Reggie: Indecision over which to taper first

[Reggie]

Hello there, I'm, itching to start a withdrawl but keep changing my mind on which one..

 

- mirtazapine (45mg) will probably be the easiest from past experience and makes me fat - but does help me sleep and potentially buffers the sexual side effects of venlafaxine

 

- venlafaxine (112.5mg ER)  is nasty stuff and I want to see if I have a proper libido left! Feel it caps my emotions a lot. Scared of reducing it though after cymbalta experience in 2007

 

- lamotrigine (300mg) on this high dose is really slowing me down, starting to compromise my immune system and I reckon doesn't help libido. since going up to this dose alcohol even ocasionally in small amounts is nasty. Like the idea of getting it down somewhat. I came off it back in 2011 OK but that was from a possibly sub-therapeutic almost placebo dose of 150mg not the monster 300mg I'm now on. Feels like poison at this level. My suspicion is that the earlier stages of the reduction of this - perhaps the opppoisite of AD's - will be the hardest?

 

Is it best to start with the easiest? Is lamotrigine best kept on while reducing AD's due its GABA/glutamate effects? How about focusing on one for a bit, then another, then returning to the first? I am planning a slow taper.

 

Just generally feel they don't do much apart from the side effects, my body is still trying to present the deep trauma that needs facing and I still need to work on taming the mind. They seem redundant and I am learning to trust in other tools and my body but scared of the withdrawl effects..I am having a lot of life changes so won't do it just yet but want to be prepared. Try not to let my anger at psychiatry and pharma and fear compromise my nervous system further but that can be hard

 

Thanks!

 

Here's my history:

 

-----------------------

Current: Venlafaxine 112.5mg; Lamotrigine 300mg; Mirtazapine 45mg

restarted Lamotrigine/Mirtazapine in 2012, bumped up Lasmotrigine and then very reluctantly added Venlafaxine in 2013 and further bumped up Lamotrigine in 2014. Got a new psychiatrist since who is less med focused!

Reduced Vn to 75mg in 2013; brief experiment a year later reducing venlafaxine to 37.5mg, ended up going back to 112.5mg! (bit hasty).

This year dropped Lamotrigine to 250mg under psychiatrist's advice (he suggested to 225mg)  - nasty stuff, too quick! A time of personal change so decided to put back up rather than tough it out - maybe too hasty but I have the fear!

Impatient to start getting off them - libido, weight gain, tiredness, capping of mood yet not really helping with depression. Though I have a lot of life changes at the moment so more that i want to get prepared so I can hit the ground running.

Recently started seeing highly recommended acupuncturist with experience of med WD to boost my system, take omega 3 (recently started fermented cod liver oil in addition to EPA/DHA) and restarted vit D., try to follow guidelines in Mood Cure book (keep meaning to give gluten free diet a proper go), do good therapy on psychological issues, work part-time etc

Previous meds:
2006 Citalopram quickly switched to Duoloxetine;
2007 off Duloxetine with continual tiny taper over six months (sexual side effects), bad WD's in the end, lasted a couple of months off and was then tried on...
2008: Mirtazapine up to 45mg (off 2010) + Lamotrigine up to 150mg
2009-2010 came off mirtazapine in 6 tapers of 7.5mg, no big issues, felt better for it.
2011 - came off lamotrigine over a few months, tapers of 25mg a time - little bit of depression returning.
summer 2012 big crash after lots of life changes over the last year!

Feel like my nervous system is severely sensitised even with (or due to!!) the meds.

Diagnoses: reactive depression, bipolar depression, borderline traits - according to which professional you speak to!

Edited July 19, 2016 by scallywag
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[oskcajga]

You're on a number of different medications, so getting off of them is going to be complicated, depending on who's advice you take.  This website tends to suggest that you do one drug at a time, 10% per month of current dosage.  That means you will be taking medication for many years to come, but when you do finally get off of it, you'll probably have little to no lingering effects.  This is by far the most conservative technique I've read, but the goal here is to prevent you from getting seriously disabled by some horrendous withdrawal effects. 

It's suggested that you get off of the most activating medication first, so the Venlaxafine would be that one (from what I understand).  I think the idea behind this theory is that if you get off the activating one, the calming drugs (i.e., lamictal) will help make the experience a bit less of a roller coaster.

The SNRIS (i.e., effexor, pristiq, cymbalta) are some of the most difficult of all the antidepressants to stop taking.  There are no shortages of horror stories on the web from people who stop taking it abruptly, or even taper somewhat slowly.  It's just a nasty nasty chemical with a very short half life.  I think that you should be aware of this anecdote before you decide what to do next.  My personal opinion would be to switching over to a drug with a longer half life, such as prozac, stabilizing on prozac for a couple of months (at least), and then tapering off the prozac slowly.  I personally did this myself on one round of the antidepressants that I've taken in my life, and I experienced little to no withdrawal effects.  I don't see this advice recommended on this website too often, but I've read that some of the countries best doctors (e.g., those at Harvard medical school, etc) recommend doing this to avoid the side effects of short half life antidepressants.

I wouldn't suggest that you quit anything too quickly, ESPECIALLY not the effexor - that stuff can seriously maim you for many years if you get off of it too quickly.  Your issues with cymbalta may have been because although you did a slow taper, you still did it too quickly.  Cymbalta is the one that got me - I tapered like 5mg every 2 weeks and then stopped at 10mg, and I've been messed up pretty badly every since.

