FlorestaTropical: planning Viibryd weaning off, need advice

[FlorestaTropical]

Hello community,

 

Thank you all for this wonderful resource!  I have been reading this website since long before I made the decision to start Viibryd, and it is a wealth of information.

 

Because I was recently diagnosed with posterior subcapsular cataracts that were likely either caused or exacerbated by the Viibryd, and because the benefits are not enough to justify continuing this damage to my eyes, I have decided to start planning the weaning off process.  I would like advice about rate and timing since I need to try to do this faster than would normally be recommended.

 

Quick psychiatric background:  I went through betrayal trauma due to discovering my husband’s infidelity and was diagnosed with PTS, anxiety, and depression.  After several years of herbal and natural mood-related supplements, I still felt many symptoms and received the same diagnoses again.  So, against my normally holistic approach to health and healing, I decided to start an SSRI.  I got the Pathway Genomics psychiatric pharmacogenomic panel, and the results were that Viibryd was the only SSRI that my body might potentially tolerate.  

 

My original plan was to take the Viibryd for a couple of years to get through separation, divorce, moving, etc, and then to taper off slowly using the recommended 5- 10% per month or so method.  But a few months ago, my optometrist found cataracts, and I went to two separate ophthalmologists to confirm.  There is plenty of scientific literature about research that has shown that SSRIs cause cataracts, and incidentally it was listed under the “rare” side effects in some Viibryd studies.

 

So, I need to try to find a way to wean off faster, within a few months if possible.  I need to stop the excess serotonin, which is what is causing the cataracts to grow.  I’m wondering if I should cut the 10’s into halves to create a month or so of 15, then 10, then 5, then 0 (I could try making a second cut to get 2.5, but it might be too uneven or crumbly).  Or if it would be better to taper by smaller increments (necessitating a compounding pharmacy, if it's possible) every couple of weeks instead.  (I would rather avoid the cognitive difficulties of trying to make powder and capsules, liquid solution, or other methods myself.)  I am aware that it is an iterative process and the need for stabilizing, updosing if necessary, etc.  So, I'm thinking I'll ask my psychiatrist to request permission from the insurance company for a couple of 10's per day (current approval is one pill only per day) for the next six months or so.

 

Other relevant info includes that the weaning ONTO Viibryd process was horrible for me (1 month 10 mg, 1 week 15 mg, then 20) with panic, severe anxiety, lightheadedness, and many other difficult symptoms.  Since then, there have been a number of side effects including a period of chronic migraines, and mostly fatigue, cognitive fog, dissociation, sleeping issues, and a long list of other symptoms that I have been documenting.  The anxiety and depression have been slightly better, but still not enough to be really functional, and certainly not enough considering the cataracts.  

 

I haven’t been working the past few years because of these health problems, so I can focus solely on healing during withdrawal and hopefully will be able to be productive after recovery.  Also, I have continued my healthy lifestyle of organic, vegan, gluten-free diet, yoga, exercise, nature, etc. and have implemented natural modalities including acupuncture, massage, therapies, etc.  So what I need help with is just the tapering off of the Viibryd as quickly as possible. 

 

I would appreciate any advice about recommended rates and timing for trying to wean off using a faster method.  Thank you for your time, and I look forward to any suggestions!

 

 

Edited May 29, 2018 by ChessieCat
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[Petunia]

Welcome Floresta Tropical,

I'm sorry your antidepressants are causing problems for your eyes, unfortunately we hear this kind of thing a lot. Often the side effects caused by these drugs are worse than the problem they are being taken for. Evidence is starting to show that long term, they do more harm than good. I'm glad you found us, there is a lot of good information and support here for safely tapering off your medication.

 

We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?  (The general philosophy of gradual tapering) 

 

Of course you may be able to taper faster, and its your decision if you want to try. But if you start experiencing withdrawal symptoms, the only way to stop them is to hold your taper, wait until you stabilize and then resume at a slower rate. You may be able start tapering at a faster rate, but as the dose gets lower, you may find that withdrawal symptom start to arise and you may need to slow down.

 

I can't suggest anything faster than what we recommend here, because of the risks involved, but you are welcome to make your own decisions, and we will support you through any problems, offering suggestions as we are able.

 

I will post some links which may be helpful.

 

Tips for tapering off Viibryd (vilazodone)

 

Preparing to taper

 

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want. Its a good idea to bookmark it or follow it, so its easy to find again. 

 

Please stay in touch and let us know what you decide.

 

Petunia.

 

 

[FlorestaTropical]

Thank you very much for your prompt response.  All of you are so very helpful and caring.  I completely agree with the prudent, risk-averse philosophy of this website.  Maybe what I can do is follow the harm reduction model described by implementing the tapers just slightly more often than once a month if I have few adverse reactions. If I can get the 10 mg pills and make a second cut to make 17.5, that should get me started.  (Unsurprisingly, my psychiatrist said to just take the 20 mg every other day, then every 3 days, and so on, but I insisted on requesting two 10’s).  I’ve talked to insurance and pharmacy about compounding, but still need more info to find out if it’s possible.

