LarryS: tapering off venlafaxine / Effexor 225mg

[LarryS]

Six Week Hold: 10% Drop From 7.5 mg

Dropping to 6.75 mg January 17, 2022.  To do this drop, I am cutting from 20 beads to 18 beads, each bead valued at 0.375 mg.  I have not had any anxiety since December 14, 2021.  I have a clear mind and feel emotionally stable.  I started counseling January 3,2022.  Scores below are averages from the last two weeks of the total six week hold period.

 

Anhedonia         2.00     Feeling good and caring about myself and others.

 

Insomnia            5.78     Slept less than 5 hours with 1 interruption.

 

Fatigue               5.71     Moderate fatigue all day.

 

Head-pressure 1.93     Very light head pressure, almost imperceptible.

 

Back Pain          6.07     Uncomfortable pain

 

Neck Pain         2.64     Low to less than mid-level pain.

 

I consider a score of 7 and above getting into the hard to tolerate range.  I highlight cells with 7 or above, in yellow, on my spreadsheet, which shows patterns of difficult days.  I just thought of this now, but it shows the windows and waves of my existence.  What an interesting thought.  🙂

 

I have dropped my anhedonia score from the previous score of 4.32, to 2.00 primarily because of how I perceive myself.  Scoring anhedonia is the most subjective of the items that I track.  I do have a 10-point scoring system, which I will share hopefully later in my blog.

 

Insomnia has been a bit of a struggle lately.  I get by much better with at least 6 hours of sleep.  I will have to say though that getting out of bed with less than the preferred amount of sleep is a personal decision.  I have been stimulated lately, waking up with a lot of good thoughts running through my brain, and a desire to get going so that I may capture them in writing.

 

My fatigue score has slightly risen, but I consider it to be stable.

 

My head-pressure has decreased from 4.60 to 1.93.  This category relates to any odd physical feeling that I perceive in my head.  This drop in symptoms makes sense because previously I was dealing with anxiety and considerable pain.

 

My back pain decreased slightly from 6.52 to 6.07.  I do not consider back pain to be a symptom of tapering venlafaxine, but it can potentially cloud how I feel otherwise and effect how I score other symptoms.

 

My neck pain decreased from 5.76 to 2.64.  I am very pleased about this.  Again, I do not consider neck pain to be a symptom of tapering venlafaxine, but it can potentially cloud how I feel otherwise and effect how I score other symptoms.

 

I total all my scores together, for each tapper period.  I am showing a decrease in overall symptoms from 31.08 to 24.13.  This is a substantial decrease in overall symptoms.  I have had total scores in the past less than 24.13, but I consider it a relatively good score.

 

I started totaling my symptom scores for each drop period beginning February 24, 2020.  Out of 24 total scores, I only have three drop periods that score less than 24.13.  My lowest total score was 19.49.

 

I record all this data for the record, not specifically for a reader’s enjoyment.  It will help me tell my success story in the future.  And future researchers may love this kind of information.  I’m a geeks geek, with a Bachelor of Science degree in engineering.  Another thing I don’t mind doing is tracking my personal budget in Quicken.  Done it for years.  I find it helpful for making economic decisions.  🤑

 

 

[LarryS]

--------------------------------------Tracking Anhedonia--------------------------------------------------

I came across the word anhedonia for the first time when beginning to explore SurvingAntidepressants.org.  It seemed to describe what I was feeling, so I accepted the word and its definition as describing a part of myself.
After deciding that I wanted to track “Anhedonia” I then realized that I would have to set consistent criteria for doing that.  I wanted to use a ten (10) point scale.  I knew that I would have to write it down so that I could refer back to the criteria and promote consistency in my tracking.
First, I found the definition of anhedonia.
Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure.  While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers to refer to reduced motivation, reduced anticipatory pleasure (wanting), reduced consummatory pleasure (liking), and deficits in reinforcement learning. 
I was unable to find anything on the web to help me set the criteria, so I invented the following criteria scale.  I often wish that it where better defined.  I also believe that of the things I track, anhedonia is the most difficult to assign a number to.  The assignment of a number is very subjective and based upon how I am feeling at the time of assignment of the number.  

----------------------------------------------Tracking Scale-----------------------------------------------
1.    Fell life is great and pleasurable living.
2.    Feeling good and caring about myself and others.
3.    Feel caring about myself and others with some motivation.
4.    Some caring and pleasure about my health, being loving and respectful of others.
5.    Some caring and pleasure.
6.    Less care about myself and pleasing others, less pleasure.
7.    Don’t care much about myself and others, little pleasure.
8.    Care much less about myself and others, no pleasurable feelings.
9.    Don’t care or have pleasure from basic things like eating, love, and respect for others.
10.    Don’t care to even get out of bed, no anticipation of anything pleasurable.

I started my tracking spreadsheet June 5, 2018, the very first day of dropping from 225 mg to 202 mg.  I had been reading quite a lot on S.A. prior to getting started on my taper.  I started tracking three things: Lethargy, Anhedonia and Fatigue.
Petunia, the first moderator to address me on my new introductions page said the following.
“I'm glad you found us, it sounds like you have looked around the site and now have a good understanding of tapering and the possibility of withdrawal.”
I was pleased that I was getting started correctly. ☺️
 

[LarryS]

This taper drop to 6.75 mg venlafaxine has been accompanied by higher symptoms than in the past.  I have had considerable difficulty sleeping without interruption, which has been understandably accompanied by greater fatigue.  My back pain has also ramped up.  I have also noted four days of feeling jittery, or in other words, feeling agitation in my chest area.  I have had to take one to two naps during the day to get through my day.  I’m anticipating that these symptoms should calm down over time.  These ramped up symptoms at the beginning of my taper are new to my experience.

 

I have utilized the drug Valium (Diazepam) twice in the first seven days of my drop.  It did help relieve the agitation in my chest, but I want to be very careful not to over utilize this benzodiazepine type drug.  The Diazepam pill is 2 mg.

 

I want also to note that this two-bead drop is as close to a perfect 10% drop as can be achieved.  Each bead averages 0.375 mg.  0.375 plus 0.375 equals 0.75, exactly 10% of 7.50 mg.

