H8fxr: Effexor what to do about the mini-tablets in generic capsules?

[H8FXR]

Hi Everyone,

AFAIS, Venflafaxine immediate-release tablets are not available in Canada. That would have been my plan A. Plan B was to open the generic Sandoz Venlafaxine capsules; they don't advise: but I did.

 

There are no beads! Shocker. There are mini-tablets packed in the gelatin capsule. The 150mg capsule contains 3 three 50mg tablets. The 75mg capsule cobtains two smaller 37.5mg tablets and the 37.5mg capsule contains one of these.

 

My Question is this:  does anyone here have experience with these minitabs?  It stands to reason that in between the doctors suggested drop from 112mg to 75mg you could plunk a 100mg in by taking 1 50mg minitab out of the 150mg capsule. It doesnt seem like a big deal

 

But what about cutting the minitablets in half or quarters, or mixing a 50mg minitab with a 37.5mg minitab in the same capsule?  Safe?  Does the extended release still work? I think the sustained release works because the venlafaxine is embedded in a non-soluble matrix and its not due to some coating. Please share you ideas, opinions or experience on tapering with mini-tablets from generic venlafaxine XR!

 

Edited October 15, 2018 by ChessieCat
change some font to lower case

[ChessieCat]

Hi H8fxr and welcome to SA,

 

This is SA's topic on Tips for tapering off Effexor (venlafaxine)

 

This is the search results in the above topic for mini: 

https://www.survivingantidepressants.org/search/?q=mini&type=forums_topic&item=272

 

You can check out which members have posted in this topic and visit their Intro topic if you want to ask them a question.

 

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[ChessieCat]

 

Please create your drug signature.  It appears below every post you make and makes it easier for your drug history to be seen at a glance.  Thank you.

 

On 10/15/2018 at 4:14 PM, ChessieCat said:

To help us out please create your drug signature.

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7 hours ago, H8FXR said:

I am just scared to death he is not going to comply when I suggest this course of action. After all, i need him to prescribe 150mg caps (above my current dose) so I can use the 50mg minitabs in it to make my next step down of 100mg (currently on 112.5mg) and then again for 50mg + 37.5mg after that. Thank you all for being here, your courage inspires me.

 

These topics had helpful ideas for dealing with the medical profession to get what you need:

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

[H8FXR]

On 6/10/2013 at 7:15 PM, alexjuice said:

I have found only tepid interest in the topic from a number of psychiatrists. I have my theories for this but I think the luke warm reaction is largely due to simple human motivations which effect doctors. Doctors make a nice living "doing good" and are rather invested in maintaining this self-perception. I don't think most psychiatrists are willing to retool their practices as would be ethically necessary if they acknowledged problems with their Rx interventions so they therefore are reflexively uninterested in considering protracted withdrawal.

 

The positive is that since your doctor will no nothing about withdrawal except what you teach them, then you are actually very much in charge of your treatment, something I found very rewarding to consider.

 

So if your doctor isn't interested in learning about withdrawal simply inform him or her of your desire to reduce your medication by a small amount and let them follow along on your journey... Maybe she'll learn something too!

I am more than happy to ask my doctor to reduce my medication and let them follow my along on my journey, and actually my doctor is on board tapering off the venlafaxine XR.

 

The problem is this: his taper is going to be 112.5mg to 75mg to 37.5mg perhaps with some alternate-day dosing to step down "gradually". And as ghastly as this is it is all he really has to work with because the drug only comes in those doses.

 

I have to convince him that all kinds of intermediate doses can be made if I open up the capsules and mix and match and cut up the minitabs. But that is not standard procedure of course!

 

Further more, I need access to the 150mg caps which contain 50mg minitabs which would be useful to me but 150mg is above my current dose so how could I justify being prescribed that?

[ChessieCat]

If you explain to him that you would like to go much slower than what he suggests because you are very concerned about experiencing withdrawal symptoms and that you believe that it is better to go slow and not risk getting them, instead of going too quickly and suffering.  You can explain that you have done your research and found Surviving Antidepressants which was started back in 2011, has many case studies of people tapering a variety of psychiatric drugs and found a way to taper using a harm reduction method.  If he baulks at your proposed method, tell him that you would like to try doing it your own way to see how it works.

 

It's important to be gentle, calm but firm when discussing with a medical professional.  Try not to seem like a know-it-all.  Many of the product leaflets now have warnings about withdrawal symptoms and the DSM has "Antidepressant Discontinuation Syndrome DSM-5 995.29 (T43.205A)" which you could mention.

 

You could also show him this:  Why taper paper: dose-occupancy curves  There are graphs which follow a similar curve to the 10% taper recommended by SA.

