Rob66: happy to have found this site :)

[Rob66]

29 minutes ago, baroquep said:

Hi Rob66, you might want to see if you have a compounding pharmacy in your area.  I have Effexor compounded every month and it sure helps not having to prepare my own pills.  It takes all of the guesswork and stress out of the equation and they are very precise.  

Thanks baroquep.  I do have a compounding pharmacy very close to me.  Now to find out if insurance will cover it is a different story.  Sertraline is dirt cheap with my insurance.  Probably very expensive without it.  Does your doctor have to send orders to the pharmacy with each new dose?  Not sure how this all works. 

[Rob66]

Because my primary care doctor considers me a Zoloft "lifer" he just prescribes me 90, 100mg pills at a time.  Easier than refilling every month.  He has no idea that I'm in the process of weaning, so I'll have to have a chat with him at my next physical, which is in one week.  Im sure he can answer some of my questions when I see him.

[AliG]

Rob.It's probably best to talk to your Doctor but normally you can get a script from your GP that can be faxed to the " compounding pharmacy". Is your doctor someone you can talk to and he will understand or someone that you have to " hide" the truth from?    

[Rob66]

21 minutes ago, AliG said:

Rob.It's probably best to talk to your Doctor but normally you can get a script from your GP that can be faxed to the " compounding pharmacy". Is your doctor someone you can talk to and he will understand or someone that you have to " hide" the truth from?    

My doc is a pretty understanding guy.  He typically doesn't stiff arm any of his patients.  I haven't told him of my weaning simply because I haven't had to see him in a long time.  He is a GP and not a shrink.  I gave up psychiatrists long time ago since all I ever needed was refills.  I don't foresee a problem with him

[AliG]

Ok. All good. If that is the case then you really shouldn't have a problem in the future with any compounding scripts.

[ChessieCat]

Once good way of wording it, rather than saying you are getting off your AD is to say that you want to reduce your dose.

 

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

What should I expect from my doctor about withdrawal symptoms?

[Rob66]

3 hours ago, ChessieCat said:

Once good way of wording it, rather than saying you are getting off your AD is to say that you want to reduce your dose.

 

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

What should I expect from my doctor about withdrawal symptoms?

Thanks Chessie for the links.  I've already been preparing for my visit with him, lol.  Don't want to ruffle any feathers.

[baroquep]

Hi Rob66, re compounding.  Before I started to taper, I spoke with my family doctor and told her that I wanted to wean off of these drugs.  I'd had difficulty trying to come off of these drugs twice previously and she was aware of this and she readily agreed to reduce by 10%.  She wrote me a script with those instructions for the compounding pharmacy and all I've had to do is keep in close touch with the pharmacist to confirm my dosage each month and then she fills the script accordingly.  The pharmacist is dealing directly with my family doctor for all the behind the scene things so I really don't have to worry about anything.

I've done a few holds over the last 11 months and recently reduced the percentage of the monthly taper to 5% as I've destabilized twice from going too quickly and now know that my quality of life (i.e. little to no physical or emotional withdrawal symptoms) is more important than getting off of these drugs quickly.  I've just reached 50% of my original dose and will likely hold here for two or three months just to make sure that my CNS has healed and is good and stable, I don't take chances anymore.   

 

re Insurance Company - obtained approval from my insurance company prior to tapering and asked them to approve the brand name Effexor as I didn't want to deal with generics.  In Canada, they substitute generics for brand names unless you have a doctor's approval to take brand name.  Because I was going to taper off, I wanted the brand name as they are dose consistent and I didn't want to run into trouble with quality control and generics.  The approval process with the insurance company was pretty easy, they approved everything and I actually don't have to pay anything for the prescription now.

 

Best of luck with your doctor's appointment, sounds like you are in good hands.  
 

[Rob66]

27 minutes ago, baroquep said:

Hi Rob66, re compounding.  Before I started to taper, I spoke with my family doctor and told her that I wanted to wean off of these drugs.  I'd had difficulty trying to come off of these drugs twice previously and she was aware of this and she readily agreed to reduce by 10%.  She wrote me a script with those instructions for the compounding pharmacy and all I've had to do is keep in close touch with the pharmacist to confirm my dosage each month and then she fills the script accordingly.  The pharmacist is dealing directly with my family doctor for all the behind the scene things so I really don't have to worry about anything.

