anse: can I still restart my SNRI so as to taper properly?

[anse]

Hi friends!

 

I am a 24 year old male. I had been using Venlafaxine XR 225mg capsules for around a year and a half ( July 2017- April 2019). I'd started Venlafaxine for my chronic fatigue which was thought to be depression (it most probably was).

Other drugs I used:

-Pre Workouts(PW): Mix of Caffeine, PEAs, and a variety of nootropics. I used these almost daily to try to stay awake. They helped me enormously with school and social life; to the point that I got psychologically addicted.

-Modafinil(rarely): Best antidepressant I've ever felt in my life when it was combined with the Venlafaxine. Not stimulating like the PWs, just made me feel completely normal.

- 4 LSD trips over 1 year

 

In March of this year I had decided that the Venlafaxine had not been having any major positive effects and that I was better off stopping it. Together with my psychiatrist we decided to taper off of it. At the time I didn't know about the importance of proper tapering and neither does my psyhiatrist. Her plan consisted of reducing to 150mg for 2 weeks and then 75mg for another two, after which I went down to 0. I had the classical 1-2 weeks of acute withdrawal with the brain zaps, nausea, depersonalisation, derealisation, extreme depression and anxiety etc. Followed by this I went through about 2 weeks of what I would consider complete normality and I thought I was out of the woods. Following those 2 weeks it got really bad.  I got severe parestethias, numbness, extreme fatigue, anxiety, lack of concentration. 

 

Over a period of 1 month I failed 3 exams in med school. I was trying to keep myself focused and alert with the PWs and Modafinil but I seemed to be hyper-reactive to them. Sometimes they worked really well but sometimes they gave me this intense head pressure where I could theoretically see but it was more like a brain and "eye" fog. Before the withdrawal, and before every taking Venlafaxine, my tiredness, or low mood, or anxiety could be temporarily fixed by taking PW. I was not getting any of the functional use anymore. Since then, I've been getting waves of this sort of state, with waves of feeling "better", but I haven't felt close to how I used to feel on Venlafaxine since, or even before starting Venlafaxine. In other words I'm doing worse now than before starting the VF. In the worst parts of the wave I can't even take caffeine anymore without getting head pressure and a sense of overstimulation. Before all this it was like I didn't even have a threshold for how high I could go with stimulants without adverse effects, but now I take 1/4-1/8 of what I used to, and even that's risky. I'm not looking for the "rush" again, I'm just trying to be as transparent as possible with how my body reacts.

 

For my last exam in July, I had a 3 week period where I took Wellbutrin IR 150mg so I wouldn't fail again. It seemed to help bring me a bit closer to stability, but again nothing like before. On Jul 5th I quit Wellbutrin cold turkey. As far as I can tell I've had no withdrawal symptoms at all. 

 

Nowadays I try maintaining stability by Meditating, taking Mg Glycinate( 400 - 800 mg ) and Fish Oil. I've also had another 2 LSD trips and one Mushroom trip. All of these have helped me with accepting my symptoms and powering through the day. I'm still taking low doses of PW to get any sort of semblance of energy and focus through the day. 

 

However, I'd ideally like to reinstate VF so I can taper properly and be stable. These symptoms are very disruptive and I'd love to go back to any semblance of my old stable self. Would it still make sense for me to try reinstating something like 37.5mg or 75mg Venlafaxine now and starting tapering? Is my only other option waiting it out? Sorry for the long block of text. Any advice is appreciated.

[Sassenach]

Hello Anse, welcome to SA.

 

This site is run by volunteer Adminstrators and Moderators.

We have an increasing workload and would appreciate your co-operation with requests for info.

 

I am sorry you are having such a rough time, we will try to help.

Could you please complete your drug signature by clicking on the small arrow ( top right) next to your name and going to account setup.

Include all dates, drugs, doses and supplements including caffeine .

Difficult I know but as you have a complex history it will enable Mods to see you history at a glance. It will appear beneath every post you make.

23 hours ago, anse said:

Caffeine

Was this coffee or supplement?

 

23 hours ago, anse said:

PEAs

What are these?

 

You are in W/D (withdrawal ) from a cocktail of drugs and supplements

23 hours ago, anse said:

As far as I can tell I've had no withdrawal symptoms at all

You were already in W/D from the Venlafaxine.

We do not usually recommend reinstatement beyond 3 months of stopping the drug.

After this period success is less likely.

You did however have the three weeks on Wellbutrin which may change the situation.

It would take one of the more experienced mods to evaluate that.

