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1968creative: Tapering advice needed

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1968creative

Ok

My name's Adam. I'm 48.

I suffer with A&D.

I was on 40mg Citalopram for about 8 years. My psychiatrist moved me on to Effexor about 10 weeks ago. The drug hasn't agreed with me, and I'm n the process of tapering off.

I was initially on 75mg immediate release (sold tablet), and was taking one a day (people have said this should have been a split dose. Anyway, that's in the past.

My tapering history is that I've been taking 3/4 of a tablet - about 58 mg for the last 4 weeks. I think my depression has worsened over last 2 weeks, BUT that may be attributable to life's circumstances.(divorce).

My questions are:

1. Am I withdrawing from Effexor, or perhaps SSRI's in general? i.e. Is this really a Citalopram withdrawal considering I've only been on Effexor for a very short time.

2. How slowly should I taper off Effexor, and in what increments?

3. Do I need to split my dose and take twice a day? At present I'm taking the 58mg in one dose

Answers to the above and any other advice appreciated.

Thanks

Adam

Edited by scallywag
add generic drug name tag

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scallywag

1968creative -- Welcome to Surviving Antidepressants (SA)
 
It's likely that you are dealing with symptoms from discontinuing citalopram.  75 mg of Effexor is a low maintenance dose and 40 mg is the maximum maintenance dose of citalopram.  What was the thinking behind the switch to Effexor?
 
Effexor is taken twice daily; Effexor XR is generally prescribed and taken once daily.  Do you still have the box/bottle in which your Effexor tablets were packaged?  The label from the pharmacy will indicate "Effexor" or "Effexor XR"  There is probably also a drug identification number under which the medication was registered with the FDA. 
 
Are you taking brand-name Effexor or a generic venlafaxine?
 
Why are you reducing your dosage of antidepressant medication?

A request: Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly?

  • Any drugs prior to that can just be listed with start and stop years.
  • Dates are best; if you can't remember the date "mid-May" or "early September 2016" are more helpful than relative timeframes, "last week" or "3 months ago."
  • You don't need to include symptoms or diagnoses other than the initial condition that led to prescribing the first drug.
  • We ask for this information in your signature so that we can see it at a glance. A list is easier to understand than one or multiple paragraphs.
  • You can find instructions in this topic: Please put your withdrawal history in signature

Although you've already started reducing the dose of Effexor you take, please read the following topic:
Before you begin tapering -- what you need to know
 
 
You'll probably recognize symptoms discussed in these topics:
What is withdrawal syndrome
Important topics about symptoms including sleep problems
Glenmullen’s withdrawal symptom list
 
We suggest that people taper medication by reducing no more than 10% monthly to minimize the risk of withdrawal symptoms and to maximize the ability to respond to symptoms if they do occur.
Why taper by 10% of my dosage?
Tips for tapering off Effexor (venlafaxine)
 

 

Please take a moment to create your signature and to reply to the questions I asked above, formatted in blue-green italics.

 

This is YOUR introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.

 

I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

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1968creative

It's likely that you are dealing with symptoms from discontinuing citalopram. 75 mg of Effexor is a low maintenance dose and 40 mg is the maximum maintenance dose of citalopram. What was the thinking behind the switch to Effexor?

 

Answer: My psychiatrist felt that Effexor would be better for by Anxiety

 

Question: Should I go back up from 62 to 75, hold for a month, then begin a 10% taper?

 

Effexor is taken twice daily; Effexor XR is generally prescribed and taken once daily. Do you still have the box/bottle in which your Effexor tablets were packaged? The label from the pharmacy will indicate "Effexor" or "Effexor XR" There is probably also a drug identification number under which the medication was registered with the FDA.

 

Answer: It's Effexor solid tablet NOT xr

 

Are you taking brand-name Effexor or a generic venlafaxine?

 

Answer: It's a generic Venlafaxine

 

Why are you reducing your dosage of antidepressant medication?

 

Answer: Because Effexor doesn't agree with me, and I want off AD's and ultimately Benzos

 

A request: Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly?

 

Answer: Done

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scallywag

Hey Adam, thanks for the answers to my questions and for taking the time to create a meds/wd signature. It would be helpful if you added the fact that you took citalopram from 2008 - Sept. 2016, or whatever the years/months were.

