LarryS: tapering off venlafaxine / Effexor 225mg

[arbor]

I appreciate your sharing with us @LarryS.  I'm thinking of you and hoping you find some relief soon.

Arbor 💜

[RachelSusan]

@LarryS

I think your decision not to taper right now is a wise one. Yes, as I add on the years I have discovered as well that I too don't respond as quickly to any prescribed treatment. By the way, I have been doing a mild to moderate workout for almost a year now, five days a week, and what in my younger days would have resulted in an improved appearance with better endurance is not happening.  I guess I will follow your lead, slow and easy.

[Doctorsrcrap]

Hiya. Was reading through your topic .

Great job on how thorough you are being. Wish I had managed to do that.

I have a question. How did you manage to use diazipam during yout taper without making it worse? 

[LarryS]

@Doctorsrcrap My primary care physician gave me 10 pills of Diazepam 2 mg tablets. I still have the prescription bottle.  Looking inside, looks like I took only 3 1/2 tabs worth after my one and only short panic attack. All I really know is that I have not had a second panic attack.

I researched the drug before taking it and learned that it had additive qualities.  I was cautious not to take more than I felt I needed.

[LarryS]

@RachelSusan I would not give up on working out.  It is still good for us.  I am simply patiently waiting for my painful condition due to after surgery infection to dissipate.  I intend to get back to the gym as soon as I feel I have the energy.

So, I am asking you to not follow my lead, and enjoy a suitable work out if you are able. 😎

[RachelSusan]

@LarryS Larry, I will not give up.  If I stop moving I get too creaky. 😀 

[LarryS]

Saw Infectious Disease Care doctor yesterday.  He looked in my painful left ear and found so much wax he could not give me a diagnosis.  Sent me to urgent care to get my ear cleaned out.  Urgent care cleaned out ear and upon inspection declared that indeed my ear canal was swollen and infected.  Gave me antibiotic ear drops to take 4 times per day for 10 days.  This infection is separate from my other infection which I am continuing to treat with an antibiotic.  I am glad that I finally am starting to treat the very painful ear.

On a positive note, the pain from my other infection has subsided significantly, but I will still have to be very careful in how I sit, stand and walk for a while longer.

I am continuing to hold venlafaxine at 3.75 mg.

[RachelSusan]

@LarrySI am so glad to hear that your issues are being addressed by the medical community. It sounds like you are on the road to recovery. Good for you.

 

As for holding your venlafaxine, it is a wise move. When you are recovered from the infections you can start your taper again.

 

[LarryS]

I think, I have turned the corner and am heading more strongly back to health.  My most recent sharp pains have dissipated greatly.  I still have the opioid medication, Hydrocodone-Acetaminophen, but I have gone back to using Ibuprofen to determine if it is adequate to help with the more minor pains.  Last time I took the Hydro-Acet. was yesterday evening at 9:00 pm.  So far, Ibuprofen has been adequate.

I am sticking close to home this Labor-Day weekend.  I'm taking short walks in fresh air and sun 🌞 which I do not think I get enough of here in Washington, west side.  I am napping morning and afternoon, avoiding wearing myself out.  I do have basic responsibilities to maintain.  I sit in my outdoor lounge chair soaking up a few rays from the sun, but careful to not over do this.  Also enjoy the beauty of my back yard.  It is gorgeous here.  It will only get to 79 degrees today, perfect weather.  I'm grateful to enjoy these simple fine experiences.

I'm getting hungry for lunch.  Totta Loo

[arbor]

This is really good news @LarryS and, seems to me, pretty quick, considering you're dealing with tapering and w/d!  I imagine the beautiful days are helping.  That, and your ability to appreciate them.  Thanks for the update.

Sending you well wishes,

Arbor 💜

 

[LarryS]

I was doing well enough on Sunday September 4th that I decided to drop all Ibuprofen on Monday.  I was fine with no noticeable pain on Monday, but by Tuesday morning some pain was back related to infection.  I saw the infectious disease doctor that day at 1:00 pm.  He did not give me any additional drug for the pain in the surgery area, and said it was time to just see how well I continued to heal.  He inspected my infected ear and found it still red and sensitive.  Asked me to finish the 10-day regimen of antibiotic for ear infection, through Friday, tomorrow.  Asked me to go see my urologist.  Did get an appointment with Urologist.

 

I definitely know that I still have some healing to do.  I will need to slowly build my former strength.

 

I have decided to move forward with venlafaxine taper and dropped one bead yesterday.

[RachelSusan]

@LarryS Sounds like things are looking up, fantastic!!! Please let us know how you most recent drop goes.

