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hopes4hopes Is it the Effexor causing current anxiety, insomnia, akathisia?

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hopes4hopes

Hi there, I’m in my mid 40’s and am here hoping for some help with my current issues with anxiety, agitation, insomnia (early morning awkening) and akathisia, which I think may be medication related. My current meds are:

  • Effexor immediate release tabs, 100mg in the morning, 50mg in the evening - taken for 18 years at various doses
  • Trazodone 50mg at bedtime - taken for 18 years
  • Klonopin 0.25mg 1-2 times/day as needed - taken for about 6 mos
  • Lamictal 100mg twice a day - titrated up over several weeks and at stable dose for about 2 weeks now
  • Risperdal 0.5mg at bedtime, 2-4 times a week as needed, for several weeks
  • Restoril 15mg at bedtime, 2-4 times a week as needed (not with the risperdal though), for a few weeks
  • Omega 3's, 4 capsules a day
  • Vit D3 5000IU /day

So my story in a nutshell is that in early 1997 when I was 26, I became clinically depressed after a bad breakup. I was sequentially given a large number of antidepressants and other psych meds including Prozac, Serzone, Paxil, Wellbutrin, Remeron, Buspar, Nortryptiline, Depakote … none of which I could tolerate for one reason or another. SSRIs seemed to agitate me fairly quickly and the depression became a terrible agitated depression and I was hospitalized twice. The second time, I was there for 3 weeks and somehow was put on a cocktail that actually worked: Effexor, Trazodone, Risperdal. 

 

I came off the risperdal fairly quickly on my own and, after that, I was able to function fairly well and did quite well for several years. I just took the Effexor (mostly at 100mg twice a day) and Trazodone 50 at night, until the end of 2003, at which point I decided to taper off both over 2-3 months, which was associated with the brain zaps and other withdrawal badness but I was off both by the end of the year.

 

In Spring 2004 I had what I thought was a relapse into an awful agitated depression (but which I now think may have in fact been withdrawal from Effexor) and restarting Effexor did not seem to help. I was tried sequentially on yet another bevy of psych meds including Prozac, Zyprexa, Seroquel, Remeron, Buspar, Librax, Neurontin, Klonopin, Cymbalta, Lithium, Lexapro, Abilify, none of which made a dent in the agitated depression ... there was a suicide attempt and by summer/fall was I hospitalized twice again. The second time, I got ECT, just 8 unilateral treatments, which was CURATIVE and incredibly I was well again, and back on Effexor 100mg in the morning and 50mg in the evening, along with trazodone 50mg at bedtime.

 

This seemed to keep me stable for many years, and I did very well again, was high functioning, accomplished a lot and was quite happy with my life. Very social, able to work hard, very in control of things and overall very content. 

 

In early 2014 I got into a relationship which had good things about it but also some very very difficult qualities, and my self-esteem was slowly eroded over the course of the next year or so. In addition, for whatever reason, I decided to taper off the evening dose of effexor at some point, so that I was only on 100mg in the morning (again, immediate release doses). Still, I remained functional until late 2014/early 2015 when I started noticing increasing anxiety, which seemed relationship-related at first, but slowly began to be more constant. 

 

By March of 2015 (this year) I was waking up early every day, which has always been a sign of my clinical depressions in the past. By May I was unable to work; the relationship became strained and we ultimately broke up, which added to the stress. I increased the Effexor back to 100mg/50mg and then to 100mg twice a day, and also saw a pdoc who prescribed Klonopin 0.5mg tabs as needed, of which I've only taken a half tab as needed, being terrified of benzo dependence, although I'm surely dependent by now as it’s November and I’ve taken at least 0.25mg every day since May (but not more than twice per day).

 

The anxiety has continued and worsened along with recurrent clinical depression, and I was tried this time (on top of the Effexor and traz) on Zyprexa, seroquel, Abilify, Lyrica, Lexapro, none of which helped, or side effects were too much.

 

During this entire time I’ve still had early morning awakening, never sleeping past 430AM. I never have a problem *falling* asleep. 

 

In June-August 2015 I had another round of ECT again hoping for a similar curative effect as in 2004, and wound up having 25 treatments including 15 bilateral and several with ketamine. Unfortunately this did not help much and I was having the same amount of bad anxiety (with consequent depression) as before the ECT. This along with discouraging memory loss and cognitive impairment, which I still have effects from.

 

Since September, I’ve gone back to Effexor 100mg in the morning and 50 in the evening. I was recently started on Lamictal which I’m currently on 100 twice a day, Restoril 15mg for sleep as needed, Risperdal 0.5 as needed for sleep. No matter what I try for sleep (zyprexa, seroquel, restoril up to 45mg, risperdal) I simply cannot sleep past 4-430AM. My pdoc gave me Halcion 0.25 to try when I wake up early, but that doesn’t help either.