 

I could say that my symptoms have carried over from my previous anxiousness and panic attack.

 

I can say that I have not been feeling anxious.  I have been purposefully working on staying calm.  I am controlling my thoughts that would lead to anxiousness.

 

I will need to allow additional time for healing.

I have had two sessions with a psychologist recently.  I believe these sessions are helpful.

 

I want to continue learning how others have overcome during this part of the taper journey.  I need to be opened to making changes as this journey continues.

 

Edited February 1, 2022 by ChessieCat
added spacing

[LarryS]

LOOKING BACK:  LARRYS HEALTH HISTORY

I will be 74 years old February 2022.  The thought has come to me, that telling a portion of my health history, may provide some insight for myself and others. 

 

SUMMARY

This health record begins in 1996, age 48, with the issue of fatigue.  Fatigue effects mood.  Then two accidents occurred, which added pain to the issues.  Pain zaps energy, causing greater fatigue.  Greater fatigue brings on periods of lower mood.  My health deteriorated slowly over time.  When you tell the doctor you feel fatigued and down, the solution was and is psychotic drugs.  Looking back, I, myself, am surprised at how many psychotic drugs I have been given over the years.  I usually told the doctor I was fatigued, not depressed.  But that made no difference.  I will say that I was depressed two or more times, but these episodes were relatively short in duration.  I can thankfully say that I never felt hooked on any of the drugs that were given to me, other than Venlafaxine.

 

I trusted what the doctors gave me to be safe and took the drugs without reading much about them.  But I always thought the drugs should be temporary, not permanent.  It was not until after the psychiatrist (who I initially trusted) dropped Venlafaxine by 75 mg for weaning off the drug, and my post difficulties with that, that I started to mistrust doctors in general.  The internet made it possible for me to start researching what was happening to me.  This eventually led me to SurvivingAntidepressants.org.

 

Psychotic drugs:  Celexa (Citalopram) 20 mg (SSRI); Zoloft (Sertraline) 50 mg (SSRI); Lexapro (Escitalopram) 10 mg (SSRI); Desyrel (Trazodone) (SARI); Klonopin (Clonazepam) (benzodiazepine); Ativan (Lorazepam) 0.5 mg (benzodiazepine); Risperidone 1 mg (antipsychotic); Effexor (Venlafaxine) 250 mg (SSNRI).

 

Pain drugs:  Celebrex (Celecoxib) 200 mg (NSAID); Vicodin 5/500 mg (acetaminophen/ hydrocodone an opioid pain medication); Ibuprofen 200 mg (NSAID); Tylenol (acetaminophen) 500 mg.

 

HEALTH HISTORY

The following history comes from several sources.  I requested notes from my primary care physician (PCP) and sleep doctor some years ago.  I did my best to interpret their notes into a computerized “WORD” document.  After compiling the doctor notes, I started taking my own notes of doctor visits.  I also worked with a psychologist on and off over the years.  I made notes and tracked progress of various issues.  Part of the reason for working with a psychologist was to try and work toward getting off psychiatric drugs.  As I recall, I was successful weaning off at least one of the psychiatric drugs, but not sure about which one.

 

During November 1996 at age 48 I was experiencing ongoing fatigue.  I had a sleep study done by a doctor who specialized in sleep disorders.  The result was that I started using a CPAP machine at night.  This machine put me under a pressurized flow of air, which decreased sleep apnea events.

 

In May 1999, my primary care physician (PCP) put me on Celexa (Citalopram) 20 mg for mood. 

 

During February 2000 I complained to sleep doctor of shortness of breath during the day.  I occasionally would feel the need to take a deeper breath.  I attributed my daytime shortness of breath to sleeping with the CPAP machine, which was conditioning me at night not to have to breath normally as I would without it.  The sleep doctor did not believe my shortness of breath could be caused by using a CPAP machine.

 

During February 2000 I told primary practice physician (PCP) I had neck pain due to skiing accident.

 

In June 2000 I told PCP about right hip and leg pain.  I had lifted a heavy vehicle wheel and moved a cord of wood.

 

In July 2000 I was referred to specialist doctor for Disc/ displacement bulge.  I had hurt back by picking up vehicle wheel with tire.  Ongoing problems since then.

 

In August 2000 neurologic evaluation, per CT scan has revealed broad based bulge of disc L5-S1 which does come up and meets the S1 root and slightly displaces it posteriorly.

 

In September 2000 PCP describes pain HNP L5-S1, fatigue all the time.  Prescribes Celexa 30 mg.

 

In January 2001 PCP prescribes Celebrex 200 mg.

In February 2001 Slow improvement of herniated disc.  Prescribed Celexa 20 mg and Celebrex 200 mg.

 

In April 2001 PCP, performs complete physical due to increased fatigue.  Lack of sleep.  Back doing well with physical therapy.  Medicine Celexa.

 

In November 2001 physical therapy ended in less than 1 year and I resumed a more normal lifestyle.  I ran out of Celexa October 30th and stopped using it because I did not believe I needed it anymore.  I was experiencing less fatigue.  I had a long discussion on depression and using Celexa with PCP.  Doctor said that I may very well be over my depression and that I could go off the drug.  I continued Celebrex.

 

On December 10, 2001, I discussed medications with PCP.  I resumed taking Celexa 20 mg.  I obviously failed to get off Celexa.

 

On June 7, 2002, PCP discusses changing meds from Celexa to Zoloft.  Can’t get a decent night’s sleep last 6 months, fatigued, neck hurts a lot.  Jogging some, feels like a “wreak.”  Start Zoloft 50 mg.  I was on Celexa for 3 years and 1 month.

 

On June 27, 2002, PCP notes; patient has decided to wean off Zoloft.

 

Since January 2004, I have experimented with decreasing my dosage of Lexapro 10 mg.  My initial reason was because I was feeling dulled by the drug.  This was after discussion with a doctor.  I have been under the impression that at some time in the future I would be able to get off depression medications.  That has not been the case since 1999.  At ½ tab per day, at first, I felt less drugged and more in tune with life.  I got down to ½ tab every other day.  At this point, I was unable to sleep a full night, waking at 2:00 AM, unable to go back to sleep.  A greater amount of fatigue was an issue.  However, I went off the Lexapro over a 3-day weekend.  I felt tiered and “anxious,” not depressed, like I had felt in times past. 

