medfreeoneday: withdrawal symptoms after Prozac bridge from paroxetine?

[medfreeoneday]

Hi @Altostrata

 

So my latest waves have been like this:
 

-Depression in the morning (mild to moderate)- very hard to get out of bed.

-Slight sick feeling in my stomach

-Mood fluctuates up and down a lot during the day. 

-Some fatigue.

-Tinnitus (but I think I always have this and hard to say if I just notice it more when I’m not well)

-Some anxiety but fairly mild

 

The pattern over the last month has been I’m fine even good for a week or so and then it comes back- latest wave has been going on since Sat afternoon and it’s now Wed.

 

Overall, it is unpleasant not debilitating like previous waves have been in the last few months. I think overall the intensity of the waves have become milder over time.

 

Also-like many people who have been on ADs a long time- it is difficult to know what my ‘baseline’ without ADs is as I’ve been on them now for 22 years. From my memory-the depression before I started taking ADs lasted longer and wouldn’t fluctuate with good periods as much as I’m experiencing now.

 

Edited June 15, 2022 by ChessieCat
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[Altostrata]

What does this "depression" feel like? What times o'clock do you take your drugs, with their dosages? Does this morning symptom occur before or after you take Effexor?

 

You've only been stabilizing from withdrawal for 1.5 months. It sounds like you are still having waves of withdrawal symptoms. This can occur for quite a while as your nervous system gradually settles down. It sounds like you have seen partial improvement already. I would not attempt to taper again until these waves go away entirely. 

 

 

[Altostrata]

Hello, @medfreeoneday, how are you doing?

[medfreeoneday]

Hi @Altostrata

 

The good news is that I am now down to a 16mg dose of Venlafaxine (I started tapering from 150mg) and have been careful to taper slowly.

On Thursday night, however, I went into a worry/anxiety spiral which has turned into a wave. The trigger for this spiral is that I am starting to suspect that I have PSSD. While some general symptoms caused by Venlafaxine have improved as I have reduced the dose- two things have remained constant without any notable improvement: emotional blunting and ED.

 

I had got myself into a mindset that I would be broadly home free if I tapered off carefully as I have. The realisation that even if I do that I could be in for more years of PSSD symptoms has been devastating for me. It’s a bit like running a marathon, getting near the end and then realising you have to run another one straight after. 
It could be that the PSSD symptoms fade when I come off Venlafaxine completely but I think I need to mentally prepare myself for the possibility that that will not be the case.

 

 

[medfreeoneday]

Latest update: after tapering and dealing with pretty bad withdrawals I got to 20mg weight of beads (not active dose) and switched to counting beads. To do this, I tried to count out average size beads and put the equivalent of 20mg which I worked out to be 20 beads. Big mistake. After about 10 days I crashed and got hit with akathisia which is the one symptom I just cannot handle. I switched to counting I think it was on 8 Sept and got hit with the akathisia on Monday 18 Sept. I've now switch back to the 20mg weight and felt better yesterday. Today I wouldn't say that I have akathisia but I do certainly feel distraught- maybe it's just aftershocks from being in such a bad state. I will be sticking at 20mg for the foreseeable future until the withdrawal symptoms have resolved themselves. I have also bought a more expensive set of digital scales which hopefully can deal with lower doses since after this debacle I just want to minimise any mistakes with dosing in future. 

 

All this has made me have a major rethink about my strategy. I have pushed quite hard to get off these meds over the last 3 years and have made a lot of progress but my quality of life has not been good because of how bad the withdrawals have been. I think I am just going to slow right down. If it takes me another two years (or more) to get off this last 6mg of Efexor then so be it.

 

Any advice is greatly received but really I think this is just a waiting game from what I can see for the time being. 

[medfreeoneday]

Latest update: I got down to 5mg and crashed after getting cocky and doing a number of drops over 10%. From Oct 1 I dropped to 20mg (weight of beads) to 19mg. Then from 19mg to 18mg on Oct 5 and then finally to 17mg of beads (equivalent to 5mg active dose) on Oct 15. Since then I have had a couple of very serious waves where I had intense anxiety/dread, suicidal ideation and the awful cortisol spike waking up at 5am every day. After a second scary wave I realised I had destabilised my CNS and so decided to updose. I have now updosed back to 18mg and may go up to 19mg (mainly because I don't fully trust my scales and I want to be sure I am actually going up in dose). I am now going to hold at this dose until I stabilise. I don't foresee dropping my dose again for at least another 6 months. I am not going to ever ever drop more than 10% again as the risks are just too great. Does anyone have any advice for anything else I should do? Do you think I upped my dose by enough?

[2cats2272]

Just stopping by to see how you’re doing! 

