☼ MostlyAlive: Looking for stability

[MostlyAlive]

Tapering Effexor. Jumped benzo's 6 months ago. Two weeks ago I hit a hard wall at 18mg effexor and have scrambled back up to 30mg. I'm barely non-functional.  sx are a combination of benzo  (muscle spasm/cramps) and AD sx (zap). I can write clearly only because it's the PM. In the AM... I am a mute tortured potato.

 

 I know I have violated 3s's.

1) Not Slow. 37.5 to 18 is way too fast.  I was fooled by ease of 300 to 37.5 over 4 months (%50 reductions) and maybe confused by immediate release. Things are blurry.

2) Not Simple. After benzo withdrawal I deserve a break. I really didn't intend to quit AD this soon after.

3) Not Stable...

 

I need advice on how to stabilize my situation.

 

Was going to 30mg enough to recover? Would 37.5 or more be better?

 

Should I bridge to another SSRI to stabilize on Effexor?

What should I know about tapering SSRI being newly benzo free? Double waves?

[dowdaller]

I came down from.375mg effexor. I did it over 18 months. I would hang tough if I were you, take fish oils, and vit b 12 and magnesium. It should stabilise in a number of weeks. Then take it slow before any more reductions.

[KarenB]

Hello MostlyAlive - so glad you've found this forum and done a bit of reading already.  You've figured out some basics about tapering, and that's great.  I'm tapering Effexor myself, and it sure ain't easy but it can be done.

 

A couple of questions - when did you start effexor, how long were you on 18mg, and for how long have you been back up on 30mg?  This will help us work out your next steps.  (Putting this info in your sig. would be great too). 

 

A long hold is the best way to stabilise after all those hard and fast changes.  You can also take Fish oil and Magnesium.  B vitamins are not recommended unless you were already taking them before you got into w/d.  Avoid caffeine and alcohol, and keep exercise gentle. 

 

When you are ready to begin tapering again, we recommend a gentle taper, reducing by no more than 10% of your current dose each month.  This allows your brain time to adjust as you go, and lessens any withdrawal.  In case you didn't see it yet, here's our page on Tapering effexor

 

Bridging is always iffy, especially when you have already become destabilised.  There is more discussion here:  http://survivingantidepressants.org/index.php?/topic/1463-the-prozac-switch-or-bridging-with-prozac/

 

Have a read of those and then you can come back to this thread to discuss things further.  This can be your journal to record your tapering and healing progress, and to ask questions. 

 

Welcome to SA,

Karen

[MostlyAlive]

Thank you dowdaller and Karen. Noticed destabilization beginning about 10 days ago.
Reconstructing this with best guess as I didn't write it down. (lesson learned)

 

Began Pristiq 18 months ago switched to Effexor 9 months ago.

last 7 days          30mg       (30 XR beads)
previous week    18mg       (9mg IR am + 9mg IR pm)
previous week     27mg      (mix of 18 beads + 9mg IR)
previous week     37.5         was stable here. Things went to hell when I started playing with IR pills and busting open XRs.
 

I read the recommended pages last week while researching decision to go to 30 from 18.

It seemed easier to take a pill action than to register for the site and craft a question. That means I was very confused/paranoid. That means I'm less confused (or more able to focus) now. Hmm. I'll see in the morning I guess. in the evening (now) I'm often very clear and not self destructively anxious. 

In the morning... ehhh, not so much.

[KarenB]

Mornings are hard for many of us because that's when cortisol naturally runs higher.  If you can plan some soothing gentle things to help you get through the morning, that may help - yoga, guided meditation, colouring in, patting the cat - whatever seems like the best fit for you personally. 

 

Looking at those dates and doses it's probably best to stick with 30mg for now, since you've been there 7 days already and you will have adjusted in to that level to some degree.  It can take some time to settle after dose changes, so get your best patience-hat on now .  Recording your symptoms and their severity each day can help you to make decisions down the track.  Sleep is an especially good indicator - when it starts to settle you know you're on track.  Your decreased confusion is also a good sign. 