 

Recently, my pdoc has attempted to switch the Effexor to Pristiq (too activating, plus effexor withdrawals, sweating, worse anxiety), and Brintellix (also too activating, with headache, worse akathisia, and could not go down on Effexor much without brain zaps and that sinking headache feeling). In fact the Lamictal is somewhat activating as well, but I’ve stuck with it. Everything seems to make the anxiety worse. Actually, I feel better for a day or two after starting a new med, then the anxiety catches up and I can’t tolerate it. 

 

This whole time I’ve wondered if it’s just the Effexor which somehow stopped working in 2014 and is now just giving me anxiety, akathisia, agitation. Or, am I just not taking enough of it?? Regardless, I brought the dose down yesterday to 75mg in the morning and 50mg in the evening.

 

I feel like I have to get off the Effexor somehow but I’m terrified of another severely agitated depression occuring like in 2004. The depression this time has not nearly been as bad as the previous ones, and right now I think it’s mostly the constant anxiety that’s the problem. However I still have very little interest in almost anything I used to enjoy, and am not functioning very well in areas of my life that I had absolutely no problems handling for years. It is not anywhere near an agitated depression though, at least not yet.

 

The anxiety is quite bad though, and has led to near-agoraphobia and an almost complete inability to socialize or even to listen to music or watch TV - too many things trigger anxiety attacks or feelings that I’ve wasted my life somehow or that I’m falling behind in my life … things that aren’t logical but my mind just feels twisted and having odd anxious thoughts constantly. 

 

I’m tired of adding more and more meds and this website has given me hope that maybe the problem isn’t “not enough meds” but “too many meds”.

 

I was wondering if there are any suggestions on what I should try … I feel like the Lamictal should help at least with preventing another massive depression if I come off the Effexor? Yet the Lamictal is another med now that I’m stuck on. 

 

BTW my diagnosis during most of this has been unipolar major depression, although my current pdoc feels like there might be a component of Bipolar 2, hence the Lamictal.

 

Also, I started rTMS (repetitive transcranial magnetic stimulation) last week in a “last-ditch attempt” to try to control the depression and anxiety; hopes are not high for this but I figure it can’t hurt …

 

I'm so pissed that I've sunk back into barely functioning depression and anxiety after being so well and high functioning for so many years ... so pissed :(

 

Sorry for this huge post but if anyone has any suggestions I would greatly appreciate it. Thanks in advance. 

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ChessieCat

Hi hopes4hopes,

 

Welcome to SA,

 

I've just read you intro post (which you can use to ask questions and  as a type of journal from now on).  It is long, but I think it will be very helpful for the people here to understand your whole situation.  It's good that you've also included you history in your signature.

 

There are other members here who will be better able to offer suggestions but I'll point you to a couple of topics that you can be reading which might help you understand the information that will possibility be discussed.

 

Why taper by 10% of my dosage?

Why taper?

Important topics in the Tapering forum and FAQ

All the best, you've come to a great informative forum with supportive and helpful members.

 

CC

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hopes4hopes

Thank you ChessieCat, I will take a look at those links you shared.

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rausmitcha

Hi!

Just thought I'd share what's really helped me with sleep disturbances and akathisia.

Magnesium Citrate. I swear by it!! I take two gel caps at night. Get a chelated form of Magnesium- not magnesium oxide- because they are absorbed better. My akathisia used to make me cry it was so bad. Then I read about Magnesium citrate and tried it. It works very well. Take care of yourself

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nz11

Just thought I'd share what's really helped me with sleep disturbances and akathisia.

Magnesium Citrate. I swear by it!! I take two gel caps at night. Get a chelated form of Magnesium- not magnesium oxide- because they are absorbed better.

Thanks for this i tried 'magnesium ultra' dont know if that is a chelated form but does say on the back free of magnesium oxide. But to be honest it didnt seem to do anything....maybe i give it another go then.

 

Sorry hopes4hopes. Welcome.

Later ....holy crap ...that is some drug cocktail you are on.

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nz11

ok i ran some of this stuff through  the drug interaction checker.

 

Interactions between your selected drugs
Major trazodone venlafaxine

Applies to: trazodone, Effexor (venlafaxine)

Using traZODone together with venlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate clonazepam temazepam

Applies to: Klonopin (clonazepam), Restoril (temazepam)

Using clonazePAM together with temazepam may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate risperidone lamotrigine

Applies to: Risperdal (risperidone), Lamictal (lamotrigine)

Using risperiDONE together with lamoTRIgine can increase your blood levels of risperiDONE. This can cause side effects such as excessive drowsiness, dizziness, increase in heart rate, seizures, and tremors. Talk with your doctor before using these medications together, and report any side effects promptly. You may need a dose adjustment or special tests to safely take both medications. Avoid driving until you know how these medications will affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate trazodone lamotrigine

Applies to: trazodone, Lamictal (lamotrigine)

Using traZODone together with lamoTRIgine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate temazepam lamotrigine

Applies to: Restoril (temazepam), Lamictal (lamotrigine)

Using temazepam together with lamoTRIgine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate clonazepam lamotrigine

