Jetchet34: taper off venlafaxine ER

[Jetchet34]

I've been on antidepressants for close to 18 yrs. They were originally prescribed for severe PMS. The doctor said the Prozac was very safe. Ha! After several years, I tried a couple times to get off of the Prozac under my doctor's supervision, but each time I had withdrawal symptoms. I thought it was my depression returning, and took it as confirmation that my condition was permanent and that I would just have to be on meds the rest of my life. No one EVER explained about the possibility of withdrawal symptoms from the medication or that the symptoms may subside once my body adjusted to being without the medicine.

 

I was on Prozac for about 7 years before it stopped working for me. Since I switched from Prozac, I've gone through multiple antidepressants (SSRIs/SNRIs but no atypicals.) Same vicious cycle: try something new, feel better, it quits working, up the dose, feel better, it quits working, try something new... You get the idea. My depression has gotten so much worse over the years. My doctor put me on Effexor, and I was flying high at the first follow up appointment. The next week, I was suicidal. Up the dose...add Wellbutrin... here we go again.

 

I was feeling like I was running out of options, and I really didn't want to go the atypical antipsychotic route so I started looking online to see if maybe I could go back to Prozac and have it work for me again. I found this site's info on prozac bridging and tapering. I ordered the book Anatomy of an Epidemic by Robert Whitaker. Both I and my husband read it. Wow! Why hadn't anyone told us this before!!! Talk about feeling deceived! (My husband and I are both science people. I graduated with a degree in premed and he is a PhD biochemist so we are familiar with evaluating scientific data. Whitaker was definitely not selling snake oil! It's scary to think that doctors don't even know this stuff.)

 

My husband and I discussed it and decided that I would talk to my doctor about tapering off. I had my husband go with me to the appointment. My doctor thought I was nuts but agreed to order  capsules for me so I could try tapering. I've been tapering 10% a month for over a year now. I've gone down from 250mg of Effexor (venlafaxine ER) to under 50 mg. I've had a couple times I've had to hold off on lowering my dosage until I felt better, but overall I seem to follow a pretty consistent pattern as far as my body's response to the cut in meds. About 2 wks after I cut my dose, I feel crummy: really irritable and lacking in motivation. After another 2 wks I've usually stabilized enough to cut the dose again. Just knowing why I'm feeling horrible helps so much! I hope to be down to the minimum effective dose in February. Yay! Then I'll need to taper off the Wellbutrin...

[nz11]

Welcome JC34,

 

I think you have just written everyone's story ..so glad to have another hoodwinked patient join us.

 

My husband and I are both science people. I graduated with a degree in premed and he is a PhD biochemist so we are familiar with evaluating scientific data.

With well educated folk like yourselves getting trapped what  chance did us lessor mortals have. (speaking for myself of course).

 

I ordered the book Anatomy of an Epidemic by Robert Whitaker.

Brilliant. 'Time for another hunger strike' ...what do you reckon?

 

My depression has gotten so much worse over the years

I strongly suspect that the 'd' word you use is really psychotropic drug wdl symptoms.

 

Did you read Glenmullens checklist of wdl symptoms its one of the best out there...

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

I am sure with your desire to get self-informed you will be able to 'unpatient' yourself and get free of this drug merry go round once and for all.

 

Never heard of pantaprozole ..whats that for? im being lazy suppose i could google it.

 

Dont know if there is such a thing a a minimum effective dose ...this is something mythical from the pharma marketing dept.

 

Just like to confirm with you your taper method.correct me if i am wrong but it appears you may be tapering at 10% of your original dose per month ie you are taking 250 times 0.1 =  25 mg and dropping 25mg every month ...am i correct? (Doing the 10% of previous dose method would have taken 17 months to get to 50mg you have landed on 50 mg about 6 or 7 months early which is why i suspect this).

later edit ..just realised you said 'less than 50mg' how much is less than ?

 

If so it may be very wise from here on in to do the taper on 10% of previous dose below 50mg. Each drop getting progressively smaller.

This is informed by the sert diagms in this study,

Why taper? Paper demonstrates importance of gradual change in plasma concentration

Also at lower doses 10%of original dose is proving to much for many. Basically the lower the slower is the rule.

Why taper by 10% of my dosage?