 

Could you put those new details in your sig. for future referfence?  Ta.

[MostlyAlive]

thank you so much for your kind help.  I've got some more points for clarity...

 

1)  need to feel batter fast. I'm in a crisis. I'm fetal rocking.

2)  don't care about setting me back in terms of how long my eventual taper off ADs will take

3) will do whatever it takes to feel better now - with the exception of benzos.  I'm not willing to give up those gains. Not yet. Although, if this continues, I will do anything. I have three kids I need to take care of.

 

What are the pros / cons of taking more Effexor at this point?

Any thoughts on what might happen if I go to hospital?

[mammaP]

Hi MA, sorry you are feeling so bad. How are you now, I notice it was 2 days since your last post and I am sorry that it slipped off the page. 

 

Can you tell us when you started to taper from 300mg? 

[JanCarol]

Hey Alive - I'm sorry to hear you are struggling.

 

 

Some of this may be reactions from moving from XR to IR.  This all happened so fast!

 

If you want to go back to 37.5, please, don't wait for us to tell you.  You are the one in charge here, and you came off your big dose of 300 just this year.  I agree with Mama, it is important the date you started to taper Effexor, and it is also important the date that you came off benzos.

 

Just please be careful.  I think this is a mixture of too-fast tapering, and mixing in IR with XR and reacting to the fast changes, as well as possibly some delayed benzo withdrawal.  Please make your changes slowly, and only make changes after giving it 4-7 days to reach steadu state.

 

I think you will see a positive response, going back to 37.5 XR.  If this is the case, it is a guideline, a navigational tool.  If you see improvement there, we can consider whether to go up again.

 

In a normal slow taper, your combination of counting beads + IR is brilliant technique - it just went too fast, and on the heels of of your benzo withdrawal.

 

Why did you decide to taper so quickly?  Was there a pressing need - like side effects or health problems?

 

Please, take some time to listen to First Aid for Panic.  It's just 4 minutes, and it helps so many people here.

 

And consider finding some Non Drug Techniques for Coping with Emotional Symptoms that work for you.

 

Please let us know what you decide to do.  If you are in trouble, hospital is an option, though you run the risk of losing control of your taper, and having to surrender to their protocols.   

[Altostrata]

Welcome, Mostly.

 

When did the zaps start?

 

You are taking 30 beads? Out of how large a capsule?

 

30 beads may not equal 30mg. You'd need to count or weigh all the beads in the capsule to figure out how many beads amount to 30mg.

 

A compounding pharmacy can do this for you, with a prescription.

[KarenB]

Thanks Alto for picking up on that.  MostlyAlive - could you change your sig. so we know the amount you are on?  Thanks.  How are things lately?

[JanCarol]

Please disregard my comment about 37.5.  I thought you were taking mg, not beads.  Until we know your real dose, my suggestion is all out-of-whack.

[MostlyAlive]

THE BEADS

I made a rough estimation equivalence beads and mg by counting a 37.5 cap and finding ~37 beads.

I don't count the obviously smaller of the two (?) bead sizes.

The beads are from 37.5 mg caps and 75 mg caps.

 

BENZO TAPER

1/1/2016  last benzo dose after 2 years tapering.

The jump was from very small dose of clonazepam, however, it resulted in extreme anxiety.

 

EFFEXOR TAPER

1/15/2016 tapering Effexor from a consistent dose of 300mg during previous year to 150mg.

-  because I thought the nor-epinepherine part of Effexor was not helping the post benzo jump anxiety

 

3/15/2016 continued to taper Effexor to 75mg

- because (Fall 2015) plan to try TCA or MAOI because of apparent "treatment resistant" depression (needed to "clean out")

 

5/1/2016 arrived at 37.5 Effexor with no acute depression

- began to cut to 18 mg using combination of IR and XR

 

THIS WEEKEND

Th, Fri, & Sat added 25mg nortriptyline.

- Why? So you would all roll your eyes and never read another of my posts?

