Salvo: Effexor XR amongst others

[Salvo]

Hi I am new to this forum. I have read through many posts and gained some very helpful info and it is comforting to know I am not alone. Looking some advice regarding my current AD regimen.

 

I have OCD and depressive symptoms. Was started on Effexor XR by GP for mild low mood ( probably anxiety was more of the problem) after returning home from foreign charity work trip early due to homesickness in 2001. Had a number of years of anxiety and obsessive thinking (no psychology/counselling input) following severe depression in a close relative and then a long period of doing better. Anxiety and obsessive thinking on occasions throughout this period (looking back this was probably worse than I would care to admit to myself). Significant problem with anxiety; attended psychiatry and resulting (unsuccessful) change to citalopram and back to increased dose of Effexor XR 150mg. Further better period until 2012.

 

Change in job circumstances requiring long hours shift work, long daily commute at same time as second child being born. Developed constant abdominal pain and subsequent reduced sleep, increased anxiety and lowering of mood over 2-3 years (but retained interest). Changed Effexor XR to sertraline equivalent dose by GP (to see if Effexor XR responsible for abdominal pain). Reduced work time and then had to stop working for a period due to pain (investigations all normal - likely IBS). Changed job (better hours) and had short period of relief from all symptoms. Further abdominal pain, recommencement of OCD symptoms. Developed increasing loss of interest, reduction in motivation and low energy.  Return to psychiatry - nortriptylline added - no improvement. Medication changed or doses increased (see signature below) - no improvement. 

 

Weaned off Effexor XR over 5 weeks (during which I felt much better for about 3) and 2 weeks on nothing before commencing the MAOI Nardil. During those 2 weeks and first few of commencing nardil had brain zaps, nausea, dizziness, temperature dysregulation and severe OCD symptoms (worst I ever had). Nardil over a period of 3-4 months increased up to 120mg daily - intolerable side effects including insomnia, unable to pass urine or stool, dizziness, weight gain, panic attacks for first time. It was during this time I realised that it could be the medications that were not helping and potentially hindering my mental health. Recommenced Effexor XR at dose of 150mg.

 

Have now been on effexor XR 150mg since Jan 2018. Symptoms since then have included increasing levels of: fatigue, brain fog (at times severe), low mood (I truly believe I was never severely depressed until I was on the high doses of ADs), loss of interest in everything, poor motivation and concentration, no libido.

In the last 2 months I have had a couple of episodes of derealization, increasing levels of brain fog, nausea, headache, flu-like aches, dizziness on occasions, constipation, intermittent facial twitching around the eye, irritation (the slightest thing irritates me)/agitation. Now having crushing episodes during the day of what I would describe as severe fuzziness of the head where I feel like I lose focus mentally and visually, become more agitated, cannot seem to move my body without extreme effort and have racing thoughts (?depressive ruminations ? OCD). 

 

After reading many forum posts it seems I have gone from high doses of antidepressants to half that dose in a short period of time and that is far too fast. However I have now been on this dose for 5-6 months and wondering is it too late to re-increase the dose slightly to decrease more slowly? Also I have read that the 6 month period after reducing or going cold turkey the symptoms seem to get worse so is it better to ride it out longer at this dose hoping to stabilise and not lose the reduction I have made. Truly my days at the moment are largely unbearable and I feel very dysfunctional yet through years of pushing myself can manage to look after activities of daily living. But not sure exactly what would be best to do. 

 

I have tried to be concise here but it looks like a long post - apologies. This forum is great and thanks for all the great advice and encouragement. Wishing all who are here the best in their recovery.

Salvo

 

[Songbird]

Hi Salvo, welcome to SA.  Thanks for creating a signature with your med history.  Please use your introduction topic to post your updates and ask questions about your situation.

 

I think what has happened is that all the med switches have confused and destabilised your system.  Doctors often switch meds around without realising that they often do not cover for each other very well.  When you change quickly from one med to another you get withdrawal from the previous med along with start-up effects of the new one.  It seems you also had quite bad adverse reactions to Nardil.  What you are experiencing now is the end result of all the changes made.

 

I think what your system really needs now is stability.  At this point it's impossible to predict the outcome of a dose increase.  It may be that, after all the changes, Effexor may not work the same for you any more.  Any changes in dose (whether up or down) could cause further destabilisation.  If any dose changes are made, they should be very small to reduce the risk of symptoms becoming much more severe.  Riding it out at the same dose could also be an option.  I will see what other mods think and we'll reply here.