 

And there are many submissions about withdrawal available for reading here, some from medical professionals:  http://www.parliament.scot/GettingInvolved/Petitions/PE01651

 

One member recently made a post about if a doctor doesn't want to prescribe a certain form of drug because of the cost that you can mention that the medical community has caused you to become physiologically dependent on the drug so it is their responsibility to get you off safely.  However I would use this as a last resort.

 

And if you have issues with this doctor you might have to find one who is willing to help you.

 

It might be helpful to do some dialogue rehearsals before you go.

 

My own experience with trying to reduce my Pristiq too quickly.  I went from 100mg to 50mg and suffered extreme cog fog for 3 weeks, and even the simple task of walking took my full concentration.  After 3 weeks I was unable to type, and because I've been a typist for 40+ years I knew that something was wrong.  Thankfully I had joined SA a few days before this happened and they suggested taking extra Pristiq.  I did this and about 4 hours later I was able to type again and the brain fog was lifting.  Because I had a benchmark I knew it was due to the drug.  I have since been tapering following SA's protocol and am down to 6.5mg only experiencing mild withdrawal symptoms.

[H8FXR]

Thank you Chessie Cat!

[H8FXR]

I just had a general question if withdrawal symptoms from weaning of   effexor xr are worse near the end of the taper when small amounts of ledication are used? This is assuming the percentage of each drop stays constant as well as the time to adjust to each new dose. Any feedback would be appreciated. Best regards to all!

[H8FXR]

TLDR: Dr. wants to cross-taper Effexor XR to Trentellex. E.X.: drop Effexor from 75mg to 37.5mg while upping the Trentellex from 5mg up to 20mg. A big drop of Effexor like this seems sketchy, any advice?

 

Hello, I'm (35M) very grateful to be part of this group and I'm sorry if I stray from proper form as I'm new.

 

I have been on Effexor XR for 18 years for GAD and depression - never more than 150mg/day and currently 75mg. I cannot attests to this med helping me and I continue to take it because of the severity of the W/D syndrome. What I hate most about it is the sexual dysfunction side effects (lack of sexual desire, impotence and trouble achieving orgasm). Getting off Effexor has become one of my most important goals in my life.

 

Recently I've been feeling anxious and depressed and avoided seeing my doctor because I knew he would want to up my dose. I fought long and hard to get to 75mg and the side effects are just barely manageable so I absolutely will not.

 

He suggested Trintellex, - and knowing my intense desire to get off Effexor - suggested a cross taper. The plan is to take 5mg Trintellex a long with my usual 75mg of Effexor for 2 weeks and then reassess the anxiety/depression and maybe start weaning Effexor from 75mg to 37.5mg while simultaneously upping the Trintellex. I've been lurking here long enough to know I'm in for some serious W/D if I cut by 50%, but does anyone know if the Trintellex will make this bearable?

 

I would have flat out said no, but after some research I discovered that Trintellex may have less sexual side-effects and has a much longer half-life (which could be easier to getting off)

 

As far as my options for weaning Effexor, the generic Effexor XR I get here in Canada has mini-tablets inside and not beads so I'm limited in how I can taper. Immediate release is also unavailable in Canada afaik.

 

Drug History:

 

2003 - 2012 150mg Effexor XR;

2012 - 2016 112.5mg;

2016 - 2017 150mg (parents passed away);

2017 - 2019 112.5mg;

Feb 15 2019 75mg; (decided to get off)

March 12 2019 37.5mg;

April 6 2019 0mg (severe discontinuation syndrome)

April 14 2019 75mg (Effexor reinstated)

Feb 16 2021 75mg Effexor XR and 5mg Trentellex

 

 

[H8FXR]

Hey I am interested in bead counting to reduce my Effexor. Anyone know what the best brand/manufacturer of Effexor is best for large amount of beads per capsule?

[ChessieCat]

Tips for tapering off venlafaxine (Effexor)

[H8FXR]

TLDR: Dr. wants to cross-taper Effexor XR to Trentellex. E.X.: drop Effexor from 75mg to 37.5mg while upping the Trentellex from 5mg up to 20mg. A big drop of Effexor like this seems sketchy, any advice?

 

Hello, a bit of an update/new intro. I originally posted a new intro but it never went up. Anyhow my quest to wean off Effexor continues. This time dr. is considering bridging to Trintellex.

 

I have been on Effexor XR for 18 years for GAD and depression - never more than 150mg/day and currently 75mg. I cannot attests to this med helping me and I continue to take it because of the severity of the W/D syndrome. What I hate most about it is the sexual dysfunction side effects (lack of sexual desire, impotence and trouble achieving orgasm). Getting off Effexor has become one of my most important goals in my life.

 

Recently I've been feeling anxious and depressed and avoided seeing my doctor because I knew he would want to up my dose. I fought long and hard to get to 75mg and the side effects are just barely manageable so I absolutely will not.

