Apocryphus: Trintellix/vortioxetine withdrawal

[Apocryphus]

Hey everyone,

 

I'm posting this in a relatively scared/anxious state. I've been doubting every day whether this will actually ever get better, and the thought of this lasting for the rest of my life is terrifying.

 

So, my background: I took Trintellix 10 mg (started at 5 mg for a week, then increased) for about 2.5 months. It also has gone by the names Brintellix and vortioxetine. My psychiatrist at the time said that I didn't have to taper off, since it says in the accompanying informational booklet that there's no possibility of adverse effects when discontinuing such a low dose. So, I stopped cold turkey. 

 

I had been off of plenty of antidepressants in the past, and never experienced a real problem, and I thought I knew what to expect from the withdrawal. It was standard at first. Occasional brain zaps, vertigo, etc. I had a couple alarming incidents where for a period of 5-10 seconds, I would become completely confused/disoriented, forgetting where/who I was for those brief periods. From what I understand, those couldn't be absence seizures because I was fully aware that I was having them. They were a bit scary, but they sort of just stopped, and those haven't resurfaced since.

 

However, about 6 weeks after I had stopped taking the drug, the real symptoms surfaced, seemingly overnight, and they've persisted to the present moment. I went to sleep one night with a lot of stress on my mind, and woke up with a sore neck (which has since gone away), as well as all of my current symptoms: disorientation/confusion, random moderate bouts of vertigo, and an inability to visually process information like I used to. I can't look at pictures or screens anymore, because my eyes get tired instantly; it's like they don't know where to look, and trying to move them is exhausting. I also can't drive, and I can't work. I feel disabled, and the only clue I've gotten is from a different psychiatrist (not the one who prescribed the medication), telling me that these symptoms sound consistent with SNRI discontinuation syndrome, even though Trintellix isn't a strict SNRI. For obvious reasons, I haven't taken any other medications since I stopped Trintellix, and I luckily wasn't on any others at the time of discontinuation.

 

Simply put, this has ruined my life. I can't enjoy anything in this current state, because I feel so detached, and even the seemingly-easy task of sitting down and enjoying a movie has become exhausting and daunting. I haven't really felt any enjoyment or happiness since this all started about 4 weeks ago. As far as I can tell, it also hasn't gotten any better. I'm terrified at the prospect of this being permanent. I'm terrified at the prospect of this even lasting another month. Every day feels like agony for me. Out of nowhere, my life has basically been put on hold, and I'm not sure whether I'll ever be able to get back to it. Any advice or experience with similar symptoms would be much appreciated. I feel like I'm losing my mind.

 

Thanks, and hope your journeys are going better than mine.

[KarenB]

Hello Apocryphus,

 

Thanks for writing your signature.  Can you add any other drugs from the last year or two, and the start/stop dates for Trintellix.  (Please use this format for dates: 12 October 2016).  Thanks. 

 

We recommend that people taper Trintellix in the same gentle way as other psychiatric drugs - Tips for Tapering Trintellix and why-taper-by-10-of-my-dosage.

 

Many people find Fish oil and Magnesium useful during withdrawal.   

Non-Drug Techniques to cope with emotional symptoms.

Melt into your own life

 

Reinstatement might be worth considering, as it isn't so long since your last dose.  We have a thread that discusses it here reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/  If you decided to reinstate, it would be of an amount somewhere between your last dose and 0mg, as your brain and Central Nervous System will have adjusted part way.   Once you were stable again you could taper off according to our 10% monthly guide.

 

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.  People do heal, although it can be slow. 

 

Welcome to SA,

Karen

Edited July 6, 2017 by KarenB
added white space cause it keeps disappearing!

[Apocryphus]

Hey KarenB, thanks for the reply. I've updated my signature per your request.

