DragonButterfly Husband going off Effexor

[DragonButterfly]

Hi everyone,

My husband is currently on 150mg of venlafaxine (regular tablets). He was taking it just in the morning but with the aim of starting the tapering schedule suggested here, a week ago he split the dose, now taking 75 mg in the morning and 75mg at night. Since this change (note: not a drop yet just a split) he immediately started getting withdrawal symptoms - fatigue, loss of appetite, tremors, body rushes, vision changes, vertigo, negative thoughts, anxiety. I'm wondering if this is because he's on just the tablets, not the slower release capsules? I'm wondering whether we should go back to the 150mg in the morning or stay at this level of 75mg (am) and 75mg (pm) until he feels well again? He says he just wants it over with and is ready to drop to the next dose but I envision that being potentially dangerous and am desperate for support in deciding what to encourage him to do. He can't even handle talking dose numbers at the moment, so I guess it's down to me to figure this out and advise him as best I can.

 

For the record, he has been taking the venlafaxine at the 150mg dose for 1.5 years, along with a cocktail of other drugs. I might add that what's happening now is not as bad as what happened a few months ago when he followed the GP's advice to come off his quetiapine pill over a 15 day period. What ensued was SEVERE withdrawal - vommiting, the runs, crawling up the wall with day terrors, electric shock feelings, plus everything he's feeling now. It took him about a month before he started to feel better. Up until a week ago he was feeling very good. We knew this one would be another hard one to come off so we wanted to follow the 3-4 month tapering schedule we found here. Frankly, we know the GPs haven't a clue about these things. He's been on a list waiting to see a NHS psychiatrist since January 2016. He's been through 3 months of CBT therapy in the meantime...  (FYI he is also still on temazepam 10mg and mertazapine 15mg at night before bed).

 

Any advice / support / thoughts / feedback most welcome.

 

Thanks so much in advance.

Edited October 17, 2016 by scallywag
tags

[Altostrata]

Welcome, DragonButterfly.

 

I've moved your post to start your Introductions topic, where you can ask questions and find the answers. Please bookmark it or follow it.

 

Was your husband taking 150mg Effexor XR or 150mg Effexor immediate-release? When does he get the withdrawal symptoms?

 

Is he taking any other drugs? If so, please put ALL the drugs in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html
and copy and paste the results in this topic.

 

Going off quetiapine may have made his nervous system sensitive to drug changes.

 

Please keep daily notes on paper about symptoms, when he takes his drugs, and the dosages.

[ChessieCat]

Hi DragonButterfly,

 

Welcome to SA.  It's really good that you have found this site as there is a wealth of information here and you will be supported as you help your hubby.  By the way, mertazapine is spelled mirtazapine.  You will need the correct spelling for the Drug Interactions Checker

 

It will be helpful if you would complete a drug signature:  Please put your Withdrawal History in Signature.  Please include details for the last 12-18 months of all drugs, dates, doses and discontinuations & reinstatements.  If you can't remember dates, please write it as "early March" or "mid-August".  Please provide a summary of any drugs prior to that which can just be listed with start and stop years. Please include all prescription, non-prescription drugs and supplements he is currently taking.

 

Once we have additional information we will be better able to offer suggestions.  Here is an example of how to Keep notes on paper

 

Meanwhile you can these links provide useful information:

 

Before you begin tapering what you need to know

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist

 

What should I expect from my doctor about withdrawal symptoms?

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

 

Tips for tapering off Effexor (venlafaxine)

 

Tips for tapering off Remeron (mirtazapine)

 

Tips for tapering off Z drugs for sleep (Ambien, Imovane, Sonata, Lunesta, Intermezzo, etc.)

 

Taking multiple psych drugs? Which drug to taper first?
"If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug)."

 

These helped me to under SA's recommendations.  They might help your husband understand that the drugs need to be tapered slowly so that the brain adapts to not getting as much of the drug.

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

 

You can ask questions here in your Intro/Update topic and journal your progress.  Click "Follow" top right and you will be notified when someone responds.

[DragonButterfly]

Thank you both so much.  

The box says 'Venlafaxine Hydrochloride' 75 mg tablets

 

He seems to be generally feeling these withdrawal symptoms all the time now (since the change last week) but in his words he is not 'crawling up the walls, yet'.

 

The results from the drug interactions checker are not good. I am trying not to completely freak out right now. How does one test for serotonin syndrome? He suffered some of these symptoms on a daily basis over the past year (stomach cramps, nausea, diarrhoea to name a few). He resorted to smoking cannabis, in large quantities, daily, in order to cope with the nausea and gain appetite (this was prior to finally coming off of the quetiapine in July 2016). 