 

He suggested Trintellex, - and knowing my intense desire to get off Effexor - suggested a cross taper. The plan is to take 5mg Trintellex a long with my usual 75mg of Effexor for 2 weeks and then reassess the anxiety/depression and maybe start weaning Effexor from 75mg to 37.5mg while simultaneously upping the Trintellex. I've been lurking here long enough to know I'm in for some serious W/D if I cut by 50%, but does anyone know if the Trintellex will make this bearable?

 

I would have flat out said no, but after some research I discovered that Trintellex may have less sexual side-effects and has a much longer half-life (which could be easier to getting off)

 

As far as my options for weaning Effexor, the generic Effexor XR I get here in Canada has mini-tablets inside and not beads so I'm limited in how I can taper. Immediate release is also unavailable in Canada afaik.

 

Drug History:

 

2003 - 2012 150mg Effexor XR;

 

2012 - 2016 112.5mg;

 

2016 - 2017 150mg (parents passed away);

 

2017 - 2019 112.5mg;

 

Feb 15 2019 75mg; (decided to get off)

 

March 12 2019 37.5mg;

 

April 6 2019 0mg (severe discontinuation syndrome)

 

April 14 2019 75mg (Effexor reinstated)

 

Feb 16 2021 75mg Effexor XR and 5mg Trentellex

[Erell]

Hello H8fxr,

 

I've merged your new post with your intro topic : there is only one introduction thread per member, please post in your thread.

 

Have a nice day 

[H8FXR]

I was under the impression if I "reply to this thread" I AM posting in my thread. That's what I did, clicked on "reply to this thread" and posted on bridging to Trintellex. 

[Altostrata]

You are posting in your Intro topic, thank you.

 

If the point is to go off an antidepressant, I cannot see how switching to Trintellix achieves that objective. It may be trendy but it's not a good bridge off Effexor, meaning after substituting Trintellix, you could more easily go off the drug. 

 

If you want to taper Effexor, see Tips for tapering off venlafaxine (Effexor), it will explain how to divide the mini-tabs.

 

As this is a site for going off drugs, we cannot counsel you about drug switches so you can continue a drug. That's what your psychiatrist gets paid for. It sounds like your psychiatrist is useless for tapering. Any doctor can prescribe these drugs, you may be able to get your Effexor prescription from your GP.

 

[H8FXR]

Thanks for the reply Alto. I agree with what your saying. I wonder why on earth my doctor thinks trintellex may make tapering Effexor easier. I know it won't. It will still be difficult and then I will be stuck on a different drug. I'm planning on getting of generic (minitabs) and getting brand name effexor with beads. Following protocol and dropping 10% of each new dose. Just need to figure out how to simplify this (too many steps):

75mg (current dose)

67.5mg (next dose 10% less)

60.75mg (ditto)

54.675mg (etc)

49.2075mg

44.28675mg

39.858075mg

35.8722675mg

32.28504075mg

29mg

26.1mg

23.49mg

21.141mg

19.0269mg

17.12421mg

15.411789mg

13.8706101mg

12.48354909mg

11.235194181mg

10.1116747629mg

9.1005077629mg

8.19045698661mg

7.37141138661mg

6.63427028661mg

5.97084328661mg

5.37375898661mg

4.83638318661mg

4.35274488661mg

3.91747048661mg

3.52572348661mg

3.17315118661mg

2.85583608661mg

Next drop is less than 1 bead. Protocol suggests switching to liquid instant release preparation.

[H8FXR]

My EFFEXOR XR

TAPER
exponential reductions of 10% from 75mg/day of Effexor XR

Phase 1

1)

75mg

(switch to brand name)
2)

67.5mg

3)

60.75mg

4)

54.675mg

5)

49.208mg

6)

44.287mg

7)

39.858mg

*can stay at 37.5mg if necessary

Phase 2

😎

35.872mg

9)

32.285mg

10)

29mg

11)

26.1mg

12)

23.49mg

13)

21.141mg

14)

19.027mg

15)

17.124mg

16)

15.411mg

17)

13.870mg

18)

12.484mg

19)

11.235mg

20)

10.112mg

21)

9.101mg

22)

8.190mg

23)

7.371mg

24)

6.634mg

25)

5.971mg

26)

5.374mg

27)

4.836mg

28)

4.353mg

29)

3.917mg

30)

3.526mg

31)

3.173mg

32)

2.856mg

 

Next drop probable less than 1 bead:
switch to Instant release liquid preparation

Timeline:

4 week intervals

2 years and 7 months

2 week intervals
1 year, 2 months, and 3 weeks

 

Any questions, comments, suggestions?

 

[ChessieCat]

Are you thinking of making 10% reductions every 2 weeks?  If yes, I do not think that is wise.

