Juan: I'm confused of what to do and how to do it

[Juan]

Hello SA members, I am new here.

Before June 2017 I was taking Lexapro/60mg and Lithium/600mg, I stopped cold turkey, did well for 2 months but ended up going to the ER for insomnia, was sleeping less than 2 hrs. at night.

I didn’t know anything about withdrawals weeks ago; the doctors don’t talk about it, they just want to put you on something.

I spent 10 days in the Psych ward in Sept/2017, they started me on Remeron 15mg and Effexor 37.5/75/112.5/150mg, after I left the hospital my psychiatric increased to Remeron 45mg and Effexor ER 150mg.

Since I started Effexor ER 150 noticed hyperactivity episodes, so the Dr. decreased to 112.5mg and I have been trying to stay on 75mg

I want to start to taper them and when I stop my final doses I want to replace them with supplements and vitamins.

It's been only a month since I started taking Remeron and Effexor.

I am scared and confused of what to do and how to do it.

Please help.

[Gridley]

Hi, Juan and welcome to SA,

 

I'm really pleased that you have found this site.  What you are experiencing are withdrawal symptoms from having gotten off the drugs too quickly when you did your cold-turkey.  SA recommends tapering by no more than 10% of the previous dose with a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

The first thing we would like you to do is to complete your drug signature which will appear below every post you make.  Please follow these instruction:

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly? 

• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs. 

• Any drugs prior to 24 months ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
• Link to Account Settings – Create or Edit a signature.

Here are some links for you to check out:

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

These really helped me to understand SA's recommendations:

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

 

This is your own Introduction topic where you can ask questions and journal your progress.  Once you've posted your signature we can help you with your taper.

 

 

[Altostrata]

Welcome, Juan.

 

How do you feel on 75mg Effexor and 15mg Remeron? When do you take them? Do you take any other drugs? How is your sleep?

[Juan]

Gridley, thanks a lot for your answer. Do you think I could be having w/d from Lexapro/Lithium c/t since June 2017, even if I'm taking new meds now?

 

Altostrata, I'm taking 45mg of Remeron before bed, and 75 of Effexor ER with breakfast. My sleep is ok, a lot of dreams tho. I use Klonopin 0.5 for anxiety.

I feel trapped taking these drugs, their side effects, especially suicidal feelings for no reason. Sometimes I get tingling on my feet and head.

The Dr. decreased the Effexor from 150 to 112.5 because I was feeling hyper, but even on 112.5 I get a little hyper, so I have been trying to stay on 75 since last Sunday (Oct.22)

Do you think is it too fast to go from 150 (for a month) to 115 (for a week) to 75?

 

Thank you,

J

 

 

 

[Altostrata]

Have your symptoms gotten better or worse since you decreased to 75mg?

 

Why do you say "trying to stay on" 75mg? Do you feel you need more Effexor?

 

Are you taking 45mg of Remeron?

 

When do you get anxiety? How often do you use lorazepam?

 

The combination of Effexor and mirtazapine can cause bad reactions. Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results in this topic.

 

[Juan]

Interactions between your selected drugs

Major

venlafaxine mirtazapine

Applies to: Effexor XR (venlafaxine), Remeron (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.

[Juan]

Altostrata,

I'm taking Remeron/Mirtazapine 45.mg at night.

I was feeling high/hyper/anxious during the day (after) taking Effexor XR (venlafaxine) 150 and still a little on 112.5, so I moved to 75.

After I left the hospital I saw and asked my doctor about the serotonin syndrome using Remeron and Effexor, she said there's not a problem with those. I can't believe that doctors don't admit that there's withdrawals, and lately putted me on 2 meds with interactions.

No, I don't think need more Effexor so I will stay on 75.

The Clonazepam (0.5) I use daily for panic attacks during the day or at night (1.mg max. daily) or when I don't want to leave the house but have to.

[Gridley]

Juan, please don't forget to do your signature.  The instructions are in my previous post.

 

 

[Gridley]

 

 

4 hours ago, Juan said:

Do you think I could be having w/d from Lexapro/Lithium c/t since June 2017, even if I'm taking new meds now?