Applies to: Klonopin (clonazepam), Lamictal (lamotrigine)

Using clonazePAM together with lamoTRIgine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate risperidone venlafaxine

Applies to: Risperdal (risperidone), Effexor (venlafaxine)

Using risperiDONE together with venlafaxine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate temazepam venlafaxine

Applies to: Restoril (temazepam), Effexor (venlafaxine)

Using temazepam together with venlafaxine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate clonazepam venlafaxine

Applies to: Klonopin (clonazepam), Effexor (venlafaxine)

Using clonazePAM together with venlafaxine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate trazodone risperidone

Applies to: trazodone, Risperdal (risperidone)

Using traZODone together with risperiDONE can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate temazepam risperidone

Applies to: Restoril (temazepam), Risperdal (risperidone)

Using temazepam together with risperiDONE may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate clonazepam risperidone

Applies to: Klonopin (clonazepam), Risperdal (risperidone)

Using clonazePAM together with risperiDONE may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate temazepam trazodone

Applies to: Restoril (temazepam), trazodone

Using temazepam together with traZODone may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate clonazepam trazodone

Applies to: Klonopin (clonazepam), trazodone

Using clonazePAM together with traZODone may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate venlafaxine lamotrigine

Applies to: Effexor (venlafaxine), Lamictal (lamotrigine)

Using venlafaxine together with lamoTRIgine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs that your selected drugs interact with Interactions between your selected drugs and food
Moderate trazodone food

Applies to: trazodone

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Moderate risperidone food

Applies to: Risperdal (risperidone)

RisperiDONE oral solution should not be mixed with tea or cola. It may be taken with water, coffee, orange juice, or low-fat milk. Avoid drinking alcohol. It can increase some of the side effects of risperiDONE. You may feel more restless, drowsy, dizzy, and experience blurred vision if you take if with alcohol.

Switch to professional interaction data

Moderate venlafaxine food

Applies to: Effexor (venlafaxine)

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Moderate lamotrigine food

Applies to: Lamictal (lamotrigine)

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

  • trazodone
  • venlafaxine (active ingredient in Effexor)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication Benzodiazepines

Therapeutic duplication

The recommended maximum number of medicines in the 'benzodiazepines' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'benzodiazepines' category:

  • clonazepam (active ingredient in Klonopin)
  • temazepam (active ingredient in Restoril)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication Psychotherapeutic agents

Therapeutic duplication

The recommended maximum number of medicines in the 'psychotherapeutic agents' category to be taken concurrently is usually three. Your list includes seven medicines belonging to the 'psychotherapeutic agents' category:

  • trazodone
  • venlafaxine (active ingredient in Effexor)
  • clonazepam (active ingredient in Klonopin)
  • temazepam (active ingredient in Restoril)
  • risperidone (active ingredient in Risperdal)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication CNS drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'CNS drugs' category to be taken concurrently is usually three. Your list includes nine medicines belonging to the 'CNS drugs' category:

  • trazodone
  • venlafaxine (active ingredient in Effexor)
  • clonazepam (active ingredient in Klonopin)
  • temazepam (active ingredient in Restoril)
  • risperidone (active ingredient in Risperdal)
  • lamotrigine (active ingredient in Lamictal)

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

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nz11

BTW my diagnosis during most of this has been unipolar major depression, although my current pdoc feels like there might be a component of Bipolar 2, hence the Lamictal.

 

Do you know what i reckon.

I feel your pdoc is misinformed these are not harmless shiny red apples he is peddling. (Thats a very nice statement for me regarding these people).

It may be time to find a new doctor someone who will work with you to get you off this stuff.

It may be worth checking out the recommended doctors thread.

 

I am so sorry you have been put through this.

 

Do you have a library near you then may i suggest a book... its called 'psychiatric drug withdrawal' by P Breggin.2013

 

I wonder if Shipko lives in LA ...i'll get back to you.

Later...

 

www.stuartshipko.com
Stuart Shipko, M.D. Psychiatry and Neurology
97 W. Bellevue Dr., Pasadena, CA 91105
phone: 626 577 8290
fax: 626-795-3527

He lives in Pasadena...is that LA?? Well its CA so maybe it is ....hey i 'm just a country boy from ekatahuna. Besides we all make mistakes ..like the american bus driver woman when in kansas many years ago who thought i lived in Oakland ...When i told her auckland  in NZ she said 'you are good at english'

I just said 'why thankyou ...we learn it in school you know'

 

Well its an option

Good luck

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ChessieCat

Hi again,

 

Within the Important Topics for Tapering there one about Which Drug to Taper First?

 

I wasn't sure if you had seen it so I thought I'd point it out.  Further down in that post there are links to TAPERING OFF SPECIFIC PSYCHIATRIC DRUGS.

 

Someone with more knowledge in the area of multiple medication with suggestions on what you might be able to do should be along soon.