 

Also, after tapering since October 2015 and not being off until the end of 2022, my advice is to not get caught up with planning too far ahead because it can lead to frustration and disappointment.  I used to watch the calendar very closely during the first half of my taper and time between reductions seemed to go slowly.  These days I'm surprised when I realise that the 4 weeks of a dose reduction is almost finished.

 

Any reduction is getting you closer to being off, we get there eventually so long as we head in the right direction.  The goal is to get there with the least amount of discomfort as possible.

 

Recently I've posted my musings about how I will get to zero.  I suggest you have a read of it.  It isn't just my thoughts but some other members have posted their own.

 

By the way, I think having a longer hold at 37.5mg (which I assume is a standard dose) is a good idea even if you are feeling okay.  It will give you a rest from tapering mentally as well as allow your brain to do any catch ups which it might need to do that you don't have any noticeable symptoms of.  I did a 3 month hold at 50mg (standard dose) and a 7 week hold at 20mg (I had extra compounded capsules).

 

chessiecat-so-im-not-the-only-one-pristiq-desvenlafaxine

[H8FXR]

Thanks for the your comments CC. It hard to accept such a long slow taper, but I see a lot of truth to what you are saying. I will have to see how it goes b/c I haven't started yet; a part of me is hoping I don't react too badly and can just amble along. Probably wishful thinking. Isn't it true that some people don't experience very bad w/d's and can taper more rapidly. Some Reddit users claim to have gone through it and there tapering regimes are drastic and short. How do they come out unscathed?

 

I quit my job to do this (which in hindsight is a mistake because it may take so long) and my thinking is that I can afford to feel a little discomfort. But I get what your saying: don't push it. My well-being is key.

 

Your account of using a liquid preparation to taper the smaller amounts has got me thinking (ahead) that maybe a switch from Effexor XR to Pristiq might be wise (since it's practically the same drug) but I can't make a tincture from effector XR. Unfortunately, immediate release Effexor has been discontinued in Canada asaik. Do you think such a switch could cause someone trouble?

 

Thanks again

[ChessieCat]

Pristiq is only available in standard doses of 25mg (not Australia, I emailed Pfizer about this and was told that it was the Australian Therapeutic Goods Administration that have only allowed the larger doses), 50mg and 100mg.  The tablets are difficult to cut evenly so they would need to be weighed or compounded.  I've been paying out of pocket to get mine compounded.  It has cost me a lot of money.

 

The tablets cannot be dissolved in water because they go gluggy.  However I have discovered recently that I can empty the contents of a compounded capsules into water without initial stirring and it will dissolve if left for a couple of hours.

 

Another consideration is that Pristiq is stronger than Effexor, but it is not known what the equivalency is.  Some members have switched from Pristiq to Effexor and have had difficulties because of this.  From what I have seen it seems 50mg Pristiq is equivalent to a bit more than 100mg Effexor but not as much as 150mg.

[H8FXR]

Hey CC, thank you for your continued contributions to my intro topic. Every bit of info and input helps.

 

Just to clarify: were you using the extended release form of Pristiq to make the liquid? I couldn't find any info on immediate release Pristiq: I'm not sure it exists. I'm just intrigued if you were able to make a liquid from an XR medication as I read in the tips thread that this doesn't work (with Effexor XR)

 

In regards to the possible switch from Effexor to Pristiq it's disheartened to learn that it's not so straightforward. I'm not saying I want to switch just exploring my options and learning more about what's available.

 

So I found this:

Dosage Forms & Strengths

tablet, extended release

• Pristiq

  • 25mg (contains 38 mg of desvenlafaxine succinate)
  • 50mg (contains 76 mg of desvenlafaxine succinate)
  • 100mg (contains 152 mg of desvenlafaxine succinate)

This seems to either complicate or simplify

 the conversion. Looks like 50mg of Pristiq is comparable to 75mg of Effexor unless desvenlafaxine succinate is stronger than venflaflaxine in which case you are right and it's harder to predict. I know that desvenlafaxine is a metabolite of venflaflaxine so maybe some searching of the medical literature can provide clues in regard to there comparative strengths.

 

 

 

[ChessieCat]

3 hours ago, H8FXR said:

Just to clarify: were you using the extended release form of Pristiq to make the liquid? I couldn't find any info on immediate release Pristiq: I'm not sure it exists. I'm just intrigued if you were able to make a liquid from an XR medication as I read in the tips thread that this doesn't work (with Effexor XR)

 

Pristiq tablets are different to many other ADs.  The drug is combined with a "glue" which makes the tablet extended release and the tablet is then coated with film which doesn't do anything and the drug information says not to be concerned if you see it in your bowel movement because the active ingredients will have been absorbed.