 

Tapering is a real pain in the butt, and bead counting with effexor is a miserable experience - but if you don't switch over to something like prozac which is a powder that can be dissolved in water, it's going to be a necessary evil.  Effexor has those little beads, and those little beads dont dissolve in water because they're protected by a time-released seal.  That's going to mean that you need to open each little capsule, pour out the beads, and count them (there's like 200 in each pill).  I almost drove myself nuts doing this with duloxetine myself.  I don't know how some people can do it.  Buying a nice scale that can get down to the 100mg range would be my preferred option.   As annoying as it might be to taper slowly over time, it's well worth it. 

 

You're correct about the drugs not doing much other than give you side effects.  It's unfortunate that you've gotten on so many drugs simultaneously, but you asked for help at the correct juncture so you will be OK.  You're in the right place, this is a very helpful place for you to get advice on the subject and you'll get plenty of input from people that know an awful lot about the subject.  I would be leery about trusting any psychiatrists or general practitioners on helping you, they don't know much about the drugs - or how to safely come off of them.  If they suggest anything more than a 20 or 30% taper, they obviously have no idea what they're talking about. 

 

You may find many of the stickies on this website to be immensely informative and helpful, and I encourage you to read them.

[Petunia]

Welcome Reggie,

I'm glad you found us before beginning your taper, you will find lots of good information and support here. I can't really add anything to oskcajga's great response, but here are some links to information you may find helpful:

 

Taking multiple psych drugs? Which drug to taper first?

 

Why taper by 10% of my dosage?

 

We usually recommend tapering from the drug you are currently taking because switching to a new drug can create its own problems and sometimes doesn't work, leaving you with withdrawal from the previous drug, but here is the link FYI

The Prozac switch or "bridging" with Prozac

 

Tips for tapering off Effexor (venlafaxine)

 

Tips for tapering off Remeron (mirtazapine)

 

Tips for tapering off Lamictal (lamotrigine)

[Altostrata]

Welcome, Reggie.

 

What is your daily symptom pattern relative to when you take your drugs? What time of day do you take each of them?

 

Why was the lamotrigine added?

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and copy and paste the results in this topic.
 

[Reggie]

Hello - I'm keen to get off my cocktail and have made some early steps but am still unsure the best way to approach it. I joined a while ago and have been meaning to start posting for a while.

 

I read the thread on tapering multiple meds (benzos and AD's etc.) which seemed really relevant and was going to post on there but didn't want to clog it up too much.

 

-LONG POST-

 

Here's what I take:

1) Lamotrigine. I have reduced recently from 200mg to 175mg in early Jan and then to 125mg a few days ago, via a stopover of just two weeks at 150mg. Not long enough holding, for sure.... I'm debating bumping back up to 150mg.

It is now hitting me - nasty low mood and spiked nervous system, which almost feels like the type on increasing anti-depressants plus a certain darkness that is perhaps different to the serotonin one and reminiscent of my stopping the diazepam I took briefly. I'm getting better and better at discerning what's what - when a low mood is rage, grief etc. that's bubbling up, when it's my body needing rest, when it's med adjustment related etc.

 

I've taken this med from 2008-2011 and then 2012 to present, came off before with relatively few bumps (heart rate and sleeping difficulties at the later stages) and felt the finer subtler points in life reemerge.

 

2) Venlafaxine 75mg.I reduced it from 112.5mg to 75mg (XR) back in October- it hit a few weeks later but also led me to a new energy healer following a friend's recommendation.

I've taken this from May 2013 to present and have always resisted it from the off, psychiatrist really pushed me to give it a go. I've never been on more than 112.5mg (twice). I have a low sex drive (despite a keen interest in women, if that makes sense?) and I blame it primarily on this, plus psychological issues.

 

3) Mirtazapine 45mg. Not touched this yet

This my second time round on this, took it from 2008 to 2010, coming off in six stages over a year, relatively easily (some sleep disruption, transient drops in mood). Started up again 2012. Good for sleep, crap for weight and overeating.

 

Other meds: I also took Citalopram for few months in 2006 and then Cymbalta 2006-7, coming off (by counting beads out continuously) was not easy and ended up with going back on meds. Original psychiatrist tried to put me on lithium in 2013, did for a handful of weeks and then I took myself off it, nasty, thinking what the hell is going on here..

 

I had a big 'relapse' in 2012, about a year totally med free and I do wonder how much of that was my nervous system being primed by the meds. Though also it seemed like deep and long-ago stuff needed to come up. Maybe it would have happened anyway - who knows..

 

Diagnoses': not a fan! Depression NOS/reactive depression by doc. Lots of anxiety and racing mind rather than low energy. Previous psychiatrist had me as bipolar depression which led to over medication, more recent one as borderline features which fits much better aka sensitive with certain childhood situations, that led to deeply supressed difficult emotions. And medication has no proven benefit with borderline. Therapy and somatic bodywork help me much more.

 

Like many I curse the day I ever (reluctantly) got involved with psychotropic pharmaceuticals and diagnoses - feel like I was led up the garden path for years by all this and worry my CNS has been damaged and made reliant on chemicals that no longer help but just give side effects and interfere with natural healing whilst beeing hell to come off, when actually I needed to go deeper into myself all along. A cruel joke.