- No, really it was Desperation. And I had filled the script in early May. Thought this might be the right time to add it in.

- remembered that adding this in was in Fall 2016 treatment plan (along with Prozac bridge)

Sunday added 10mg nortriptyline.

 

TODAY

no nortriptyline, Don't like it at all. Can't deal with more tinnitus, stomach cramps, nausea, weakness / fatigue.

if I continue with an AD it won't be one that mucks with serotonin re-uptake as my belated reading says TCAs do. That system needs rest / recovery.

added 7 more beads today (total 37 beads). estimated 37.5 Effexor.

ordered 37.5 mg XR

 

Very depressed

Very anxious

self harming thoughts,

crying,

confusion

catastrophic thinking,

muscle cramps + spasm + twitching

 

Thank you Thank you Thank You !!!!!!! God bless you all.

hope this is somewhat coherent... I re-wrote it 6 times.

[Altostrata]

Your method of counting beads is very inaccurate. It is not possible that 37.5mg Effexor XR capsules contain only 37 beads of active ingredients.

 

You cannot disregard the smaller beads, and you cannot mix beads from different milligram-strength capsules.

 

You're going to have to figure out how to measure the contents of the XR capsules more accurately and take one-half of a 37.5g Effexor XR capsule. You can get a compounding pharmacy to make any dosage you want, see Tips for tapering off Effexor (venlafaxine)

 

Your inconsistent dosing is probably causing a lot of problems.

[MostlyAlive]

Thank you.

 

I tried not to mess with the beads but the IR pills seemed to not work for me when I went from 37.5 XR to 37.5 IR by breaking up the IR into halves. It seemed to stop working for me when I did that so I started to mess with the capsules and ... well then I think I got too confused to do anything right.

 

It seems that this is a dangerous area for Effexor. Thank you for recommending the compounding pharmacy. Is this the way Effexor users typically navigate these dosages?

[Altostrata]

Please read Tips for tapering off Effexor (venlafaxine) carefully.

[MostlyAlive]

Your method of counting beads is very inaccurate. It is not possible that 37.5mg Effexor XR capsules contain only 37 beads of active ingredients.

 

With all due respect...

Just back from the pharmacy with a new bottle of 37.5 mg Effexor (Teva  white + yellow  "93/7384").

There are from 37 to 39 large beads in each capsule.  Median value of # large beads = 37.

There are often 2-3 medium or small beads in addition.

[KarenB]

Would you say that the 'beads' inside look like small pills rather than tiny (smaller than a pin-head) beads?  I've been looking on Drugs.com and I'm amazed at the variation, but I can't find any yellow and white examples, or examples of what the contents of each capsule looks like.

 

My 75mg effexor capsules are filled with hundreds of tiny beads, which I weigh on a micro-scale (The Gemini-20). 

[JanCarol]

Okay Mostly.

 

You survived the weekend.  And you learned that Noritryptaline (and messing with other drugs) is not really the best option.

 

We're trying to suss out your effexor, which it looks like you're on a normal 37.5 mg dose now.  We can work on "mini pills" and other variations as you hold your 37.5.  Since you are in America, I think that investing in the Gemini Scale is a smart buy.  This is the one I got:  http://www.amazon.com/American-Weigh-GEMINI-20-Portable-MilliGram/dp/B0012TDNAM?ie=UTF8&keywords=gemini%20mg%20scale&qid=1465288564&ref_=sr_1_1&sr=8-1 .

 

They are a little fiddly, but I've found that keeping a nickel under the dish before I TARE makes it slightly more accurate.  It's definitely more accurate than an eyeball!

 

Please be patient with us - we're all volunteers - and there's a world of variation in these pharmaceuticals!