I've done a few holds over the last 11 months and recently reduced the percentage of the monthly taper to 5% as I've destabilized twice from going too quickly and now know that my quality of life (i.e. little to no physical or emotional withdrawal symptoms) is more important than getting off of these drugs quickly.  I've just reached 50% of my original dose and will likely hold here for two or three months just to make sure that my CNS has healed and is good and stable, I don't take chances anymore.   

 

re Insurance Company - obtained approval from my insurance company prior to tapering and asked them to approve the brand name Effexor as I didn't want to deal with generics.  In Canada, they substitute generics for brand names unless you have a doctor's approval to take brand name.  Because I was going to taper off, I wanted the brand name as they are dose consistent and I didn't want to run into trouble with quality control and generics.  The approval process with the insurance company was pretty easy, they approved everything and I actually don't have to pay anything for the prescription now.

 

Best of luck with your doctor's appointment, sounds like you are in good hands.  
 

Thanks so much for the info!  I'll let you know how it goes on Sept 7th.

[Rob66]

Had a great chat with my doctor today during my yearly physical.  We talked about a bunch of things, among them was the Zoloft weaning subject.  Told him I've been carefully reducing my dose.  Wasn't sure how he would react at first.  Seems I had nothing to worry about as he was completely supportive of me reducing the drug burden.  Exactly what I was hoping for.  I inquired about compounding pharmacies also.  He stated that in his experience, most insurances will not cover compounding prescriptions and would be very expensive.  I just left it at that.  Perhaps I'll look into it more later.  I was just grateful that he is willing to give me full control of my weaning process.  Just keep the pills coming and leave the rest to me.  Just how I want it.

 

I do have one important question though.  I've had a case of toenail fungus for many years now.  I asked my doctor about this and he suggested I take Lamicil to treat it rather than a topical treatment.  It would be 250mg/day for 3 months then I would be done.  I picked up the prescription today but thought I would ask here before I start taking it.  Anybody have experience with this drug and did it have any negative effects related to AD withdrawal?

[ChessieCat]

terbinafine is the drug name for Lamisil

 

From  Drug Interactions Checker:

"Applies to: Zoloft (sertraline), terbinafine

Terbinafine may increase the blood levels and effects of sertraline, even up to several months after you've stopped taking terbinafine."

 

I've done a search on SA and found this in a member's topic by Altostrata (Alto is SA's owner):

 

 

On 11/10/2014 at 9:42 AM, Altostrata said:

This is what happens: Terbinafine blocks the processing of venlafaxine and risperidone in the liver, causing blood levels of both these drugs to rise and the effects of both of them. It also causes a concentration of drugs in the liver. This causes liver damage.

 

I got such damage, which was quite severe, within one month of taking terbinafine with paroxetine. I stopped terbinafine immediately. t took my liver ONE YEAR to recover.

 

These are not mild risks. If you are having any adverse effects at all from any of your drugs with the addition of terbinafine, you need a liver function test immediately. Your doctor is not paying attention to red flags.

 

I'm really glad you thought about checking first.

 

[Rob66]

This really scares me.  My doc put in orders to have my liver enzymes checked one month after starting Lamicil.  Doesn't make me feel warm and fuzzy in the least.  I'm hesitant to start this at all if it has a high risk factor. What to do....what to do....

 

My liver enzymes have been healthy for ever.  Not sure I want to gamble for the sake of toenails.  Hmmm.

[ChessieCat]

It's disappointing that we have to check up on what a doctor prescribes.  At least we have the ability to find out the information these days which wasn't available during my younger years.

 

And many/most doctors are annoyed about people using Dr Google!!!

[ChessieCat]

You might find these interesting.  Gwen Olsen was a pharmaceutical rep for 15 years.  I think it was in her book that she writes about when a new drug was being introduced and she asks about it causing another issue (diabetes I think) and the response something like well they can just take "x" drug for that.