 

He was put on all of these medications in May/June 2015 after suffering 'severe depression, anxiety and panic disorder'. We were living in Canada at the time and have since moved back to the UK with our two small children (Sept 2015). 

 

Since then, we have been through 5 GPs, 1 counsellor and cannot get in to see a psychiatrist. After reading about the major risk between venlafaxine and mirtazapine I'm wondering if I should just borrow the money to pay for a private psychiatrist...

 

I will try to add the history into my signature as requested.

 

Interactions between your selected drugs

Major venlafaxine  mirtazapine

Applies to: 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 temazepam  venlafaxine

Applies to: temazepam, venlafaxine

Using temazepam together with venlafaxine 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.

Switch to professional interaction data

Moderate temazepam  cannabis

Applies to: temazepam, cannabis

Using temazepam together with cannabis (Schedule I substance) 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.

Switch to professional interaction data

Moderate temazepam  mirtazapine

Applies to: temazepam, mirtazapine

Using temazepam together with mirtazapine 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.

Switch to professional interaction data

Moderate venlafaxine  cannabis

Applies to: venlafaxine, cannabis

Using venlafaxine together with cannabis (Schedule I substance) 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.

Switch to professional interaction data

Moderate cannabis  mirtazapine

Applies to: cannabis, mirtazapine

Using cannabis (Schedule I substance) together with mirtazapine 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.

Switch to professional interaction data

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.

Other drugs and diseases that your selected drugs interact with

• cannabis interacts with more than 200 other drugs.
• mirtazapine interacts with more than 500 other drugs and more than 10 diseases.
• temazepam interacts with more than 300 other drugs and 10 diseases.
• venlafaxine interacts with more than 500 other drugs and more than 10 diseases.

Interactions between your selected drugs and food

Moderate venlafaxine  food

Applies to: venlafaxine

Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with venlafaxine. Do not use more than the recommended dose of venlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate cannabis  food

Applies to: cannabis

Alcohol can increase the nervous system side effects of cannabis (Schedule I substance) such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with cannabis (Schedule I substance). Do not use more than the recommended dose of cannabis (Schedule I substance), and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate mirtazapine  food

Applies to: mirtazapine

Alcohol can increase the nervous system side effects of mirtazapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with mirtazapine. Do not use more than the recommended dose of mirtazapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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 CNS drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'CNS drugs' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'CNS drugs' category:

• cannabis
• mirtazapine
• temazepam
• venlafaxine

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

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:

• mirtazapine
• venlafaxine

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

[ChessieCat]

Hi DragonButterfly,

 

Please don't panic.  We have members who have been on larger cocktails of drugs who have managed to reduce their drug load and start to feel improvement.

 

"After reading about the major risk between venlafaxine and mirtazapine I'm wondering if I should just borrow the money to pay for a private psychiatrist..."

 

Even if you did this, you aren't necessarily going to find one who is wise about psychiatric drug withdrawal etc.  This is why SA has so many members, because we can't get the support and advice from the medical professionals.  SA can provide the information and support you need.

 

If you provide the information requested we can offer suggestions.  As previously mentioned, we need the details in a drug signature so we can do this.  Keep it simple as per the instructions, don't include diagnoses or symptoms, just the original reason for starting on the drugs.  And please remember to update as he makes changes so it remains current and we will be able to see it at a glance without having to read through your posts.  Thank you!

[DragonButterfly]

Thank you. Please bear with me as I get to grips with the site and everything. I am so grateful for the immediate communication. In tears now as the support means so much to me, and will for my husband as well, you have no idea... Or probably you really do.  I've created an email signature, please tell me if you think it is too detailed or missing anything else important. I will try to get more info from my husband when he wakes up tomorrow. I will check out the links you provided. It's pretty late here so will continue with a fresh start tomorrow. Peace x

[ChessieCat]

Hi DB,

 

Thanks for doing the sig.  I suggest you put at the very bottom so it is easy for us to see immediately   Current:  drug + dose; drug + dose etc.

 

And yes, we do understand!

[Altostrata]

DragonButterfly, prior to switching to 75mg Effexor IR twice a day, was your husband taking 150mg Effexor XR?

 

Why were mirtazapine and temazepam added, and when?

[DragonButterfly]

After some online research, I'm pretty sure that venlafaxine is the same as effexor XR. If that is the case, then yes, he was taking 150mg of this every morning for about the past 16 months, up until a week ago when he switched to 75mg twice a day. (Exactly the same medicine just divided into two daily helpings instead of one. If that makes sense?)

 

I have asked my husband to help please keep a written record of times for meds, symptoms, etc. for the next few days, which I will share on this thread, so we can track any patterns. Such a good idea.