 

My tablets were compounded.  That is they were crushed up very finely.  As soon as that is done, the drug becomes immediate release.  A slow release formula added to help with this but from what I have told this only makes it 6 hours.  After I got to 10mg I started taking my dose twice a day, not equal doses because the smallest dose was 0.125mg (they can make smaller but it costs much more).  My idea was if I couldn't half the dose equally to take twice a day then I took the larger amount in the morning and the smaller dose at night to hopefully not wake up with withdrawal.  In hindsight, I should have been split dosing after I got below 50mg.  Before that I had been taking a combination of tablet and compounded capsules so I had the benefit of the extended release tablet.  Again in hindsight it probably would have been a good idea to dose 3 times a day.  If I had known that I could use the capsule contents to make a liquid I would have been able to halve/divide my dose more evenly.

 

I tried chopping up a tablet and left it in water to see what happened but it just stayed lumpy.  Even if that had worked it would have been wasteful at small doses because I would have had to use a 50mg tablet.  When I make the liquid I open a compounded capsule (currently using 2mg which I had left over, and will then use 0.125mg) and add the finely crushed contents to water.  I do NOT stir it at this time but let it sit for a few hours and it dissolves completely.  Before extracting my dose with a syringe I give the liquid a stir with a mini whisk, but I have to be careful not to whisk the liquid because it causes bubbles to form.

 

One option would be to crush Pristiq tablets and then weigh the powder before adding to water.  After having experienced the convenience of the compounded capsules I could not be bothered crushing and weighing.  

[ChessieCat]

From the Tips for Tapering Pristiq topic:

 

On 7/17/2011 at 2:52 AM, Altostrata said:

Switch to Effexor or Effexor XR
Note: If you've had an adverse reaction to Effexor before, do NOT switch from Pristiq to Effexor.

"Desvenlafaxine (O-desmethylvenlafaxine) is the major active metabolite of venlafaxine."

Since the relationship is so close, switching to regular immediate-release Effexor tablets, which you can cut up or make into a liquid, this may be the best way to taper off Pristiq. Because it has a mean half-life of 5 hours, you'd have to take regular Effexor twice a day.

 

Alternatively, you might substitute Effexor XR, which is released gradually like Pristiq and needs to be taken only once a day.

 

You'd have the difficulty of tapering off Effexor or Effexor XR -- themselves notorious for withdrawal difficulties -- but at least you can do that gradually. See Tips for tapering off Effexor and Effexor XR (venlafaxine).

According to FDA Prescribing Information for venlafaxine (Effexor), the usual dose of Effexor is 150mg per day.

Since 150mg Effexor and 50mg Pristiq are both "normal" dosages of their respective drugs, they may be roughly equivalent.

 

[H8FXR]

Thanks for the reply CC. Lots of useful details in there. 

 

I now see no real benefit to switching from Effexor to Pristiq since the tablets are extended release.

 

But you have me intriguing idea: that the mini-tablets in some generic Effexor XR capsules (Sandoz for example) can likely be crushed just like the Pristiq and resulting powdered wieghed and dosed or used to make a liquid. Of course, it will need to be treated as immediate release and taken twice a day. Even then there might be some issues with dose dumping because no slow release mechanism is being added as was the case with your compounded capsules. Could be useful however, as a last resort, if I cannot get immediate release Effexor for the liquid dosing during the last part of the taper. 

 

Cheers

[ChessieCat]

You are welcome.

 

In most instances they certainly do not make it easy to get off this stuff do they?

 

Please post any of your "experiments" and results with Effexor here in your Intro topic and also in the Effexor tips for tapering topic so that the information will be there for other members.

 

It was only because I saw bubbles' posts about experimenting with an oral solution for her sertraline tablets that I had the idea of trying to make a liquid with my compounded capsules.

 

Another thing you could do regarding the Effexor is to contact The Association of Compounding Pharmacists of Canada https://acpcrx.org/

 

I would contact them first, not a compounding pharmacy, because sometimes a pharmacy will say that it cannot be done when in fact it can (I am aware of several cases where this has happened).  If you contact the Association and they tell you that it can be done then if you then go to one of their member pharmacies and they say it cannot be done you can ask them to contact the Association.  There is no email or online contact form just an address and phone number.  If it was me I would be writing, not phoning.

 

 

[ChessieCat]

There is a lot of discussion in this topic which you might find helpful:

 

tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine

 

[H8FXR]

TLDR: switched from 75mg/D Sandoz (generic) Effexor XR to 75mg/D Wyeth (brand-name and with beads) Effexor XR. Doctor did not support bead counting/wieghing; suggested alternating dose regime and then Pristiq. 