 

"The fact that you are breathing means there is more right with you than wrong with you in this moment." - Jon Kabat-Zinn

 

Please keep trying things until something makes you feel better:  Claire Weekes - Self Help for your Nerves, 

 

EFT:  http://www.emofree.com/

 

Mindfulness:  Mindfulness and Acceptance

 

Other tools:  Non-drug techniques to cope with emotional symptoms

 

Build a "toolkit" - effectively a list of things you CAN do.  Watch cartoons on TV.  Color a mandala. Doodle on a musical instrument.  Walk around the neighborhood.  Listen to music that you like.  Play with a pet, or a friend's pet.  Rock in a rocking chair (literally, there have been people here who rocked through their akathisia), sit in the sun, sit in the shade,  call a friend on the phone.  Have a cup of herb tea.  Drink a glass of water - slowly, mindfully, feel the cool water soothing your throat an nourishing your cells.  Keep your list tacked up on the bathroom mirror, where you can check it and add to it, as you find more things that you can do when you are in distress.

 

Okay, so the glass of water only lasted a minute - but that was a minute you were not suffering.  Each minute you accumulate - like pearls on a string - gives you more "in the bank" towards feeling better.  Sometimes survival takes place a minute at a time.

 

So - it's been a couple of days on 37.5 - is there any improvement?  Still at least 2 more days to hold there, please.  Preferably a week, if you can.

 

It can get better.

[MostlyAlive]

Thanks you for your kind efforts. I'm so sorry if I conveyed impatience. I appreciate your work and know you will receive far more from the universe than you can imagine for your generosity.

 

BEADS

The larger beads are the size of a homeopaths preparation. Slightly smaller than the ball of a ball-point pen perhaps.

Please forgive... the color listed is not yellow but white:  http://www.drugs.com/imprints/93-7384-93-7384-15941.html

 

 

Please assume, for the moment, that my counting has been accurate. The mg estimation may have been wrong due to assuming that the beads in the Teva 75mg were the same as the beads in the 37.5 as AS pointed out.

[MostlyAlive]

Yes, I have regular 37.5 XR now. I usually take the Effexor in the AM. Last night I took an additional evening dose.  I'm trying to get a little more into my system.

 

My health has impoverished the family. It is just after end of school here and I have 3 bored energetic kids and a wife with an extreme case of "compassion fatigue" (to be kind).  These kind of activities are being met with derision.  I know it is frightening to look upon someone in my state. I'm Living breath to breath.

 

@JanCarol  Your posts reflect acute empathy. That Kabot-Zinn quote is a favorite and meditation and AudioDharma got me through benzos. The current intensity of depression is making it difficult for me sit "properly" at this time.  I am horizontal.

 

Thank you so much for your helpful words!

 

At this point I think maybe the wise thing would be to go to 75 mg and have a year hold. Thoughts?

[JanCarol]

So - (I can almost hear Kabat-Zinn's voice for this) be horizontal, now, if that is where you are comfortable.

 

Appreciate the horizontal way that gravity is relieved, and the coolness of your breath as your ribcage and belly gently expand and contract....

 

Honor the head on the pillow, as being alive - in whatever state it is in right now.  Explore the tilt of your pelvis against the mattress - spend a moment flexing and extending your lower back and then let your pelvis and sacrum and lumbar settle into a gentle, comforting place.  

 

Feel your deeper exposure to earth, as you have more points of contact with the mattress - or floor, if that is more comfortable for you.  (yes, that was my best JKZ voice....)

 

(just so you know, after years of pain, I despise "sitting meditation!")

 

Please refrain from "extra doses" of Effexor.  

 

This is your brain.  This is a brain as a basketball.  Every change you make keeps hitting the basketball again, so it continues to bounce.  Please take a steady amount every day, same time every day.  For at least a month - before considering any changes at all.  We want the brain to settle down, to come to stillness so that we can move it gently, slowly, carefully as a baby.  (okay, mixing metaphors now, time to go back to my coloring books)

 

Give the 37.5 a chance to work, first? I would hate to throw you into an even greater extreme state.  

[MostlyAlive]

ok. will refrain. I know you are right. Probably.

you do a wonderful Zinn. No,  Better than Zinn.