Of course its up to you to decide but given your history of long term exposure it may be a good idea to tread slowly and carefully..what do you think?

 

With two ads i thought id run the drug interactions checker for you.

 

 

Interactions between your selected drugs

Major bupropion venlafaxine

Applies to: Wellbutrin SR (bupropion), venlafaxine

BuPROPion may cause seizures, especially at higher dosages, and combining it with other medications that can also cause seizures such as venlafaxine may increase that risk. The interaction may be more likely if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. 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.

 

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

• pantoprazole interacts with more than 100 other drugs.
• venlafaxine interacts with more than 500 other drugs.
• Wellbutrin SR (bupropion) interacts with more than 300 other drugs.

Interactions between your selected drugs and food

Moderate bupropion food

Applies to: Wellbutrin SR (bupropion)

Using buPROPion with alcohol may increase the risk of uncommon side effects such as seizures, hallucinations, delusions, paranoia, mood and behavioral changes, depression, suicidal thoughts, anxiety, and panic attacks. On the other hand, sudden withdrawal from alcohol following regular or chronic use can also increase your risk of seizures during treatment with buPROPion. If you are prone to frequent or excessive alcohol use, talk to your doctor before starting buPROPion. In general, you should avoid or limit the use of alcohol while being treated with buPROPion. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects 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.

 

Moderate venlafaxine food

Applies to: 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.

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:

• venlafaxine
• bupropion (active ingredient in Wellbutrin SR)

 

http://www.drugs.com/interactions-check.php?drug_list=1790-0,2296-0,440-204

 

Maybe this can help join some dots.

 

Another book you might find insightful is P Breggins 'your drug may be your problem' maybe you already read it.

So glad you found sa.

Welcome.

[Fresh]

Hi Jetchet , welcome to the site.  Good to hear you've been onto the myth for a while and have been tapering well.

 

As nz11 pointed out , the 10% reduction recommended here is a percentage of your previous dose , so you might

want to think about slowing down.  It would be great shame to waste all the hard work you've done by blowing it

right at the end.

What is the "minimum effective dose" you refer to?    An effective dose is whatever your body deems effective ,

which may be as low as 0.5 mg.   As you get lower , the dose that is effective for you will get lower too. Don't

believe the doses recommended by the manufacturer. 

Try reading   

What is withdrawal syndrome?

 

Good to have you on board ,  Fresh

If you click FOLLOW at the top right , you'll receive an email each time someone posts here. 

[ang]

Welcome!   This site is wonderful, and yes listen to those that have been thru this stuff, make new friends, who joined around the time you have.   The support, and friendships are invaluable.  The research links are wonderful........... Welcome from Angela, Downunder...   Albany Western Australia!  Now only nutty 20% of the time, and improving!  Thanks to this site..........

[Jetchet34]

Thanks for taking the time to respond to my post and for looking up additional info for me!

 

 

NZ11--Just like to confirm with you your taper method.correct me if i am wrong but it appears you may be tapering at 10% of your original dose per month.

Don't worry. I'm only tapering by 10% of the previous dose. Got a nifty spreadsheet that calculates it all out for me. (Double checked by the math savvy husband, of course. ) I've been tapering since sometime in Aug 2014, so I guess it's closer to a year and a half than a year. I've read the info on the 10% taper and the article about plasma concentrations. Just checked them again after my first post.

 

Fresh--What is the "minimum effective dose" you refer to?

Minimum Effective Dose (MED)is just the lowest dose needed to produce a clinically significant result in a clinical study. For some weird reason, I was thinking that I could get off the meds more quickly once I hit the MED. WRONG! The end is not the time to go down more quickly! Warnings appreciated.

 

nz11--Never heard of pantaprozole ..whats that for?

Pantoprazole is a Rx for acid reflux. Believe it's a proton pump inhibitor like Nexium, Prilosec, etc. Started having reflux issues right after I started tapering so it might be related.

 

nz11--I strongly suspect that the 'd' word you use is really psychotropic drug wdl symptoms.

I'm convinced that my increasing depression resulted from long term antidepressant use. The depression hasn't been any worse while I've been tapering than at some of my low times while I was on the full dose of the meds. Less medicine with no measurable increase in depression is fine by me!