[medfreeoneday]

Hey @2cats2272 thanks for stopping by. It means a lot to me- I’m sure you know how this can be a very lonely process sometimes.
 

As for how I’m doing- have had a bad day where I had severe flight and flight (which you just mentioned in your post). I get very scared when this happens as I start panicking it’s the return of akathisia. Do you get heard palpitations? They always freak me out.

Although I am having a bad day- I have had good days recently and the thing I am most thankful for is that I am getting more sleep now. I use a combination of melatonin and CBD oil plus I bought myself a Fitbit which reassured me that I was getting more sleep than I realised (although it does misread lying still in bed as light sleep sometimes). 

I also started taking CBD gummies during the day if my anxiety is particularly bad and they do seem to help- at least for now.

I hope you’re feeling better too.

[2cats2272]

@medfreeoneday I do get palpitations. With my symptoms I’m just trying to remind myself that’s it’s withdrawal or anxiety. I find the more I pay attention to them the bigger they get. I’m not very good at doing this yet but I’m trying. 

[medfreeoneday]

Update: I'm afraid to say that my situation has not improved since my last post. I am still rapidly cycling through 2 or 3 ok days followed by an extreme day or two where I am severely ill with withdrawal to the point where I am basically bedridden. Symptoms on a bad day include: deep depression, fatigue, nausea, a general feeling of being very very ill.  I'm getting close to having to quit working. This is the lowest point in my tapering journey so far and the lowest point in my life.

 

Last week, I had a consultation with Mark Horowitz and he suggested upping my dose (I was at 5.7mg). On Sat 30 Dec I raised my dose to 6mg and then raised it to 6.3mg on Monday. I'll wait a week to see if I notice any improvement.

 

p.s I've stopped taking the CBD as Horowitz advised against it (up until last week I had been taking it intermittently).

[medfreeoneday]

@brassmonkey @Karma

I’m in a bad way. After being destabilised since 8 Nov I upped my dose from 5.7mg to 6mg on 30 Dec and then to 6.6mg on 1 Jan. Since then, I’ve taken a plunge for the worse. Going from 8.5 out of 10 on my worse days to 9.5 or 10. I’m very scared. Should I immediately revert back to my previous dose of 5.7mg or just try to ride it out now I’ve gone up to 6.6mg? 

[Karma]

I’m no longer a moderator, but I’ll respond. It appears you have been jumping around in doses treating your CNS like a pinball machine. You need to give your system time to stabilize. 
 

In general, I’ve only seen recommendations to reduce back down when you’re having an indication of having updosed too much. Go back to your post with ChessueCat on May 3, 2022. Did you have improvement and then your symptoms declined? If you didn’t have improvement, then my suggestion is to stay at the dose Horowitz recommended, 6.6mg and ride it out.

 

You need to give your system time to adjust and finds its balance. 

[medfreeoneday]

@Karma thanks. I will do.

[medfreeoneday]

Since Jan 6 when I was full blown suicidal the sense of crisis has calmed down a bit (although I am still working on putting together a safety plan with my family just in case). Yet despite that my symptoms are still very bad- really debilitating depression, a chemical sick feeling, severely impaired cognition, intense anxiety. I do have some ok days (say 1 or 2 a week). Really though if I'm honest I haven't seen any improvement since I crashed Nov 8 except maybe some improvement with insomnia (I still have to get up at least once in the night but nowhere near as many times as when I first crashed). The plan is to hold my dose and pray that I stabilise.

[medfreeoneday]

Update: unfortunately no signs of improvement.

I now think that I may be experiencing a paradoxical reaction to Effexor. I have recently found out that tragically my scales were mismeasuring the dose and that I accidentally jumped from 6mg to 15mg and have been at that dose without realising for several months. This could explain why I have not been able to stabilise or see any improvement in my symptoms. Unfortunately as I did this without knowing I don't know when this mismeasurement started but I know it has been going on for at least two months. Could it be then that the large jump in dose has led to a paradoxical reaction to the medication?

 

Is there any way to distinguish between a paradoxical/adverse reaction to the medication versus withdrawal? 

My symptoms are that I feel a severe chemical sick feeling and have started to have akathisia, intense tinnitus plus a myriad of other symptoms. I am starting to become suicidal on a regular basis.

 

Whether or not I am experiencing a paradoxical reaction obviously has implications for what I should do going forward. If I am experiencing adverse effects from the (accidental) updose then surely the way forward would be to start tapering down whereas if what I am experiencing is withdrawal then I should carry on holding (even though I am not seeing any improvement). 

 

I would really appreciate hearing the expertise from SurvivingAntidepressants as I am very very desperate now and close to the edge.

 

@Catina7 do you know who I should tag to get advice from? Altostrata no longer provides advice is that right?