 

But I live in an area with - and am friends with - healers and those a spiritual persuasion and I still hold faith - as testing as it is at times like this- in the power of the body to heal. And also that going through this is part of my spiritual journey....

 

What next?

I've told the psychiatrist and GP that I no longer have any time for biomedical psychiatry and want to get off the drugs. (I told the GP at one point that Venlafaxine will one day be made illegal) They are OK with that but, quelle surprise, see it as a straightforward and relatively rapid affair.

 

The docs and psychiatrist say get rid of one at a time

1. Lamotrigine -> 2. Mirtazapine (most) -> 3. Venlafaxine -> 4. final 15mg of Mirtazapine

Getting rid of the easier ones first to build up my confidence is their logic?! One GP also suggested Lamotrigine is a 'dirty drug' (the others are lovely and clean of course).

 

I have always been dubious of this but after my initial Venlafaxine drop, largely went along because I thought Lamictal easiest to come off from past experience and wanted to start crossing them off.

 

So the plan was: reduce Lamotrigine by 25mg every fortnight....I was feeling in good spirits about it but..

 

The max Lamotrigine I was on was 300mg, from June 2014 to August 2015 (latest whim of original psychiatrist) when I on an impulse (unsupervised) dropped it to 200mg straight off, with no obvious adverse effects! Strangely when I went down just to 275mg earlier in 2014 it hurt more and I reinstated it as I had changes coming up. It seems a very whimsical drug and I wonder if at particular levels it doesn't agree with your system but either side it can?! I remember that to a lesser degree when I withdrew from it previously.

 

I feel less toxic and lethargic and with better memory since reducing it from the 200mg six months ago. Also I feel that it was dampening me in a way that was stopping the processing of trauma.

 

I am really disappointed just now - I was hoping it was going to be relatively straightforward this time. I almost wonder if reducing it has activated more of the anti-depressants - whenever I have started or increased anti-depressants I have felt suicidality creeping in, and I have that same feeling.

 

My current plan (and one I was always keenest on)

Hold lamotrigine or back up to 150mg? or try dropping a little further to a sweeter spot?, bearing in mind it has been trickier than hoped (perhaps due to the cocktail it is part of, or perhaps meds have just screwed with my system more these days)

Have a rest, then...

1. Venlafaxine - a little scared of its reputation but would hope the other two would mitigate its withdrawal and it's a relatively low dose to come off of.

-> 2. Lamotrigine or Mirtazapine? -> 3?

 

Here I have some questions:

- Mirtazapine should help with mitigating Venlafaxine withdrawal overactivation? But then again Venlafaxine as an SNRI is activating in it's own right no so maybe that doesn't matter so much ? Or is that just at higher doses where it effects noradrenaline?

- The fact that Mirtazapine works on serotonin and noradrenaline in of itself could help buffer venlafaxine?

- Mirtazapine feels fairly benign in comparison, apart from the weight gain. So in some ways I'd be happy to be on it - particularly at a low dose- for a good while.

 

- I did leave Lamotrigine until last on my last time around on the Lam-Mirt combo. Does leaving GABA-acting drugs like benzos to buffer the system last also apply to Lamotrigine even though it works on glutamate rather than GABA?

 

OR keep doing some of each in turn??

 

I have been going somewhat faster than your recommendations because I'm so sick of the drugs - number one complaint low libido; and I have an acupuncturist and doing some energy healing too, as well as general healthy eating and work-life balance. I have done a lot of work on myself in psychological terms (always more that can be done). In my previous time coming off I tended to do bigger bumps down than 10% but then with a bigger gap in-between. I'm so impatient now I want to do bigger bumps with short time periods....I want to get most of it done this year but I know, not realistic even with all the support, probably. But then again I came off OK and could have gone faster last time.

 

I'm 41 and want to get free of these things while my body is still in a decent condition to heal and I want to make up for the relationships I've stayed away from because of the side effects and psychological issues. And in the longer term I am drawn to massage and energy healing work and in the longer term would like to go into that, mostly med-free if not all. It's been almost 10 years since I first swallowed one of those pills and I feel like I never knew really dark feelings until they came into my life. I never felt as bad before as I did after! God I hate these drugs! They can help in the short term but my word do you pay for that in the long run.

 

Let's hope that this is all part of the healer initiatory process as an interesting thread elsewhere on the site proposes. The anger poisons an already fragile nervous system if it runs out of control, I find...

 

Thanks for reading!! Any suggestions or thoughts most appreciated.

[KarenB]

Welcome back Reggie,

 

I joined your new intro up with your old one, as it's one Intro thread per member.  This is a good place to ask questions about your specific situation. 

 

To answer some of your questions: 

 

Venlafaxine is only an SNRI at 150mg and over. 

 

I do think it would be sensible to go back up to your last dose of Lamotrigine and allow your CNS to stabilise again.  Then you could look at further options.  Keeping yourself stable throughout is the key.  Going lower when you are already unstable would likely cause increasing problems. 

 

It's also worth nothing that the reductions you have been making are quite large.  If you can stick to 10% reductions monthly you will probably do much better.