 

If you are planning to see a doctor after reading through the drug interaction list that NZ posted, my suggestion would be to wait until you have received some ideas of what to do BEFORE you see the doctor.  Then read up on those ideas (and ask questions) if you need to, so that when you see the doctor you are armed with information so you will be able to have a conversation (ie not being told what to do) about what you would like to try.  The doctor will possibly suggest you do a fast taper or going cold turkey off one or more of the medications.  Having the knowledge is going to help you to make your own decisions about your body and your health.

 

I hope this helps.

 

CC

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Austin

 

Later ....holy crap ...that is some drug cocktail you are on.

 

 

Yeah. . . holy hell.  I thought I had been on a lot of stuff. . .

 

Hang in there hopes.  I just read your entire post and literally the first thought that jumped out at me is that if you've been through all that, a little withdrawal should be relatively easy.  Not EASY easy, but by comparison  I don't mean to diminish what you're feeling, but you're obviously a pretty strong person to have put up with all that and still be here.  So, high fives for that.

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hopes4hopes

Wow, thank you everyone for the suggestions. Rausmitcha, I actually have some chelated magnesium that I haven't been using (wasn't sure it was helping). But I'll give it another try. And thanks Austin for the kind words. 

 

Nz11, this Dr. Shipko's office is actually less than a 5-7 drive from where I live!! Especially since you're researching from New Zealand? What are the chances of that?

 

What about Dr. Shipko makes you recommend him? Is he particularly known for helping people with their meds cocktails? 

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LoveandLight

So happy you've found this site :) best wishes.

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Pugknows

Hi Hopes,

 

All the drugs you are taking are likely causing you to feel so poorly. NZ11 did you a solid collecting the drug interaction data for you and you seem to be flirting with some dangerous incompatibilities.

 

I wish you all the best getting off the drug cocktail you're on. You have taken the first step by finding this forum and there are many people on this site who will support you.

 

Love, Sofa

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Pugknows

I'm not a fan of Shipko either. Many bad stories I've personally encountered from his patients.

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nz11

I'm not a fan of Shipko either. Many bad stories I've personally encountered from his patients.

Wow sorry to hear this.

I felt Shipko was at least kind of getting it. I also think he is a generous kind person.

 

Hopes4hopes ..at the end of the day you have to take responsibility for what you swallow and we all need to  spend time doing research and homework before we swallow it. World authority s are now referring people to this site. There is a mountain of gold on this site its worth your while reading some of it.

 

I looked at that link...i think there are dark forces against people who want to expose crime. eg Elliot Spitzer.

 

I actually liked what Shipko said to that woman 'there is nothing wrong with you' if more doctors said that the world would be in a much healthier place.

(what about #4 that was positive).

 

 We need more people to say hey there is nothing wrong with you.

 

i wonder what Shipko would say to a person presenting  regarding ....a relationship breakup say

there is nothing wrong with you

or you have 'faulty wiring' a 'chemical imbalance' ...

 

....one answer leads to personal growth, empathy, compassion, strength and resolve the other often leads to a false concept of self a push down the slippery slopped rabbit hole of psych druggery inducing  the possiiblilty of a  lifetime of chronic illness.

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hopes4hopes

Pug/sofa, yes there do seem to be a lot of interactions ... I'm going to hold off on Shipko for the time being.

 

I'm going down to 50mg twice a day on the Effexor today. This after being at 75mg in the morning and 50mg in the evening not too many days, down from 100mg in the morning and 50mg in the evening before that. 

 

I've read on these pages that at the higher doses the withdrawal symptoms aren't as bad ... I've been through the withdrawal mult times in the past so I think I know what to expect (and not looking forward to it but hopefully will just be a few days worth of symptoms). 

 

Just want this anxiety/akathisia to be better ASAP. Not planning to go down any further for a little while though.

 

Also hoping the Lamictal will hold off any recurrent depressive symptoms for the time being; not sure if that is realistic or not. Supposedly it's been shown to help keep depressions at bay. 

 

Honestly, I'm torn. I really do think the Effexor saved my life in 1997 and has helped me through the years; coming off of it in 2003-2004 led to either a relapse or at least a recurrence of crippling agitated depression, which I absolutely cannot have happen again. 

 

On the other hand, I've been on it 18 years now and keep reading about "poop-out" and wonder if this is what happened with the Fex, and that all I'm getting is the side effects from it now - the excessively activating, anxious, paradoxically depressive side effects. I've remained on it all year and the anxiety just never seems to go away (unless I take a klono or something like that). 

 

I really appreciate everyone's thoughts and hope your own journeys are going alright ... 

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nz11

H4H

Is it ok if i just point out to you the link on tapering at 10% that cc gave you. Your planned drop may prove to be too much.

 

I've read on these pages that at the higher doses the withdrawal symptoms aren't as bad

Perhaps for a majority but actually i dont know so much.

Withdrawal can be delayed and cumulative perhaps thats why this thinking occurs.

