zenOT: coming off Effexor/venlafaxine

[zenOT]

Hi, I have had a long and varied history of taking psycho-active drugs, mostly anti-depressant medications.  I have epilepsy and take an anti-epilepsy drug which also boosts my mood.  Although my provider is not sold on the idea that I can do without the anti-depressants, she agreed to provide me some smaller pills (25 mg but not XR) to start a decrease in the dosage.  Her goal is to decrease the dose, mine is to stop the anti-depressant.  I think this will work well and I still have trepidation regarding the process.

 

I started this taper on a dose of 225 mg of XR.  I started 2 days ago with a decrease to 212.5 (150 mg XR and 72.5 regular, split into 37.5 in the morning and 25 in the afternoon).  No problems so far, but I've been at home ....  The big test will come tomorrow when I am back in the stressful world of work. 

 

I know I'm supposed to put my withdrawal history into the bottom of the entry, but I'm not how to do that.  I also wrote that out to the best of my abiiity when I asked to join and I had hoped that I could copy and paste it here, but I can't figure out how to do that, either.  In the past, I've been put on and taken off meds w/o much in the way of a taper.  (As advised by the MD/ARNP involved in prescribing the meds.) 

 

This time, I broached the subject with my ARNP (Advanced Registered Nurse Practitioner), and she wanted me to reduce my dose from 225 mg XR to 150 mg XR overnight, but agreed to prescribe smaller pills to make a more gradual taper (but I had to suggest this to her). 

 

Thanks for listening!

 

 

[nz11]

Welcome zen

 

Please spend some time reading this

http://survivingantidepressants.org/index.php?/topic/272-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine/

 

I started this taper on a dose of 225 mg of XR.  I started 2 days ago with a decrease to 212.5 (150 mg XR and 72.5 regular, split into 37.5 in the morning and 25 in the afternoon). 

So i think you are saying you take 150 plus 37.5 in the morning and 25 in the afternoon?

 

To do your drug sig click on your name at the top right of the screen then click on settings and go to signature on the left hand side.

 

nz11

[ChessieCat]

Hi zenOT,

 

And welcome to SA.  I'm really pleased that you stood up for yourself and requested the lower dose drug.  There is lots of information here and plenty of support.

 

Thanks NZ!  I couldn't work out what drug zen may have been taking.

 

The drug history that you completed when joining is a behind the scenes list which only certain admin peeps have access to.  I thought I had completed my signature and was surprised when I was asked to complete it.  So unfortunately you will need to complete your history again.  Here is the link to the instructions:  Please put your Withdrawal History in Signature

 

Provide details of the last 12-18 months and a summary of anything prior to that.  Please include all drugs, dates, doses and how you decreased/increased.  Having this information will allow us to make suggestions based on your individual situation.  Please remember to update it whenever you make a change so it remains current.  Thank you.

 

SA recommends a 10% taper (or less) of the previous dose with a holding period of about 4-6 weeks to allow the brain to adjust to not getting as much of the drug.

 

Before you begin tapering what you need to know

Why taper by 10% of my dosage?

 

What should I expect from my doctor about withdrawal symptoms?

How do you talk to a doctor about tapering and withdrawal?

 

These helped me to understand SA's recommendations and has helped me to stay patient and taper slowly and carefully:

 

Brain Remodelling (Rhi's Description of Brain Healing)

Video:  Healing From Antidepressants - Patterns of Recovery

 

Have a read of the above links and then ask any questions you have here in your Intro/Update topic.

[zenOT]

OK, so I managed to get my drug info in.  I don't know if what I did is what is most helpful ... it's been a long haul for me, and much of the info about changes and so forth has slipped my mind.  It has also been only in the past 2 years that I have been more conscientiously involved in drug changes; prior to that, I mostly did what the docs said to do. 

 

I will follow up on folks' ideas for info.  I did quite a bit of looking around on this site before I signed up, so I think I've read quite a bit of what has been suggested (and I'll double check).  I also am a mental health professional by trade and know a bunch from both sides of the equation, both explaining the "need" for meds to clients and being a patient myself.  I joined a Hearing Voices Network support group about a year ago, and have been looking into the psychiatric survivor movement.  I've found a good deal of scientific research that has not been widely publicized regarding the ineffectiveness of and/or harm attributed to antidepressants.  For example, I found a recent study on the use of mindfulness for depression that indicates that those on antidepressants benefit LESS than those not on antidepressants. 

 

My current frustration is that since I started to taper off the Effexor, my sleep quality has been poor.  I'd rather take Benadryl than the trazodone, but the Benadryl only makes me sleepy and doesn't improve the quality of my sleep. 

 

Thanks, all!

[scallywag]

zen - were you taking a split dose of Effexor before you started to taper?

[zenOT]

No.  I was taking 225 mg of the extended release version.  The lowest XR capsule was 37.5 mg and she wanted to get a smaller dose for me.  So, she ordered the 25 mg tab size.  Because they are not XR,  I need to split the part of the dose that comes from the 25 mg tabs. 