 

I'll let a more experienced mod help you figure out the plan beyond that. 

 

Best wishes,

Karen

[Reggie]

Thank you very much people for all your helpful comments and suggestions- and humble apologies to those who responded to my original introduction last July!! I had forgotten I'd actually posted that then - thought I'd just done a draft - and whenever I referred to the site now and again since I didn't log in. Doh! And thanks to KarenB for putting the posts together.

 

I am going to give it a couple of days more at 125mg lamotrigine with a view to putting back up to 150mg. And then ask GP for venlafaxine XR capsules rather than XR tablets so to get prepared down the line once system settles awhile- I've broached the subject of counting beads already.

 

The thing I find that complicates it is I am doing some energy healing work on deep buried anger and my feelings of absolute rage and despair over the last 24 hours at meds/pharma/psychiatry seem mixed up in the same feelings about earlier stuff. i.e. difficult states potentially coming to the surface. Very confusing. What a layer of nasty confusing counter-productive mess these drugs add to already complex healing process..

 

Altrostrata, re: your questions:

I take Venlafaxine in the morning. If I forget I often feel better or notice I have more libido, it's that fast acting, and that's the the XR version! Or sometimes feel the head whooshing if I can't get back to take it until the evening

I take Lamotrigine in the morning and evening, split the dose, more in the morning if anything.

I take Mirtazapine in the evening, normally knocked out after an hour or so especially if I eat carbs.

 

Often a pattern on bad days is wake up feeling after nasty trauma type dreams, anxiety builds after eating breakfast/facing the day (?), the mood and racing mind worsens over the day. Worst time is early evening (which when I'm feeling good in life is often my best time) and then lessens somewhat into the evening. Not always like that but that would be the most common example

 

Lamotrigine was added as a short term crisis med/adjunct at 25mg back in 2008 (first time around) (along with Seroquel which didn't last long, I was on holiday on the other side of the world starting on Mirtazapine- insane) and then as the shrink I started seeing on my return postulated 'bipolar spectrum/bipolar depression' (the darling concept of many of them it seems) it was ramped up to a higher dose over that year. I had a sense it helped me more than AD's and told him that but I'm not sure if I was partly seduced because of hatred of SNRI's and allure somehow of the spectrum diagnosis. All feels like a long long time ago (and 'borderline features' and a deeper psychotheraputic approach were not on the menu - meds and CBT only).

 

And here is the Drug interactions report:

Interactions between your selected drugs

Major venlafaxine mirtazapine

Using venlafaxine together with mirtazapine 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

venlafaxine lamotrigine

Using venlafaxine together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as 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.

[Reggie]

Hi there - I've not followed the guidelines, my impatience and optimism and desperation to be off  Venlafaxine got the better of me!

 

Here's what I've been doing reducing Venlafaxine (it's in my sig too)

 

Switched from 75mg XR to regular 37.5mg tabs and used a milligram jewelry scale to break bits off one of them and reduced to equivalent doses every two weeks as follows:

 

Apr 13:  to 60mg (-20%) am + pm

Apr 27: to 47.5mg (- 21%) am + pm

May 11: to 37.5mg (-21%) am + pm

 

Originally was going to pause there for at least a month but all seemed OK and I didn't want to overly focus on the reduction and give the meds too much power, stay positive etc. so pressed on....

 

May 26: to 25mg (-33%) am

June 8: to 15mg (- 40%) am

 

I know, that is a big drop in two months...

 

Last week been nasty - awful mood, nasty black and white negative thoughts (trapped on meds forever etc.), nervous system really raw etc, cancelling work jobs - i.e. classic depressive symptoms. When I look back been sliding a little last four weeks though also working through some psychological issues so didn't particularly spot the physiological bite coming.

 

My acupuncturist/herbalist has not been so happy the last couple of times I've seen him. In fact we changed herbs last week to help support libido restoration now that I'm nearly off Vn and that correlates with the worst of times though it may just have been post that acupuncture (I remember having some shiatsu treatments when coming off Cymbalta back in 2007 that made me feel super raw).

 

I have no other symptoms, two to three days immediately after each reduction I'd have transitory and intermittent minor head whooshing and nausea.

 

My inclination is to reinstate to 37.5mg - or should I just hang fire through it now that I've done it?

 

Thanks

Edited June 19, 2016 by scallywag
Moved from new topic started in Tapering

[scallywag]

Welcome back to SA, Reggie

 

Please set your intro page as a bookmark or favourite in your browser so you can find it again. It's also useful to follow your introduction topic so that you get email notifications when someone posts a comment or question to you. You can choose the conditions of the notifications -- how soon you get them and/or how frequently. 

 

To follow your topic, go to the page linked above and click the grey "Follow this topic" button near the top right; it's on approximately the same horizontal line as the thread title.  An options box appears, select one of the follow options and then click "Follow this topic" in the follow options dialog box.

 

Your question about increasing your dose:

Our symptoms are our best guide to changing doses, whether up or down. How were your symptoms when between May 26 and June 7, when you were taking 25 mg Effexor?

[SquirrellyGirl]

It is entirely up to you as to whether to reinstate or hang fire, Reggie.  You need to decide whether the your current withdrawal symptoms are at a level you can tolerate or not.  Also know that you would likely experience the Windows and Waves Pattern of Stabilization as your system gets caught up.  Up-dosing would eliminate some of that, I'm sure. If you do hang out at 15 mg, I'd strongly suggest holding there for a few months.