 

I do have a couple questions: As I get to lower and lower doses of medication, can I expect it to take me longer to stabilize? The past couple dosage drops I've needed more than 2 wks. (Could just be holiday stress, I suppose.) Do people taper all the way down to 1 mg? That'll take me like 3 more years! (I really want to have a baby, and my biological clock is ticking!)

[nz11]

Hey Jetchet thanks for the update and feedback...

 

so I guess it's closer to a year and a half than a year.

there ya go then the plane is right on time....

 

Sounds like you got this game sorted.

 

nz11--Never heard of pantaprozole ..whats that for?

Pantoprazole is a Rx for acid reflux. Believe it's a proton pump inhibitor like Nexium, Prilosec, etc. Started having reflux issues right after I started tapering so it might be related.

 

Wow what do you know ....acid reflux in tapering thats exactly what i had too ...  think i had this while on the drug too... i' m still joining the dots .....

 

Minimum Effective Dose (MED)is just the lowest dose needed to produce a clinically significant result in a clinical study.

Well certainly don't want to argue with a premed graduate. (not sure what a premed graduate is but im sure its high-powered)

 

But here is another ...ok a cynical nz11 go at a defn of MED....

 

MED is  the highest dose possible  for which a company can get away with refusing to produce a smaller dose, a dose  which  produces a clinically significant maximised profit resulting in a windfall of billions.

 

Where am i getting this from....

 

 

"In company trials no company is prepared to take a chance that their drug wont beat placebo, so they err on the side of a higher dose or more poisonous dose. If these studies get the drug on the market, the trial results are then taken to mean that doctors should use the dose of the antidepressant used in the trial  even though it is likely to be too high for many people."

"Once a drug is launched companies..................refuse to make lower dose formulations of a medicine available" .

Healy Pharmageddon 2012; p88.

 

"When the price had been settled for a 20mg dose [prozac] a top psychiatrist who had done research with fluoxetine postponed approval as she found that 5mg was the maximum dose that should be allowed, and she demanded that the 5mg dose should be made available. However Lilly managed to avoid this which might potentially have reduced its income by 75%."

Gotzcshe  Deadly medicines and organised crime, 2013; p 203

 

I do have a couple questions: As I get to lower and lower doses of medication, can I expect it to take me longer to stabilize? The past couple dosage drops I've needed more than 2 wks. (Could just be holiday stress, I suppose.)

Well i think you have answered this for yourself.

I can see the doctor coming out of you here...blame the situation (or the person).

 

Do people taper all the way down to 1 mg?

Some are having to go lower...its really about listening to your body .

Here's the thing if you think you can go faster or jump off sooner you wont know if youre one of the unlucky ones until its too late.

And if you trigger full blown snri/ssri withdrawal it may be something that may be difficult to find relief from....all bets are off.

[Jetchet34]

 

nz11,

 

MED is  the highest dose possible  for which a company can get away with refusing to produce a smaller dose, a dose  which  produces a clinically significant maximised profit resulting in a windfall of billions.

I really like your definition! LOL! I don't doubt it at all.

 

(not sure what a premed graduate is but im sure its high-powered)

Premed is just a major specifically designed to prepare you for med school. Pretty much a biology major with a chemistry minor. I didn't end up applying to med school--mostly because I didn't think I could handle the sleep deprivation and pressure along with my messed up emotions/ depression. I ended up meeting my future husband in organic chemistry lab (knew that class was good for something), and decided that I never really wanted to juggle being a doctor with having a family anyway. =-) Of course, we haven't been able to have kids yet, but that's another story. Hope you don't think I mentioned our degrees to make us sound smart. I was just making the point that if the evidence the author gave didn't support what he was saying, we'd have known it.

[Fresh]

"As I get to lower and lower doses of medication, can I expect it to take me longer to stabilize? The past couple dosage drops I've needed more than 2 wks."

 

As you get lower , you might want to consider longer holds rather than shorter ones.  The recommendation is 4-6 weeks

between drops.  This is because w/d symptoms are often delayed and don't begin till 2 weeks after the cut.   

 

There are many people , including some members here , who have tapered slowly and come off , only to be assaulted by

intense w/d symptoms many weeks later.  (See Shipko's latest).   The only insurance against this is to slow down

and allow your brain to recover after each cut.  

[nz11]

Thanks for that clarification, sounds like there really was some organic chemistry going on in organic chemistry.