 

UPDATE: M36, 75mg/dEffexor XR. I saw my doctor after the two week period in which I was supposed to bridge to trintellex (which I didn't take) for the purpose of cross-tapering. For two weeks I steeled myself to go in there and succesfully switch from generic Effexor XR containing mini tablets to the Wyeth brand name Effexor XR with the beads so I could do the 10% taper. My hope was he would be on my side and support it.

 

I told my doctor I couldn't tolerate the Trintellex and right away we begin discussing tapering Effexor. I told him straight away I would like to switch to beads and proposed titrating the dosage 10% (hyperbolically) by compounding the capsules by weight in lower dosages. He was against it, saying that the time release mechanism would be compromised. I responded that I had looked at the patents and the the extended release was an enteric coating on the microspheres.

 

He quickly moved the conversation away from what I presume he thought was "tampering" with the medication. I acknowledge that he may not want to be liable for endorsing it.

 

He suggested I achieve a 10% reduction by filling my script with 37.5mg capsules and taking 2 37.5mg capsules for 3 days and then just one 37.5mg capsule for one day and then back to two or 3 days. I told him I don't follow how that would be a 10% reduction. He said that the medication "bioaccumilates" and that I wouldn't fell to much on the low dose day. I told him I would surely be a mess on the off day because of the short half-life of the medication and I feel this would be playing ping pong with my brain. He said I could dose a half-tablet twice a day because the 37.5mg capsules are immediate release. I asked him if he was sure, because afaik IR was discontinued. He looked it up and agreed and he had a chance to see that Pristiq was related to Effexor and also available.

 

So then he started exploring the possibility of switching to Pristiq. I told him I've looked into it and since it is also extended release and similar if not stronger than Effexor this would not help tapering. I promptly apologized for all the push-back, and explained that I had been researching this a lot and getting off Effexor was extremely important to me.

 

He then steered the conversation back to the alternating half-dose day and it began to look like that was my only option. Furthermore he was proposing I use the current generic caps with the mini-tablets. So as a last resort I asked him if I could switch to the brand name at the current 75mg/d dose and see how that goes. He said that's a good idea because they are not bioequivalent and I would need an adjustment period. Great - I feel like at that point he just wanted to get me out of there. So he filled the script and I got the beaded medication of my heart's desire.

 

I'm going to take it as prescribed at 75mg/D for 4 days or so while I wait for my jewellers scale to arrive and so that I can establish whether its effect is much different than the previous generic brand.

 

The bad part is that now I feel like I have to keep it hidden from my doctor that I'm self-titrating the medication. I'm pretty sure he will have figured out that this was the end-game of my visit anyway. It's now and awkward situation because if I need his support or any helper meds (god forbid) it will be difficult if I don't tell him what's actually going on. I'm prepared to do it alone but it sure would be nice if he was supportive of this unorthodox method of tapering. 

[ChessieCat]

Well done.  Bravo.  You achieved what you needed.  Very assertive and the time you took to do your research paid off.  It is exciting to hear this.  And remember, any doctor can prescribe the drug so it might be a good idea to always keep the last package so if needed you can prove to a new doctor that you have been taking the drug and do not leave it until the last minute to get a new script.  You would not tell the new doctor that you are tapering.  The important thing will be to not complain.  He will obviously know that you are tapering but so long as it is not on record he will not be liable which is probably what he is trying to avoid.  However I think he will be willing to continue prescribing and he may even be interested, perhaps overtly, in your taper.  I think this is how my doctor is, just watching and waiting (but not negatively).  He told me that not many people can get off psychiatric drugs easily and he knows that I'm getting my Pristiq (a do not cut drug!) compounded at a local pharmacy.  Hopefully these doctors will learn something from us and be able to help other people.

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

His suggestion of taking different doses on different days is definitely not good.  My doctor wanted me to alternate between 50mg and 100mg Pristiq tablets, which may have worked okay, but I went to 50mg daily which actually caused very bad withdrawal symptoms.  My goal at the time was to reduce my dose to 50mg and stay there (due to mild serotonin syndrome).  The withdrawal symptoms ended up being a blessing in disguise because I ended up finding SA and learned the truth about psychiatric drugs and that I did not need them like a diabetic needs insulin (counsellor's words).  I have been successfully tapering with only mild withdrawal symptoms and I am now down to 0.365mg.

 

When you go back for the next script just be matter of fact and state that you are there to get a script for whatever you need.  He may ask you how you are going so be prepared with some answers, perhaps give him some general response/s like it's going well or I notice a few mild withdrawal symptoms just after I make a reduction but then they go and I don't reduce again until I am feeling stable.  Overtly teaching him.

 

Unfortunately there are not many medical professionals who understand psychiatric drugs and how to get off them.  They get their information from pharmaceutical companies, who of course are happy to get people onto a drug but not off.  That's the reason why SA and other similar sites exist.  And it can be very helpful to have the support and encouragement of other members who understand what we are going through.  There have been times during my taper that I've wanted to go faster and after posting others have responded and it has helped me to be patient.