 

Be sure to read both threads "Before you begin tapering" and "Why taper by 10%?"

 

When do you take your single dose of Effexor IR (immediate release) or, if you will Effexor OG (original generation)?

If you notice that you have symptoms arising 12 or more hours after your daily dose, it may make sense to move to split dosing. If what you're doing is working for you, stay with what works.

 

Stay where you are with your Effexor dose until your symptoms are stabilize.  "Stabilized" means that there are no wild swings within a day with your symptoms or from day-to-day; your symptoms if any should be at a daily level of "annoying" or less before reducing dose again.  It may take a while, i.e. several months, given the significant change you went through moving from citalopram 40 mg to Effexor 75 mg.

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1968creative

Thanks

 

So to summarise, I don't need to go back up to 75 from 56.25 where I'm currently at?

 

I've ordered some scales, as though I have a pill cutter, the process is not an exact science, particularly if I'm going to be cutting for a split dose. I assume it's OK to add the crumbs/dust to get the weight right, and to swallow these 'bits' of tablet?

 

Thanks again

 

Adam

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Shep

Hi, 1968creative.

 

Welcome to the forum from me, too.

 

I'm a bit concerned about your other drugs, Quetiapine and Valium because in your signature, you state that you're taking them as needed.  Taking drugs "as needed" can make your AD taper more difficult, as it can destabilize your central nervous system (CNS) even more, as well as making it difficult to know what symptom is coming from what drug. 

 

It's best to take the same amount of each drug consistently each day, keeping everything as stable as possible for your already stressed CNS. 

 

From your signature, it looks like you've been on Valium for 20 years, but you only started Quetiapine last month - is this correct? How many days have you been on Quetiapine? 

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1968creative

About 14 days on quietiapine

 

Adam

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Shep

Thanks, Adam. 

 

I'm going to ask the other moderators for their opinion. I'm wondering if you may want to come off the Quietiapine sooner rather than later, as you may not have developed a dependency to it yet. Quietiapine is an antipsychotic, although at the dose you are currently taking, it is acting on histamine receptors, as opposed to dopamine. But it still comes with some difficult side and withdrawal symptoms. 

 

Also, it's adding to your drug burden, including adding to the "moderate" adverse reactions listed here in the drug intereaction checker report I ran for your three drugs. You can see the report here - https://www.drugs.com/interactions-check.php?drug_list=2296-1524,1979-1274,862-441

 

It will really help us give you the right information if we can see your withdrawal symptoms within the context of when you take your drugs. In order to do this, please list your symptoms in this format:

 

Keep notes on paper about your drug dosages and daily symptom pattern

 

I've asked the other mods to take a look at your thread, but in the meantime, please read through the links that Scallywag left and let us know if you have any questions. 

 

Sending healing vibes your way. 

 

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1968creative

3 weeks

 

Adam

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Shep

I'm not sure what you mean by "3 weeks".  Is that 3 weeks instead of the 14 days you mention here

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1968creative

Sorry - I checked and it's been 3 weeks

 

Adam

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Shep

Thanks for clarifying, Adam.

 

How does the Quetiapine affect you? Is it helping you sleep? 

 

If you can list your symptoms in this format, we'll be able to give better advice:

 

Keep notes on paper about your drug dosages and daily symptom pattern

 

It's really going to be important to keep taking the same amount of each drug each day. So keeping this kind of journal will help you track your symptoms and guide your taper. 

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1968creative

I've read the article on 'before' you start tapering. I'm going through a stressful divorce. I'm wondering if I'm better going back up to 75mg (from 62), and holding until life gets better? - The only symptoms I've had from the Citalopram 40mg to 75mg Venlafaxine are head zaps (now gone).

 

I'm ** really ** confused about what to do now.

 

Adam

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Shep

When you say that your "only" symptoms are head zaps, which are gone now, I have to ask about something. You were on Valium for a number of years before going on an antidepressant. A lot of long-time benzo users report depression as a result of benzos, and then ending up on an AD. This makes sense - benzos, especially sedating ones like Valium, are central nervous system depressants.

 

And then you had to add in an antipsychotic just 3 weeks ago, so it sounds like you're covering up symptoms with other drugs.