 

It’s interesting that it is mentioned that withdrawal symptoms are actually a neurological injury causing brain damage.  I wonder if that also means that I suffered from neurological injuries when tapering on since I had so many adverse symptoms.  It was quite bad for the first two months and especially horrible for a week or so each time I raised the dose.  Not to mention ongoing and current side effects.  I also wonder how this psychiatric pharmaceutical type of damage compares qualitatively and quantitatively to the original brain damage of the trauma itself and all of the symptoms since then.  It seems that neurosciences are making some progress with brain imaging, but not yet to this level of knowledge.

 

I will post updates as I figure out my tapering off plan, and I also hope to help and support others here including by sharing natural health oriented information and resources that I have.  Thanks again for all your work on these forums!

 

Edited June 2, 2018 by ChessieCat
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[Songbird]

On 5/29/2018 at 10:41 PM, Petunia said:

Of course you may be able to taper faster, and its your decision if you want to try. But if you start experiencing withdrawal symptoms, the only way to stop them is to hold your taper, wait until you stabilize and then resume at a slower rate. You may be able start tapering at a faster rate, but as the dose gets lower, you may find that withdrawal symptom start to arise and you may need to slow down.

 

I agree with this advice from Petunia.  If you've been on Viibryd since December last year, it has been no longer than six months, so it's possible you may be lucky.  My experience with SSRIs was that I was able to taper quickly the first two times with few problems after about six months on.  Individual responses vary a lot and are unpredictable, so in general we recommend the slow taper because it's safer and more likely to be successful.  I think the best idea is to listen to your body and adjust your taper according to what it tells you.  I would suggest you hold at each dose for a minimum of three weeks.

 

You'll need to find a way to measure your dose more precisely than just chopping roughly into quarters.  If you don't feel up to making your own liquid, compounding could be a good option.  Some people have tapered using compounded capsules.  Another possibility is to get a liquid made by a compounding company (something I have done in the past).  If you are not able to get the Viibryd compounded, you may be able to cut the pills and weigh the pieces (something I've also done).  You need a digital scale for that method - here is some more information about it:

 

using a digital scale to measure doses

how to calculate dosages and dilutions spreadsheets and calculators

 

If you have any questions about these methods, please ask as we have plenty of experience with them here.

[FlorestaTropical]

Thank you for your prompt response!  I agree that one of my next steps is to figure out a system for preparing the 10% dose reduction amounts.  I confirmed insurance coverage and found a pharmacy that can compound vilazodone, so if I can get my psychiatrist to cooperate, compounding might work out.  I’ve also been reading the other threads here to assess the pros and cons of the cutting and weighing vs the liquid method in case I’m unable to get compounding, or if needed further along in the process.

 

Unless my math is wrong, reducing from 20 mg at a rate of 10% of the previous dose would take 45 reductions to get to 0.17 mg.  At the rate of a 10% reduction per month, it would take around 4 years.  Is this a good plan for me even though I’ve been on it for 7 months?  Although I can make changes later if need be, I need to create an initial prescription plan to ask my psychiatrist to get insurance approval and then submit to the compounding pharmacy, so I’d appreciate any feedback.

 

I’m afraid that I’m going to have a hard time convincing my psychiatrist to request a several year prescription according to the 10% plan.  He said that it should take months, much less than a year, so he doesn’t seem familiar with withdrawal problems.  I can look for a new psychiatrist, but it could take time to find someone willing to prescribe a slow taper.  To start, maybe I’ll give him the first 12 dose amounts as a one year plan and try to find someone more knowledgeable in the meantime.  Thanks again for this extremely helpful website!

[Songbird]

I agree four years seems a very long time when you've only been on seven months and need to get off because of damage from a side effect.  Perhaps don't think about the four years or whatever total time-frame for now, but come up with an initial plan and then see how your body responds and adjust your taper plan accordingly. 

 

The advantage to using a scale or making your own liquid is that you have flexibility over your dose and when to change it.  The advantage of compounded capsules is that someone else does all the work in the lab, and doses are probably more accurate, but you don't have that flexibility to change dose whenever you need, so have to plan more in advance.

[FlorestaTropical]

Yes, I agree, hopefully I can progress a little faster.  That is my understanding too about the pros and cons of compounding vs making it yourself.  For now, if I can indeed get insurance approval, I may as well take advantage of one less stressful thing to do.  The question will be how quickly I can request and receive the next dose down if needed earlier than 30 days — I guess I’ll see.  In the future maybe I’ll need other methods too.  Thanks again!

[Carmie]

Hi FT, 

 

How are you doing?💚