 

Video:  Ex-Big Pharma Rep:  We’re Trained To Misinform -The Drugs ARE Dangerous (6 minute video)

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)

 

[Rob66]

Thank you very much Chessie for your concern!!  You go above and beyond to help all of us on a daily basis.  For that I am grateful!  I've become very weary in my middle age to just accept a doctor's advice without checking first.  I've been dupped more than once by blindly following doctors orders.  I'm sure he means no harm.  He just doesn't know any better is my thought.  I would've gobbled down my first pill today without thinking if it wasn't for this site. I really don't want to risk it so I'll just fore go the Lamicil.  I've never been keen on pedicures anyway.

[ChessieCat]

I've  got my own case of fungal nails.  Sometimes they get itchy and I use hydrogen peroxide (20% strength) applied a couple of times a day with a cotton bud or cotton tip or Q tip I think they are called elsewhere.  Unfortunately even with filing down the surface of the nail and using the hydrogen peroxide for about 6 weeks I haven't managed get rid of it and now they have just got very thick.  I'm not sure if the topical treatment works and they are too expensive to buy to try.

 

Just did a google search and found this:  http://www.top10homeremedies.com/how-to/how-to-get-rid-of-toenail-fungus.html.  Trouble is most of them have to be done 2-3 a day for a month.  I don't think I could be that committed.

[Rob66]

Doc said prescription topicals only have a 20% success rate and are ridiculously expensive.  He stated treating it internally has about a 80% success rate and the medication is cheap.  Of course I chose the latter of the two, who wouldn't.  Only caveat being, your gambling with possible liver damage.  No thanks, I'll live with the toenail fungus for the time being.  It's not THAT bad.

[Cheeky]

Hi Rob ,

i just want to let you know, I had the same thing happen to me , I went on the oral medication  for 3 months, it did however fixed my problem but I ended up in wiithdrawal . At the time I didn't realise what was happening to me , so I upped my medication.  

I have now got it again and soak my feet in Apple Cider Viniget. 

Its totally not worth it.

[Rob66]

9 minutes ago, Cheeky said:

Hi Rob ,

i just want to let you know, I had the same thing happen to me , I went on the oral medication  for 3 months, it did however fixed my problem but I ended up in wiithdrawal . At the time I didn't realise what was happening to me , so I upped my medication.  

I have now got it again and soak my feet in Apple Cider Viniget. 

Its totally not worth it.

Thank you Cheeky for your reply.  Sorry to hear it put you in withdrawal.  I'm in a very stable position right now and don't want to take anything that will impact my CNS.  I have a good thing going so far and have made lots of progress.  Don't want to mess a good thing up.  Thanks for your advice

[Cheeky]

Good one, it's not worth the risk.

[Rob66]

Just an update.  Things are still going extremely well with me.  I continue to feel very stable and happy most days.  I seem to be experiencing some emotion that I haven't felt in a lot of years.  It's such a great feeling!!  Not uncontrolled emotion, but normal situational emotion.  It's been so long since I've been able to cry about anything.  7 years ago my father died from a long battle with cancer.  I think back to those days and remember how emotionless I was.  I wanted to be sad but I think that my drug took that away from me.  Last night me and the wife attended another funeral for a friend of ours.  He was in the military.  When they did the military honors, I just about lost it.  Tears streaming from my eyes.  Haven't been able to have that kind of emotion in forever.  I hope this means that there is some kind of healing taking place in my brain.  I'm so tired of feeling like a zombie all the time.  I welcome the changes and embrace them!  

[baroquep]

Hi Rob, am happy to hear that things are going well for you.  Remember the first time that I could actually feel some real emotion, it was a big turning point for me as well.  Just noticed that you reduced 9.0 mg back on September 18th and wanted to warn you not to speed up your taper at this time, faster is not better when dealing with these drugs, and even an extra 3.1 mg can destabilize your CNS very quickly. It is easy to get overconfident, and I can relate, when we start feeling so better, the desire to get off sooner can be tempting.  I shaved off a little more than 10% a couple of times and it set me back a few months.  Just want to remind you to slow it down a bit, maybe wait an extra couple of weeks before you make your next reduction so that you CNS can catch up and make sure to keep your decreases to 10% or less.  I learned that it is better to be safe than sorry and want you to avoid making the same mistake!!!