 

So, since April 5, I have now returned to the recommended dose of 10 mg.  This evening, April 12, 2004, I feel good.  I do not feel anxious or depressed.  During the day at work, I became somewhat anxious about solving a budgetary problem that I have been working on for months.  I was tiered at noon, so after a quick 15-minute lunch, I walked for 20 minutes, and rested in my chair, eyes closed for 10 minutes.  This helped.  By 2:30 PM I was fatigued, so I took a 15-minute relaxation break away from my office, by closing my eyes, and breathing deeper than normal.  This helped get me through the rest of the workday.  I read most of the way home on the bus but rested my eyes for about 15 minutes again before getting home.

 

I have been doing some research of articles on the internet.  I have read some remarkably interesting research from the National Institute of Mental Health.  They have discovered that three different gene scenarios are passed on from our parents.  One of the scenarios allows a person to be more susceptible to depression, anxiety, stress, etc., than the other two.  Therefore, my condition may be more hereditary than, past knowledge had surmised.

 

I took a short question/ answer quiz about depression that I found on the internet.  It categorized me at the low end of the moderate spectrum of depressed persons.

 

March 2010 PCP prescribes Trazodone 100 mg to promote sleep.  He states this drug also treats depression. 

 

August 2011 MRI scan shows a bulged disk at lumbar 5, probably related to occurrence 8/2000.  Pain started consistently but not sharp, then built up to sharp pain that radiated around the bottom of my rib cage.  Sometimes if I moved wrong the pain would be sharp enough to take my breath away.  Doctor PCP gave me a shot of cortisone in the general area of the back, but this did nothing.  Referred to spine specialist, who at hospital September 13, 2011, administered a deep shot of cortisone as close to L5 disk as possible.  Felt less pain in one week but pain continued, so took Vicodin to control.  My age is 63.

 

September 2011 Continuing on Trazodone, 100 mg.

 

October 2012 prescribed Vicodin 5/500 mg for pain.

 

June 26, 2014, Emergency Dept. Physician, Reason for visit, Elevated Blood Pressure, Anxiety.

 

July 16, 2014, Hospital Medical Center, Psychiatric, Follow up with your Primary Care Physician in 1 week.

 

July 22, 2014, Hospital Medical Center, signed form “New Patient Information Sheet.”  Admitted to psychiatric ward of hospital.  (I vividly still recall that I became very depressed prior to being admitted to the hospital.  I lost 15 pounds in a matter of days, was in a stupor, hearing voices of accusations of failure, and thinking of suicide.)

 

July 27, 2014, Discharge from Hospital Medical Center psychiatric ward.  Report to Doctor of Psychiatry as outpatient.  Also, diagnosis of High Blood Pressure.

 

August 19, 2014, Doctor of Psychiatry, Eliminate Clonazepam over 3-week period.  Start 150 mg dose Venlafaxine.  Stop taking Risperidone 1 mg tab.

 

September 19, 2014, Doctor of Psychiatry, Dose 225 mg Venlafaxine daily, and Lorazepam 0.5 mg daily.

 

February 3, 2016, Doctor of Psychiatry, changed Venlafaxine dose from 225 mg to 150 mg.  I had requested to taper off the drug. 

 

August 3, 2016, Doctor of Psychiatry, Changed Venlafaxine (Effexor-XR) dose from 150 mg to 225 mg.  At my request, up-dosed because I was not feeling well.  I felt depression.

 

June 2, 2017, Fatigue check – nothing identified.

 

June 4, 2018, PCP: Fatigue, Neurotic Depression- discussed Alcohol Disorder.

 

June 5, 2018, Re-start taper off 225 mg venlafaxine.

 

Found lots of testimony on internet about the long-term effects of using venlafaxine.  Only helps for a short time, then over time people experience being in a brain fog, perhaps from damage to the brain, which is being affected.

 

Edited February 1, 2022 by ChessieCat
added spacing for easier reading

[LarryS]

I have been experiencing high levels of back pain since January 2, 2022, sixteen days.  I had four corticosteroid injections into my S1-L5 low back region as of December 2, 2021.  I knew early on that they were not providing as much relief from pain as previous injections.   The pain level has varied between 6 and 8 with an average of 7.3.  The pain from my low back promoted pain all the way up my spine to my neck, which gave me a headache.  The headache affected my cognitive ability.  I have also occasionally been experiencing some agitation in my chest.  

I went into Urgent Care Doctor Office (Not Emergency) February 2 and received a throughout review.  I was given an ECG due to agitation and it came back normal.  I received prescription for Lidocaine Patches for pain and Cyclobenzaprine 5 mg as muscle relaxant.

I picked up both prescriptions the next day and started them at noon.  I became fatigued and took a very nice 2.3-hour nap.  I applied both before bedtime and slept better that night.

I skipped the treatment this morning and felt somewhat better in the am.  I took both treatments at 1 pm, and I will take both treatments before bedtime today.

I made an appointment with my GP doctor, but it is out two weeks.  I also sent a note to the doctor who is taking care of my pain management.  

I can't think of any particular reason why the pain has ramped up as high as it has.  Time to practice self-care and patience.

[LarryS]

Five Week Hold: 11% Drop From 6.75 mg
Dropping to 6.00 mg February 21, 2022.  To do this drop, I am cutting from 18 beads to 16 beads, each bead valued at 0.375 mg.  I have not had any anxiety since December 14, 2021.  I have a clear mind and feel emotionally stable.  Scores below are the average over the five-week period.
Anhedonia           3.34    Feel caring about myself and others with some motivation.

Insomnia              4.20    Slept minimum of 6 hours with 2 interruptions during the night.

Fatigue                 6.08    Moderate fatigue all day.

Head-pressure    4.26    Light head pressure.

Back Pain             6.88    Uncomfortable pain

Neck Pain             5.80    Uncomfortable pain.