 

Also hoping the Lamictal will hold off any recurrent depressive symptoms for the time being; not sure if that is realistic or not. Supposedly it's been shown to help keep depressions at bay.

 

I think what you call depression is really a drug induced iatrogenic injury ...its not depression at all ...sadly it ticks all the boxes for said fooling everyone including doctors and making pharma more than happy.

 

Wow i am impressed with your reading up on this site. great job good going ...so glad you found sa.

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hopes4hopes

NZ, I know what you're saying about the recommended 10%. And I am concerned as well about the w/d symptoms and the possibility, at least, of precipitating a worsened depressive/anxious state. I'm just so tired of and debilitated by this diffuse anxiety that I feel like I can't wait another 4-6 weeks to go down 10mg or 7.5mg ... perhaps I'm just shooting myself in the foot by going down faster BUT i'm anticipating it will only be for these relatively higher doses? 

 

According to this link from the SA site, a drop of venlafaxine from 150/day to 100/day really doesn't change the "striatal 5-HT transporter occupancy" very much, although what that actually means in clinical practice I'm admittedly not really sure. It looks like it's really not till you get below 50mg/day that the occupancy levels drop precipitously, for what it's worth. 

 

I agree with you that a lot of times people get diagnosed with relapsed depression when in fact they probably are having delayed withdrawal symptoms from their psychotropic med. I'm terrified of that happening again to me BUT having the Lamictal on board at a "therapeutic" dose makes me feel a little more at ease about going down at least some on the Effexor ... don't know if I'll ever be able to get completely off it but the side effects I think are consuming me at the current time ... (or the anxiety/akathisia/agitation could be from something else entirely, who knows)

 

And this early morning awakening at 4-5AM, every single day for so many months! Feeling like it will never go away :(

 

Thank you for following up on this and sharing your insights, it really means a lot to me. 

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KarenB

Hello hopes,

 

Honestly, I'm torn. I really do think the Effexor saved my life in 1997 and has helped me through the years; coming off of it in 2003-2004 led to either a relapse or at least a recurrence of crippling agitated depression, which I absolutely cannot have happen again.

 

I'm another Effexor taperer, and I've struggled with major depression for most of my life.  SSRIs made everything worse for me (after being a bit helpful for a year or two).  I read in Anatomy of an Epidemic that in every case, long term results are better for those who never take these drugs, next best results correlate to how short a time a person was on them. 

 

That was the drive I needed to start me tapering, and to also start putting in place everything I could to create strength in myself.  I believe we have huge amounts of strength (which doctors seem to just not see) and are able to learn ways to manage things life throws at us - like depressive episodes, anxiety, whatever.  What we need is support from our family and friends, and to learn the skills to manage things when they arise.  

 

It will take time to get off these meds, but I now view them as another traumatic part of my life that I will be able to leave behind.  Perhaps you could do this too?  I think it's a much less dicier than relying on meds.

 

Also, I was on 150mg a day, and I had awful trouble even with a 10% taper.  Not everyone is so sensitive, but it may not be wise to assume anything...  At least if you start slow and steady you can increase the rate later if you seem to be able to tolerate it.  Easier than starting off too fast and crashing. 

 

It's good to have you here,

KarenB    

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Altostrata

Welcome, H4H.

 

That is indeed a massive drug cocktail you're taking. Thank you, nz, for posting the drug interaction report from Drug Interactions Checker http://www.drugs.com/drug_interactions.html

 

Just the interaction of Effexor and trazodone could be causing the symptoms you've described. Trazodone has an active metabolite that may be causing hellish symptoms during the day, see info about trazodone in Tips for tapering off trazodone (Desyrel)

 

Effexor alone is well known for causing insomnia. A side effect of the 4 CNS depressants you're taking is "depression." Overdoing it with the CNS depressants can cause paradoxical waking; the benzos are notorious for rebound anxiety.

 

Taking multiple psych drugs? Which drug to taper first?

 

If one doctor prescribed all those drugs, that doctor is far too drug-happy. It would be best if you could work with someone who will minimize these drugs. I don't know if Dr. Shipko can help you, you'd have to ask him. (He can be blunt, which sets some people aback. I looked at the ripoff report site and those complaints look like they're from cranks.)

 

H4H, have you had a liver function test done recently?

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hopes4hopes

KarenB - thanks for responding, it sounds like your Effexor withdrawal was quite difficult and protracted. I'm trying to decide what to do about mine ... just desperate to rid myself of the activating effects of it ASAP but also don't want to destabilize an already fragile nervous system ...

 

Altostrata - that is crazy about the trazodone. I've been taking it 18 years and never knew about that metabolite and the problems it can cause. In fact, always assumed the trazodone was the safest part of my meds ... not sure why. I do know that when I've accidentally not taken it in the past, I am utterly unable to fall asleep. But that mCPP looks terrible. And my body is physiologically dependent on that too at this point : (

 

What baffles me is that I have been on both Effexor and trazodone for soooo long, and last year/early this year it plain just stopped working, or at least was just not working like they used to. Part of this may have been my reducing the fex on my own to just the once in the morning dosing, and/or the stress of the relationship I was in, but ... since then I've been on a merry-go-round of other meds to chase symptoms and nothing has helped with the anxiety.

