Bridgetini: tapered mirtazapine, now venlafaxine

[Altostrata]

Ordinarily, we recommend going off venlafaxine first, as it can disrupt sleep on its own and tapering can bring on insomnia. If you're taking lorazepam, that might counter the adverse effects.

 

Why was lorazepam added in the first place?

 

Withdrawal insomnia tends to be very resistant to non-pharma anxiety reduction -- though that is helpful for other symptoms.

 

Strongly recommend you taper at least part-way off venlafaxine before reducing lorazepam. Tips for tapering off Effexor (venlafaxine)

[Bridgetini]

Hi Alto, thanks for your care and help.

 

In 2014 I was in the psych ward in hospital and when I was discharged I was on,  I think, 8 mg Lorazepam,  a sleeping tablet (soon discontinued as an outpatient under instruction from the psychiatrist), and 375 mg Venlafaxine. On the psychiatrist's instruction as an outpatient I reduced the Lorazepam to 1.5 mg in early 2015. I was still depressed, tired, and weepy, ("treatment- resistant depression") so the psychiatrist introduced Mirtazapine as well.

Since 2016, the psychiatrist has been encouraging me to discontinue Lorazepam (as it is "addictive"). Each time we met we would discuss it, and as I had begun tapering off Mirt, I was not prepared to reduce Lorazapam as well. So now that I am off Mirt, the psychiatrist is all in favour of reducing Lorazapam. They did propose a 25% reduction each time (over 4 weeks, I think). I suggested 10% reductions of previous dose, and showed a sample reduction graph that I had prepared. The psychiatrist went to speak to the pharmacist and came back and agreed to 10% reductions per month. I believe that the psychiatrist felt that, given my own anxiety about reducing Lorazepam,  cutting down slowly is better than than not cutting it down at all.

 

I take all your advice about Venlafaxine reduction. I could try one or two reductions of it instead of Lorazepam before I am scheduled to see the psychiatrist again in May. But this would cause the psychiatrist to be concerned that I am still reluctant to reduce Lorazepam as I am "addicted" to it.

 

[Bridgetini]

I have been reading the tips for tapering off Effexor and how to measure using a digital scale. Thank you for that. I am on Efexor XR, so I will order a scale and gelatine capsules.

[Tyron]

Hi Bridgetini,

I am now in my fifth week of tapering Mirtazapine from 45mg down to 36mg. It needs to be done very slowly; eat well, exercise and drink plenty of water.

Stay away from coffee and alcohol. I am now in my fifth month of no paxil and I feel great! This is my year (the year of the pig) I will succeed and so can you.

Good Luck and blessings. 

[Bridgetini]

Hi @Diehard, thanks for stopping by and for the encouragement.  Well done on stopping Paxil! I hope that your Mirt taper hasn't been too bad.

I am almost 2 weeks Mirt-free: still have itchy, tingly skin; some digestive issues as my system adjusts; increased anxiety, not helped by some family of origin complications. I am trying to sleep, rest, exercisr, eat properly, breathe, and be gentle and kind with myself.

Seeing my therapist at noon today.

 

Peace to everyone out there.

Bridgetini xx

[marie123]

Hi Bridgetini. I've been reading your mirt posts. Nice to see you've jumped off! Did you have any mouth issues with mirt like dry mouth, burning mouth, etc.?

 

Congrats.

 

Marie

[Bridgetini]

Hi Marie,

I only had dry mouth very occasionally during Mirt withdrawal,  and no burning sensation. I always have a glass or bottle of water to hand 24/7 and tend to sip frequently. 

[Bridgetini]

Unintended Venlafaxine skipped dose: A cautionary tale.

I had a cold virus about a week ago and was trying to take things easy to recover. I normally make up my morning and evening med doses in a 7-day pill holder with a.m. and p.m. sections. I add my vitamins /supplements in so that I take them all at breakfast or around 8 p.m.

BUT this week I had to refill my prescription and didn't realise that I had put Ativan and vitamins in the morning holders but NO Venlafaxine for a couple of days. There was a mix-up with the script,  and I was already ill, and when I got back from the pharmacy I forgot to put the new Venlafaxine into the pill holder sections. 

So Wednesday night I had a lot of strange dreams/nightmares. Not too bad. I stayed in bed late on Thursday ( to help recover from the virus), got up and went through my day. Mid-afternoon I was feeling tired, achey and MISERABLE, crying, apologizing for feeling sorry for myself. No appetite, and having extreme diarrhea. I thought the virus must now be flu, so I went to bed. I had a horrific night of sweats and terrifying nightmares, at least 3 different very detailed scenarios. 