I consider a score of 7 and above getting into the hard to tolerate range.
Insomnia has been more prevalent over this period.
Fatigue has been difficult and ongoing during this period.
I have suffered a lot with high levels of back pain, neck pain, and left hip pain.  I went to urgent care doctor February 2, 2022, and was given cyclobenzaprine 5 mg to relax muscles.  I was also prescribed 4% Lidocaine pain patch which I have been using daily on my low back.  Both prescriptions have helped me feel less pain and therefor better.
I have also seen my spine care specialist who has referred me to an associate who will perform “Diagnostic Test Block” of nerves in hip February 24.  The proposal is to later more permanently deaden the nerves in my hip which are causing me to feel the pain.  I have more questions to ask before I get the final treatment.
In conclusion, it has been a difficult period, but I feel that I will be fine to proceed with my taper of Venlafaxine.
 

[LarryS]

Four Week Hold: 6% Drop From 6.00 mg
Dropping to 5.62 mg March 21, 2022.  To do this drop, I am cutting from 16 beads to 15 beads, each bead valued at 0.375 mg.  I am dropping only one bead this period because it keeps me closest in value to the calculated and recommended 10% drop.  I have a clear mind and feel emotionally stable.  Scores below are the average over the four-week period.
Anhedonia            2.96    Feel caring about me and others with some motivation.

Insomnia               3.32    Slept minimum of 6 hours with 1 interruption during the night.

Fatigue                 4.78    Mild to Moderate fatigue all day.

Head-pressure     1.67    Very light head pressure.

Back Pain             5.96    Uncomfortable pain.

Neck Pain             5.78    Uncomfortable pain.

I consider a score of 7 and above getting into the hard to tolerate range.
Insomnia score improved from previous period.
Fatigue improved significantly.  Fatigue had 7 days of severity 7 or greater.  
Back pain has subsided to more livable levels than the previous period, thankfully.  I have no explanation for why it has subsided.  There were only 9 days when it was 7 or higher.
I have seen my spine care specialist who has referred me to an associate who will perform “Diagnostic Test Block” of nerves that may be causing hip pain.  This test has been delayed but will happen later.
In conclusion, I have felt much better this period.  I will be fine to proceed with my taper of Venlafaxine.
 

[LarryS]

                                             TRACKING SYMPTOMS
It is recommended, on this web site, that we are to track our symptoms, so we have a better understanding of how we are progressing in our taper from an antidepressant.  We are to keep a daily logbook of our journey.  And we are to rate our symptoms.  But there was not a lot of information on how to rate symptoms.
I had learned as an engineer, that goals, progress, and schedules needed to be tracked to keep the big picture in view.  I also knew that it was best to define each goal.  It was preferable that each goal be defined in such a way that it was “measurable”.  It is also desirable to have a written plan to follow for consistency of tracking.
I first had to define each symptom.  Then I had to devise a scale in the continuum from best outcome to worst outcome.  I knew this process would provide consistency in scoring progress.  Consistency of scoring would provide the most accurate picture possible of each symptom I chose to track.
I have previously shared my tracking scale for “Anhedonia”, the loosest and most difficult to define.  I will now share my scoring system for insomnia, fatigue, head pressure/ headache, back pain, and neck pain.
I am proficient in using Microsoft Excel, so I decided to go the extra step and input my daily tracking scores into Excel by the end of each drug level drop.  This has allowed me to get a very quick average score for any time period.  I am also able to highlight scores of 7 and above, which makes it easier to see when I am going through a more difficult period of time.
A 0-1 indicates the least amount of symptom imaginable.  A 10 indicates the greatest amount of symptom imaginable.
INSOMNIA
0    Slept minimum 8+ hours without interruption
1    Slept minimum 7 hours with 1 interruption
2    Slept minimum 7 hours with 2+ interruptions
3    Slept minimum 6 hours with 1 interruption
4    Slept minimum 6 hours with 2+ interruptions
5    Slept 5 to 6 hours with 1+ interruptions
6    Slept less than 5 hours with 1+ interruptions
7    Slept less than 4 hours
8    Lay awake ¼ to 1 hour prior or after sleeping less than 4 hours
9    Lay awake majority of night
10    Could not sleep at all
ADD 1 point for every awakening (interruption) beyond 1+ or 2+
Example:  Slept 6 hours with 3 interruptions.  This would be a score of 4 plus 1 additional interruption beyond 2 interruptions, for a score total of 5.
FATIGUE
0-1    None to slight
2-3    Minor fatigue after noon
4-6    Mild to moderate fatigue all day
7-8    Affects ability to think/ concentrate
9    Naps on and off all day
10    Bed ridden fatigue
HEAD PRESSURE/ HEADACHE
1    No headache or odd feelings in my head.  Clear head.
2-4    Very light head pressure
5    Moderate head pressure
6-7     More than moderate head pressure or odd feelings in my head
8-9    Head hurts, throbbing pressure, some prickly pain
10    Head hurts a lot, sharp stabbing, or throbbing pain
BACK PAIN OR NECK PAIN
0-1    No pain
2-4    Low to less than mid-level pain
5    Mid-level pain
6-7    Uncomfortable pain
8-9    Bad pain, controlling movement
10    Severe, excruciating, wreathing pain

[JessB]

On 3/24/2022 at 11:54 AM, LarryS said:

                                             TRACKING SYMPTOMS
It is recommended, on this web site, that we are to track our symptoms, so we have a better understanding of how we are progressing in our taper from an antidepressant.  We are to keep a daily logbook of our journey.  And we are to rate our symptoms.  But there was not a lot of information on how to rate symptoms.
I had learned as an engineer, that goals, progress, and schedules needed to be tracked to keep the big picture in view.  I also knew that it was best to define each goal.  It was preferable that each goal be defined in such a way that it was “measurable”.  It is also desirable to have a written plan to follow for consistency of tracking.
I first had to define each symptom.  Then I had to devise a scale in the continuum from best outcome to worst outcome.  I knew this process would provide consistency in scoring progress.  Consistency of scoring would provide the most accurate picture possible of each symptom I chose to track.
I have previously shared my tracking scale for “Anhedonia”, the loosest and most difficult to define.  I will now share my scoring system for insomnia, fatigue, head pressure/ headache, back pain, and neck pain.
I am proficient in using Microsoft Excel, so I decided to go the extra step and input my daily tracking scores into Excel by the end of each drug level drop.  This has allowed me to get a very quick average score for any time period.  I am also able to highlight scores of 7 and above, which makes it easier to see when I am going through a more difficult period of time.
A 0-1 indicates the least amount of symptom imaginable.  A 10 indicates the greatest amount of symptom imaginable.
INSOMNIA
0    Slept minimum 8+ hours without interruption
1    Slept minimum 7 hours with 1 interruption
2    Slept minimum 7 hours with 2+ interruptions
3    Slept minimum 6 hours with 1 interruption
4    Slept minimum 6 hours with 2+ interruptions
5    Slept 5 to 6 hours with 1+ interruptions
6    Slept less than 5 hours with 1+ interruptions
7    Slept less than 4 hours
8    Lay awake ¼ to 1 hour prior or after sleeping less than 4 hours
9    Lay awake majority of night
10    Could not sleep at all
ADD 1 point for every awakening (interruption) beyond 1+ or 2+
Example:  Slept 6 hours with 3 interruptions.  This would be a score of 4 plus 1 additional interruption beyond 2 interruptions, for a score total of 5.
FATIGUE
0-1    None to slight
2-3    Minor fatigue after noon
4-6    Mild to moderate fatigue all day
7-8    Affects ability to think/ concentrate
9    Naps on and off all day
10    Bed ridden fatigue
HEAD PRESSURE/ HEADACHE
1    No headache or odd feelings in my head.  Clear head.
2-4    Very light head pressure
5    Moderate head pressure
6-7     More than moderate head pressure or odd feelings in my head
8-9    Head hurts, throbbing pressure, some prickly pain
10    Head hurts a lot, sharp stabbing, or throbbing pain
BACK PAIN OR NECK PAIN
0-1    No pain
2-4    Low to less than mid-level pain
5    Mid-level pain
6-7    Uncomfortable pain
8-9    Bad pain, controlling movement
10    Severe, excruciating, wreathing pain

I really like how you have scored all of this. Great job

[LarryS]

@JessB  Thank you for dropping by and for the compliment.

[LarryS]

Five Week Hold: 13% Drop From 5.62 mg
Dropping to 4.87 mg April 25, 2022.  To do this drop, I am cutting from 15 beads to 13 beads, each bead valued at 0.375 mg.  I am dropping two beads this period because it keeps me closest in value to the calculated and recommended 10% drop.  I have a clear mind, but fatigue and pain has been an ongoing issue as usual.  Scores below are the average over the five-week period.
Anhedonia      3.06    Feel caring about me and others with some motivation.

Insomnia         3.46    Slept minimum of 6 hours with 1 interruption during the night.

Fatigue            5.14    Mild to Moderate fatigue all day.

Head-pressure 1.94    Very light head pressure.

Back Pain        6.17    Uncomfortable pain.

Neck Pain        6.14    Uncomfortable pain.

I consider a score of 7 and above getting into the hard to tolerate range.  There are 35 days in this period.
Insomnia increased slightly from previous period.
Fatigue increased over previous period.  Fatigue had 17 days of severity 7 or greater.  
Back pain has increased over this past period.  Back Pain had 13 days of severity 7 or higher.
Neck pain has increased over this past period.  Neck Pain had 11 days of severity 7 or higher.
The reason fatigue can have an overall lower score than Back Pain and Neck Pain, even with more days above severity 7 is because it has greater variability than pain.
In conclusion, even though the severity of my scores have slightly increased, I am making the choice to move forward.  I did a significant up-dose in December 2021 which has basically added nine months to my overall taper duration.  This dose level of 4.87 mg is about the same level I was at in August 2021.  I have given myself an additional nine (9) month at a very low dose for my body to adjust and heal from venlafaxine.  I will continue the slow process and progress.

[arbor]

Thank you for the update @LarryS

Sending you best wishes,

Arbor

[LarryS]

Five Week Hold: 8% Drop From 4.87 mg
Dropping to 4.50 mg May 30, 2022.  To do this drop, I am cutting from 13 beads to 12 beads, each bead valued at 0.375 mg.  I am dropping one bead this period because it keeps me closest in value to the calculated and recommended 10% drop.  I have a clear mind, but fatigue and pain has been an ongoing issue as usual.  Scores below are the average over the first 23 days of the period.  I took a nine-day trip and decided not to track progress during the trip.
Anhedonia      3.17    Feel caring about me and others with some motivation.

Insomnia         3.17    Slept minimum of 6 hours with 1 interruption during the night.

Fatigue            5.91    Mild to Moderate fatigue all day.

Head-pressure    2.56    Very light head pressure.

Back Pain        6.95    Uncomfortable pain.

Neck Pain        6.43    Uncomfortable pain.

I consider a score of 7 and above getting into the hard to tolerate range.  There are 35 days in this period.

[LarryS]

Review of People Who tapered to ZERO Using Bead Counting Method

Since I have very small beads that contain 0.375 mg active ingredient each of venlafaxine, I have become interested in utilizing bead counting all the way to zero.  There are two basic factors in tapering; amount of drop and time held at that drop amount.  My theory is that as the percentage of drop increases due to the fixed size of the bead, the time held should be extended.

 

I decided to research this site to find out about the experience of those who utilized bead counting down to zero.  It was not easy to find other people who wrote about their experience of utilizing beads down to zero.  But I found a few.  I will summarize what I found.

 

MammaP utilized multiple sized Effexor (Venlafaxine) beads from a capsule.  She tried utilizing liquid but had a reaction to it and went back to beads.  She stabilized on 4 large beads.  She would progressively utilize smaller beads to make up the 4 beads, then drop to 3 large beads.  Then she would progressively utilize smaller beads to make up the 3 beads, then drop to 2 large beads and so on.  

 

MammaP described her process in topic 1461 “Conting Beads in a Capsule versus Weighing”.

“I have finished my Effexor taper and want to share my method for tapering the last few beads. When I was at 4 beads I couldn't get down to 3 without withdrawal, tried alternating 3 one day 4 the next but still had withdrawal. I cut to 3 and had to up-dose again, and thought I would never get off those 4 beads.
 