 

I'm willing to try reinstating a half-dose (5 mg) and see how I feel. It's tough to figure out what to do, because the one doctor who actually identified this as withdrawal also told me not to go back on Trintellix since it's been too long. I'm planning on talking with him a bit more next week, to see if maybe he changes his mind once he sees that my symptoms still haven't improved at all. I'm pretty torn on what to do, and it's stressing me out; I feel like it could be worth a shot to try it, but I don't know how long after reinstating that I should expect my symptoms to improve.

 

I've tried most of those supplements/techniques and, unfortunately, I haven't really noticed a huge impact on my situation, at least. Maybe they'll do more over time.

 

Thanks again for all the advice! I'll be sure to update as my situation changes.

 

 

[KarenB]

I'm thinking maybe even smaller than 5mg, but I'll see what the other mods think (I always like extra brains on dose reinstatements).  Finding the smallest dose that you can stabilise on is what we are aiming for. 

[PoetJester]

Hey Apocryphus,

 

I have heard of reinstatements going well even a year after withdrawing from a med, should you choose to go that route.   2 months really isn't that long as far as reinstating goes.  I am still in wd, 3 1/2 years after quitting Zoloft and zyprexa cold turkey,  where one month feels like 5 or 6 months and you never feel too certain about making it through the end of the next week.    as you are aware, it's not really living, but surviving.   a lot of people do eventually heal a year or two out.   I also withdrew from Zoloft and zyprexa for 2 months in early 2004 and had a successful reinstatement only to quit the meds again a year later for 10 months.  my second reinstatement got me functioning again although with fatigue and hypersomnia (12-14 hour a day sleeping).  it seems that the more often one reinstates, the less successful it becomes each time, although I didn't have a computer or internet service back then or any knowledge of the community of folks suffering from psych meds otherwise I may have planned differently than quitting the drugs cold turkey each time, but hindsight is only 20/20 as they say.

 

poetjester

[scallywag]

Apocryphus

 

You discontinued Prozac a year ago. What prompted that decision?

[Apocryphus]

Hey, sorry for the delay. Thanks for the insight, @PoetJester.

 

@scallywag, I discontinued it because of sexual side effects, and I was generally "feeling better", or so I thought. The Trintellix ended up having worse side effects on that front, though, so it wasn't even helpful in that respect.

 

I think my current plan is to wait one more month to see if this resolves on its own. If it doesn't, I'll try reinstating for 2 weeks and see if that helps. 

 

I really hope it does go away soon, though. Every doctor I see just tells me it's anxiety, yet I haven't been feeling much more anxious than in the past. My only source of anxiety is trying to figure out what's going on with these symptoms.  

[scallywag]

The timing of of reinstating is, of course, your choice.  Please know that reinstatements are more predictable (likely to work) the sooner they are started after the last dose.

 

We've seen far too many people trapped in unnecessary suffering for far too long because of their desire to be drug-free.

[Apocryphus]

So, I had a change of heart (partially due to @scallywag's reply) and decided to try a 5mg dose of Trintellix this morning, which is one-half of the dose that I took for a couple months way back when.

 

I noticed an improvement within hours! It's not full remission, but I noticed that my eyes are much more easily able to follow things without getting lost. I'd say it's about 40-50% better. And this is just after one dose.

 

Correct me if I'm wrong, but the right move now is to slowly go back up to the full dose I was on, stay there for a bit, and then taper off extremely slowly, right? When I originally started Trintellix, I took 5mg for a week and then moved up to 10mg. Is that too fast for the second time around? It's tricky, because all I have right now are 10mg tablets, which are tricky to accurately cut. As far as I can tell, 5mg and 10mg tablets are the only forms I'll have access to.

 

Also, I just want to say thanks to everyone who's offered advice in this thread. Today is the first day in a month that I finally caught a glimpse of a life worth living. Sure, it's not perfect yet, and it's still fluctuating a bit, but I'm extremely hopeful at this point.

[Altostrata]

Hello, Apocryphus.

 

If I were you, I would NOT increase the dosage of Trintellix. It will take at least 4 days for the 5mg dosage to reach steady-state in your body. You probably will find the effect gets stronger over the next few days to a week.