 

As for up-dosing, I think 37.5 mg would be too much since you have been down from that since early May, might overshoot your level of healing and cause adverse effects or start-up type side effects.  You might go back to 20 mg and hang out there a good while, probably a couple of months.  Your fast tapering has kept your system scrambling to keep up, so hanging out at 20 mg for a couple of months would give it a chance to catch up and get on solid footing before challenging it again with tapering, this time at no more than 10%.  What do you think about that?

 

Had you done a 10% taper, you'd be around 54.5 mg now, and this is a rate that hopefully allows the system to adjust fully between cuts, so you can see that you are way ahead of schedule and there is much adapting to be done, yet; thus, the long hold recommended.  We don't know for sure where your system is at, which is why I suggested a 5 mg increase rather than more.  Hopefully, that would give you enough symptom relief, though after a week you can reassess and do another small up-dose if you feel it is needed.

 

Let us know what you decide to do :-)

 

SG

[Reggie]

Thank you guys (and for putting post back here, I'm now following it)

 

Symptoms on 25mg between 25 May and 8 June:- mm, let's see, I was sliding ainto loneliness and introspection and a more negative outlook but it was a slightly odd time: social engagements falling through, work getting unhelpful in this regard, certain issues really coming to the surface. It's hard to isolate just the med factor.

 

I'm feeling things a little more in perspective now.

 

My current plan is to review over next three days, have a chat to acupuncturist/herbalist (who has good experience of these matters) and then either bump up to 20/25mg or hang fire at 15mg (and do so for a good while).

 

I'll keep you updated, thank you

[Reggie]

I've not made any bumps back up, as yet...

 

I'm pretty depressed at the moment, struggling to get my work done (I'm mostly self-employed) and really worried about what course to take with this. Nervous system feels spiked and I'm just not sure if it is going to settle without me going back up, and indeed whether that will help. Brings back memories of coming off Cymbalta in 2007, which ended up with me back on anti-depressants of a different class.

 

Me and SNRI's are really not a good mix!!

 

I had a slightly better week following my last post, finally spoke to the acupuncturist/herbalist later in the week (23rd I think) and he suggested giving the new herbs another go (I'd run out of the old herbs anyway). So I did, and felt a little worse again.

 

A week ago, 29th June, I had an actual session with the acupuncturist, I felt my nervous system really spiked the next day. It seems acupuncture is doing that at the moment. Under his advice I am giving my new herbs as little longer to really give them a chance - I see him in two days and we'll make a decision then.

 

Three days ago at a party I drank a little whisky - big mistake, following day I felt so low!

 

And very confused, I'm also doing other 'work' with an energy healer who's working on my heart chakra and soothing my system; family constellations where abandonment issues come up and  talk of first chakra instablity; trying to really be with the body sensations in a mindful manner; acupuncturist saying about spleen-heart imbalance. All of these make sense individually - but what the hell do I do about now!?!?

 

I really hate having to deal with these drugs as well as all the sh*t in life! It seems like when the withdrawal kicks in all the psychological stuff hits the fan too. Perhaps I'm just not ready to have done this reduction in this nasty drug, or have I just gone too fast and need to in fact stablise by going back up??

[Reggie]

In general I've found that I notice a lowering of mood on reducing drugs 3-4 weeks after the reduction. When I came off Mirtazapine in 2009-10 I did it with three big 'staggered double drops' spread six months apart (September 2009 45 -> 37.5mg for two weeks -> 30mg) (April 2010 -> 22.5mg two weeks -> 15mg April) (October 2010 -> 7.5mg two weeks -> nothing October 2010). Each time I'd notice a temporary dropping in mood after that lag time where I would worry about it but nothing at all disabling and it would settle fine and I would feel better for ir.

 

And it was about that length of time after currently reducing my Vnlafaxine to 37.5mg that things started to go down the pan. I regret not holding at 37.5mg for a long time - maybe I just go back to there until next year? In the meantime consider doing slow tapers on the others.

[scallywag]

Reggie, Here's my interpretation of your venlafaxine taper from your signature:

 

75.0 mg starting dose

60.0 Apr 13

47.5 Apr 27

37.5 May 11

25.0 May 25

15.0 June 8

 

What are the systems that have caught up with you and are biting your behind?

 

Holding at a dose for a good long period is an excellent idea. Effexor is like all the other drugs, the lower the dose the smaller reductions we have to make and the longer we have to hold at a dose. 

 

You've been taking 15 mg for close to 4 weeks; it might not make sense to go all the way back up to 37.5 mg. If you're feeling the need to updose, try 20 mg for a week to see how you feel. Keep a written paper log of your symptoms and when they occur. Your symptoms will be the best guide.

[Reggie]

Thank you  - I've just been writing a bit of a log as follows, giving a summary for the week as I remember it (I used to keep a mood diary, then the clinical psychologist of a few years ago decided to ban it so I didn't focus on my mood - he was running out of ideas - and I've never got back in the habit...)

 

week beginning

Apr 11     60 mg        OK as far as I remember

Apr 18                       OK as far as I remember

Apr 25    47.5            tired

May 2                        Started to get more obsessive in my thoughts. End of fixed term psychotherapy (weekly over last six months).