 

I'm losing faith in my pdoc ... he added Pristiq to the mix the other week, which I was trying to cross taper with the Effexor to no avail, and then when that didn't work he changed the Pristiq to Brintellix, which also threw me into hyperdrive and agitation, when taken along with the Effexor which I cannot come down on very quickly obviously. 

 

Starting to feel like I'm screwed ... : (

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peggy

i haven't read all the posts very carefully, so what i am about to say might be obsolete - but if you are taking 100 in the morning and 50 at night of the immediate release, then is it possible that you are having interdose withdrawal?  It would possibly be more prudent to be taking 75mg morning and night - at least that way you should be better covered.

 

I am so sorry for the mess your pdoc has created by this unjudicious use of medication.  

 

There are other people on this site who have also been on big drug cocktails who are in various stages of slow multi drug tapers.  It seems that it is certainly doable, but requires commitment and determination on your part - it also requires you to do a lot of reading and research so that you can have a clear understanding of what you are doing.  

 

welcome to SA and we look forward to getting to know you better  :)

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KarenB

It was difficult, but now it's only protracted and with minimal symptoms - even this current wave I'm in is minimal and manageable.  And that's what I was hoping for when I decided to go real slow - I'm fairly functional now.  So I've only gone from 150mg down to about 133mg, but even this has given me a reduction in the adverse reactions I was having before tapering.

 

I too recall feeling 'screwed' when I was in the worst of it at the start of tapering, but finding the appropriate taper rate for me has shown me that there is a way through.  You'll find yours too - just go real easy and gentle, and take really good care of yourself - find some non-drug ways to manage anxiety.

 

Hugs,

KarenB

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Altostrata

Unfortunately, there are many bad doctors among psychiatrists.

 

That's why I asked about your liver -- you are getting older, your liver may not be clearing all those drugs like it used to. This can elevate drug-drug conflicts.

 

You are taking an excessive number of psychiatric drugs. Either you will need to figure out how to reduce them, or you will need to search for a doctor who can help you minimize drugs. They are very hard to find.

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hopes4hopes

Noticing a definite flattening of mood and affect so far today, along with some nausea ... I think going down to 50 twice a day of the Effexor was too soon, plus there's some family health stuff going on that's quite sad so that might be bringing the mood down too. 

 

So, took an extra 25mg of Effexor around 11AM ... guess I'm gonna bring it back up to 75mg in the morning and 50 in the evening for now. 

 

Peggy, thank you for the words of encouragement, I definitely need it.

 

KarenB, glad to hear that your slow taper is going OK. I'm doing what I can to manage anxiety in non-drug fashion, it's just so hard sometimes. But am exercising hard 4 times a week and trying to eat as well as I can ...

 

Altostrata, I did have some liver tests about 6 months ago which were alright ... no alcohol since that time and trying to take care of myself otherwise. Not looking forward to the search for a new pdoc ... there's so much trial and error ... feeling so discouraged. 

 

Thanks everyone for your responses, really appreciate it. 

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Altostrata

You don't need to see a psychiatrist, any doctor can prescribe these drugs.

 

You'll want to look for one who will cooperate with any tapering plans you might have. Very, very few will be able to make a tapering plan for you.

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hopes4hopes

Well, I'm back on the Effexor 100mg in the morning, 50mg in the evening. The past few days on 50mg and the 75mg in the morning have been rough, with lowered mood, elevated anxiety, poor sleep (early morning awakening plus lack of deep sleep according to my sleep app), and just generally feeling worse, and it's hard to say how much of that is from trying to go down even a bit on the Fex. So back to 100mg again this morning, sigh.

 

I'm also convinced that the Lamictal 100mg in the morning is causing me to be extremely drowsy all morning ... can barely keep my eyes open. (Maybe I need to take a Lamictal at 4AM when I wake up for no reason) Then the evening dose of Lamictal 100mg seems to have the opposite effect - seems to cause that hyped up anxious feeling instead. Ugh.

 

Plus, now wondering what to do about the trazodone ... I've been on 50mg at night for years and years and it does work to help me FALL asleep (though I can't sleep through the night anymore). The prospect of trying to fall asleep without it is quite daunting ... plus the 10% taper for that will take months it seems ..

 

Or, try to get off the Lamictal first? since that was the last med that was added to the mix, wouldn't that be less difficult to get off of? 

 

The anxiety is always worse in the afternoon and evening ... rarely have really bad anxiety in the mornings (even before the Lamictal) ... does this mean anything?

 

Just increasingly confused about what to do and still having so many issues with anxiety and low mood/affect ... frustrated and demoralized. 