[Rob66]

3 hours ago, baroquep said:

Hi Rob, am happy to hear that things are going well for you.  Remember the first time that I could actually feel some real emotion, it was a big turning point for me as well.  Just noticed that you reduced 9.0 mg back on September 18th and wanted to warn you not to speed up your taper at this time, faster is not better when dealing with these drugs, and even an extra 3.1 mg can destabilize your CNS very quickly. It is easy to get overconfident, and I can relate, when we start feeling so better, the desire to get off sooner can be tempting.  I shaved off a little more than 10% a couple of times and it set me back a few months.  Just want to remind you to slow it down a bit, maybe wait an extra couple of weeks before you make your next reduction so that you CNS can catch up and make sure to keep your decreases to 10% or less.  I learned that it is better to be safe than sorry and want you to avoid making the same mistake!!!

Thank you baroquep.  I guess I should know better.  It was time for me to make another batch of pills and I already have a container full of 50mg pills sitting there waiting for me.  The difference between my current dose and 50mg is 15%.  I hated the thought of going through all that filing when I could do a 15% drop just this one time and be done with it.  Just so darn tempting to get to 50mg, then there isn't all this filing down large amount of pills to go through.  My insurance won't cover compounding so I'm sorta SOL in that regard.  I guess I'll just have to bite the bullet and keep filing until 50mg to keep me safe.  Thank you for watching out for me

[ChessieCat]

Here is a topic which is well worth checking out:  Why taper paper: dose-occupancy curves

 

I've added a "perfect" 10% taper graph as a comparison.

[Rob66]

17 minutes ago, ChessieCat said:

Here is a topic which is well worth checking out:  Why taper paper: dose-occupancy curves

 

I've added a "perfect" 10% taper graph as a comparison.

Thank you Chessie.  Yeah, I've read that sticky like 5 times now and understand the need to go slower as you get lower.  It's me just being an idiot trying to get to that 50mg Mark and then coasting for a while.  I'll reinstate to my last dose and go from there.  This is basically me getting frustrated.  I thought that I might be able to handle a one time 15% drop and then slow down from there.  I know better, you know better.  The whole weaning process is just getting to me somewhat.  I need to just forget about it and live life.  

[ChessieCat]

9 minutes ago, Rob66 said:

I need to just forget about it and live life.

 

Yes, once you can get to this point it does become much easier to handle.  I can understand you wanting to get to the 50mg.  I must admit that trying to predict my taper and calculating my doses for compounding is the really hard part of my taper, but once it's done and I have my capsules I don't need to worry about it until the next lot of calculations.  I can imagine that having to try and get an accurate dose every day or week does become frustrating.

 

Have you thought about getting the additional part of your dose by making your own liquid?

 

15 minutes ago, Rob66 said:

I'll reinstate to my last dose and go from there.

 

You don't need to go to your last dose.  Just go back to what would have been 10% of the previous dose.  I make that 53mg.

[Rob66]

15 minutes ago, ChessieCat said:

 

 

 

Have you thought about getting the additional part of your dose by making your own liquid?

 

 

You don't need to go to your last dose.  Just go back to what would have been 10% of the previous dose.  I make that 53mg.

I only thought about the need for a liquid when or if I ever get to the smaller doses.  My Gemini scale is working quite well for the time being.  My large fingers may not be able to hold on to a pill while filing later on.  That's when I figured I would have to switch to a liquid.

I'll go back to 53mg and stay there for a while.  Thanks so much for the advice.  It's very much appreciated!

[Rob66]

I'll be going back to 53mg tomorrow.  Do I need to put the 4 days I was at 50mg in my signature or is it irrelevant at this point?