May 9      37.5           Not very grounded good mood or actions (Spring?) and long week work-wise (for me...) w/ some bad news on personal front (real trigger)

May 16                      Again not very good personal news and obsessing over trigger and tired

May 23    25              tired, long work week, starting to isolate myself

May 30                      OK but then related trigger and blow to confidence at end of week, started to spiral a little. Acupuncturist less positive. Work now became more monotonous.

June 6     15              Low and tendency to isolate, getting quite down. Gap in my weekly sessions with energy healer for this week and next.

June 13                     Almost a write off - cancelled nearly all work jobs to stay in bed, felt very low. Acupuncturist less positive -I felt awful after session/new herbs

June 20                     somewhat better, still not good, feeling low/tired in evenings and difficult weekend

June 27                     Difficult but manageable, crashed at weekend, pushed my self through neighbourhood party, drinking bit alcohol.

July 4                        Terrible days so far

 

When I say OK earlier on in this time frame, I was still doing some psychotherapy and healing work and stuff was coming up at times and could be challenging but in a very different way to my current nervous system rawness. Even though I can easily forget how to discern the two.

 

How can I describe it? Very negative racing thoughts - catastrophic, highly self critical and hopeless at times - which gets exhausting and confusing, high anxiety, managing to get through some days (without others noticing) but crashing some days; feeling like isolating myself, sleeping in, missing work, rawness in body especially in legs, some flashes of libido coming back but massively overshadowed by darkness. I've lost my routine, spiralling....

 

So when I look at this, I see other factors than just med reduction at play (end of therapy, psychological triggers, work changing for the worst) and I wonder to which med reduction the various drops in mood/functioning could be attributed i.e. the lag time. I feel foolish for being so gung ho but trying not to beat myself up.

[scallywag]

Reggie, it's great that you kept records of how you were doing and feeling.

 

Please don't feel foolish about the pace of your taper or not noticing all that was going on.  We all learn life by living it.

 

Let us know what you choose to do -- updose, hold at 15 mg, cold-turkey (don't you dare!!!  ) -- and how you're doing.

[Reggie]

Thank you. Had a long chat with a good friend who's seen me go through things over recent years. I'm going to go back up tomorrow - I reckon to 37.5mg, my system feels pretty shot and it is really impacting on my functioning so don't reckon a small increment is enough. And I want to keep working through some issues without my nervous system being too compromised by this. I'll let you know how it goes

[Reggie]

Well, did a day at 37.5mg but also rediscovered my tryptophan so tried that - but was just getting worse, I've been really struggling to work, feeling really bad. And I crashed after my last acupuncture session two days ago, felt hopeless and really confused, told a couple of friends quite how bad things were getting, felt like I was really acknowledging it too. One of them is a nurse who also takes meds and she suggested going right back up to 75mg, in fact we called the non-emergency health line and then I went to an out of hours doctor yesterday - have a new script for 75mg!! I know really that's what I need to do.

 

I hope I'm not overshooting by going all the way up to 75mg bt don't want to mess around. It seems I've gone right outside my window of tolerance and it's really impacting on my life.

 

Feel really disappointed. I just want to stablise and get my life back on track, though I worry that I now won't restabilise back at 75mg. Friend and GP both suggested I'd see the difference within a couple of weeks since I'm still on the drug. They also agreed I'd done it too quickly. Of course the GP didn't see the point of taking any below 37.5mg but I wasn't expecting any different from her.

 

I was telling my friend about this site and how I'd worked out it would take me three years to get off the venlafaxine alone using the 10% rule, hence speeding up the process (dramatically!!). She said that is nothing in the grand scheme of things. 

 

I do wonder if actually my body just needs that 75mg, at this point in life anyway, and I shouldn't even consider even an ultra slow taper any time soon. I'm back to the biochemical model of depression and how though I fight it so much and want to 'beat' it with therapy etc., that perhaps it is just part of my life. My friends said if that's what it takes to be me then that's OK and the libido issues can be worked around with the right person. The acupuncturist talks about how these drugs are part of my nervous system and need to be gently teased apart while I do other work on nurturing my 'authentic self', I told him about the plant and trellis analogy I saw on here, which he likes. I have another session with him on Tuesday.

 

Another interesting thing my friend and the GP mentioned was how out bodies continue to change and how even if I find I do need this medication regime for a while things can change. And of course life always does...

[Reggie]

Having to miss work at moment, spend the week resting and considering going off sick more formally. That could be a time dedicated to getting myself just stablised again back at 75mg or stablised again somewhere lower e.g. 37.5 mg

 

A question lingers -  have I overshot by going right back up to 75 mg? Opinions much appreciated

[Reggie]

ps. I've realised that the the extended release version works better, hence the idea to go back up to a full tab of one of those and work on the doctors to give me the capsules so in time I can start a slow taper using my scales.

[scallywag]

Reggie,
 
Sorry you haven't had a reply until now. Going from 15 mg back up to 75 mg is a large jump, and possibly destabilizing. If you feel updosing is the next step, try 20 mg or 25 mg for a week. Continue keeping notes on your symptoms. You may find that the updose back to 25 mg where you were before that big 10 mg cut in May, might work. You could then hold there a good long while before starting to taper again but slowly this time.
 