 

[Catina7]

5 hours ago, medfreeoneday said:

Update: unfortunately no signs of improvement.

I now think that I may be experiencing a paradoxical reaction to Effexor. I have recently found out that tragically my scales were mismeasuring the dose and that I accidentally jumped from 6mg to 15mg and have been at that dose without realising for several months. This could explain why I have not been able to stabilise or see any improvement in my symptoms. Unfortunately as I did this without knowing I don't know when this mismeasurement started but I know it has been going on for at least two months. Could it be then that the large jump in dose has led to a paradoxical reaction to the medication?

 

Is there any way to distinguish between a paradoxical/adverse reaction to the medication versus withdrawal? 

My symptoms are that I feel a severe chemical sick feeling and have started to have akathisia, intense tinnitus plus a myriad of other symptoms. I am starting to become suicidal on a regular basis.

 

Whether or not I am experiencing a paradoxical reaction obviously has implications for what I should do going forward. If I am experiencing adverse effects from the (accidental) updose then surely the way forward would be to start tapering down whereas if what I am experiencing is withdrawal then I should carry on holding (even though I am not seeing any improvement). 

 

I would really appreciate hearing the expertise from SurvivingAntidepressants as I am very very desperate now and close to the edge.

 

@Catina7 do you know who I should tag to get advice from? Altostrata no longer provides advice is that right?

 

 

Hi @medfreeoneday, I'm sorry you're having such a difficult time.  Yes, Altostrata is no longer actively involved on the site.  

 

From what I understand, if your symptoms increased AFTER you accidentally updosed, then perhaps you have "kindled" yourself or are experiencing an adverse reaction.  I understand you wanting to get some official feedback from one of the moderators.  KenA, LotusRising, and Emonda come to mind.

 

[medfreeoneday]

I would really appreciate hearing the expertise from SurvivingAntidepressants as I am very desperate now.

@Emonda @KenA @LotusRising

 

I think that I may be experiencing a paradoxical reaction to Effexor. I have recently found out that tragically my scales were calibrated wrong and I have been mismeasuring the dose and I accidentally jumped from 6mg to 15mg and have been at that dose without realising for several months. This could explain why I have not been able to stabilise or see any improvement in my symptoms. Unfortunately, as I did this without knowing I don't know when this mismeasurement started but I know it has been going on for at least two months. Could it be then that the large jump in dose has led to a paradoxical reaction to the medication?

 

Is there any way to distinguish between a paradoxical/adverse reaction to the medication versus withdrawal? Are there specific symptoms which are more typical of adverse reactions than withdrawal?

My symptoms currently are that I feel a severe chemical sick feeling and have started to have akathisia, intense tinnitus plus a myriad of other symptoms. I am also starting to become suicidal on a regular basis.

 

Whether or not I am experiencing a paradoxical reaction obviously has implications for what I should do going forward. If I am experiencing adverse effects from the (accidental) updose then surely the way forward would be to start tapering down whereas if what I am experiencing is withdrawal then I should carry on holding (even though I am not seeing any improvement). 

 

Any advice from the moderators would be greatly appreciated.

 

 

[LotusRising]

@medfreeoneday

 

I'm so sorry to hear that you're struggling so much. 

 

We'll do our best to help you tease out what's happening.

 

You mentioned an accidental updose and this may have happened in January, when you thought you increased to 6.6mg - is that correct? And you have not made any changes since then?

 

 

[medfreeoneday]

Thanks for getting in touch Lotusrising. 

 

So there have been 2 updoses at separate times. One was intentional which I did on 30 Dec and 1 Jan (from what I thought at the time was 6mg up to 6.6mg) The second one occurred by accident and was a far more significant jump from 6mg to 15mg and could have happened any time after I bought my new scales which I used from December onwards. Basically for the whole of December, January and February I thought I was weighing 6mg (until I updosed slightly to 6.6mg) but it now turns out that for at least some of that time I was actually measuring out over double that dose at 15mg. However, as I discovered this late I don't know when the change happened. Since discovering this error I have continued at the higher dose as I thought it made sense not to jump back down again as I would have been on the 15mg for at least a month and likely longer by now.

 

Since crashing on Nov 8 my symptoms have evolved but they seem to have gotten worse and worse without any signs of improvement. I think the fact that I did such a large updose may have made the Effexor turn paradoxical which would explain the extreme nature of the symptoms. I have spoken with someone who had a paradoxical reaction from Effexor and the symptoms he describes match what I am currently experiencing: the chemical sick feeling, nausea, extreme tinnitus, akathisia. So my question is: is there a way to distinguish a paradoxical reaction from regular withdrawal/destabilisation? Do the symptoms differ in certain ways? I appreciate it is a difficult task for you given that we don't know exactly when the updose took place but any clarity would be really helpful as I can't keep on like this. The symptoms are just too extreme.