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hopes4hopes

... and now, about 1-2 hours after I posted the above post, the anxiety, agitation and akathisia have returned full force; it is so high level and relentless and a dose of 0.25 Klonopin, which usually helps, hasn't helped much, and I'm afraid of taking more Klono than that (I take it as needed and it usually winds up being once or twice a day).

 

Could this be from increasing the Effexor back up to 100mg this morning?? ... so weary of all of this and just don't know what to do ...

 

I know I'm looking at a slow taper off of SOMETHING (Effexor, Lamictal, trazodone) but don't know where to start and don't know if I have the wherewithal to deal with this terrible anxiety over such a long period of time ...

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hopes4hopes

*topic moved from tapering forum

 

Hi, I'm wondering if my recent major worsening of depression could be due to a small change (albeit more than 10%) in my Lamictal dose - 

 

For about a month now I've been on Lamictal 200mg/day taken as 100mg twice a day. Before that there was a gradual titration up from 25mg over 5-6 weeks. 

 

I also take Effexor 100mg in the morning and 50mg in the evening, Trazodone 50mg at bedtime, and klonopin 0.25mg once or twice a day as needed. Occasionally I'll also take Risperdal 0.5mg at bedtime and had been taking that the past several days as well. My dx is depression and anxiety, POSSIBLE bipolar 2 (not sure). Intro post is in my signature. 

 

I had noticed more drowsiness and also some possible cognitive slowing while on the 200mg/day of Lamictal (in fact it was up to 300mg/day briefly and was just zonked) and it didn't seem to be helping so my pdoc okayed me going down on the Lamictal; in fact he seems to be of the notion that Lamictal can just be stopped abruptly and he says he's not seen any significant withdrawal or discontinuation symptoms from it. 

 

I decreased the Lamictal from 100mg twice a day to 100mg AM/50mg PM evening about 5 days ago and initially felt quite a bit of nausea and generally felt not so good. Thought it could be related to the risperdal I was taking at night, or to the Lamictal decrease.

 

About 3 days ago I started noticing a definite worsening of my mood, increasing apathy and sadness, increasing empty feeling and anhedonia, flattening of affect.

 

Since then these symptoms seem to be worsening and I'm still having nausea; a sense of pessimism and despair has set in, and It's been difficult getting through the days. Empty void in my chest. Did not take any risperdal last night and still feel the same.

 

I saw the pdoc again a couple of days ago and he didn't know what to make of it, again reiterating that Lamictal was usually OK to just stop. He thinks I should continue the risperdal, and get off the Lamictal ASAP and start Lithium, which I'd prefer not to do if at all possible ... he also gave me an Rx for Concerta as I was desperate for something to feel better with soon, but I'm trying not to take that as it will probably worsen the anxiety ...

 

My questions are: 

- Can such a small decrease in dose of Lamictal cause this to happen?

- If so, should I just try to hang on and wait it out, or increase it back up?

- Either way, I seem to be reaching a very difficult and worrisome point in the depression, and am trying to hang on as best as I can, still forcing myself to exercise and eat as well as I can, but it's getting very hard to do anything ... is there ANYTHING I can do to relieve some of these symptoms soon? I'd rather not take new meds of course but I'd try something temporarily if it would help 

 

Thanks in advance, 

 

H4H

Edited by Petunia
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hopes4hopes

I'm having a major worsening of depression recently and wondering if it could be due to a small change (albeit more than 10%) in my Lamictal dose?

 

For about a month now I've been on Lamictal 200mg/day taken as 100mg twice a day. Before that there was a gradual titration up from 25mg over 5-6 weeks. 

 

I'm still taking Effexor 100mg in the morning and 50mg in the evening, Trazodone 50mg at bedtime, and klonopin 0.25mg once or twice a day as needed. Occasionally I'll also take Risperdal 0.5mg at bedtime and had been taking that the past several days as well. I've also been trying to use less klonopin than usual, although that just means trying not to take 0.25mg more than once a day (but maybe this is related to the symptoms?)

 

I had noticed more drowsiness and also some possible cognitive slowing while on the 200mg/day of Lamictal (in fact it was up to 300mg/day briefly and was just zonked) and it didn't seem to be helping so my pdoc okayed me going down on the Lamictal; in fact he seems to be of the notion that Lamictal can just be stopped abruptly and he says he's not seen any significant withdrawal or discontinuation symptoms from it. 

 

I decreased the Lamictal from 100mg twice a day to 100mg AM/50mg PM evening about 5 days ago and initially felt quite a bit of nausea and generally felt not so good. Thought it could be related to the risperdal I was taking at night, or to the Lamictal decrease.

 

About 3 days ago I started noticing a definite worsening of my mood, increasing apathy and sadness, increasing empty feeling and anhedonia, flattening of affect.

 

Since then these symptoms seem to be worsening and I'm still having nausea; a sense of pessimism and despair has set in, and It's been difficult getting through the days. Empty void in my chest. Did not take any risperdal last night and still feel the same.