 

Have a read of these topics about reinstatement and keeping things stable:

 

about reinstating and stabilizing to reduce withdrawal symptoms

 

the rule of 3KIS - keep it simple keep it slow keep it stable

[Altostrata]

Welcome, Salvo.

 

On 6/24/2018 at 10:54 AM, Salvo said:

Weaned off Effexor XR over 5 weeks (during which I felt much better for about 3) and 2 weeks on nothing before commencing the MAOI Nardil. During those 2 weeks and first few of commencing nardil had brain zaps, nausea, dizziness, temperature dysregulation and severe OCD symptoms (worst I ever had). Nardil over a period of 3-4 months increased up to 120mg daily - intolerable side effects including insomnia, unable to pass urine or stool, dizziness, weight gain, panic attacks for first time. It was during this time I realised that it could be the medications that were not helping and potentially hindering my mental health. Recommenced Effexor XR at dose of 150mg.

 

Have now been on effexor XR 150mg since Jan 2018. Symptoms since then have included increasing levels of: fatigue, brain fog (at times severe), low mood (I truly believe I was never severely depressed until I was on the high doses of ADs), loss of interest in everything, poor motivation and concentration, no libido.

In the last 2 months I have had a couple of episodes of derealization, increasing levels of brain fog, nausea, headache, flu-like aches, dizziness on occasions, constipation, intermittent facial twitching around the eye, irritation (the slightest thing irritates me)/agitation. Now having crushing episodes during the day of what I would describe as severe fuzziness of the head where I feel like I lose focus mentally and visually, become more agitated, cannot seem to move my body without extreme effort and have racing thoughts (?depressive ruminations ? OCD). 

 

Reading the above, I am seeing the same likelihood as Songbird: You are experiencing the result of drug changes and possibly an adverse reaction to Nardil, which destabilized your nervous system.

 

It seems recommencing Effexor XR changed your symptom pattern for the better. It's not as activating as the Nardil. The rest of the symptoms are the dysautonmia of a destabilized nervous system.

 

Are you currently taking any other drugs along with Effexor?

 

In order to isolate possible adverse effects from the drugs you're taking, we need your daily symptom pattern. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. We'll need to see this over perhaps a week.

 

[Salvo]

Thanks Songbird and Altostrata.

 

I will aim to keep daily notes about symptoms. I am struggling to define what might be underlying symptoms v withdrawal symptoms and they vary from week to week/month to month. I take Effexor Xr 150mg in the morning with omega 3 and B vits. Generally no problems getting over to sleep or staying that way.

 

I first developed significant anhedonia while on higher doses of sertraline/nortriptilline or effexor and struggle with this pretty much daily for last 2 years. I have lost interest in everything and generally feel emotionally numb. This seems to be worsening in since April 2018. In addition very poor motivation, initiation of tasks and a lot of agitation. I also have a feeling of inner restlessness which I cannot define - it might be akin to akathisia (but not always having the urge to move). 

These often fluctuate in their severity both on a daily basis or even an hourly basis. On occasions, all symptoms will settle slightly in the evening for an hour or so. I am really struggling to concentrate on what people are saying and find I no longer look forward to doing anything or seeing anyone (the idea of doing anything seems to have a strong distaste or massive effort required to even do it). Contact with others has always been something I loved and now at times I cannot bear even seeing others inc close family/friends - agitation and irritability. However when alone I feel v unsettled/agitated also.

All these are causing a despair of sorts which I cannot seem to shift. There are no obvious triggers - it is just a constant set of thoughts and feelings.

 

Over the last 3 weeks I have increasing "brain fog" - my head feels very fuzzy and I find it extremely difficult to concentrate, think or remember things. Also increasingly tired.

I have lost a lot of hope which used to drive me through difficult patches. 

 

From a physical point of view I have tinnitus (doesn't really bother me), poor energy, occasional throbbing of neck, jaw and gums, pulsation in abdomen, effort required to maintain visual focus, and occasional headache. But the main problems are anhedonia/poor motivation and agitation. 

 

Will try to keep simple diary. 

Feel I need a higher dose of antidepressant - given the core symptoms of anhedonia, anergia and poor motivation but also keen to get off meds as I'm not sure whether or not they are actually contributing or the cause of these symptoms.