[LarryS]

@RachelSusan @arbor

It has been 8 days since dropping to 3.38 mg (9 beads) venlafaxine.  I do not attribute any unusual symptoms related to doing the drop.

 

Tomorrow will be 9 weeks since TURP type prostate surgery.  Took my last antibiotic September 8.  I definitely know I still have some healing to do from the surgery and two following infections.

 

The current challenge it to get enough quality sleep to feel like I have some energy with less fatigue.  I manage to get basic chores done, but not anything more.  Still to fatigued to feel the slightest bit motivated to go visit the gym.  The Urologist said that this would be a difficult surgery to heal up from, in general, but I think I went a little overboard, always trying to excel.  🤢  (joking around)

 

Part of the sleep issue has been related to our cute toy dog "Pepe".  He is a 2-year-old Maltese - Shih Tzu.  He has the unlimited energy of youth, unlike his handlers.   He has been waking us up night after night barking at something heard or just something who knows what.  Come on Pepe, knock it off, go back to rest.  He gets too much rest as it is, on wife's lap.  I wake up one to two times a night as it is.  I don't need any encouragement. 😑

 

Good thing I know how to take cat naps. 😴

[LarryS]

I came across an interesting post on drugs.com.  They show the average rating of various antidepressant drugs in list form.  If the drugs where receiving grades in a college class, many would be receiving a C, D or F grade.  The scores range from 5.5 to 7.4 out of 10.  I tried to look at some of the comments made associated with the various drugs.  Apparently drugs.com is not sharing many of the comments.

 

I think this is indicative of the poor performance of antidepressant drugs.  And in the end, they poop out.

 

List of 99 Depression Medications Compared - Drugs.com

 

 

[RachelSusan]

@LarryS Thanks for the update. It has been such a difficult time for you with the surgery and the infection I am very pleased to hear there have been no other setbacks.

 

Pepe sounds adorable except for the part about waking you up at night. It was funny to hear you say that you take cat naps because your dog wakes you up. Not funny for you of course, but it made me smile.

 

The link to the comparisons of the anti-depressants was fascinating. There was one commenter on there who was on on such a high dose of so many things that they sounded like a walking pharmacy. They didn't mention being unhappy or stressed with the drugs so that was good. Sadly though all I could think about was how long it would take them to get off all of this stuff, should they choose to.

 

Congrats on the most recent drop. Glad to hear you have not encountered any problems.

 

Keep up the good fight Larry.

[j1290]

Hi Larry!   Fellow bead counter here.  Took a minute, but I got off the max dose of Effexor.  I lived it and it's still hard to believe that reducing one tiny little bead could have such an effect.   Enjoyed your writing, and looking forward to more of it.  All the best!

[LarryS]

@j1290 Thanks for stopping by and the complement about my writing.  

[LarryS]

I'm still holding at 9 tinny beads.  I have noticed considerable anhedonia lately.  There are multiple reasons why I could be feeling this way.  Fatigue has been very prevalent, and anhedonia is the buddy of fatigue.  To be on the safer side, I'm thinking of holding 5 to 6 weeks.  Life is best lived when you take time to enjoy something about each day and be thankful for it.  Lowering one's expectations also lowers one's frustrations.  Put in another way, it is being more in the present.

 

Finally saw my Urologist Friday.  It was helpful for me to learn about the perspective of the surgeon.  The bleeding I have been experiencing is common to those who go through the surgery.  It can come and go, come and go, multiple times.  He instructs me to be careful not to do things that would put any strain on my body, such as lifting things heavier than 10 pounds.  This sounds like a simple instruction to follow but can easily be forgotten in the spur of the moment, I find.  They do not consider their patients healed until after a full year.  I seem to be receiving multiple lessons in patience.  Hum.  I presume I need the lessons in patience. It is said that patience is a virtue.  Therefor I best submit to the training.  We also both agreed that the initial reason for doing the surgery is successfully unfolding as the time goes by.  I'm satisfied.  🙂

 

Infection and associated painful swelling have dissipated thankfully.  Due to ever present low back pain and hip pain I am finding that I must be careful how and how far I walk.  Yesterday was one of the rare sunny days we get in the Puget Sound region, so took wife and dog Pepe' (pronounced Pepa) to the shores of Puget Sound to smell the salty air and view the beauty of our surroundings.  We were all blessed with the experience.  

[LarryS]

Since I have recently been experiencing "anhedonia" again as a symptom of how I feel, and having an article listed by @Altostrata on the subject, I decided to read it.  It was not an easy read, due to all the unfamiliar terminology, but I managed to get all the way through it.  I found it fascinating that there has been so much study done on the symptom and its relationship to depression and substance abuse.  The types of treatment used to lessen the anhedonia symptom where also of interest to me.  