 

I saw the pdoc again a couple of days ago and he didn't know what to make of it, again reiterating that Lamictal was usually OK to just stop. He thinks I should continue the risperdal, and get off the Lamictal ASAP and start Lithium, which I'd prefer not to do if at all possible ... he also gave me an Rx for Concerta as I was desperate for something to feel better with soon, but I'm trying not to take that as it will probably worsen the anxiety ...

 

My questions are: 

- Can such a small decrease in dose of Lamictal cause this to happen? 

- If so, should I just try to hang on and wait it out, or increase it back up?

- Or, is my trying not to take my usual 0.25mg of klonopin 1-2 times a day more likely to be causing this?

- Either way, I seem to be reaching a very difficult and worrisome point in the depression, and am trying to hang on as best as I can, still forcing myself to exercise and eat as well as I can, but it's getting very hard to do anything ... is there ANYTHING I can do to relieve some of these symptoms soon? I'd rather not take new meds of course but I'd try something temporarily if it would help 

 

Thanks in advance, 

 

H4H

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Petunia

Hi Hopes,

I joined the new topic you started with your original intro/update thread. You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want. Its a good idea to bookmark it or follow it, so its easy to find again.

 

I'm so sorry your doctor has got you into this mess. I wish I knew what to suggest, but after reading through all the previous replies I don't have anything to add, except perhaps I'd highly recommend reading Anatomy of an Epidemic by Robert Whitaker.

 

With all those drugs you are taking, with all the interactions that NZ11 posted, its impossible to know what any particular drug is doing in your nervous system.

 

You are considering increasing doses, adding more drugs, when its clear that your problem is too many drugs.

 

I think this is an important topic for you to read: Taking multiple psych drugs? Which drug to taper first?

 

Then this one, where you will find tips for tapering off your specific drugs: Important topics in the Tapering forum and FAQ

 

Here is another resource you may find encouraging. The owner of this blog was poly-drugged for years and became very ill because of it. She has managed to carefully taper from her medications, learn how to take care of herself, and regain her health:  Beyond Meds

 

Hang in there, you can do this, and we are here to support you.

 

Petunia.

 

edit:  One more link I think is important for you:  The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

Edited by Petunia
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KarenB

Hello Hopes,

 

Sorry it's got so difficult for you.  I had a couple of thoughts.

 

1.  Taking uneven doses in the morning and evening could be causing unnecessary difficulties.  It's not as stable as it could be for your CNS. 

 

2.  It sounds like you are still looking to drugs to solve the problems - which they cannot do.  At best, they mask.  You can get through this - people here have got through all sorts of difficult stuff, but you'll need to get a strong focus on healing without meds.  

 

Have a read of Petunia's links, and listen in close to yourself to find your path through this.  

 

Wishing you peace,

KarenB 

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starcontrol2

Hi h4h,

 

I am very sorry about your situation and I am no expert on drug cocktails but I have two questions.

Are you still doing TMS? I know they say no side effects but there can be changes along the way, it is says on faq at tmsneuro. I backed out of tms at last moment because I didn't want any more confusion for my brain. If you are changing doses and doing TMS who knows what's going on.

Are you over the relationship? If relationship trouble gives you so much stress plus taper on top... Just like you I had a really bad break up many many years ago. Luckily I didn't take any pills and although i was dysfunctional it did burn itself out after a few years. I would have taken anything to feel better, I didn't even know it was an option.

Relationship trouble is always a big trigger for me. I regret i ever took lexapro to "solve" my situation but it only delayed/delaying the fact that i have to solve situation and now dealing with horrible withdrawal on top.

I want to understand why i get so personal about these things and it may be a step for you.

I am sorry if I wasn't very helpful, emotional stress is a killer for me :(

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hopes4hopes

Hi guys, thanks so much for the responses. Petunia, I've taken a look at some of those links before and will check out the others as well. Karen, you're right about meds not being the answer; I'm just finding myself in somewhat of dire straits of late and at least hoping for a short term way to feel better in order to get back on track with therapy and the like - I'm still doing my best to exercise and be healthy otherwise but it's getting increasingly difficult.

 

Starcontrol, thanks for the insights and for reading through my whole shpiel - I'm still doing the rTMS and you're right, that could be muddying the waters a bit; the rTMS doc doesn't think it's likely to cause a worsening in my symptoms but he acknowledges it's a possibility. 

 

As for the relationship - it's hard to say if I'm completely over it. It's still on my mind from time to time and there are still things I think about that trigger anxiety and/or sadness sometimes.  I think it will just take more time and I guess some working through with therapy, which I'm trying to do but it's hard in the current condition. 

 

Appreciate everyone taking the time to help ...

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AliG

Hope4hopes,

 

I  think your dosing is very uneven . Effexor :  am 100 mg , pm 50 mg .  why not , 75mg am , 75mg pm. ? The same with Lamictal  100mg in the am , 50mg in the pm. Why not 75mg / 75mg.  You  seem to be " bouncing " your brain around , like a " ping pong " ball.  Not good for your C.N.S.    See this link  :

 

http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

Ali

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