 

Thanks

Medfreeoneday

[LotusRising]

13 minutes ago, medfreeoneday said:

I think the fact that I did such a large updose may have made the Effexor turn paradoxical which would explain the extreme nature of the symptoms.

I am thinking two things. I'm not convinced this is a paradoxical, though I'm open to the possibility. I do question whether this could be hypersensitivity/kindling. Have you read this topic on Hypersensitivity and Kindling? I think the abrupt and large increase destabilized your system since your body had already adjusted to the lower dose. So, it may not necessarily be WD symptoms, so much as it's your body being activated by the increase.

 

16 minutes ago, medfreeoneday said:

the chemical sick feeling, nausea, extreme tinnitus, akathisia.

Did you have any of these symptoms before?

[medfreeoneday]

Hi Lotusrising

 

Thanks for your reply. What is the difference between paradoxical and kindling? I kind of thought of them as the same thing. 

 

I didn't have the chemical sick feeling, nausea or akathisia before my crash. 

 

 

[medfreeoneday]

I definitely feel activated at the moment. It's awful. 

[medfreeoneday]

Hi @LotusRising

 

Thanks for your reply. What is the difference between paradoxical and kindling? I kind of thought of them as the same thing. Doesn’t being kindled trigger an adverse reaction from the drug? I read through the thread on kindling but ended up being a bit confused (my intense brain fog doesn’t help).

 

I didn't have the chemical sick feeling, nausea or akathisia before my crash. 

Would it be advisable to hold my dose (even though I don’t show signs of improving and the symptoms are severe) or should I start to taper off because the drug has turned on me? 
 

Also I am getting pressure from concerned friends that I should try benzos. I know how dangerous they are but I am getting increasingly desperate and that this site doesn’t advocate their use but my symptoms are so severe I can’t hold on much longer unless I get some relief.

[LotusRising]

5 hours ago, medfreeoneday said:

What is the difference between paradoxical and kindling? I kind of thought of them as the same thing. Doesn’t being kindled trigger an adverse reaction from the drug?

I wouldn't say it's a clearcut definition when it comes to withdrawal. My understanding is that a paradoxical reaction can be a form of kindling.

 

Do you notice these symptoms at certain times of the day? Are there times in the day you feel better or worse? What time do you take your medication?

 

5 hours ago, medfreeoneday said:

Also I am getting pressure from concerned friends that I should try benzos. I know how dangerous they are but I am getting increasingly desperate and that this site doesn’t advocate their use but my symptoms are so severe I can’t hold on much longer unless I get some relief.

I do understand they're concerned. Personally, I feel this is a risky choice since they can be habit-forming very quickly. I took a benzo to 'fix' my buspar reinstatement and it made me worse and left me with another taper. If you're correct about your weights being off since December, this means you've  been at this dose since for about 3 months with no improvement?

[medfreeoneday]

On 3/2/2024 at 2:59 PM, LotusRising said:

Do you notice these symptoms at certain times of the day? Are there times in the day you feel better or worse? What time do you take your medication?

@LotusRising I take my medication at 8am every day. At the moment the symptoms are just constant- perhaps more intense earlier in the day (even before I take my meds) and then becoming less intense in the evening (although sometimes this pattern flips and I have an intense evening). 

 

On 3/2/2024 at 2:59 PM, LotusRising said:

If you're correct about your weights being off since December, this means you've  been at this dose since for about 3 months with no improvement?

Yes, no improvement -  if anything the symptoms are getting worse. I didn't have this constant akathisia like I have now. 

[LotusRising]

Hi @medfreeoneday

 

Sorry for the lag in response. I'm just speaking to the team to get their input. 

[medfreeoneday]

@LotusRising Thanks 

One other thing I would add is that I have window days (like today) occasionally. Say once or twice every week. I'm happy to do a daily log of my symptoms if needed.

 

 

[LotusRising]

On 3/4/2024 at 8:55 AM, medfreeoneday said:

One other thing I would add is that I have window days (like today) occasionally

This could potentially mean you're starting to stabilize at this dose, but I can't say for sure. I see there are two options: one would be to continue holding in hopes that you' might be stabilizing. The other would be to make a reduction, since the symptoms you're experiencing could indeed be related to a kindling response. 

 

I'm sorry I can't give you a more definitive answer.

 

I would definitely try to avoid benzos if you can. I realize they can be a lifesaver sometimes, but they can lead to physiological dependence in a very short period of time so please tread carefully.

[medfreeoneday]

Thanks @LotusRisingI'm leaning towards this being a kindling response so I am going to cautiously reduce my dose.

[LotusRising]

This sounds like a good decision. Please keep us updated.