 

I followed the link in the article to the SHAPS scale for measurement of anhedonia.  It will cost me $35 to obtain it.  I may decide later to buy the article.

 

I provide the link below to the article I read as a convenience to anyone else who may be interested in looking at it.

 

Frontiers | Anhedonia and Substance Dependence: Clinical Correlates and Treatment Options (frontiersin.org)

[Altostrata]

An emotional anesthesia is very common as people go off antidepressants. The Frontiers article refers to withdrawal anhedonia:

Quote

As previously mentioned, anhedonia has been found to be a common feature in withdrawal syndrome and it is due to a central dopaminergic dysfunction.

 

However, as is typical in addiction medicine, though they assert "central dopaminergic dysfunction" is involved, that is only hypothetical. Nobody knows the cause of this symptom, which appears across psychotropics regardless of mode of action. SNRIs such as venlafaxine are not particularly dopaminergic.

 

I would not bother with SANS or whatever or spend any more article on the article. What we see is that withdrawal-induced emotional anesthesia very gradually resolves after go off. (This is also true in recovery from addiction, by the way. Addiction medicine has its own myths about withdrawal syndrome.)

 

Quote

Among psychotherapeutic techniques, behavioral activation (BA) might be particularly appropriate in cases with motivational anhedonia. BA was initially developed as a component of cognitive behavioral therapy (CBT), from which it differs primarily in its conceptualization of patient cognitions as a ruminative behavior (Dimidjian et al., 2006). The goal of BA is to help patients to identify whether they are engaging in rewarding or non-rewarding behaviors, and to make behavioral choices that are likely to increase exposure to positively reinforcing experiences. As suggested by initial evidence coming from studies by Coffman et al. (2007), BA may surpass CBT by emphasizing an increase in motivated behaviors, particularly with patients diagnosed with comorbid personality disorders. Recent evidence of the efficacy of BA and CBT in anhedonia comes from functional magnetic resonance imaging (fMRI) studies, which have shown that treatment response to CBT results in a progressive decrease in amygdala sensitivity to negative stimuli (Siegle et al., 2006), while successful treatment with BA leads to increased BOLD responses of the striatum during reward anticipation (Dichter et al., 2009).

 

This seems like a typically wordy, jargon-laden way of saying "change the channel" and move towards experiences you enjoy. We encourage people to do this.

 

If you want to go drug-free, I would not use the drug therapies they recommend.

[RachelSusan]

@LarryS I am glad to read that your infection and pain has dissipated.

 

I was just reading your drug signature. It looks like you are doing a very sensible taper.  I am impressed.

 

Stay healthy. 😀

[LarryS]

Four Week Hold: 13% Drop From 3.38 mg
Dropping to 3.00 mg October 5, 2022.  To do this drop, I am cutting from 9 beads to 8 beads, each bead valued at 0.375 mg.  I am in the final phase of my tapper, utilizing the Venlafaxine beads that I have.  I have chosen to utilize bead counting, rather than make a liquid solution.  The percentage of each drop will get larger with each drop.  To compensate, I will progressively hold at each drop for a longer period-of-time.

Fatigue and pain have been an ongoing issue as usual.  Both fatigue and pain increased because I was recovering from surgery during this past 12 weeks.  I am currently treating my left ear with two more days, a total of seven days, of antibiotic ear drops four times per day to continue the healing of an ear infection.  I will be checking in with an ear, nose, and throat doctor October 11 to evaluate how the ear healing is coming along.  My current fatigue is more extreme than prior to surgery.  Back pain and neck pain are making getting a good night’s sleep impossible.  I compensate with one to two naps during the day.  I have been having ongoing high blood pressure also.  I will be checking in with my general practice doctor October 18 to discuss my issues.

I can be thankful that I am past the previous excruciating pain in my scrotum and ear.  🙂 🙏

Scores below are the average over past 28 days of the drop period.

Anhedonia      4.03    Some caring and pleasure about my health, being loving and respectful
                                    of others.

Insomnia         3.78    Slept minimum 6 hours with 1 interruption during the night.

Fatigue            7.00    Affects ability to think and/or concentrate.

Head-pressure    3.07    Very light head pressure.

Back Pain        6.78    Uncomfortable pain; but not that far away from a level 7 which 
                                     I consider to be hard to tolerate.

Neck Pain        6.39    Uncomfortable pain.

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

[RachelSusan]

@LarryS Wishing you luck with your drop 3.0mg.