 

If you taper carefully by listening to your symptoms and not the calendar and do not reduce when you are experiencing withdrawal symptoms but holding for longer as needed, eg additional stress, sickness, travel, then there should be no reason to take an additional drug.  If you are getting more than mild withdrawal symptoms it means that you are tapering too quickly and the solution is to reduce by less and / or hold for longer.  Adding in another drug can cause issues and you will have another drug to taper off.

 

And do not rely on updosing as a back up.  It is better to go slowly and steadily enough so that you do not need to updose than to yo-yo your dosing, because it's effect is cumulative.  At the start of my taper proper I had to decide about whether to updose a few times.  The question I asked myself was:  if this persists for a few weeks can I put up with it?  If the answer was no, then I updosed by a very small amount, not back to the previous dose.  If the answer was yes, then I held for an additional week or two or possibly longer.

 

Remember it is not a race.  The idea is to get off the drug with minimal discomfort so that we can live our life as normally as possible during the taper.  Any reduction is going in the right direction and any reduction of the amount of drug we take is reduction our drug burden.  We will get off eventually.  It will take longer than we would like it to.  I know for me it is taking a lot longer.  I will be 64 when I get off completely.  I was hoping to be off by 60 years.  But after a while I got used to tapering and it became part of my life and just went on in the background.  Every now and then I would get frustrated and think about stopping but then common sense and being aware of the bad experiences of other SA members who have stopped too high and/or too soon as well as some TLC from other members and I'd go back to trudging along patiently.

 

[H8FXR]

Awesome, thank you CC! I'm excited to start tapering once I adjust to the brand switch. I'm currently trying to find a good scale because the one I ordered - although it its a 0.001 scale - has a tolerance of +/-0.005g which is 5mg! I tested it and it's closer to +/-0.002g - that is, a variance in up to 2mg per measurement. That might not work (especially) when 75mg becomes 30mg or 20mg's so I'm a bit frustrated. 

By the way, I really appreciate you taking the time to share your wisdom and support!

Edited March 4, 2021 by H8FXR
Additional comments

[ChessieCat]

The Gemini 20 scale is what many members here us.  Brassmonkey used it for his entire taper, even down to the tiniest of doses.  There is more information about it around the site.

 

Here is the link to the search results for posts made by him in the Tapering forum with for the word "scale".

 

And the link to the search results for posts made by him in the Tapering forum with the word "gemini".

 

 

[LarryS]

H8FXR    I have just finished reading your thread.  I'm thrilled you have now figured out how to get started on your taper.  I think you will do well with tapering, as long as you heed slow and steady.  You have received some very good advise from ChessieCat.  I have also received some very appreciated help from ChessieCat.  Best wishes for a smooth journey.

[H8FXR]

Thank you Larry for taking the time to read my thread. I dropped 10% from 75mg to 67.5mg on March 8th by wieghing the beads in Wyeth Effexor XR capsules. So far not too bad, just fatigue and some gastro issues. Keep us updated as to how your doing. I'm following you so if you post in your intro I am notified.

 

Best regards

[H8FXR]

My progress so far has been dropping from my usual dose of 75mg to 67.5mg on March 8 2021 following the recommended 10% exponential decay taper. This was a 10% drop in dose and 0.66% drop in sert occupancy (I will explain how I know this). The w/d symptoms were exceedingly mild so after two weeks I took a risk and dropped from 67.5 to 56.7mg, a drop of 1.23% in sert occupancy (rougly twice the impact of my previous drop). 

 

Looks like if I make my next 3 drops equivalent to 1.23% drop in sert occupancy I should be on 37.5mg in 4 months. So far, day 5 I have no symptoms and planning to hold a month:

 

1) 67.51mgai(82.88%SO)

-10.8mgai/-16%T/-1.23%SO

1 month hold

2) 56.71mgai(81.65%SO)

-8.0mgai/-14%T/-1.23%SO

1 month hold

3) 48.69mgai(80.42%SO)

-6.2mgai/-13%T/-1.23%SO

1 month hold

4) 42.49mgai(79.19%SO)

-4.93mgai/-12%T/-1.23%SO

1 month hold

5) 37.56mgai(77.96%SO)

 

SO is SERT occupancy

T is % drop from previous dose

 

I will adjust depending on symptoms but so far I am having faith in Horowitz's recomendation for dropping the dose in relation to the reduction of biological effect (sert occupancy)

 

I was able to digitize the graph from a PET study on SERT occupancy vs dose from a study to confirm the data conforms to the function they used: f(x)=90(x/x+5.8)) to find which dose (x) corresponds to a given sert occupancy. 