 

What we see is that withdrawal often makes nervous systems more sensitive, which is why we suggest trying partial dosages to test the waters. Quite frequently higher doses will make people worse. 

 

Also, it will take some time for your nervous system to settle down from the upset of withdrawal. Please be patient and treat it gently, it may be in a vulnerable state. It may not react well to more drugs.

 

It's a good sign that you're feeling better with this one dose. Please let us know how you're doing.

[Pepita]

I understand about the reinstatement, your conditions sound very upsetting!!! Withdrawal is simply one of the meanest things there is. But I have to say, given to having seen what those pills can do I'd want to rather get rid of them than to incease any dosage:) Also know that healing takes time, your body might need longer than you want it to but it's well worth it :)))

All my best,

Pepita

[scallywag]

Echoing what Alto suggested, hold your dose at 5 mg, with one addition: another reason to give a lower dose a fair trial is that you'll have a lower dose to taper from later. A taper from 10 mg will take longer than one from 5.  If you stabilize on 5 mg, side adverse effects are less likely to occur and/or are less intense than at a higher dose.

 

It's a good practice to keep track of your symptoms. Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

Edited July 14, 2017 by scallywag

[Apocryphus]

OK, thanks for the advice, everyone. It sounds like, at the bare minimum, I'll reassess how I'm feeling in two weeks to figure out whether to increase the dose or not.

 

Unfortunately, today wasn't as great. I still had my regular issues throughout the day. I'm starting an exercise/diet routine at the same time (to deal with the possibility that this really is all caused by anxiety, as some doctors suggested), so hopefully that doesn't go against @Altostrata's advice. Do you have any other recommendations to keep things easy on my nervous system?

 

I'm a very anxious person (hence why I've been prescribed all these medications over the years), and I can't help but constantly ruminate on whether I made the right decision by going back on it. I think I did. It's so hard to tell. I really just want to be better. I miss being able to drive and live a normal life.

[scallywag]

Symptoms may not improve noticeably day over day.  Please read about The Windows and Waves pattern of stabilization.

[Apocryphus]

Thanks for the info, @scallywag.

 

Update, though: I can say with plenty of confidence now that I'm not feeling any better with Trintellix, after 5 days of taking it. Only the first day showed any improvement, and that might have been from the exercise and diet. If anything, the medication has been making me more tired.

 

I think I should definitely try to get off of it again ASAP. Since it's only been a few days, would it be reasonable to just take 2.5 mg for 1-2 weeks (I've only been taking the 5mg dose for a few days) and then stop? I definitely don't want to take this long enough to deal with two Trintellix withdrawals.

[scallywag]

Have your symptoms worsened in the 5 days, as in, dramatically worsened?

 

It's unlikely that you would see improvement after 5 days. It takes about 3-4 days for the drug to reach steady state in your blood and then some time after that for your CNS (central nervous system) to begin to respond.  What do you think about giving the reinstatement a full 2 weeks?

[Apocryphus]

I don't know if I'd say they "dramatically" worsened, but I suddenly found it tough to complete even simple life tasks because of the extra fatigue. Compounded with how I was already feeling, it just made everything too difficult.

 

Additionally, I'm still exploring the possibilities that these symptoms are caused by anxiety, or labyrinthitis (which I just learned about a couple days ago). Since I'm seeing a bunch of doctors in a couple of weeks to explore these issues, I'd prefer to be off the Trintellix, since it could complicate my ability to tell whether the treatments that they suggest end up working.

 

Hopefully that makes sense and I'm not being illogical here. With so many thoughts swimming through my head, it's sometimes hard to tell.

 

 

 

[scallywag]

As always, the decision to be on or off medication is yours to take.  If you intend to discontinue the 5 mg reinstatement, better sooner than later. Be prepared for windows and waves: The Windows and Waves pattern of stabilization.

 

If you wanted to discontinue by reducing dose, you could take

• 25% reductions: 3.75  then 2.5 mg (50% decrease) then 1.25 mg, each for a few days
• 50% reduction to 2.5 mg for a few days before stopping.