 

 

You could be experiencing withdrawal from the old drugs and/or start up, side effects or possibly a bad reaction to the new drugs.  This is why it is generally not recommended to switch drugs.  Now the waters are muddied and we don't know what is causing what.

 

[Juan]

(I am sorry, promise to do my signature soon.)

 

Do you think that I went too fast from 150 (started from Sep.16 to Oct.15 / 2017) to 75 of Effexor.ER TODAY.

I took 112.50 for a week (Oct 15-22 / 2017 )

 

Physically I don't have pain, but anxiety, depression and suicidal thoughts are increasing.  

I have plans to see a new (natural medicine) doctor next week, and a vacation to Mexico in Nov. with my father, but I feel I can't take it anymore.

 

 

[Altostrata]

When did these bad feelings start? Do they occur at a particular time of day?

 

It is possible some of your symptoms are side effects of the drugs you're taking. Effexor, for example, can cause anxiety or sleeplessness. The Effexor-mirtazapine combination can cause other side effects. It's called "California rocket fuel." (Your doctor is not correct about this being a harmless combination.)

 

To figure out what's going on, please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages.

[Juan]

Those are horrible feelings as you can imagine, they come and go without notice or reason. I think they're side effects from these A/D "medicines", and since I still have to take them, have to deal it for now, because I'm NOT changing meds or going up on my dosage. 

Thanks to S/A I don't feel alone in this battle. 

 

[Juan]

Hello again,

Yesterday (Sunday) I started taking 75.mg of Effexor XR. I know it's a big jump from 112.50, but I still get the suicidal feelings daily. Also, I haven't been on this drug for more than 2 months, and don't want to stay in a higher dosage because it's going to take a very long time to do a 10 % taper.

I'm sleeping ok, hope not to be opening the hell door this holidays.

Please let know what you think about my decision.

Thanks,

Juan

[Juan]

Sorry, I just wanted to post these links here because I need them.

 

 

 

 

[Juan]

 

[nz11]

Greetings Juan

Wow you CT off 60mg of lex and 600mg Li ...no wonder you ended up in hospital.

 

Juan when did you start the clonazepam? 3 Dec? today?

When did the Lithium and escit. use start May 17? Jan 16? , ?? How long did you take 60mg of escit for ...1 week , 1 year, 2 years..??

 

Were you aware that dependency on the benzo could happen within 1-2 weeks and it will need to be tapered also. Why was this added? It is far better to do a slow taper than to add other drugs to find relief from wdl symptoms. Doctors are very unaware how severe wdl symptoms can be. Please don't assume that because the doctor prescribes it then it must be safe. 

 

Sorry I'm finding the drug sig a little confusing.

Is this correct: you took 150 mg of Effexor from sept to 8th Oct, then dropped to  112 mg of Effexor from Oct 8th to Dec 2nd.  This sort of cut is not rec here and can trigger severe wdl symptoms one of which is s.i. So you reported the suicidal feelings to the doc and they decided due to that to reduce the drug again to 75 mg and also add clonazepam?? is that right. In other words the doc decided to further destabilize a destabilized cns in freefall. These doctors drive me nuts!

On ‎12‎/‎5‎/‎2017 at 2:24 PM, Juan said:

I haven't been on this drug for more than 2 months, and don't want to stay in a higher dosage because it's going to take a very long time to do a 10 % taper

Compared to many here two months exposure is not a lot (having said that dependence is established within a months use) however I then noticed you have prior exposure to psych drugs being escitalopram and Li.(at high doses...oh my goodness 60 mg of escitalopram is equivalent to 113 mg paxil...what on earth was the doctors reason to justify putting you on that truck load). You haven't clarified how long you were on them for but exposure is accumulative and the brain and cns would have been  carrying past injury from this exposure. Imo within the two months dependence would have been well established on the Effexor and yes you would need to do the 10% taper as a harm reduction approach. 

 

Withdrawal reactions off these drugs cause unbelievable pain and suffering, none of us were told or warned by the doctor how severe these reactions are. By continuing to throw more drugs at wdl symptoms the doctor is turning you into a medicated train wreck.