[Jetchet34]

"As I get to lower and lower doses of medication, can I expect it to take me longer to stabilize? The past couple dosage drops I've needed more than 2 wks."

 

As you get lower , you might want to consider longer holds rather than shorter ones.  The recommendation is 4-6 weeks

between drops.  This is because w/d symptoms are often delayed and don't begin till 2 weeks after the cut.   

 

There are many people , including some members here , who have tapered slowly and come off , only to be assaulted by

intense w/d symptoms many weeks later.  (See Shipko's latest).   The only insurance against this is to slow down

and allow your brain to recover after each cut.  

"As I get to lower and lower doses of medication, can I expect it to take me longer to stabilize? The past couple dosage drops I've needed more than 2 wks."

How I wrote that was confusing! I drop my dose and start feeling lousy 2 weeks later.  Two weeks after THAT I'm usually stablized again. So I usually end up dropping every month or so. I'm so glad to be able to compare notes with people who have already been through this! It's really upsetting to find out that the hardest part is probably still ahead of me and that I  may have to taper even more slowly as I progress. Still, I know God has a plan for my life, and He will see me through this whether I understand it or not! Thanks so much for your input! It is very much appreciated!

[Altostrata]

Welcome, Jetchet.

 

As Fresh noted, the amount of the decrease gets smaller as you calculate 10% based on your last dose. How much Effexor XR are you taking now? How are you measuring your dosage?

 

Please see Tips for tapering off Effexor (venlafaxine)

 

Also, please consider going off pantoprazole. You will need to taper that, but not as slowly. See Tips for tapering off stomach acid blockers or PPIs...

[Jetchet34]

 

I'm taking 47 mg. Before I started tapering, I weighed the beads from multiple (like 20) 150mg capsules using a jewelry scale and averaged the weight.(Wah! Quality control on generic meds is bad! I've seen you comment on this before.) Anyway, using that weight I was able to calculate the appropriate bead weight to give me the appropriate dosage. Excell spread sheets are wonderful! I am only dropping by 10% of the previous dose. I'd love to get off the pantoprazole too, but I'm not ready to tackle that just yet.

[Jetchet34]

Feeling really scared right now about what may be coming as far as withdrawal symptoms as I continue to taper.  I really haven't had a bad time of it so far, but should I expect more severe symptoms as my dose gets lower?

[ChessieCat]

Hi JetChet,

 

We are understandably scared of the unknown and of course getting off these drug/s is a big unknown so fear is to be expected BUT we can learn to recognise and understand the fear and find ways of coping with it.

 

Watching this might help:  the-dr-claire-weekes-method-of-recovering-from-a-sensitized-nervous-system

 

CC

[Seeker53]

Feeling really scared right now about what may be coming as far as withdrawal symptoms as I continue to taper.  I really haven't had a bad time of it so far, but should I expect more severe symptoms as my dose gets lower?

Hi jetchet34. Don't be frightened. Maybe hold for longer before your next drop. Say 4 to 6 weeks. Then you should feel pretty stable and not be having symptoms before the next taper. Then, if things do happen to get worse down the track (and it may all be fine) then you have a good place to go back ,to dose wise, should you need to. The hardest thing is wanting to get rid of the drug only to be too quick near the end. I speak from experience here lol. Just listen to your body and your symptoms and do what you feel is sensible at the time.

Also, do watch your anxiety levels and find ways that help to reduce stress. But you are doing very well.

Keep us posted too.

Thanks, s53

[Jetchet34]

I've been tapering off of venlafaxine XR (Effexor XR) for about a year and a half now. I'm also on Wellbutrin 150 mg daily. Wellbutrin gives some people more energy so I thought it might be good to stay on it until after I'm done tapering the Effexor. However, now I'm wondering if I would feel less agitated if I went ahead and got off the Wellbutrin. It's almost impossible to know how the 2 medications are interacting in your system!  I'm also wondering about the birth control (Sprintec) I'm on. Doctors prescribe it to level out hormones, but that certainly isn't our natural state as females, and my confidence in the medical establishment continues to wane. Recommendations or links to info would be appreciated.

[KarenB]

It is possible to start tapering a different drug.  You need to make sure you have a good hold between your last taper of Effexor and your first taper of Wellbutrin.  Get to a really settled base-line first, and keep good symptom notes.  That helps to lessen any confusion about what drugs are doing what.