 

Thanks again

Salvo

 

 

 

[Altostrata]

We'll need those symptom pattern notes to determine if any of your current symptoms are from the Effexor. If they are, you will not want to increase the dosage, that would increase the side effects.

 

It's possible some of those symptoms are because the dosage is too high rather than too low. Since your system has been sensitized by adverse drug reactions, your reactions to all kinds of drugs will be different.

 

Also, after severe accidents with psychiatric drugs, it may take some time for your nervous system to settle down. Symptoms come and go in waves and often change. If you're getting sleepy, your nervous system might want more sleep, which is good -- sleep is healing.

 

See What is withdrawal syndrome? 
 
About reinstating and stabilizing to reduce withdrawal symptoms
 
The Windows and Waves Pattern of Stabilization

 

Emotional anesthesia is a common side effect of antidepressants. It will take some time for this to go away even when you get off the drugs.

[Salvo]

Thanks Songbird and Altostrata

I have attached some symptom pattern notes and times as you had suggested over a week. I have general background of low mood, poor motivation, complete disinterest/loss of pleasure, feelings of guilt. 

Salvo

Symptom diary Salvo.gdoc

[Carmie]

Hi Salvo, 

 

How are you doing?💚

[Salvo]

Hi Carmie

 

Thank you for you inquiry

I have just come back to the forum after a good while away. I'm not doing too good. I seem to be getting new symptoms despite no medication change.
Although I have to say that my anxiety has lessened significantly since I've come down dose of effexor. 

Agitation is particularly bothersome, seem to be constantly irritated, but also a deep inner restlessness (which from reading from the forum posts sounds like akathisia).
Other symptoms are profound anhedonia and poor motivation, like I'm walking around in a bubble of numbness. I find this quite hard to bear. I feel like since I was on high doses of medication and through to now I'm experiencing true major depression for the first time (looking back all those years ago I think what I described to my healthcare professional was anxiety and mild low mood).

Physical symptoms include - tinnitus, headache, pains behind nose and eyes, jaw and neck discomfort, dizziness, "jelly legs", nausea and constipation and random feelings of pulsation around the body. The discomfort these cause can very greatly in duration and severity.
 

I've been on 150mg Effexor XR for a year and reduced down to 135mg approx 4 months ago and symptoms just gradually seem to be worsening. Any hints or tips are welcomed.

 

Salvo

[Lloyd]

Hi Salvo,

 

Stress definitely makes withdrawal symptoms allot worse. I'm going to write a list of things that stress me & see which triggers i can eliminate & ones i can minimize exposure too. Just an observation about myself but if i'm feeling really bad i go play a video game which seems to take my mind of it & i generally feel better after. Seems to keep the brain busy so its not thinking about all the other stuff.

[Carmie]

Hi Salvo, 

 

I’m really sorry you have so many symptoms. Maybe you weren’t stable enough before you went down from 150mg to 135mg, as you had done such a rapid taper a year or so ago. When we make big changes it can sometimes take more than a year to properly stabilise. The more meds we’ve been on the more sensitised our brains can become. I’ve been on so many things that I’m really sensitised now, I feel every little drop and change, and I can’t taper by 10%. I’m tapering just under 4% now. 

 

How were you feeling before you jumped down to 135mg? Were your symptoms stable?

 

Please keep us updated as to how you’re doing, sending hugs 🤗

[Salvo]

Thanks Carmie

I'm really struggling. To be honest I've had many of the symptoms continuously and never really had any period of stability. The symptoms that definitely have appeared or got worse over the past few months have been neck pain, tinnitus, throbbing of ears tongue and throat and brain fog. Also the anhedonia, energy levels and.concentration have got worse. The biggest thing for me in all of this is a hard to describe inner restlessness or discontent, a sort of inner despair and agitation. There are times when I have all the symptoms mentioned including anhedonia but without this inner restlessness and they seem to be more bearable. But when this inner feeling is bad (which is becoming more intense and prolonged) just existing nearly feels unbearable. I feel nearly completely disconnected from others especially my family which I find distressing. Ive tried everything I know of but have had limited success in anything. 

Like many people on this forum I feel completely different from what I was like before starting antidepressants. 

J

[Carmie]

Hi Salvo, 

 

You certainly sound like you’re going through a rough time. I’m sorry. I noticed last year that Alto asked you to keep a symptoms log, Could you please do that again. I couldn’t open the link you posted back then. Maybe because I’m on my iPad?