You unfortunately decided to speed up at the time you needed to slow down.  
 
We have a topic here that discusses a medical research study about what happens to serotonin transporter occupancy at different doses of 5 common anti-depressants: Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Paxil (paroxetine), and  Effexor (venlafaxine).
 
Why taper paper: dose-occupancy curves
 
The paper is linked in the first post. The first SERT occupancy curves are on page 4 of the paper; the graphs for venlafaxine are Figure 5 on page 6 of the PDF, marked as page 831 of the original publication.

[Reggie]

Thanks Scallywag, I really appreciate you following my story and advising.

 

Well, today I got the script for 37.5mg Capsules - finally! - and doc seems happy to leave it in my hands so from tomorrow I'm going to start back at a lower dose such as you suggest (today I just did a 37.5mg tablet, so just four days at 75mg, one at 37.5mg, which hopefully won't be too much of a bump). I'm half inclined not to updose but just work with what I now have and leave it alone for a good while.

 

This is in large part due to the below.

 

Interestingly, I'm realising that these symptoms could also be (and I believe, in part are) waves of the buried trauma I experienced back in 2012 that ended up with me back on meds but deeply confused about what was happening to me. My body is trying to process this, I have to feel it and be with it and work on healing it, even if it is dehabilitating.

 

That's one thing this site doesn't talk much about - that as the meds go down difficult emotions/states that the meds were surpressing could come up - so can all of our symptoms be attributed to the CNS adapting to life without meds? This I can find confusing as it could be both of the above mixed up, at times becoming unmanageable.

 

Another thing I'm working on changing is not fighting the meds, psychiatry, doctors, pharma any more - to see the drugs as something that has been my ally and that all those people (pharma managers aside) have been trying to help me to the best of their ability  -  that I'm now slowly and (increasingly ...) respectfully changing my relationship with as I go deeper into things. A session today with my energy healer who is I suppose a spiritual guide/mentor has helped me clarify things.

 

Let's see what happens, I'm taking a little time off work and that is giving me space to explore the boundaries here.

[Reggie]

Well, the 37.5mg capsules I've ended up with are Venlablue, which just have 3 mini XR tablets. Just had a read up on them on the tapering off effexor page.

 

So that is decided - two of those i.e. 25mg and let's see...have an appointment with regular GP in two or three weeks to review and I can always ask for a new script specifying bead type capsules to fine tune it.

 

I'm still interested as to how much my symptoms are withdrawal and how much are 'the depression', no exact answer of course..

 

(And on a chemical front, I am using more and more essential oils to help me, either vaporising blends or buying blank  Vicks'inhalers on ebay which I can then load with oils, to carry around with me)

[SquirrellyGirl]

My question for you, Reggie, is:  what is the character of your depression?  What is it about?  

 

This is just my opinion, but when it is withdrawal, it goes away when a window comes along.  The thing with depression is, it is such a continuum. There are depressive types, and then there are normal people who have a depression hit that resolves eventually on its own if left without chemical interference.  I was a depressive type, from my teens, but it was about low self esteem, lack of confidence, shyness, never feeling good enough, perfectionism, etc.  This was all amplified by 1000 when I was in protracted withdrawal.  I have embarked on some CBT work in the last year that has done wonders for breaking old wires, thought patterns.  

 

SG

[Reggie]

Good question - I really don't know any more....I am profoundly confused as to what is what. It could be considered a trauma and/or childlike state, characterised by confusion, raw nervous system, deep feeling of not being good enough/rejected/unloved.

 

Feel a massive split when ti comes to what my depression is all about, want to leave behind the medical model and meds but maybe that just isn't realistic..

 

I am faced with what seems like an impossible dilemma at the moment. I feel **** because:

 

1. I am getting properly depressed again and need the Vn back up to 75mg as my body just seems to need it for now, at least

2. I am getting properly depressed again, it is a chemical imbalance (I don't like that model, but perhaps it is true) and I will need meds ongoing - this hurts

3. I am suffering w/d effects from going too fast and need to hang fire where I am

4. I am suffering w/d effects from going too fast but reinstating to 25mg is not enough so need to go further - but ohw far and how long will it take?

5. I am getting properly depressed again but need to really go into the trauma and learn to heal myself, be mindful in the heart of it. I am drawn to being a healer but feel million miles from it at moment, maybe I'm deluded, maybe this is not a test exactly but an opportunity (which was my approach in last few days, resting and getting embodied)

 

Mostly I am torn between 1, 2 and 5. 2 feels awful, 1 perhaps manageable, 5 is best outcome in long run but might be waste of time. 1 in conjunction with 5 could be good, 3/4 in conjunction with 5 be good but should I keep tweaking the meds?

 

Today I've been on the verge of just putting it up to 75mg again, in fact took two extra mini-pills before giving 50mg today so

 

9th 75mg,

10th 75mg (mood picking up)

11th 75mg, (awful after acupuncture)

12th 75mg,

13th 37.5 mg

14th 25mg

15th 25 mg (mood definitely dropping)

16th 25 + 25  =50mg!

 

I don't know what the hell I'm doing on any level at the moment...