 

I am very pleased to read that your surgical pain is behind you.

 

Warm wishes.

[LarryS]

Extreme Fatigue

I am experiencing day after day extreme fatigue accompanied by cognitive slowness.  I find myself making mental mistakes, and then correcting myself.  This has been ongoing since about August 18, 2022.  On that day I note being exhausted.  Since I am mature in years, 74 years on earth, the doctor also says it will probably take longer to heal.

I know I have a lot of healing both physically and mentally going on.  The urology surgeon said he would not consider me fully healed for a full year.  I was surprised to hear that he believed it would take that long.  There may be no surprise from other medical professionals about what I am experiencing.  I will be talking to my primary care doctor October 18.  

My initial concern for going to see my primary care doctor was my high blood pressure which has also been going on for over a year.  Quit often it will be in the 150 to 160 range lately.  I currently take 5 mg of Amlodipine for high blood pressure.  I presume my body is under stress from all that I am dealing with.  I can’t always rest when I want to.  I am sole care giver for my wife who has dementia.  I’m bearing up under the situation as best I can.

I am wondering how much my tapering of venlafaxine is having on my fatigue.  This is a very complicated question because of all the factors going on at the same time.  I have found tips for better sleep on this website.  I will look for tips for reducing fatigue also on this website.  
 

[RachelSusan]

@LarryS

I wanted to say hello and offer my best wishes.  I hope you can resolve what is causing your fatigue. Between your high blood pressure, caring for your wife, and yes still recovering from your surgery, I would say that you have a lot going on. I am pleased to read that you are going to see your primary care doctor. It's always good to have a medical professional give you a look over and hear how you are feeling.

[arbor]

Gosh @LarryS you're dealing with a ton.  Cognitive slowness doesn't seem surprising.  I would imagine you'd need a lot of rest  I send you best wishes during this time.

Arbor 💜

[LarryS]

DOCTORS ANAYLISIS AND MY OBSERVATIONS

I talked with my primary care doctor this week.  The nurse measured the usual standard vital signs.  Since I was there regarding my blood pressure, the doctor also took my blood pressure to verify the nurses reading.  The doctor recorded a blood pressure of 122/64 which is excellent.  I have seen lower readings in the doctor’s office before, than mine taken at home.

My blood pressure readings which I have been taking at home utilizing an Omron machine was giving me significantly higher readings.  I had been seeing multiple readings with systolic pressures in the above 150 range prior to setting up the appointment.  I shared eight recent readings with the doctor that had an average of 138/76.  I would not have gone to the doctor for average readings under 140.

I also informed the doctor that I was experiencing some extreme fatigue for the previous two months.
He sent me for blood work to check for anemia and my A1C levels.  He ordered three blood tests: CBC auto differential, comprehensive metabolic panel and TSH.  All tests showed I was in normal ranges.  I can at least rest easy about these issues.

I am left with believing that the fatigue is elevated due to continued healing, poor sleep and possibly the tapering of venlafaxine.  Also, perhaps the higher blood pressures where a result of my struggles with healing from recent surgery and infections.  I have hope that continued healing will occur and that I will regain my former health prior to surgery.

However, as I write this, I am now dealing with another ear infection, now in my right ear, not in my left ear as before.  The pain started three days ago, not as painful as my left ear pain.  I have no clue as to why I now have this additional ear infection.  I went to a walk-in clinic for urgent care and have received medication for the ear infection, which I will take for seven days.  Then I have an appointment to see an ear, nose, and throat specialist at the end of the seven days.
 

[RachelSusan]

@LarryS You said something very interesting.  I never get a fever when I have infections.  I asked my doctor what were some of the diagnostic tools he used in diagnosing me in the absence of a fever. He said my blood pressure goes up when I get sick. I had never heard of that and now I hear you saying the same thing.

 

Sorry about the ear infection but I am pleased to hear that everything else appears to be normal.

 

Any symptoms from your Oct. 5 taper?

[LarryS]

@RachelSusan I believe I have no symptoms from dropping October 5.  

 

However, I have so many other symptoms going on at this time, it would be hard to pinpoint if any were from the tapering process. 

 

I once got dizzy while tapering due to missing a single dose.  Otherwise have not noticed any specific symptom that I can definitely attribute to doing a 10% drop of my venlafaxine.  I have generally waited four weeks before proceeding to the next lower dose.  I believe I am tapering slow enough that I should not feel symptoms.  Is not that the reason we do a slow tapper?

 

I have read on this web site that some people notice a change in their symptoms within a week of doing a drop.  I don't seem to be one of them.