This morning when I went to take my meds I noticed that there was no Venlafaxine in today's morning dose with the vits and Ativan. DOH!

So I presume that I accidentally cold turkeyed off my Venlafaxine yesterday (Thursday) or possibly Wednesday as well. 

Hopefully now that I have taken the correct dose my system will restabilise.

Ugh. Thank goodness I realise what the problem was.

[Bridgetini]

Just found this paper,  "Venlafaxine and Serious Withdrawal Symptoms: Warning to Drivers". It describes my symptoms from last night/yesterday exactly.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681629/

[ChessieCat]

When I was taking 100mg Pristiq, if I missed a dose (accidentally) I would get severe brain zaps and have to lie down and wait for the dose to take effect.  Even moving my eyes with my eyelids closed would give me a horrible sickening sensation and my eyes would "hurt".  There is no way I would have been able to drive.

 

When I tried to reduce my Pristiq (desvenlafaxine) from 100mg to 50mg I suffered very bad cog fog.  Even walking took my full concentration.  I only drove 4 times during that 2 week period (out of peak hour traffic) and have released since that it was very fortunate that I didn't have an accident.  After the 2 weeks I got to the stage that I was unable to type, and being a typist for 40+ years I knew that something was wrong.  I had joined SA a few days before this happened.  I took extra Pristiq and about 4 hours later I was able to type again.

 

The disappointing disgusting thing is that the date of that was 2005.  Thirteen years ago!

[Bridgetini]

A very weird sensation that I had this morning,  which has now passed, is that when I moved my eyeballs sideways I could hear it: a sort of fanning, shuffling sound.

[ChessieCat]

That's part of the sensation I would get when I moved my eyes with my eyes closed.  I hadn't thought of it that way, but as soon as I read your description I knew exactly what you meant.

 

Hopefully things will settled down fairly quickly.  I accidentally reduced my dose by 1/2 for 5 days (going from 9.5mg to 4.5mg instead of 9mg, because I picked up the 0.5mg capsules instead of the 5mg ones) and I did have an increase in symptoms for a little while.

 

At least you know what is causing it.

[Bridgetini]

Topic title:  starting Venlafaxine XR taper

 

Hi all, following a successful but veerrryy sloooow (almost 3 years) reduction of Mirtazapine from 7.5mg to 0 mg, I am now ready to start on medication no. 2. 

My psychiatric team has been pushing for years for me to come off my benzo (1.5 mg Ativan / Lorazepam) as there is a benzo addiction crisis.

However, good advice here is to reduce the stimulating SSRI (Effexor XR: I am currently on the max. dose of 375mg/ day) before the sedating benzo, so that the benzo helps to buffer the withdrawal symptoms from the SSRI.

 

I accidentally missed a dose of my Effexor XR in February and within a few hours had HORRENDOUS effects: sweats, nightmares, continuous diarrhea, confusion, hearing my eyeballs move.

 

So I spoke to my pharmacist at length, and have the support of my spouse and y'all here, and today dropped my Effexor XR by 10%. It was easy as the pharmacist gave me 2 x 37.5 mg capsules instead of 1 x 75mg capsule. So I could easily reduce by 37.5 mg (10%) by taking one less capsule.

 

I know that by tonight I will probably start having some side-effects, but have saved the links on my phone to all the good advice here on neuro emotions and non-drug ways to help with withdrawal effects. I also will keep a Dr. Glenmullen symptom diary each day to help tracking.

 

 

Big hugs to everyone out there.

 

Beannachtai la fheile Phadraig dhaoibh go leir!

Happy St. Patrick's Day to everyone!  ☘️

 

Bridgetini.

Edited March 17, 2019 by ChessieCat
added topic title

[ChessieCat]

I've merged your new topic with your original Introduction topic.  Each member has only 1 Intro topic.  This keeps their history in one place.  I've changed the title to reflect your completed mirt taper and new ven taper.

 

10 hours ago, Bridgetini said:

I also will keep a Dr. Glenmullen symptom diary each day to help tracking.

 

There are printable and computer versions of Glenmullen's symptom list available here:  Dr Joseph Glenmullen's Withdrawal Symptoms

 

10 hours ago, Bridgetini said:

I know that by tonight I will probably start having some side-effects

 

Side effects are the unwanted effects we get from taking a drug.  Withdrawal effects are what we experience when we reduce the drug.

[Bridgetini]

Thanks for all that, @ChessieCat. Sorry for the new topic! It makes sense to have a history all in one place.

Looking at the half-life curve, I will probably feel withdrawal symptoms around day 4 (Wednesday 20th March).