 

Previously:  3 XR capsules of 75 mg each = 225 mg XR

Now, (2 XR capsules of 75 mg each = 150 mg XR) PLUS (2.5 tabs of 25 mg = 62.5 mg NOT XR) for a TOTAL of 212.5 mg.  The 2 XR caps can be taken in the morning only because they are XR; the remaining 62.5 mg must be split. 

 

For practical reasons (it's very hard to cut the 25 mg tabs into 4ths), I chose to take 1.5 tabs in the morning and 1 tab in the afternoon. 

 

It is critical to avoid significant impacts to my behavior when I'm at work, so I can keep my job.  I'm at work 8-4:30; I usually take the Effexor/venlafaxine around 7 am, and all is well until the afternoon.  I'm noticing that my behavior begins to change as early as  2:30 (I become cranky and irritable and difficult to get along with).  One day, I had a verbal disagreement with a co-worker that might have been a serious issue if she had mentioned it to her supervisor.  So far as I can tell, she hasn't.  At least I haven't heard about it from my supervisor.  After 4:30 pm, I'm generally by myself or with friends who understand, so a behavioral incident would not be an issue.

 

I feel this is getting less clear the longer I type.  I'll post it now, and please ask questions if I've been unclear.

 

Thanks!

[zenOT]

I had mentioned poor sleep in an earlier post.  I got a black out blind and installed it, and my sleep is MUCH better. 

[scallywag]

How do you feel in the evenings after you take the 4:15 pm dose?

[zenOT]

Hi, Scalleywag,

 

By 4:30 (that is, before the 4:15 dose had actually kicked in), I was very symptiomatic.  As has happened in the past when I've missed a dose, I felt like I was coming down with the flu:  tired, achy, discouraged, and tearful. 

 

Today, I took the dose with lunch, around 12:30, which is the last easy time to take a med before 4:15, and I'm feeling OK (it's 6:20 here).

[scallywag]

zen - in your signature you say that you take 25 mg Effexor Immediate Release (IR, or not XR) at 4:15 pm.  I'm a little confused with your most recent post where you wrote that you took this second IR dose at 12:30. 

 

How consistent are you with the timing of this second dose? Do you take the second dose close to 4:15 every day?

[zenOT]

I will correct my history.  I am now taking the 2nd 25 mg IR dose at 12:30. 

[zenOT]

Re:  sleep

I wrote on 9/14 that my sleep issue had been resolved, but I was mistaken.  Although I woke up refreshed, I was groggy later in the morning.  I went back to the records I keep of what meds I take.  I found I'd been taking 2 Benadryl (actually, generic diphenhydramine, but that's too long to type) a night for the week before 9/14.  Apparently, I'd been so significantly concerned about not sleeping well that I over-compensated.

 

Since sleep is something that I suspect will be impacted by withdrawal if I go too fast, I want to resolve the sleep issue before going further.  So, I will only be taking the Benadryl when I don't feel tired at night.  Hopefully, sleep will stabilize, and I'll have a better baseline.

 

Deb

[scallywag]

Please keep your doses and when you take them consistent, especially as you adjust to no longer taking Benadryl. You may want to delay your next dose reduction until this sleep issue has settled.

 

Some people (I'm one of them) have had good results using very small amounts of melatonin to assist with sleep.

Melatonin for sleep

[zenOT]

Thanks, scallywag, I intend to do both those things.

 

Today went well.  No Benadryl last night, I did well today, and I'm appropriately tired as I near bedtime. 

 

I sure appreciate everyone's help and support!

[zenOT]

Things are going well.  I'm in the process of updating my history.  If there are any inconsistencies, this post is correct.

• No Benadryl for a week and excellent sleep. Black out blind is really helping with quality of sleep.
• This AM, decreased dose by another 12.5 mg:  AM dose is now 150 mg XR + 25 mg IR, noon dose remains at 25 mg IR. 

I chose this time to make the change because it has been about a month since the last decrease.  Plus, I am off work this week, so if there are any issues, it won't be as big an issue. 

 

Question:  I just noticed that my decreases are closer to 5% than to 10%.  Should I speed it up, or is this OK?

[scallywag]

5% reductions are fine. The 10% is a recommended maximum, not a commandment on a stone tablet.

[zenOT]

Thanks!

[zenOT]

I just updated my signature info.  I'm currently stable on total 175 mg (150 XR and 25 IR) and feeling good.  I have had a few "true" hypomanic episodes and am learning to manage them.  Usually, my hypomania is agitated and distressing (that is, a mixed state, not a "true" hypomania.  Lately I have felt good but been less aware of how "up" I was and the effect that had on others around me:  rapid speech, not letting others contribute to the discussion, etc.  I've realized how depressed and/or blunted I still was even while on the venlafaxine.  I'd rather cope with the "up" moods (and adjust my behavior) than live with blunted emotional range and mood swings dipping only into depression or agitated hypomania.  I am currently in a program that looks at managing behavior rather than altering the mood, and it is very helpful.  Because you need to pay to be in this program, I didn't want to post information if it was not appropriate for this site.  If it is OK, however, I'm happy to share it. 

 

Thanks!