 

Question - what symptoms did you have that led to the Quetiapine being prescribed? 

 

But to address your question about "holding until life gets better," that's a really legitimate response to all of this, and I'm really glad you're thinking this way. It's best to wait until you can handle what withdrawal throws at you.  

 

If you need to wait a number of weeks or months and deal with other life stressors, that may be best. You can always revisit coming off these drugs.

 

Please let us know what you decide. Perhaps read some of the links first. And there's a Relationship section that may also be of interest, as many people here are also struggling with relationships. Knowing you're not alone may provide some comfort. 

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1968creative

Quetiapine was prescribed to help manage my anxiety. Obviously I have to trust the psychiatrist to a degree. I think it was on the premise that Valium was having limited effect - i.e. I have become tolerant to it.

 

I'd really appreciate some advice on this.

 

Adam

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Shep

I see. Yes, let's get you some more information about Valium. 

 

Have you seen the members-only benzo section of the forum? I'm going to give you that link, as well as information about the Ashton Manual.

 

When you are ready, feel free to start a new topic for yourself to ask questions and get even more information. 

 

Members only benzo forum

 

 

The Ashton Manual will give you more information on what to expect with benzo withdrawal:

 

The 2002 Ashton Manual is at http://www.benzo.org...anual/index.htm

 

The April, 7 2011 Ashton Manual Supplement is at http://www.benzo.org.uk/ashsupp11.htm

 

Ashton and Beyond in Benzo Tapering

 

You mentioned being in the midst of a stressful divorce. As you'll see as you read around the forum, especially in the Relationship section, these drugs can take a terrible toll on relationships, not only with other people, but also with ourselves.

 

I hope this information is helpful, but do as much self care as you can, whether or not you decide to taper right now. The important thing is to stay as safe and as functional as possible. 

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Altostrata

Welcome, 1968creative.

 

How often do you take quetiapine and Valium? This is very important. Please keep daily notes on paper of your symptoms, when you take your drugs, and their dosages. This will help determine if any of your symptoms are side effects from the drugs.

 

A couple of the things your psychiatrist said make me wary. If you are "tolerant" to Valium, your nervous system is dependent on it. In effect, you are addicted. In a situation of tolerance, you may get withdrawal symptoms, usually rebound anxiety, if you don't have enough Valium in your system.

 

However, if you have spurts of anxiety, it could be withdrawal symptoms from going off a fairly substantial dose of citalopram to a lower dose of Effexor. Or, it could even be side effects from Effexor.

 

A divorce might make anyone anxious. Going off or changing drugs during the divorce process complicates everything.

 

Effexor is not better for anxiety, the noradrenergic component can cause anxiety (and sleeplessness). It's possible you're taking Seroquel to counter adverse effects from Effexor, never a good drug situation.

 

If what you have is truly immediate-release Effexor, you should take it twice a day.

 

To untangle all of this, you need to maintain a very steady drug regimen and keep those daily notes. Let us know how you're doing.

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1968creative

I typically take Valium and Quetiapine twice a day. I am happy to come off the Quetiapine if you think that's a good idea? - I have done so before from a higher dose with no side effects.

 

Yes I plan to ** slowly ** taper off Valium, but I think this is best done once there's some closure on my divorce (could be months).

 

I would be interested to know if it's best to taper off Quetiapine first? In retrospect the psych may have prescribed the Quetiapine for depression. I can't recall.

 

As for the toll on relationships - I'm proof of that, though of course it was my anxiety/depression that wrecked mine. What roll the drugs played is anyone's guess.

 

The problem we have here is that I'm **still** unsure what my plan of action should be. I'd rate my psych as pretty good, but like most of them, she's still a pill pusher, and sees no harm in rapid withdrawal etc etc.

 

So here's the question... Life is s***, I want off the drugs, where do I start?, and what do I do? NOBODY in the established medical profession is going to give what we know to be the correct advice. So it has to come from somewhere.

 

Thanks in advance

 

Adam

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1968creative

As an addendum to the above post, would say that I'm down and have anxiety GAD) a lot of the time. Due to life circumstances m A&D has worsened, but I can't really identify a correlation between this and the recent drug changes (Citalopram to Venlafaxine) and the addition of Quetiapine.