Your kindness is allowing me to cry (which is a very good thing for me, i need to do that)

just found JKZ's Full Catastrophe Living  ... cued up & headed to basement to for Srivasanha (you did try a big firm zaffu? Such saved my back)

 

thank you & blessings

[Altostrata]

JanCarol speaks truth.

[JanCarol]

Love my Zafu.  Carry it with me to every yoga class, because it's more flexible than a bolster.  Just a little support on a corner, or full support on its side.

 

But can't "sit" zen proper because the knees won't.   I need zafu now, to do child's pose.  But I still do yoga, however I am comfortable doing it!

 

Breathe, it will be a good day.

[MostlyAlive]

Well, I failed at listening to Full Catastrophe.

I'm just too uncomfortable, constant emotional pain.

 

It's been 2 maybe 3 weeks now.

How long do I stick here at 37.5 before going up? 

I see shrink tomorrow. He will want to do something.

unless there is good chance of relief in sight, I will want to agree

 

My wife is encouraging ECT and I'm considering but terrified,

 - my muscles are already violin tight (this Effexor crash has set off my benzo wd symptoms, I am in double trouble)

 - they will want to give me benzos

 - well hell, wouldn't you be?

 

What I will likely do is ask for Remeron to add to the Effexor.

I'm coming to the conclusion that I just need to be on a working AD.

 

 

To put it another way...

In response to "how can you tell AD withdrawal from underlying issues?"  THEY say....

"starts immediately when you go off"   check, got that !

"go back on and it stops"  ahhh....?

 

I think maybe I got an "underlying issue"

[MostlyAlive]

th am

blah blah all ye who enter here

pain back, hamstrings, feet

cant use muscle w/o cramping

exhausted, dizzy, bed ridden

i guess im going up to 75mg

sorry

i know i could choose to wait but my family is watching me

not faIR

[Altostrata]

We haven't seen ECT to be effective for your type of symptoms.

 

If you have an "underlying issue," it's not psychiatric. Your symptoms seem to be autonomic dysregulation, like so much of withdrawal syndrome.

 

Have you tried fish oil and magnesium?

 

http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/
 

Incredible as it may seem, some people do feel significant relief after taking one or both of these supplements. The omega-3 fatty acids in fish oil are essential to neurological functioning, and magnesium relaxes muscles.

 

There's a large range between 37.5mg and 75mg Effexor. If you feel you must take more, why not try 40mg or 50mg? Your reaction will indicate whether an increase in dosage is the right direction for you.

 

Using name-brand Effexor XR containing the tiny beads will be easier. You can get a compounding pharmacy to make custom dosages from it. You will need a doctor's prescription.

[MostlyAlive]

>>If you feel you must take more, why not try 40mg or 50mg?

Because I need to stay alive. It may have been an option a week ago, but not now. As I wrote June 1,

----->

1)  need to feel batter fast. I'm in a crisis. I'm fetal rocking.

2)  don't care about setting me back in terms of how long my eventual taper off ADs will take

3)  will do whatever it takes to feel better now - with the exception of benzos.  I'm not willing to give up those gains. Not yet. Although, if this continues, I will do anything. I have three kids I need to take care of.

What are the pros / cons of taking more Effexor at this point?

Any thoughts on what might happen if I go to hospital?

<-----

 

Nothing has improved since I asked my first question. Or posted;

Very depressed

Very anxious

self harming thoughts,

crying,

confusion

catastrophic thinking,

 

Yes, I take the capsule with tiny pills http://www.drugs.com...7384-15941.html

I take all the supplement you suggested.

I've started on 20 mg of Prozac in addition to the 75mg Effexor.

Not what any of us wanted but I can't hold on any longer.

 

I'll be ok soon.

Thanks for trying.

[KarenB]

Wishing the best for you and your family Mostly, and hoping you continue to find your way to healing.

 

Karen.

[MostlyAlive]

In yesterdays visit to my Dr, I realized I had messed up the prozac bridge by... not taking the prescribed Prozac (10 mg).

So he prescribes 20mg and puts the Effexor back up to 75. This morning... I entered a deeper circle of hell.