Personally I think Californian rocket fuel should be banned.

nz11  

 

[Juan]

Hello nz11, thanks for your response,

 

Now I can see that there's information missing in my signature, it's not on purpose, it's because I don't remember in detail, but I will do my best, sorry.

 

I started on and off Prozac since 2005, later was changed to Escitalopram in 2010, Lithium was added in 2015. Escitalopram and Lithium were increased after my mother's sudden death in Aug.2016, but since her passing I couldn't grieve properly so I stopped C/T in June 2017, without knowing about W/D at all, so I panicked when I got insomnia, went to the hospital and ended up staying "voluntary" for 10 days, I was started on the 'California Rocket Fuel'.

 

In Aug.2017 I was on Latuda for 3 weeks but I stopped because of restless legs and insomnia.

 

I have been using benzos since 2005.

 

Thanks again nz11, bye for now.

 

Juan

[nz11]

Thanks for clarifying that and updating the drug sig.

Well that is certainly many years of psychoactive drug use.

You cant do these sorts of big cuts with this history even imo 10% may be too much.

You have made a 33% cut in the Effexor. I think that's too much. As this only happened this week. Maybe an updose could be considered. Stabilize then taper at 5%.

However I am not a doctor and if your doctor cut that because of suspected serotonin syndrome then you are going to have to find a way to cope with the wdl symptoms. Ask the doctor if he has any nondrug approaches to handling wdl.

If you throw yet another drug at them then it will be a continuation of same old same old revolving door to the doctors clinic and switches and CT and ....etc.

 

You haven't clarified the benzo use but no doubt you could be suffering wdl and startup effects from that use. 

Has the benzo use been continuous since 2005. When did you start the clonazepam? If it was only this week do you think its necessary? Why did you start it...you CT it a month ago? , ?

 

wishing you strength.

So sorry the medicalprofession have done this to you

nz11

[Juan]

Yes, I have been on and off Benzos since 2005, started with Lorazepam/Ativan and changed to Clonazepam/Klonopin in 2010.

Oh my, It sounds like I'm an addict.

 

Also, I recently noticed that I forgot to mention my use of Zolpidem/Ambien between 2010 and June 2017. 

 

I did a big jump with Effexor XR/Venlafaxine ER  from 150->112.50 to 75 mg, because of side effects. My doctor wanted to change to something similar but I said no.

 

Hope you're having a good day,

 

Juan

[RobLee]

On 12/9/2017 at 9:39 PM, Juan said:

I did a big jump with Effexor XR/Venlafaxine ER  from 150->112.50 to 75 mg, because of side effects.

My doctor wanted to change to something similar but I said no.

 

 

Juan, thanks for visiting my page.  You posted this back in December and I was wondering how you're doing at 75mg.  I have dropped from 150 to 75 over the past three weeks and am looking for others who have been thru this.

 

This forum (SA) seems to be organized as "everything goes into the intro thread" rather than individual threads being grouped by topic... specific types of drugs or various facets of tapering off A/D's.  Personally I do not have sufficient expertise to counsel others in their efforts, but it seems no one ever reads my intro.  They never post there anyway.  Yet I have seen where others may start a new thread topic, and their new post ends up getting moved to their intro by the mods.  (not criticizing anyone... I also have no experience moderating an online forum, so I'm sure they have their reasons).

 

Anyway, I have one more week planned to stabilize at 75 before moving on to some lower dose, or deciding to stay at 75 for a while.  I do hope to get an MD psychiatrist involved who may be more familiar with the pharmacodynamics of SNRI's than are the oncologists and such who have been prescribing for me so far.

 

Sorry I don't have the mental clarity to follow any other threads in which you may have posted.  Good luck to you , and I hope you are doing well.

[Juan]

Hello Rob,

It's nice to see your message in here, thanks a lot.

and yes, we have to follow the rules of this forum/threads, so it's better to keep the signature updated. I think they don't want people asking the same questions all of the time and everywhere in this forum.

as my signature mentions, now I'm on 10 beads of Venlafaxine ER 37.5/mg

 

 

 

 

 

 

 

 

 

 

[Juan]

Hello there,

I have a few questions:

 

I have been on Remeron for a year, yesterday the Dr. suggested to switch to Trazadone because of the weight gain. Aren't these 2 the same kind of medication? I just need something to help me sleep, because at this point I don't know if I can sleep naturally.