 

I'm sorry to say, I have no idea why mirtazapine and temazepam were added. I expect temazepam was added because of my husband's insomnia. All the current drugs plus the quetiapine (which he no longer takes) were administered around the same time in May 2015 by a nurse practitioner in Canada. He was having severe panic attacks and suicidal thoughts as well as violent urges (caused by severe anxiety) and from what I understand, when the mild doses of whatever they prescribed initially didn't make a dent, they just started adding more things on top. I can ask my husband about this when he's awake tomorrow but I expect he remembers very little from this period of time, probably less than I do. 

[DragonButterfly]

Update: He says he's feeling a bit better (still not 100%) and is keen to drop the first dose. I asked him to hold off until we get a bit more feedback from folks on here pending his written notes. 

[scallywag]

It's far, far better for him to wait until his CNS (central nervous system) has stabilized. Tapering slowly is about managing the risks of reducing dose. Changing the dose of a psychiatric medication is destabilizing and risks intensifying symptoms that he had with the dose split and adding new symptoms none of which are pleasant. I hope you can prevail upon him to wait.

[DragonButterfly]

Does anyone have any insight into how long it usually takes for the central nervous system to stabilise? Or is it different for each person? What will the signs be that he is ready for the next step, in your experience? Thanks!

[AliG]

Hi DB.  Stabilization seems to vary individually but there are also many common denominators. Essentially , it involves getting back to more of a " normal " condition, sometimes referred to here as " withdrawal normal " where symptoms are not  debilitating and the activities of life are not quite so disrupted.

 

There is a discussion here which might help to explain this further.

http://survivingantidepressants.org/index.php?/topic/3949-stabilizing-after-a-reduction-what-does-that-mean/

 

I agree it would be wise to wait and take it slowly. Please have a read through this link:

The slowness of slow tapers

 

Ali

[KarenB]

Hello DragonButterfly,

 

Just popping my 2c in as I'm also tapering effexor.  Stabilising before tapering is essential.  I didn't heed that at the start of my taper, and things were difficult for a long time.  In the end I was encouraged to hold and stabilise, which I did.  I've just completed an 8 month hold, and am now able to taper twice as fast as previously, and with only a fraction of the w/d symptoms I had before.  Taking the time at the outset is well worth it.

 

Karen

[DragonButterfly]

Thanks for the links and feedback all. He is now reporting feeling quite normal again, with just some fatigue and head fog. All other symptoms have gone (apart from one isolated wave of nausea). We are going to wait until Thursday to start the first tapering cut. Would anyone advise whether it's best to cut from the evening dose or the morning dose first? I think, due to the recent CNS reaction to time of dose change, we really want to creep along very slowly. This is the original tapering schedule we had planned to follow before the recent events and me finding you all on this forum https://dl.dropboxusercontent.com/u/8366203/EffexorTaperSchedule.pdf - Any red flags would be gratefully received at this stage so we don't make a mess of things again! Thanks again everyone for your support.

[DragonButterfly]

Thanks for the links and feedback all. He is now reporting feeling quite normal again, with just some fatigue and head fog. All other symptoms have gone (apart from one isolated wave of nausea). We are going to wait until Thursday to start the first tapering cut. Would anyone advise whether it's best to cut from the evening dose or the morning dose first? I think, due to the recent CNS reaction to time of dose change, we really want to creep along very slowly. This is the original tapering schedule we had planned to follow before the recent events and me finding you all on this forum https://dl.dropboxusercontent.com/u/8366203/EffexorTaperSchedule.pdf - Any red flags would be gratefully received at this stage so we don't make a mess of things again! Thanks again everyone for your support.

I should also add that we planned to start on Day 25 of this schedule - my only concern is the difference between capsules and tablets. We only have access to tablets at the moment and he has never had the capsules at all. 

[DragonButterfly]

FYI - Here is his record from the last few days:

 

Sunday 16th Oct

Woke up loads throughout the night

Morning - 75 mg venlafaxine

Body rushes all day

Body aches

Tired

8pm - smoked a joint

9pm - 75mg venflafaxine, 15mg mirtazapine, 10mg temazepam

 

Monday 17th Oct

Up all night

11am - 75mg venlafaxine

Body rushes

Tired

Lethargic

8pm - smoked a joint

9pm - 75mg venflafaxine, 15mg mirtazapine, 10mg temazepam

 

Tuesday 18th Oct

3am woke up

4am woke up

5am woke up

10am - 75mg venlafaxine, tried to nap

Tired all day with headaches

Otherwise good

8pm - smoked a joint

9pm - 75mg venflafaxine, 15mg mirtazapine, 10mg temazepam

 

Wednesday 19th Oct

6am woke up, 75mg venlafaxine

Some mild nausea followed by stomach cramps

7am - smoked a joint

2pm Feel ok

6pm - Feel fine

9pm - 75mg venflafaxine, 15mg mirtazapine, 10mg temazepam