[Lloyd]

Hi Bridgetini, I had insomnia whilst i was on the Effexor, it disappeared pretty soon after stopping it & hasn't returned even through the withdrawal which has been a saving grace. My sister just recently reduced her Effexor from 375mg to 75mg however she did it in a VERY short period over 4 weeks. I don't think she has reported any major side effects (Yet) however the side effects can be delayed so i don't know if that's going to be successful. I found that when tapering my Effexor it became very difficult at the lower doses below 37.5mg. I was on 75mg (and 150mg for a few years) for a good 15+ years. 150mg to 75mg cut didn't cause me too many issues. This is actually the second time i have tapered Effexor, and i did it over a month from 37.5mg which has caused me hell.

[powerback]

On ‎3‎/‎17‎/‎2019 at 10:01 AM, Bridgetini said:

starting Venlafaxine XR taper

Goodluck Bridgetini with your taper .🙏

[Bridgetini]

Hi @Lloyd, thanks for sharing your Effexor experience.  I hope that your sister will be ok and not get a delayed WD crash.

@Powerback, thanks for the good vibes: hope you are doing ok and recovering from your bug. 

 

I am on Day 7 of my first 10% reduction: at this dose of 337.5 mg Effexor XR a day, my system is still completely swamped with the drug. I haven't had any significant WD symptoms, just occasional headache, allover tingling,  some changes to my appetite and sleep pattern, but not enough to affect my life.

It is springtime here and the days are now perceptibly longer and warmer, which is great, and must surely help with mood.

I am trying to eat less meat and also going back to no wheat (I have been mostly off gluten for 2.5 years now, but recently did start eating wheat again), as these are probably not great for my gut biome.

 

Sending happy thoughts to everyone out there. 

Hugs. Xxxx

[Lloyd]

Hi Bridget glad to hear its going well. No delayed crash yet for my sister which is good. Mind you they have on 3-4 different drugs... Weekend now which is great, going out for lunch today so hopefully the anxiety subsides a bit before then. Hope you have a great weekend!

[Bridgetini]

This is just out today on "Mad in America": https://www.madinamerica.com/2019/03/combining-mirtazapine-existing-ssri-snri-not-improve-depressive-symptoms/

 

 

[Bridgetini]

Today is Day 11 of my first (10%) drop in Effexor XR.  I am feeling pretty good! 

I have my usual aches and pains, but these are normal baseline for me.

 

If the rest of this week goes well, I will probably make another cut on Sunday (i.e. after two weeks). Dropping from the current 337.5 mg to 300 mg will be easy, and an 11% drop.

 

One thing that I was unaware of until last week: Effexor affects the menstrual cycle. See https://www.livestrong.com/article/248417-antidepressants-effects-on-the-menstrual-cycle/ and the source paper for Effexor, 

https://www.ncbi.nlm.nih.gov/labs/pubmed/12013367-venlafaxine-associated-vaginal-bleeding/. 

Also, Antidepressants and menstruation disorders in women: a cross-sectional study in three centers.

Uguz F, et al. Gen Hosp Psychiatry. 2012 Sep-Oct. https://www.ncbi.nlm.nih.gov/m/pubmed/22534402/

 

I know this now because I had not had a period on about 8 months and started unexpectedly on day 6 of my first Effexor cut.

I have had a couple of years of serious medical problems with a large uterine fibroid and haemorrhaging and have undergone several surgical procedures to help with the symptoms (addressing the cause was unsuccessful).

Now I wonder if the megadose of Effexor XR exacerbated (or caused?) this situation.

 

[Lloyd]

Hi Bridgetini, How is the Effexor drop going for you? I noticed for myself dropping at the higher doses wasn't too bad. My sister hasn't reported any major side effects yet from dropping down to 75mg yet. Mind you they put her on Aripriprozole which probably offset it.

Anyways hope you have a good week!

[Bridgetini]

Hi Lloyd, nice to hear from you. Glad to hear that your sister is doing okay so far.

I did drop from 337.5 mg to 300 mg yesterday,  but around 7 p.m. I was feeling weird, so I decided to take the leftover 37.5 mg at 9 p.m.  I took my usual 337.5 mg this morning and will stick there for another 2 weeks to give myself the full month of taper. Venlafaxine works on sooo many different parts of the nervous and endocrine systems that two weeks probably only just starts changes taking place.

Today I am super tired.

Recently I have been able to work on some projects that take planning, energy and execution, but I guess that today is a wave/stabilisation day.

 

Enjoying Spring!! Hope you are too.

 

Regards,

Bridgetini..