 

I have been on the thyroid medication (Levothyroxine 25 mcg) for almost 2 months, but I can't tell if it's "working" or not, so I want to stop taking it, so do I have to taper it?

 

Also, yesterday I asked my Dr. about TMS, and she agreed to look in to it, since I have NY Medicaid and I'm not sure if they can pay for it.

 

Thanks a lot,

[Altostrata]

Are you on only Remeron now? Did you go off venlafaxine completely? How did you go off? Are you feeling better or worse? Please update your signature.

 

For what reason are you taking Levothyroxine 25 mcg? Do you feel better or worse?

 

Why do you think you can't sleep naturally and need Remeron or trazodone to sleep?

 

Why are you asking about TMS?

 

On 9/22/2018 at 9:10 AM, RobLee said:

This forum (SA) seems to be organized as "everything goes into the intro thread" rather than individual threads being grouped by topic... specific types of drugs or various facets of tapering off A/D's.  Personally I do not have sufficient expertise to counsel others in their efforts, but it seems no one ever reads my intro.  They never post there anyway.  Yet I have seen where others may start a new thread topic, and their new post ends up getting moved to their intro by the mods.  (not criticizing anyone... I also have no experience moderating an online forum, so I'm sure they have their reasons).

 

@RobLee The Introductions topics are records of your progress. They are case histories. We move posts into the Introductions topics if they update the case history. If we did not do that, a person's case history would be all over the site and we wouldn't be able to follow it.

[RobLee]

Juan, I'm afraid I don't know anything about Trazodone other than what is online.  I was only on Remeron for ten days and the side effects became intolerable. Yes, there was significant weight gain... ten pounds in ten days, even though it did not change my appetite nor what I ate.  I will attempt to answer some questions in my own thread (you know where to find me).

 

Also I don't know anything about the other things you've mentioned, but I do think it's great that you are down to only ten beads of Effexor now. You have really accomplished something there to be proud of. Whatever problems you are facing, I'm sure you will get them resolved. Good luck to you!

[Juan]

Hello @Altostrata @RobLee, thanks for taking the time to respond.

 

First at all, not sure if I can mention it in here.

I'm a HIV/AIDS survivor since 1997, started medication (on and off) since 2001. I'm 40 y/o, 5'10", 225 lbs., overweight, prediabetic and my thyroid is slow. For the last 2 months, I have been in a low sugar/starch diet, now my glucose is normal and hoping to lose weight, especially fat.

As you can imagine, I'm kind of stuck with doctors, having an Infectious Disease Doctor and a Psychiatrist being part of my medical treatment.

I "like" my psychiatrist, she reminds of Virginia Wolf...LOL...but at the end of the day, she's a doctor and her job is to have me on medication always! So she's the one who put me on Levothyroxine, and now is suggesting Trazadone instead of Remeron/Mirtazapine, which I'm currently taking, also, she says that 37.5mg of Effexor/Venlafaxine is "too low", so she mentioned Pristiq, and maybe (in the future) try TMS if NY.Medicaid pays for it.

 

I am doing the taper without medical support, just S/A guidance and my father's help. Months ago a found a natural clinic where they believe that withdrawals happen and they prescribe vitamins/supplements and diet to help relieve the symptoms, but they don't take health insurances and those are very expensive appointments.

 

Now I'm down to 8 beads of 37.5mg Effexor/Venlafaxine and Levothyroxine 25 mcg (morning), 15 mg of Mirtazapine and Clonazepam 0.5mg (at night).

I had been cutting 3 beads every 2 months, but now that I am getting so low, I'm cutting one bead a week until I am down to zero.  I also did a big jump from 30.mg to 15.mg of Mirtazapine, because of the weight gain.  I'm hoping it still helps my sleep in the lower dose.

I have been using "help" to sleep since 2001. I'm sleeping around 6 hours.

 

For me, mornings can be difficult for energy and concentration, afternoons and nights are better to function, doing laundry, cleaning the apt, or watching tv.

[Altostrata]

What is a "slow thyroid"??

