worst, bar paxil to get off,  my opinion only, of course... Been there done that.

 

Reinstate, and go very, very slow......... cut the seroquel, and use it as a sedative, and appetite stimulant. as you cut the effexor.......... 

 

Hugs and more hugs, hope you have a happy Christmas............

 

Ang/.

[toomanymeds]

How are you doing Hopewell????

[toomanymeds]

How are you doing Hopewell????