 Then started this......I took the LARGEST 4 beads from the capsule each day. I tipped the beads out into a little box so I could find the biggest ones with a magnifying glass and pair of tweezers.  When I got to 4 of the smallest ones I went to 3.  Did the same again taking 3 of the largest beads. It is still tapering as the dose is getting smaller as the beads get smaller. At 2 beads I took 2 big ones until down to the small ones, then dropped to 1 bead. Stayed at 1 bead for a few months then quit.  All together it took 2 years to go from 4 beads to zero, the last year was as described. It is 4 months since stopping and no Effexor withdrawal to speak of, a little tingling and numbness, and insomnia which is a problem for me anyway so not blaming Effexor withdrawal. 
 
I feel like my brain is even clearer and it is amazing how many side effects just one bead can cause! I didn't rush the last leg because it is the hardest, rush and end up up-dosing again. It just isn't worth it!”

 

MammaP did experience significant but manageable waves which included brain ****, insomnia and dizziness.  It wasn’t easy but she did it.

 

SquirrellyGirl utilized Effexor (Venlafaxine) bead counting all the way to zero.  She did try utilizing immediate release liquid form of Effexor but it did not go well so she switched back to beads.  She had multiple sized beads to deal with and tried weighing beads to get to the milligrams she wanted, however the scale was all over the place at low doses.  She describes utilizing the smallest beads at the end which where a third of the size of the largest beads.  She estimated that she quit Effexor at 0.3 mg.  She made the following remarkable statement: “I can say that I have not had any major waves during and after the very slow taper.”

 

Primekittycat tried going from Effexor Extended Release beads to compounded Effexor Immediate Release capsules at dose below 37.5 mg without success.  Went back to using bead counting and weighing method all the way to one small bead, perhaps about 0.3 mg.

 

Hudgens started at 75 mg Effexor and used pill crushing, weighing, and eyeballing to make his lowest doses.  Hudgens spent 3 years, 11 months tapering.  Hudgens was approximately 58 years old when he finished his Effexor taper to zero.  Took his last dose October 31, 2014.  MammaP followed Hudgens on his introduction’s topic closely.

 

Giullietta used 0.2 mg beads to taper Cymbalta (duloxetine) to zero.  Switch from liquid form to beads at end of Cymbalta taper even though hands shaky which made counting difficult.  Held at 2 beads for 9 to 10 weeks. Waited 9 weeks on 1 bead, then attempted drop to zero.  Considerable symptoms upon changes.  Failed to drop from 1 bead to 0 the first time, and up dosed to 1 bead again.  At end when on 1 bead, utilized a process similar to MammaP, utilizing progressively smaller beads.  The final bead took about 13 weeks to get off of it.  Giullietta was on clonazepam a benzodiazepine drug while tapering Cymbalta (duloxetine).  

 

Scallywag used 0.1 mg Cymbalta bead counting to zero.  She is the rare example of someone on this site who had very minor symptoms of eye twitching while going off Cymbalta.   Below 5 mg she held each drop less than four (4) weeks, except the last dose before zero was held for almost six (6) weeks.

 

CONCLUSIONS:

All did a reasonably slow taper.  Some had symptoms and some almost no symptoms at the lowest doses.  All symptoms were manageable.  It helped to extend the hold time at the lowest doses.
 

[LarryS]

I want to share my method for counting beads.  To find out how many beads I had in one 75 mg capsule I used 7-inch diameter Pyrex bowls.  I would take about one quarter of the 200 beads and spread them out along the inside perimeter of the Pyrex bowls for counting.  I would count several times in order to insure an accurate count.  I would then add up all the beads counted out of the capsule.  I counted about 10 capsules to arrive at the average of 200 beads per 75 mg capsule.  I calculated the milligrams per bead at 0.375 mg/ bead.

 

I have been using Pyrex bowls to count out the beads that I need for daily use also.  I use a four and one-half inch and three and one-half inch Pyrex bowl.  I open the capsule over the four and one-half inch Pyrex bowl.  The vertical sides of the bowl do a great job of keeping all the beads in the bowl.  Then I pour all the beads into the smaller bowl for safe keeping with a lid on top.  Each day I take the number of beads that I need from the smaller bowl to the larger bowl.  I simply use my clean fingers to pull the beads I need from one bowl to the other.  Static cling does not seem to be an issue.  Once I have the correct amount of beads in the larger bowl, I tilt the bowl slightly, tap it to gather the beads to one spot in the bowl, then pour the beads from the bowl into my mouth while continuing to tap the bowl.  This generally works well.

 

The smaller bowl fits inside the larger bowl and is easily stored for the next day.  See pictures of the bowls below.

 

[LarryS]

Five Week Hold: 8% Drop From 4.50 mg
Dropping to 4.13 mg July 5, 2022.  To do this drop, I am cutting from 12 beads to 11 beads, each bead valued at 0.375 mg.  I am dropping one bead this period because it keeps me closest in value to the calculated and recommended 10% drop.  I have a clear mind, but fatigue and pain has been an ongoing issue as usual.  Scores below are the average over 35 days of the period.
Anhedonia      3.40    Feel caring about me and others with some motivation.

Insomnia         3.51    Slept minimum of 6 hours with 2 interruptions during the night.

Fatigue            2.88    Minor fatigue in afternoon.

Head-pressure    1.00    Very light head pressure.

Back Pain        6.88    Uncomfortable pain.

Neck Pain        6.17    Uncomfortable pain.

I consider a score of 7 and above getting into the hard to tolerate range.
 

[92sharks]

Hi @LarryS. I came to your page after posting on mine to see how you are doing. I see you're dropping tomorrow. Good luck. I also noticed your trouble sleeping. For about a year I've had troubling insomnia. Ever since forgetting a 11 bead dose one day, then dropping to 10 beads the next day (Aug.2021). That was when I experienced vertigo for 8 days, then a lot of trouble with WD symptoms. I never feel rested upon awakening and feel like I sleep so lightly much of the night with frequent awakenings coupled with laying there with my mind going over the most ridiculous things. I usually have to resort to a podcast or tv to distract myself enough to be able to fall asleep again. I finally decided to try melatonin. I have only used it the past two nights, but I have gotten some improved sleep which has floored me. I did not think it would work for some reason. What I have noticed with the very limited experience is that my mind seems more settled. I don't feel the "need" to think about a whole bunch of stuff. My mind just won't engage with those thoughts. Both nights I turned everything off so that I could fall asleep. I haven't done that for ages because I fear the quiet will just cause my mind to take off. But that hasn't happened. And when I get up to go to the bathroom in the night I go right back to sleep. Completely unheard of for months. And I haven't had the feeling that I'm waking up every few minutes. And yesterday when I woke up, I did feel rested. Again, unheard of. I just thought I would offer my experience, wondering if you have ever tried melatonin. 