 

You don't need expensive supplements to taper.

 

When did you reduce from 30mg to 15mg mirtazapine?

 

How often do you take clonazepam in a day? Do you only take 0.5mg at night or do you sometimes take more? What is your daily drug schedule?

 

Do you get any symptoms when you remove 1 bead of Effexor? Do your symptoms follow any daily pattern?  Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Are you also taking HIV drugs? Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

 

 

[Juan]

Hello @Altostrata,

I am sorry for the delay answering.

I was keeping my daily notes on paper but we had visitors at home and a child destroyed it, now I have to start again, promise.

 

-About the thyroid, my doctor calls it "slow" or "low thyroid function", I don't know about it, do you believe in that?

-I have been taking 0.25 of Clonazepam at bedtime and 0.25 mornings.

-When I remove 1 bead of Effexor, after 3/4 days of doing it, I have more depression and suicidal thoughts.

-and yes, I have to take medicine for HIV/AIDS, Biktarvy once a day, and Bactrim/antibiotic on Mon/Wed/Fri.

 

Here is my drug interaction report:

https://www.drugs.com/interactions-check.php?drug_list=2296-0,1640-0,703-0,1463-0,3891-18772,2128-3117

 

Thanks a lot,

J.

[Altostrata]

"Low thyroid function" doesn't mean anything unless your blood tests are drastically off. You need to see your thyroid test results.

 

A lot of symptoms can be attributed to hypothyroidism. Since she doesn't know anything about withdrawal syndrome or drug side effects, your psychiatrist is probably making a guess that your symptoms are caused by hypothyroidism.

 

This probably is not a valid diagnosis of hypothyroidism, she threw thyroid hormone into the mix hoping it would help. Do you feel any effect from it?

 

Please add all your current drugs to your signature, with the link to the drug interaction report.

 

Why are you on long-term Bactrim? Is that part of HIV-AIDS treatment?

 

Please stop tapering for now. What is your current symptom pattern? We do need to see those daily notes, in a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

[Juan]

Hello everybody, wishing you a 2019 filled of windows and a fast recovery.

 

Dear @Altostrata,

I have complete the tapering of Venlafaxine ER.

I stopped taking Levothyroxine, also the Bactrim; since it was a temporary treatment, after a Pneumonia in June 2018. 

 

The holidays were OK, well, it's still sad to live without my mom, soon I will be away on a trip of 45 days.

 

Here is my drug interaction report:

https://www.drugs.com/interactions-check.php?interaction_list_id=183273314&drug_list=703-0,1640-0,3891-18772

 

Thanks, bye for now.

[Altostrata]

Thanks, Juan. Please check in when you get back.

[Carmie]

Hi Juan, 

 

How are you doing? I hope you had a nice trip.💚

[Juan]

Hello @Altostrata @Carmie and S/A family,

I came back home after 30 days (not 45 as planned) of travelling out of the country.

I started driving again (hadn't driven for 20 years and back then it was a manual/stick) for my road test in NYC, failed my first try and passed on my second.

Btw, I have completed the tapering of Remeron, a month ago, April 2019.

Since it's spring, I'm dealing the pollen allergies, that means having to take/use meds (antihistamine, nasal spray and eye drops) for it.

I hope you all are doing well, have a nice weekend.

Hugs,

J.

[eymen23]

Hi Juan,

 

I’m glad to hear that things seem to be going well for you overall. In regards to your allergies, you may find that they are a little worse than usual as Remeron acts as an antihistamine. This can lead to excess histamine and worsened allergies as a withdrawal symptom. Over time and as your body adjusts to being off the drug, your histamine levels should normalise.

 

In the meantime, you might want to consider an air purifier to help with your allergies whilst indoors. I have asthma and also get hay fever on very high pollen days. A good air purifier can really help me during the night, as they can significantly reduce the amount of pollen and other allergens within a room.

 

Air purifiers are also handy as they’re a fairly simple drug-free aid, which means there are less risks of complications or side effects. You may also find it helpful to avoid foods that are high in histamine like aged cheeses and meats, whilst you are going through allergy season and also Remeron withdrawal. 

 

Edited May 4, 2019 by eymen23