 

You've done really well getting to below 50mg Effexor - I'm jealous .

[Altostrata]

Brilliant use of spreadsheets! You are an expert on the bead method.

 

I moved your recent posts here as they update your current situation.

[Jetchet34]

I've been in a holding pattern in my taper journey since late January. Everytime I think I've stabilized enough to continue tapering, I start feeling horrible again. Is it possible to have windows and waves while you're still tapering? I've gotten all the way to 37.5mg from 250mg so I don't want to quit now!

[scallywag]

Jetchet -- Waves and Windows are part of tapering for many people. The Windows and Waves pattern of stabilization

 

May your waves be mild and brief, and your windows clear and bright!

[Jetchet34]

On Sunday, I reduced dose by another 10% for the first time since late January. I've gone back and forth between feeling O.K. and feeling just plain awful for several months now. I've been really nervous about started to taper again, but I've got to start again sometime if I'm ever to get off this nasty stuff. I don't seem to have severe physical symptoms; it's the mental/emotional ones (the ones people don't understand unless they've experienced it) that get me. It's like my head is stuck in a fog or a dream, and I'm so very distracted from what's going on around me by what's going on in my head--not that I know exactly what that is--but it's really distracting! I'm so thankful for the wonderful support network God has given me to help me get through this. Have to just take it one day at a time, and sometimes that's too big of a chunk!

[KarenB]

Well done making a decision - I know it's hard, cause I've been holding since January-ish too.  Still undecided, but I think I'm finally getting some improvement, so I'm edging closer...

 

How have you been feeling since Sunday? 

[Jetchet34]

Karen B, thanks for asking! I'm not feeling terrible.  I'm wanting to sleep A LOT. Not because I'm tired, but just because I don't have to be awake and deal when I'm asleep. Managing to get a few essential tasks done so that's good I guess. Hope you'll be able to start again soon also.

[Jetchet34]

I've been able to taper my Effexor ER to 20 mg. I was down to 17mg, but I had to increase my dose a couple times over the last couple months because I've felt so bad. The increases didn't help.  I stopped taking the bupropion (wellbutrin) 150 mg in the middle of August because the pharmacy sent me pills from a different manufacturer. I've dealt with side affects from switching manufacturers before and did not feel like doing it again. I discussed it with my husband, and we decided that it was as good a time as any to just stop taking it. I didn't have any noticeable withdrawal from stopping the drug; but, in retrospect, I'm guessing the increased difficulty I'm currently having with my Effexor taper is probably due to the lack of Wellbutrin.  I've never had severe physical symptoms from withdrawal, but the emotional ones are intolerable.  I've been tapering for over 3 years now, and I'm about ready to give up and go back on a full dose of something. Waking up every day and wanting to not be alive is just not any way to live.  The thing is, I don't really want to die. I just don't want to live feeling this way.  I'm going to contact my doctor (who kind of doesn't get the whole slow taper thing) and ask him to prescribe me a low dose of Prozac so I can switch over to that, and then taper when I'm feeling better.  ( I really want to feel better!) I read over the info on Prozac bridging, but I'm still not sure what dose to ask for. I don't want to go too high and cause myself more trouble! Also, is it possible that I'm in...what do you call it? Protracted withdrawal? since increasing my dosage doesn't seem to be helping? I've tapered slowly, and I haven't had a lot of physical symptoms so it would surprise me if I were in full blown withdrawal, but I just don't seem to be stabilizing. 

[scallywag]

Jetchet -- If your doctor isn't knowledgeable about approximately equivalent doses of Effexor and Prozac, you might want to talk with a pharmacist. Pharmacists often have more detailed and more recent information about medications than doctors do so you could get a suggestion from a pharm to take to your doc.

 

Crossovers to a different medication are another level of complication -- sometimes they work well, sometimes they take more time than expected to work, and sometimes they make things worse.  Please read:

Prozac switch or bridge

 

Your statement that the wellbutrin discontinuation is probably bang on -- dropping from 150 mg to 0 overnight almost certainly had an effect.  In your situation, I'd wait at least another 3-4 months before making any other changes -- decreasing Effexor or bridging to Prozac.

Edited January 6, 2018 by scallywag
add bridge link