 

I was able to reverse the function to solve for x so I can find sert occupancy for any given dose: x = (-5.8*y)/(y-90)

 

I used to excel to make tables of sert occupancy VS dose for different reduction plans. I am using this to inform my tapering. I know my drops are larger then recommended but I'm trying to experiment to find the rate at which I can go since it varies for everyone. 

 

 

[H8FXR]

Well it's been some months since I last posted. I managed to get to my goal of 37.5mg from 75mg in 5 steps using sert (serotonin transporter) occupancy as a guide as explained in my last post. The percentage of dropped dose varied but the drop in sert  occupancy was always a constant 1.23%. The effect of each drop was about the same, and all in all I had very little symptoms.

 

For phase 2 (under 37.5mg) I decided to drop by 2.37% sert occupancy. I did this because I was able to see that in the standard 10% (of previous dosage) taper, the percentage of drop in sert occupancy increases to a max of 2.37% at one point even though the drops stay at 10% of the dosage. So I thought: I'm going to have to encounter it anyways so why not experience it now and see if I can use it to establish the rate of the rest of the taper. So far so good. I'm at 27.5mgai/91mgpw. I was able to make a spreadsheet that gives me the corresponding dosages for a consistent 2.37% drop in sert occupancy. Again, all this is gleaned from the PET studies done of tapering of antidepressants. The mathematical functions established in the study have allowed me to discover the hyperbolic relationship between dosage and biological effect (sert occupancy). The theory being that if the drop in biological effect is held constant then there are no surprises at each new dosage. This has been my experience.

 

I am beginning to realize that I am not a sensitive to drops as I originally thought. In the beginning I was hypervigilant and rather obsessive about my symptoms. The tendency was to blame everything negative on Effexor withdrawal. As time went on I got bored of recording symptoms and started to just go with the flow.

 

Some people do struggle with drops over 10% of dosage (and even less) as is evidenced here and in the Facebook group. I also discovered that many people do not (mostly Reddit). Redditors have little knowledge of the 10% rule and so you can see pretty wild tapers over there. For me it was finding what my body and mind can handle. 

 

I am not endorsing a break from the 10% of previous dosage method. I am only documenting my journey and sharing what is working for me. 

 

[18 years @ 75mg-150mg. Tapering 75mg: 3/8/21 -> 67.5mg; 3/22/21 -> 56.7mg ; 5/12/21 -> 48.6mg; 6/8/21 -> 42.3mg; 7/1/22 -> 37.5mg; 7/15/21 -> 33.5mg; 8/20/21 -> 27.5mg supplements: fish oil/magnesium/probiotic]

[H8FXR]

Here is a spreadsheet of the rest of my taper. It's on the right of the table (Phase II)

Official Taper dosevsso.xlsx

[H8FXR]

Here's a link to the study from which I got the graph and mathematical functions for sert occupancy vs dosage.

five ADS.pdf

[H8FXR]

Ugh. Have been having life problems and long story short I've had to hold a dose (27.5mgai) from August 21st to October 3rd - much longer than 4 weeks. But I did the right thing. I've decided to updose 0.6mgai which is nothing but I'm pretty destabilized rn. Don't get me wrong I feel happy I got out unscathed from my life trouble. 

 

I took alcohol, Benzo's and gabapentin during that time I was holding - hence the destabilization, which thank god is not too bad. I've got off everything but the effexor - 5 days now. But I will need to hold on this new minor updose for 2-4 weeks I'm sure. Then I might get to the next lowest rung with a Brass money slide, not sure yet.

 

Talked to a psychiatrist. Absolutely useless. The intake took 30 minutes and the discussion was 3 minutes. He new from the get go from my Dr's referral that I wasn't interested in taking more drugs.

 

I asked him if he has patients who experience difficulty tapering Effexor; he said yes. I asked him what his protocol is in this case. He said bridging to another antidepressant. He's never met someone who wants off completely (really?) He then warned me about rebound anxiety/depression when discontinuing. I asked him, what if I never had anxiety or depression before being prescribed this drug at 17 yo. He then asked why then was I prescribed it and how come I've been taking it so long. I said it was because I was duped by a gp eager to distribute blister packs: really saw the gp about headaches to begin with.

 

He then suggested I implement some psycho-social supports as I taper off in lieu of bridging to a different medication. Ok, not bad advice. He said if I didn't have depression to begin with I should taper off and see what happens. Infuriating. 

 

 

[18 years @ 75mg-150mg. Tapering 75mg: 3/8/21 -> 67.5mg; 3/22/21 -> 56.7mg ; 5/12/21 -> 48.6mg; 6/8/21 -> 42.3mg; 7/1/22 -> 37.5mg; 7/15/21 -> 33.5mg; 8/21/21 -> 27.5mg; 10/3/21 -> 28.1mg; supplements: fish oil/magnesium/probiotic]