 

I don't want to scare you about your next drop since it was when I had so much trouble at the same point; dropping from 11 to 10 beads. I think my problem was that I had been moving too quickly dropping anyway. I had gone from 60 beads in Aug.2020 to 10 beads in Aug.2021. In addition to that I had forgotten a dose so I really took a hit over a couple of days. I think I had some warning symptoms that I ignored during the months prior to dropping to 10 beads. Live and learn. I'm tickled where I am now at 7 beads. I feel certain your drop will go well. ❤️

[LarryS]

Hi @92sharks  Good to hear you are having better sleep with melatonin.  I have used melatonin occasionally in the past, but not since April 2022.  It can be helpful in resetting a sleep pattern.  I like dark and quiet when I go to bed.  I do quite well with 6 hours of sleep.  If I am tired, I can take a short nap.

 

I am 5 days into my recent venlafaxine drop and doing fine.

 

I continue to take care of my wife at home who has issues with her poor memory.  Her health has been stable.  I find that keeping our routine simplified works best.  Our routine repeats from week to week.  I attend two different care giver support groups which help me learn what works and what doesn't.  Attending a group helps me know I am not alone in care giving for another person.  Being a care giver can be physically and emotionally draining.  Having a right attitude toward the situation is important.

[LarryS]

Had TURP type prostate surgery July 14 in the AM.  Surgeon told me it would be a hard recovery lasting four to six weeks.  So far it has been a very painful recovery.  I have been able to walk around the house.  Just resting a lot and running to the restroom often.

I have continued taking venlafaxine and tracking it.

I am approximately halfway through taking the 4.13 mg dose.  

We have had nice warm sunny days in Washington state.  Nice to be able to go outside and enjoy the weather while recovering.

[rmce72a]

Hello Larry. I found your posts and history while looking for others who, like me, are trying to withdraw from Effexor. I am 75 and have taken Effexor XR 75 mg for more than 20 years for fibromyalgia (which resolved several years ago.) Doc has continued prescribing the drug and I (stupidly) have continued to take it. Why, I am not sure, just out of habit, I guess. I had no idea what I was getting myself into.

 

Two or 3 years ago I began having panic attacks, depression, and anxiety which I have never had in my life, and I have lived through and coped some trauma but always was able to handle whatever life threw at me. I think, as this is just my theory, that Effexor has altered my brain and CNS to the extent that it no longer functions properly and when it stopped working, all the symptoms of withdrawal hit me.

 

My taper is not going well. I started 9 weeks ago and am only down to 73 from 75mg and having some nasty withdrawal. I am counting beads. Did you do that?

 

My best wishes in your withdrawal and in recovering from your recent surgery. (ouch) Do take care and please message me any time. This site has become my lifeline.

[Ranger]

Hi LarryS

 

I have read your posts with great interests.  I am at 75 mg of Effexor now.  I’ve tried to go off this drug three times with no good results.  I tried to get medical assistance too but they didn’t know anything.  This site and your long but successful journey is very detailed and helpful.  Thank you for the gift of your road map and thanks to the creator and mods of this site.  I’m getting ready to try again

[LarryS]

Four Week Hold: 9% Drop From 4.13 mg
Dropping to 3.75 mg August 1, 2022.  To do this drop, I am cutting from 11 beads to 10 beads, each bead valued at 0.375 mg.  I am dropping one bead this period because it keeps me closest in value to the calculated and recommended 10% drop.  I have a clear mind, but fatigue and pain has been an ongoing issue as usual.  Both fatigue and pain has increased because I am recovering from surgery.  Scores below are the average over 28 days of the period.
Anhedonia      3.00    Feel caring about myself and others with some motivation.

Insomnia         5.18    Slept 5 to 6 hours with 1 interruption during the night.

Fatigue           4.03    Mild to moderate fatigue all day.

Head-pressure    1.17    No headache or odd feelings in my head.  Clear head.

Back Pain       7.00    Uncomfortable pain.

Neck Pain      6.46    Uncomfortable pain.

I consider a score of 7 and above getting into the hard to tolerate range.
 

[LarryS]

Thanks for dropping by @Ranger and the kind words.  I'm happy to know you are getting some useful information from my posts.  You can do this if you are willing to take it slow, thoughtfully and patiently.  Best wishes upon your journey.

Larry

[rmce72a]

Hi Larry. It's Rebecca checking in to see how your recovery from surgery is going. I am still holding at 73mg for the 7th week. Can't seem to stabilize. Ugh. Alto doesn't think I am ready to resume taper even though I am tapering from poop out. Guess I'll just hold here. I go from an ok day to an unpleasant day to a miserable day despite not changing anything. 

 

I see that the northwest US has been having some unusual heat these days. Hope Washington has been comfortable enough for you to get outside some. Take care.  Rebecca

[LarryS]

Saw my urologist last Tuesday and he believes I am doing well in recovery.  He said I can resume driving and going to the gym, as long as I do not try to lift heavy weights at the gym.  I do feel better than three weeks ago.  I plan on starting up my swimming first and then progress slowly back to my former routines.

Planning on taking a drive today with my wife and enjoying a beautiful sunny day in the northwest.  Plan to have lunch out also.  Things are going quite well at this time.

[rmce72a]

So glad to hear this.

 

[Ariel]

Hello @LarryS

Stopping by to introduce myself. 

Glad to be on SA together with you. 

Wishing you well,

A.

[LarryS]

@Ariel  Thanks for stopping by.  I think you are headed toward becoming a moderator someday.  You provide insightful input to others.

A pleasure to say hi in return.

My best wishes to You.