 

I was so agitated that I called my Dr's pager. In a stroke of good luck, the on call Doc was a new guy.

He listened to my story and made some changes to the meds that I'm very happy with.

 

I'm now taking a 30 mg Remeron (NOT stimulating Prozac) and STICKING at 37.5 Effexor. 

Tomorrow will probably be another rough day but after that I expect relief.

This is a win win win.

 

First of all, I get to hold my taper gains. YEAY!

Second, the hell I was in today (rolling about in agony, shouting the Kyrie and self-harming... not my finest moments) should soon pass.

Third, my wife found the new Dr's office number and requested a new patient visit.

 

Thank you all who have assisted.

 

Assuming I get through tomorrow morning ok, I'm back on track with only some small bruises and the lingering question...

how / why did I "wilingly mis-remember" the order to take Prozac daily when I got under 37 mg Effexor?

[KarenB]

Wow - what a timely turnaround for you - I'm so happy that you're feeling like things are looking up.  The new doc sounds more reasonable - fingers crossed! 

 

Assuming I get through tomorrow morning ok, I'm back on track with only some small bruises and the lingering question...

how / why did I "wilingly mis-remember" the order to take Prozac daily when I got under 37 mg Effexor?

Our brains do weird stuff on drugs.  Yesterday, I mistook Friday for Thursday and therefore missed a dose of my Effexor, and have been paying for it for two days.  You'll get through tomorrow morning okay - just line up all your managing techniques ready to go.  I've been colouring in, watching movies, crying, meditating - among others.  It'll pass.   

 

Also - not wanting to put a downer on it, but you are aware that Remeron will also eventually need careful tapering?  And from the drug interactions checker: 

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

Interactions between your selected drugs

Major venlafaxine mirtazapine

Applies to: Effexor (venlafaxine), Remeron (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

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 (active ingredient in Effexor (venlafaxine))
• mirtazapine (active ingredient in Remeron (mirtazapine))

[MostlyAlive]

Yes, I'm aware. And I've been on a Remeron / SSRI combo before.

[MostlyAlive]

I'm stabilizing at 37.5 Effexor and holding off from the Remeron for now. Every day just slightly better.

 

I have read shipko's post

https://www.madinamerica.com/2015/09/shooting-the-odds-part-iii/

and identify with tardive akathesia.

 

What is the prognosis for someone like me who has been on SSRIs for 20+ years?

Shipko does not recommend stopping (any SSRI) for anyone with over 10 years exposure.

 

This is very sad news. Tardive akathesia is very painful.

[Bruin]

Hi Mostly Alive, I am sorry that this is such a painful time for you but glad that every day is slightly better.

 

Like you I have a long history with AD s and was taking Mirtazapine and Effexor for a long time.

 

I came off Effexor far too quickly  and suffered as a result  badly.

 

I am now 15 Months away from my last dose and can say that many things have got better despite me doing an effective CT.

 

The DP/DR is far better. Akathisia is mild and some nights I get 6 or 7 hours sleep.....a great improvement.

 

For a long time I did not understand that what I was suffering from was WD and I got prescribed Lyrica for my symptoms.

 

This was a horrible experience and woke me up to the whole Psych drug thing and fortunately I found this site.

 

I do believe that we all recover given time and good levels of self care....there are many stories of recovery after SSRI use

 

for  more years than 20.  The brain and body has enormous  powers to  heal . The fact that you are feeling better every day shows that 

 

healing is happening. It is a  tough process and sometimes impossibly slow ....Am cheering you on....you will recover even though 

 

it does not feel like it.

[MostlyAlive]

Thank you for taking the time to write. It is very appreciated.

I can't write more now. Kids are needing me to smile for them.

 

The hell of it is that....  that's about all I can do for them and, well...

it's a terrified smile and I think they know it.

 

I can't hide this but I don't know what to tell them either.

[MostlyAlive]

Please tell me about Lamictal and how it might help. I need something.

Fear and anxiety in the morning are overwhelming and debilitating.

unbearable