 

 

[Bridgetini]

I just read this in the current "Mad in America" issue :

 

"Even while I was coping with the side effects of quitting, there was a bright light. Just weeks after I was completely off venlafaxine, the pervasive, desperate depression I had lived with for so long simply vanished. It was as if a window shade in my head had been raised all the way to the top for the first time in years, and I knew I was going to be alright."- Jane Tholen,

https://www.madinamerica.com/2019/03/ambushed-by-antidepressants-for-30-years/

[Bridgetini]

Hi y'all, just checking in here. I am on my phone so can't figure out how to update my signature.

I dropped down another 11% in Efexor XR on the 20th April. No noticeable significant effects. I do have odd different things every day: last night I had very vivid dreams, and my teeth really hurt today. A few days ago all my joints hurt. My hearing is super sensitive and I get annoyed by noise. One morning the two kitchen clocks were banging out TICK TOCK TICK TOCK!

I guess this is all wild swinging of my neurological system trying to reach equilibrium. 

 

I am proud that I have made two cuts in Efexor.

 

Yesterday I had my four- month psychiatric clinic visit. As usual, it was a completely new doctor who was reading my file on the spot. She was mature, well informed, and seemed knowledgeable about tapering and withdrawal and binding curves, and was supportive of my strategy.

 

She encouraged me to have another session with my counsellor and also to check out mindfulness and relaxation videos on the Beaumont Hospital, Dublin, website: http://beaumont.ie/index.jsp?p=105&n=528&a=0

 

Hope everyone out there is doing ok tonight. 👌

[Bridgetini]

Sorry forgot to say that I droppped from 337.5 mg Effexor XR a day to 300 mg/day.

Still on 1mg Ativan in the morning and 0.5 mg Ativan at night.

[Bridgetini]

Just updating here: I held my last taper of Effexor XR for two months as there was a lot going on at home. I made another reduction at the end of June and am feeling okay after 2 weeks.

I was all set with a jeweller's scales and gelatine capsules to be able to make incremental cuts to beads in my capsules, but when I opened them, I didn't need to!

Each "Venex XL" capsule (manufactured by Clonmel Healthcare) contained 12 mini-tablets, each holding 12.5 mg of material. 

It was super-easy to open each capsule, take out some mini-tablets, and click the capsule closed again. I am keeping the left over mini-tablets for when I am at low dose tapering in a few months...

 

 

[Altostrata]

Well done, Bridget. Those venlafaxine capsules hold varying numbers of mini-tablets, depending on the manufacturer.

 

Reductions by 12.5mg at a time should carry you through up to a dosage of 125mg. After that, you might have to split mini-tablets.

[Bridgetini]

Hi All,

I had a couple of crummy days last week - super tired and not much enthusiasm or hope for the future. I was recovering from a bad headcold, which could have been part of the problem. 

I reached out to a friend and she invited for a cup of tea and a chat. She reckons that it could be perimenopausal symptoms - as they passed maybe she is right.

I took the leap of making another taper ( by 9.5%) of my Venlafaxine nonetheless - I am 3 days in, but don't expect any reaction until day 5 , maximising around days 12-15, then stabilising.

 

I was thinking about going back to fulltime work (I am currently a homemaker) and had an interview lined up last week for a great company, but cancelled it as I know that I am not able to deal with 39 hours a week plus commute plus housework plus everything else.

So I am going to work on my health and wellness and learning to accept the life I am in at the moment.

I am waiting to sign up for a part-time diploma course, which would give me a great project and introduce me to new people and ideas.

 

Hope everyone is doing ok. If you are somewhere with horrendous weather, I am sending you good vibes - hang in there.

 

Bridgetini xx

 

	Start date	End date	Number of days at this dose	4 week period at new lower dose	% reduction from previous dose	% reduction from initial dose	Complete
Month 0				375.0	0	0
Month 1	17/03/2019	19/04/2019	34	337.5	10.0	10	Yes
Month 2	20/04/2019	22/06/2019	64	300.0	11.1	20	Yes
Month 3	23/06/2019	24/07/2019	32	262.5	12.5	30	Yes
Month 4	25/07/2019			237.5	9.5	37

 

[Bridgetini]

Happy New Year, everyone! I hope that January is not too blue for you.

I am still reducing my Venex XR without any noticeable withdrawal effects - I am now down from 375 mg/day to 187.5 mg since March 2019.

I am determined to get off this "drug". 

 

I was at the psychiatrist a couple of weeks ago - he would like to start reducing my benzo in the spring but substituting with Valium first as it has a longer half-life. I am cool with that - I will hold my Venex XR taper wherever it is at when it comes time to start on the benzo.

 

Sending good wishes to you all.