[ChessieCat]

Yes please add that to the signature.  It really helps the mods.  Thank you

[Rob66]

The 15% drop I did on Sept 18 had a significant impact on me over the weekend.  Yep, learned my lesson.  Although I upped my dose to 53mg four days later, I still felt the impact of it for a couple days.  Last Friday, Saturday and part of Sunday I could def feel some withdrawal symptoms kicking in.  I worked nightshift over the weekend and it wasn't much fun with the state of mind I was in.  Anxiety, brain fog, and a whole mixed bag of emotions, along with major irritability.  Now today I feel just fine, like nothing ever happened.  I actually felt great today.  Perfectly happy.  Scary how fast it can all change. I'll be sure to hold at 53mg for awhile before even thinking about another drop.  Thank you Chessie and baroquep for your guidance!

[baroquep]

Yes, these drugs are very strong even in very small amounts and I too found that out the hard way.  If I were you, I'd hold until at least November before doing another decrease just to make sure your CNS has settled.  Have found that it helps to do an extra long hold every now and again.  

[Rob66]

4 hours ago, baroquep said:

Yes, these drugs are very strong even in very small amounts and I too found that out the hard way.  If I were you, I'd hold until at least November before doing another decrease just to make sure your CNS has settled.  Have found that it helps to do an extra long hold every now and again.  

Thanks baroquep.  Yes, holding until November sounds good.  Thanks for chiming in

[Rob66]

Things have been really good with me as of late.  I bounced back really well after the 15% drop I did back in September.  Updosing right away seemed to settle things down quickly.  I'm holding until November, then I plan to drop to 50mg.  I haven't been doing much as of late.  I started going back to the gym after a 2 month break.  Had a stomach virus beginning of August, got better, then just lost motivation for a while.  Feel like I'm starting over again, ugh!  At 47 I don't bounce back so fast.  Baby steps I guess.

Today I cancelled my account at another depression forum that I used to visit often.  From what I know now about AD drugs, I can no longer handle seeing the poor advice given by others who still see meds as the answer.  I look at how pro AD some of the people are on this forum and can't help but want to scream at the top of my lungs not to take them.  So many just starting Ad's and already having issues.  It really is not any of my business but at the same time feel like reaching through the computer screen and giving them a reality slap.  I was there at one point also.  I had to learn a brutal lesson the hard way.  I had to turn away from that site so I can stop worrying about all the other people making the same mistake I did.  It keeps my anxiety in check when I don't have to read those kinds of things.  I have enough concerns in my life.  I shouldn't need to worry about people I don't even know.  

[ChessieCat]

Hi Rob, glad that things have been going well.  Please update your signature with all dose changes, including the updose, you have made since May 8/17 so that we can see them at a glance whenever you post.

 

2 hours ago, Rob66 said:

I shouldn't need to worry about people I don't even know.  

 

It's not that we don't care, we do, but we need to put our own well being first.  It is very helpful when you can recognise triggers, learn to manage them or not allow the trigger into your life in the first place.

[Rob66]

7 hours ago, ChessieCat said:

Hi Rob, glad that things have been going well.  Please update your signature with all dose changes, including the updose, you have made since May 8/17 so that we can see them at a glance whenever you post.

 

 

It's not that we don't care, we do, but we need to put our own well being first.  It is very helpful when you can recognise triggers, learn to manage them or not allow the trigger into your life in the first place.

My "updose" was noted in my signature.  50 to 53mg.  Perhaps updose was the incorrect term since it was only 4 days I was at 50mg.  Thank you for your reply

[Rob66]

Everyone talks about windows and waves.  Anyone NOT experience this during their weaning process?  Every day seems so much like the last for me.  Not bad, not really fantastic either.  Just kinda muddled.  Much like when I first started tapering.  I've had some noticeable symptoms when I would do a drop, but then it would even out after a few days and return to a sort of base line existence.  It's hard to describe.  I'm almost to 50% of my starting dose and I have a hard time distinguishing whether or not there's been any changes.  I feel changes when I make a cut, but then it sorta just goes back to the same thing a week later.  Never seem to tell if there is any windows or waves.  If there is, it's so subtle I can't really tell.  I'm not complaining.  It's been a rather smooth taper so far.  Just stating some observations I've had.