[LarryS]

Four Week Hold: 12% Drop From 3.00 mg

 

Dropping to 2.63 mg November 2, 2022.  To do this drop, I am cutting from 8 beads to 7 beads, each bead valued at 0.375 mg.  I have chosen to utilize bead counting, rather than make a liquid solution.

 

I have healed up from recent infections.  I have been feeling better over the past eleven days.  I would like to declare that venlafaxine has no hold on me, but I will not.  I will proceed to continue cautiously.  It is just a matter of time until I am done with tapering.

 

Scores below are the average over past 28 days of the drop period. 

Anhedonia      4.35     Some caring and pleasure about my health, being loving and respectful

                                    of others.

 

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

 

Fatigue            6.86     Affects ability to think and/or concentrate.

 

Head-pressure 4.00     Very light head pressure.

 

Back Pain        6.46     Uncomfortable pain.

 

Neck Pain       6.61     Uncomfortable pain.

 

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

[RachelSusan]

@LarryS It's nice to hear you are approaching this so logically and patiently. I am glad you told us that you consider a score of 7 or above your hard to tolerate range. It puts the rest of the numbers into perspective.

 

I imagine the bead counting is easier than making a liquid however it does lock you into the amount you have decrease. I will be watching your posts to see how it all goes. Hopefully it will be just fine based on your past experiences.

[LarryS]

Four Week Hold: 15% Drop From 2.63 mg

 

Dropping to 2.25 mg December 1, 2022.  To do this drop, I am cutting from 7 beads to 6 beads, each bead valued at 0.375 mg.  I have chosen to utilize bead counting, rather than make a liquid solution.

 

This past four weeks I have been feeling well, active, and with good energy, with one exception.  I tested positive for COVID on November 26, 2022.  I had some fatigue, sore throat, and sinus congestion for about four days, then I started feeling better.  The symptoms were like a mild cold.  By day five symptoms were gone and I was outside doing active yard work with good energy.

 

Scores below are the average over the past 29 days of the drop period.  
Anhedonia    1.96    Feeling good and caring about myself and others.

Insomnia      3.79    Slept minimum 6 hours with 2+ interruptions during the night.

Fatigue         3.83    Mild to moderate fatigue all day.

Head-pressure    1.31    Ho headache or odd feelings in my head.  Clear head.

Back Pain     6.69    Uncomfortable pain.

Neck Pain     6.10    Uncomfortable pain.

 

I consider a score of 7 and above getting into the hard to tolerate range.
My total score for all six items is the lowest I have recorded since January 2022.  Overall, I am doing very well.
 

[j1290]

Congrats on feeling better!   I did the same thing when I got to the end of my Effexor taper, went down one bead at a time.   Such a tiny amount but it would rock my nervous system for weeks  every time I reduced!  

 

Glad to hear you're doing well!

[QueenElisabeth]

I am reading your updates all the time and appreciate your diligence. I am still on 15 mg, and scared to loose it all again if I try to come of. But your last post is so hopeful! Thank you for sharing it all Larry! 

[LarryS]

@j1290  @QueenElisabeth  Thanks for stopping by.  I'm thankful that tapering venlafaxine is going well during this time.  I have had plenty of other health issues to deal with since mid-July 2022. 

 

I had some serious pain while recovering from prostate surgery, which is now in the past.  I have just recovered from covid-19.  Today I tested negative from covid-19 after 10 days since first positive test.  My wife caught it three days before me and also tested negative today. 

 

I hear of lots of flu and other respiratory infections going on currently. These infections have infected my son and daughter also.

 

I have been trying to plan an escape to a warmer climate in February or March but have been unsuccessful so far due to these types of interruptions.  So goes life.  😆

[LarryS]

Five Week Hold: 25% Drop From 2.25 mg

Dropping to 1.88 mg January 5, 2023.  To do this drop, I am cutting from 6 beads to 5 beads, each bead valued at 0.375 mg.  I have chosen to utilize bead counting.

 

Tapering over the past five weeks has gone smoothly.  

 

Scores below are the average over the past 35 days of the drop period.  
Anhedonia      2.05    Feeling good and caring about myself and others.

Insomnia         2.40    Slept minimum 7 hours with 2+ interruptions during the night.

Fatigue           3.37    Minor fatigue after noon.

Head-pressure    1.20    Ho headache or odd feelings in my head.  Clear head.

Back Pain       6.60    Uncomfortable pain.

Neck Pain       6.31    Uncomfortable pain.

 

I consider a score of 7 and above getting into the hard to tolerate range.
My total score for all six items is the lowest I have recorded since October 2021.  Overall, I am doing very well.