 

B. x

[Bridgetini]

[Bridgetini]

Just checking in. I made another cut to Venlafaxine from 175 mg to 162.5 mg.

I am still on 1.5 mg Lorazepam.

Hopefully I won't get COVID-19: Fever and illness on top of discontinuation syndrome is horrendous. Sending good vibes to everyone out there , stay safe, look after each other, try not to panic, and remember to take time to look after your physical and mental health.

 

On a personal note: I am decided/resigned to separating from my spouse, but I need to get financially solvent first. So I have begun to apply for jobs in my home city. If I can get one I will move back and we will have to plan how to separate and still co-parent our children (16 and 18). 

We disagree over EVERY THING, so I know that I cannot get my own mental health sorted out until I am free of the arguments and negativity ( on both our sides).

[Bridgetini]

Greeting to all. I have been away, dealing with the usual existential crises. I successfully got down to 150 mg Venlafaxine XR and held it since March - my psych hospital was on reduced patient intake capacity due to pandemic restrictions. I was there yesterday and had a good chat with the psychiatrist. I am ready to start reducing my Lorazepam dose. I currently take 1.0 mg in the morning with my Venlafaxine XR (150mg) and vitamins for my arthritic joints. I take 0.5 mg at night along with a calcium and magnesium tablet.

 

I am going to start the reduction by 0.25 mg from tomorrow, 1at August - I wanted to read up on my notes and advice here before starting, and remind me of what withdrawal effects to expect and how to cope with them.

I have been drinking at home several evenings a week for some months now, which probably does not help anything. My husband and I have been at loggerheads and were seriously talking about separating two weeks ago. Things are difficult allover the world at the moment, for everyone. At least we still have a home and an income. If I left I would have neither, so we patched things up for now...

 

Hope you all are doing okay out there.

 

xxx

 

B.

[Bridgetini]

Updating on my Lorazepam taper: I reduced from 1.5 mg/day to 1.25 mg/day and have had no noticeable discontinuation symptoms as yet. I have been filling out a Dr. Glenmullen chart every evening and it is usually zero symptoms. 

I still have been drinking too much - I can usually only last one or two days before I feel the overwhelming urge to say "just one little drink won't hurt" but it escalates. I have to, have to stop. I am trying to avoid sitting in front of the TV at night as that is when I drink and also binge on whatever food is around.

 

I am excited to watch the documentary film next Saturday and hear the Q+A session. Well done to everyone involved, especially @Altostrata. 

Hope everyone out there is doing ok. ❤️

B.

 

[Hanna72]

hi @Bridgetini

17 hours ago, Bridgetini said:

I reduced from 1.5 mg/day to 1.25 mg/day and have had no noticeable discontinuation symptoms as yet. I have been filling out a Dr. Glenmullen chart every evening and it is usually zero symptoms. 

wow thats great to hear. Glad that you are experiencing a gentle road while decreasing . 

My best wishes to you.

Take good care of yourself.

 

[Bridgetini]

Thanks, @Hanna72. Hope that you are doing ok now that you are off meds and on the road to freedom. 

 

I hit a wall/got knocked by a withdrawal wave at day 20. I suddenly had very little energy or enthusiasm for anything and had to lie down for a couple of hours. I started wearing a heart-rate tracker recently and have been monitoring my sleep patterns with it: I usually sleep for about 6.5-7.5 hours a night. On day 22 I slept 9 hours at night and had to sleep another 2 hours in the middle of the day! I was supposed to be going on a trip away overnight but had to cancel as I didn't want to be having to lie down when I had scheduled visits with friends, a meal and an overnight stay. I stayed home and took it easy. I forced myself to walk the dog and eat some healthy snacks. By day 25 I was feeling a bit normal again and today I was full of beans and even went shopping and bought myself new clothes in the sales. I had coffee and cake in a cafe! But I am wary of doing too much in a window of recovery and hitting a wave again. During the wave last weekend I was having lots of catastrophic thoughts and making plans for major life changes. I had some night sweats and woke in intense pain in the joints on the side I was lying on. I know that I need to do yoga but just never get around to it.

 

I am seeing the psychiatrist again tomorrow for a monthly review of how this taper went - I think that I need more time to stabilise at this dosage, and am happy to make a 10% reduction next time. I think the 16.66% reduction I did first time was a bit much. given my very negative mood state last weekend. 

I have read again through a lot of information on benzo reduction safely and slowly and am feeling good about it all again.

 

By the way, my family sat down and watched "Medicating Normal" with me last Saturday - they didn't have much to say about it afterwards, but I hope that they understand my position a bit better now.

Sending love to everyone out there.

xxxx