 

Adam

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Altostrata

Then, you are not taking Valium as needed, you are taking it regularly twice a day? Is this also true of quetiapine?

 

Please edit your signature accordingly, "as needed" does not mean regularly.

 

You are most likely dependent on Valium. What times of day do you take it?

 

I am inclined to take your psychiatric diagnoses ("A&D") with a grain of salt. It sounds like you have may be in bad situations. Also, "depression" is a common side effect of benzos. It's highly possible that your doctor has been misdiagnosing adverse effects for many years.

 

Quetiapine is not a good drug for "depression." It tends to be stupefying. My guess is your psychiatrist prescribed it to mask withdrawal symptoms from citalopram. When you added quetiapine, did it change the way you feel in any way? How about your sleep?

 

It's normal for someone to have increased "depression" and "anxiety" while a marriage is falling apart. If your goal is to feel nothing during such events, psychiatry can definitely help you.

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1968creative

I typically take Valium twice a day, not always - hence the 'as needed' - it's somewhere in between I guess.

 

I do not take it at a specific time of day.

 

I definitely have had anxiety for 20 or so years, depression for 3.

 

All Quetiapine seems to do is make me drowsy - not necessarily what I want.

 

Your last comment scares me a little (though I'm sure not intentionally). The ramifications of the divorce may be protracted, and I cannot see the point in sedating my way through the process. I have been very bed bound and withdrawn over the past few years, and do not want to feel like this. At the same time, I need to be able to cope/function with minimal depression and anxiety symptoms.

 

We need to keep this thread going, I feel we may. E close to a decision.

 

Thanks

 

Adam

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JanCarol

Hey Adam - 

 

Anxiety is real.  It sounds like anxiety is what started your journey.  But I don't like the word anxiety, as it's a medicalized term for distress, fear, fight-or-flight, and a number of other emotions.  By calling it all "anxiety," it enables your doctor to come up with new pill plans, instead of addressing the anxiety itself.

 

But often, anxiety is a physically based reaction to an event, which is accompanied by a feeling.  Making a mental judgement of that feeling is an "emotion."

 

I find it helps to separate my physical reactions from the feelings.  I've been driving in major traffic this weekend.  People pulling out in front of me, and I can feel the physical reaction.  I try and not judge it.  I say to myself:  all my nerves just fired down my arms, and my hair is tingling and standing on end.  My heart is racing, I feel hot.  I'm shaky and unsteady.  The feelings that accompany these body events are usually fear, but I'm learning to detach from them.

 

Here is a master you can learn from, too:  Claire Weekes - Self Help for your Nerves

 

I agree with Alto and Shep, that you probably got the antidepressant to medicate side effects from the benzo - and then - got the quetiapine to medicate the side effects from the antidepressant.  This is a common enough prescription cascade.   I've seen myriads of variations of this combination - and really - if you'd learned how to deal with the problem without the benzo, you could bypass the other drugs too.

 

Your feelings, your physical reactions - are probably healthy reactions to life situations.  You do not have a disease or disorder, but your doctor has treated you as if you do.  NOW, that you are on 3 medications, you have what is called an iatrogenically induced condition - you are dependant upon 3 drugs, and you are not getting the mood support you need.  Additionally, none of these drugs are trialled for the long term (even though they prescribe them "for life"), so you are having a physical experiment, too, which could complicate your recovery.

 

After looking at your cascade, I believe you could most benefit from Non Drug Techniques for Coping with Emotional Symptoms

 

When we get your symptoms better understood, we may have you decrease the quetiapine - but the longer you delay, the deeper it gets its hooks into you, and the more of a challenge you may be setting yourself up for.

 

You can do it, there are many people in here who have come off a cocktail after a prescription cascade.  There are many of us who are still working on it - but who are happy enough that we will never go back to the drugs again.

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1968creative

Thanks. This is all very helpful.

 

Slightly depressing to read I've been hooked into the triad of meds, but I guess I'm not the first.

 

I suppose the question is... should I be coming off Quetiapine and then tapering off to he AD whist going through a stressful divorce?

 

I have come off Quetiapine before without withdrawal issues.