[LarryS]

Since my TURP surgery on July 14, I have had a setback.   When I saw the Urologist August 2, they took a urine sample for test.  Later they informed me that I had an after-surgery infection.  They started me on an antibiotic August 9.  Started feeling a different pain than previously August 15.  Reported pain to doctor next day and he is sending me to infectious disease specialist.  Made an appointment for Wednesday August 24.  On August 19 called to see if I could get an earlier appointment with "infectious disease specialist", but no earlier openings.  So, I will wait in pain and fatigue.  It is now Saturday and I'm not going to the overcrowded emergency department If I can help it.  Continuing current antibiotic till I see them.  I have started icing today.  I am also ramping up my vitamin C intake today.

 

I have read online at the Cleavland Clinic that there is still hope for a full recovery.  I have hope at least.

 

I am just staying around home at this point.

 

In the meantime, I still plan on dropping venlafaxine down at end of four week hold.  I have no significant side effects from Venlafaxine that I am aware of.

[Ariel]

Sorry to hear of your setback @LarryS

You seem to be taking it in stride. 

 

Have you considered maybe doing a longer hold?

In a little over a month your body has experienced the following significant events:

- surgery

- drug dosage change (drop)

- post-surgical infection

- antibiotics

- new pain

- increase in Vitamin C

 

For a body that is going through psych drug tapering/WD, each of the above could be experienced as a stressor. 

The effect of stress is cumulative. 

A lot has happened in a relatively short period of time.

It seems to me it might be prudent to wait a while before the next cut.

I have often seen mods advise a minimum three-month hold after illness (e.g. post-surgery; post-antibiotic treatment; post-covid; etc.) to give the body ample time to rest, recover, and stabilize prior to resuming a taper. 

 

Are you familiar with 3KIS? 

The wording in Post #1 centers on dose/drug change events, but really the principle of 3KIS applies to all external stressors that the body may go through at any given time. 

 

Just a thought. 

I trust you know yourself best and are listening to your body. 

 

Wishing you well on your continuous healing journey,

A.

 

[LarryS]

You @Ariel have pointed out some stressors going on in my life.  I don't deny that there are stressors going on.  I will take these stressors into consideration.  Seems like there are always some sort of stressors going on, the key is, how well does one handle stressors.

I have been aware of 3KIS and did re-read it.

Thanks for your observations, which have promoted thought and assessment.  😎 🧐

[RachelSusan]

@LarryS Hi Larry, I can't recall if I ever introduced myself to you officially. If I haven't, I apologize. I have been following your posts so I feel like I already know you. Just checking in to see if you got to see the infectious disease specialist yesterday and how you are doing. 

Warm wishes.

[LarryS]

@RachelSusan @Ariel Thanks for dropping by.  In my previous post on Saturday, I said I was not going to the emergency department if I could help it.  But around noon I was hurting a lot.  The only pain medicine I was using was Ibuprofen which was doing nothing for my pain. I called the hospital nurse help line to discuss my issues.  The nurse said I should go on into emergency, so I did.  The wait to get into a room was not as long as previous waits, less than an hour.  The first thing they did for me was give me some pain medicine intravenously because I was spiking into 9 out of 10 pains.  It was really good stuff because the pain came down to zero in a matter of minutes.

They took urine sample and blood samples.  They started an infusion of antibiotic, which they later decided to stop.  They switched me to a different antibiotic infusion.  They did an ultrasound on my scrotum where the pain was being generated from.  Infection had cause swelling and resulting pain.  They sent me home at 7:00 pm with a prescription for 10 pills of Hydrocodone Acetaminophen 5-325 mg which they said should get me through three days.  I took one pill prior to going to bed Saturday because the pain medication given at emergency was wearing off.  I took only 3 pills per day, instead of directed 4 pills per day in order to stretch them as far as possible.  The medication took the edge off the pain but was not able to bring it down to zero.

Saw the "Infectious Disease" Doctor Wednesday August 24th at 9:00 am.  I was out of Hydrocodone, so one of the first things I asked for was a prescription for more pain medication.  He informed me that their group did not prescribe pain medication.  I would have to get that from my Urology surgeon or primary care doctor.

After asking me a lot of questions about my case he said that he thought I was on the right antibiotic for now, Amoxicillin 500 mg, 3 times per day.  He extended the treatment from 10 days to 15 days.  Then he explained that he was not certain about what bug was causing the infection.  He said the first urine sample had shown the presence of a bug, but the second urine analysis did not show any bug.  The second urine sample did reveal other abnormalities.  I got a prescription for the treatment extension and was sent home with the instruction that if things got worse to let them know.

When I got home, I sent a very direct in tone email to my urologist telling them I needed 12 more Hydrocodone Acetaminophen 5-325 mg.  They had previously denied me a request for pain medication.  I got a call from the nurse, who asked me, are you in pain?  I was not in a mood to play games with them.  Due to the recent Opioid crisis all over the news in this country, the doctors are very cautious about giving out decent pain medication and very stingy with it.  But the doctor did relent and gave me my request.  So, I will be stretching out the medication to last me 4 days, which will end Sunday evening.  This will again take the edge off of the pain for a little while.  I'm hoping and praying this antibiotic works and that my swelling and pain dissipate.

[RachelSusan]

@LarryS Wow, what a harrowing ordeal. You clearly were in acute pain and to have to go through so many steps to get any sort of relief must have been difficult for you.  I have my fingers crossed that the Amoxicillin does the trick for you.  

 

I applaud you for managing as well as you do. You clearly have a lot going on in your life yet you seem to do everything in a logical and well thought out manner. Impressive.

 

I hope you your pain levels drop drastically over the next few days.

Warm wishes.

[rmce72a]

Oh, Larry. I am so sad to read of your ordeal. Sending love and healing vibes your way. Hope and pray the next few days bring you relief. Take care and keep us updated. Rebecca

[LarryS]

Since I am going through considerable pain and fatigue due to infection, I have decided to not drop one bead of venlafaxine at this time.  I have been holding at 3.75 mg (10 beads) for four weeks now.  My current antibiotic treatment with Amoxicillin will end September 4.  I see Infectious disease doctor September 6.  I will know more at that time about how my body is responding to treatment.

The doctor did state that the elderly do respond slower than the younger to the prescribed treatment.  I have to admit that at age 74, I am feeling elderly.  🤒

Slow and patient can pay dividends in this weaning antidepressant journey.