 

Here’s an example of how to do it: 

 

6 a.m. Woke with anxiety. 

8 a.m. Took 2.5mg lexapro.

10 a.m. Stomach is upset. 

11.35 a.m. Got a headache, lasted one hour. 

12.30 Ate lunch.

4 p.m. Feel a bit better. 

5 p.m. Took 2.5mg of lexapro.

6 p.m. Had dinner.

9.20 p.m. Headache. 

10 p.m. Took 50mg Seroquel.

10.20 p.m. Feeling dizzy. 

10.30 p.m. Fell asleep. 

2.30 a.m. Woke, took 3mg Ambien.

2.45 a.m. Fell asleep.

4.30 a.m. Woke, but got back to sleep.

 

Yes, that inner restlessness is an awful symptom. Many people on this site can relate it, myself included. The inner restlessness may be akathisia. There are different stages of it, I’ve had everything from the inner agitation where you have to keep distracting yourself, to feeling like I’m literally being electrocuted, to having to move all the time. It’s like you’re being tortured, there’s no other way to describe it.

 

I see in your signature that you’re taking B vitamins. Are you still taking them? B vitamins are activating and can actually make our symptoms worse. 

 

Take care, sending hugs🤗

[Salvo]

Thanks again Carmie. I will do the symptom log again for a week and post it. I stopped taking the b vits a few months ago when I read about them being quite activating. Just taking omega 3 now and magnesium. 

Best wishes

[bheb]

Hey Salvo, I also have that restlessness. It's hard, and also makes me want to alienate/isolate from friends and family. Hang in there.

[peng]

I noticed a minimising of prolonged anhedonia this week on 162.5mg of effexor XL.

You could go for a slow taper once you have stabilised for a while?

Best wishes

[Salvo]

Thanks Carmie, bheb and peng for the encouragement and ideas.

 

To be honest I'm not really sure what stability looks like. 

I'm battling with symptoms mental and physical all day most days for the last number of years and they just seem to have been getting more severe at points.

Over the past couple of months I am more tired, lower interest and motivation and feeling very numb and agitated. This only began when I was on highest dose of antidepressant.

Been on 150mg effexor for the past 14 months - no life events/stresses.

Find attached a symptoms diary for one week. 

 

Best wishes

Salvo

Symptom diary 2019 Salvo.gdoc

[Gridley]

1 hour ago, Salvo said:

agitated

 

You might want to consider adding magnesium, such as magnesium glycinate, to your supplements.  Many members find it calming.  Begin at a low dose in case you experience problems.

 

Magnesium, nature's calcium channel blocker 

 

I notice in your signature you take a B-complex.  While it is often a first response to stress to take a B-Complex, in withdrawal it can be overstimulating.

 

Hypersensitive to B Vitamin or B-Complex  

 

[Salvo]

Hi 

 

I haven't posted in a while. I am really struggling and have appreciated the support and info I have received here in the past. I'm really confused as to what is going on. 

I was switched to sertraline from Effexor last year (see signature below) as symptoms of agitation, irritation and anhedonia were worsening (along with periods of suicidal thoughts). I'm not sure how effective this was (or was it just a period of worsening symptoms that resolved).

Since then my baseline has been anhedonia (near total), fatigue, demotivation, slowness of thought and dizziness. 

Over the last 3 months the dizziness has worsened significantly (but waxes and wanes), have near constant headache and neck pain, throbbing jaw, teeth and gums, profound brain fog, near unbearable episodes of irritation with anything and anyone around me, pulsation in head, emotional numbness (I don't seem to have any emotional reaction to good or bad news - and this distresses and further irritates me), feel of detachment from the world around me, dulled senses (or dulled pleasure to senses) and near total anhedonia.

I feel like I don't know myself or others, I feel no love (even though I know I am loved), I feel no affection. I'm irritated inside at this change in me (I feel almost constantly angry and frustrated). 

Also having intense periods of annoyance or irritation (multiple times daily) for the slightest of things (even a simple noise or movement), and at others for simple things. 

I also feel a near constant urge to move or to distract myself from the way I feel (like a profound discomfort/restlessness).

 

This has all worsened with no change in medication, circumstance or routine. I'm wondering is it worsening of underlying mental health issue (although I do not now really know what this ever was) or is it poop-put or is it withdrawal?

 

I'm grateful for any advice or input and value the support greatly

 

Much respect to all

Salvo