 

Some definitive recomendations would be appreciated.

 

Thanks

 

Adam

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Shep

Hi, Adam.  If you've been taking the Quetiapine only "as needed" for just 3 weeks, it's safe to just stop it.

 

But we really do need to know how often you take it. Are you taking it 4 times every day? 

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Altostrata

Adam, we need to know exactly the times you take your drugs and the dosages. Please keep daily notes on paper of this and your symptom pattern. This is very important.

 

Are you taking any other drugs? 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.
 

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1968creative

I take Tramadol for back pain, but notice that's a potential risk, so have asked my doc for codein which has less interaction risk.

 

And yes, I've only been taking Quetiapine as needed, so will take no more than 2 a day for one more week then dispose of it.

 

I'll keep a log of drug times/reactions etc, but frankly my sleep pattern is so shot at present, it'd be all over the place.

 

I think someone else ran he symptom checker, and risk results were moderate, but will run again and post . A

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Shep

Hi, Adam. 

 

Please see this thread about Tramadol:

 

Tips for tapering off Tramadol

 

Please let us know ALL the drugs you are taking. How long have you been on Tramadol? 

 

Also, please take the Valium at the same time(s) every day. Your off and on use may very well be confusing your CNS and causing problems. Valium has a very long half life of up to 200 hours, but having fluctuating amounts due to erratic dosing may be causing problems. 

 

Please let us know how you're doing. If you do decide to stop the Seroquel, you may want to not make any changes to your pain meds right away. 

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1968creative

I was taking Tramadol VERY infrequently and haven't taken t for over two weeks. To my knowledge it's very much a moderate pain killer. I've had it in my arsenal for about 2 years. To take it all the time reduces efficacy, hence I was only taking as needed. The same rules should app,y with codeine. If taken too often it ceases to work, and as codeine is an opiate it's addictive.

 

I've taken your advice re.valium - though it's weird how it's universally prescribed PRN.

 

Thanks!

 

Adam

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1968creative

As an addendum, my Tramadol was 50mg. I rarely took more than 2 a day.

 

I have however read the tapering advice - somewhat horrified to see it's being considered as an SRNI!

 

Adam

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MNgal1960

Welcome, Creative.

 

Just wanted to share what my pharmacist said to me when I pressed her for her opinion. She said taper the Seroquel first because she thought it was the most dangerous of the drugs I'm on (as far as side effects) and that I had been on it too long even at the very low dose I take.

 

MN

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1968creative

At the moment I've put a call into my GP to see if it's safe to take melatonin supplement to (hopefully) reduce my dependency on Valium, allow me to come off seroquel, get me better sleep, and generally make me feel better. I just want to run it past them as all products seem to contain Htp5 which theoretically should be a good thing to boost my seratonin levels and make up for the reuptake deficiency I think Im experiencing due to my drug change from 40mg Celexa to 75mg Effexor some 12 weeks ago. Fingers crossed. Adam

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1968creative

It now transpires that I cannot buy pure Melatonin in the U.K. I have to order it from overseas via Amazon. The shop sold me a bottle of 5-http. Having checked this on a drug shop nteraction site, it appears that this could be potentially dangerous. I suspect I'd be fine, and it'd help make up the serotonin deficiency, but I'm too reluctant to risk it, and don't know where to turn to for advice. Help!

 

Adam

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MNgal1960

I take only very low dose multi-vitamin. Some people do OK with supplements. Some say absolutely no supplements.

 

Agree with Shep and stress what she is saying. Take each of your drugs on a regular schedule. Valium "as needed" and Quetiapine "as needed" make me a little nervous. If you are dependent on them, this could be really messing up your brain and causing all kinds of symptoms.

 

I'd be hesitant to throw the 5-http into the mix to try to fix the problem, but I don't know anything about it. Maybe someone else does. I'd be more inclined to give your brain a regular schedule of your medications so it can adjust and fix itself. And then continue with your taper. Very slowly.

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1968creative

Yes it's weird with Seroquel- I can very much take it or leave it, but have decided to reduce dose and then come off it in a few weeks. Opinions seem to vary wildly about this drug. A

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scallywag

Adam, would you post a list of the medications you are currently taking and the doses? I would like to make sure that the tags are correct.

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