 

Meanwhile I am avoiding social occasions, off work (but supposed to be doing sessions Tues and Thurs), feeling desperate, talking to few people about it but unable to show quite how bad I feel. And no idea how to proceed. Too many internal voices (options)...

[KarenB]

Hey Reggie,

 

You aren't alone in figuring out those options.  There are mods here who can help you.  I can help by eliminating #2.  The chemical imbalance theory was only ever a theory - it was never proven.  Furthermore, it has now actually been dis-proven.  And interestingly the scientists who first used the phrase 'chemical imbalance' have now admitted it was only ever a metaphor, rather than the result of scientific research.

 

There are so many areas of research that would encourage you in your healing, such as Neuroplasticity and Brainsculpting.  One of our members, GiaK, has a website BeyondMeds which is a great place for seeing how many healing elements work together.  Getting the bigger picture of healing can really help you pull together the smaller details, and provide a lot of encouragement. 

 

I wouldn't go any higher than you currently are.  Part of the problem is you aren't staying at any level long enough to really stabilise.  Further movement will add to the destabilisation you are already feeling.  

 

On 8th June you were at 15mg - can you update your signature so we can get the whole picture?  Otherwise our ideas might be all off-base. 

[Reggie]

Thanks KarenB...I had a session with my healer/therapist today. She persistently pointed out something I am aware of when lost in it but too caught up in  it, namely - when feeling my personal trauma/depression I lose all sense of grounding, get confused and desperate, lost in all the opinions and models, keep changing my mind... (a very confused abandoned child but that's another story)

 

Which of course can be observed in the last couple of weeks with the med changes (sig adjusted, thanks)

 

And lost in it all, I've not been managing my life very well, lot of behaviours (e.g. isolating myself, losing a routine, not actively using methods I do know in order to ruminate less) that in themselves exacerbate depression - so I'm rectifying that. And that is already helping.

 

She is an energetic healer and teacher and says when trauma is coming up, we have to feel it, that the meds change our brain chemistry in such a way that we can exclude feeling it (other times in our life we may just have done that subconsciously until it life stress/triggers etc. brings it to the surface) but it is still there and if we want to actually be free of it - and our physiological system to be properly balanced - needs to be cleared from our field, which requires feeling it and really being with it (she explains it a lot better than me). So effectively as the meds are reduced (at points in the process, as and when it happens) this trauma will come to the surface. Whether we are prepared for it is another matter...

 

This is obviously quite different to a psychiatric model but one when I feel connected within myself I increasingly know is true, but my mind can get bewildered by it and societal conditioning does not support it. How it meshes with a med reduction-brain/CNS adjustment model I'm still a little fuzzy

 

Back to the meds, OK, you probably won't be surprised to hear that yesterday and this morning I took 75 mg... I know.... (before I read your message) I was desperate yesterday...but getting a lot more grounded today.

 

I have agreed that from tomorrow I will hold a dose for a good while - with no more meddling!

 

I am inclined to make this dose 50 mg again, reasons being:

 

a) I worked out that over these last ten days of messing around my average dose has been 56 mg

 

looking back it was about four weeks after going down to 47.5 mg that things just started to slide (in a manageable way, which I would be more aware of now)

    - see post #15 above

 

c) it's relatively easy to dose with my Venlablue

 

d) it balances a relatively gentle reduction in ongoing dose from the original 75 mg (certainly compared to the previous ongoing 15 mg!) with a chance to be with the trauma, perhaps, and also to work on strengthening my mindfulness and self compassion skills to better ride the storm in the future.

 

(Though looking at post # 15 above - maybe 37.5 mg would be OK?)

[KarenB]

Looking at those jumps and responses to jumps, I think 50mg sounds fairly sensible - it being somewhere in the middle of the whole mess .  I looked at post #15 and didn't think things looked great at 37.5.  But also, there have been so many changes since then to take into account. 

 

It sounds like you have a fairly good healer.  I strongly agree that we need to see, accept and feel whatever things are in our lives in order to allow them to move on.  It can get a bit stop-start during w/d, but can still be done.  This is where it's vital to be working on non-drug techniques to deal with emotional symptoms, because these are also the techniques we use to manage emotional pain in general.  I see it as getting two cakes for the price of one! 

 

But don't wait for the manure to hit the fan.  Get in early and practice and build up your nest of strengths and supports.  This should be your main focus while you hold for a very long time on one dose in order to stabilise .   

 

Also, have I asked you before about when you started vitaminB?  If it was before you were in w/d, then all good.  But otherwise it may be making your symptoms worse as it can be quite activating. 

[Altostrata]

Reggie, we urge people to adjust only one drug at a time and be very systematic to forestall the type of confusion you're experiencing.

 

If I were you, I'd give 50mg a good trial. It takes at least 4 days for a drug change to reach "steady state." Then you need to monitor how you're reacting to it for a while after that.

 

This is not going to be an immediate fix for what ails you. Doctors will offer you an immediate fix in the form of more drugs.

 

You've been taking 3 interacting psychiatric drugs for a while and making changes for months. You need to get to a baseline in drug intake and keep notes of your symptoms at that baseline for a while.

 

Yes, we do discuss what happens if your original psychological problems re-emerge. If you want to go off drugs, you have to manage not only the tapering process and potential withdrawal symptoms but your original psychological issues. There are no easy answers for this, either.