Below are some links that will help you understand the process of withdrawal.

about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

the-windows-and-waves-pattern-of-stabilization/

derealization-or-depersonalization-dr-and-dp/

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

please-put-your-withdrawal-history-in-your-signature/

Please do not reinstate without contacting us for further info. specific to your case.

 

Again, welcome to SA.

 

Sassenach

 

 

 

 

[anse]

Hi again!

 

Caffeine was used in the form of preworkouts( supplements). PEAs are Phenethylamines, that are structurally similar to Amphetamines, but with a higher safety profile. 

 

If it's not worth it to reinstate the Venlafaxine, would it be worth it to try another antidepressant to ease out of this period and then properly taper out of that one? It would be pretty disheartening to know that I'm stuck with the paresthesia, brain fog, head pressure and others for years and I'd be really eager to try alternatives. I was also wondering what the best studies/ articles were explaining the long withdrawal process. It's very difficult for me to organise logistically with my psychiatrist seeing as she believes withdrawal ends after 1 month max and anything after that is the depression coming back again.

 

Thanks so much for your guys' help!

[Sassenach]

@Altostrata, @Shep

 

Hello Anse

 

" she believes withdrawal ends after 1 month max and anything after that is the depression coming back again. "

That is all that most in the medical profession know about withdrawal.

 

5 hours ago, anse said:

I was also wondering what the best studies/ articles were explaining the long withdrawal process.

Unfortunately because of the above there are a lot of theories and misinformation on the web.

It is worth looking around this site but there have been no independent, properly run medical trials carried out so evidence is anecdotal.

I will refer this thread to senior mods as your interim Wellbutrin and stimulating supplements, complicate the issue of reinstatement.

That does not mean it is impossible, but needs wiser heads than just mine.

 

Sassenach

 

[anse]

Thanks for getting back to be and helping out  

[Altostrata]

On 8/23/2019 at 11:27 AM, anse said:

....

Over a period of 1 month I failed 3 exams in med school. I was trying to keep myself focused and alert with the PWs and Modafinil but I seemed to be hyper-reactive to them. Sometimes they worked really well but sometimes they gave me this intense head pressure where I could theoretically see but it was more like a brain and "eye" fog. Before the withdrawal, and before every taking Venlafaxine, my tiredness, or low mood, or anxiety could be temporarily fixed by taking PW. I was not getting any of the functional use anymore. Since then, I've been getting waves of this sort of state, with waves of feeling "better", but I haven't felt close to how I used to feel on Venlafaxine since, or even before starting Venlafaxine. In other words I'm doing worse now than before starting the VF. In the worst parts of the wave I can't even take caffeine anymore without getting head pressure and a sense of overstimulation. Before all this it was like I didn't even have a threshold for how high I could go with stimulants without adverse effects, but now I take 1/4-1/8 of what I used to, and even that's risky. I'm not looking for the "rush" again, I'm just trying to be as transparent as possible with how my body reacts. 

 

For my last exam in July, I had a 3 week period where I took Wellbutrin IR 150mg so I wouldn't fail again. It seemed to help bring me a bit closer to stability, but again nothing like before. On Jul 5th I quit Wellbutrin cold turkey. As far as I can tell I've had no withdrawal symptoms at all. 

 

Nowadays I try maintaining stability by Meditating, taking Mg Glycinate( 400 - 800 mg ) and Fish Oil. I've also had another 2 LSD trips and one Mushroom trip. All of these have helped me with accepting my symptoms and powering through the day. I'm still taking low doses of PW to get any sort of semblance of energy and focus through the day. 

....

 

Welcome, anse.

 

As you're aware, you had acute withdrawal syndrome from going off venlafaxine and now you have post-acute withdrawal syndrome (PAWS).

 

Typically, symptoms of PAWS come in waves relieved by windows where you feel better.

 

We see people with PAWS are very frequently hypersensitive to all kinds of psychotropics. PAWS means your nervous system has been destabilized by withdrawal. Any psychotropic, prescribed or not, may have unexpected effects, including causing further destabilization. Many of them, such as LSD and MDMA, are serotonergics.

 

Because you've taken random drugs since going off Effexor in July, t's hard to tell whether your current symptoms are from venlafaxine withdrawal or have been compounded by adverse reactions to the other drugs.

 

I gather you have a nootropic cocktail, PW, that you take every day. To figure out what's going on, please keep PW constant (at the same time each day) and take daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. You can post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

Please include your sleep pattern. What is your usual sleep schedule? Do you stay up late on the computer?

 

We probably will need at least a week's daily notes before we can see your baseline pattern.

 

 

[Sassenach]

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 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 (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

In this format please Anse.

Edited August 27, 2019 by Sassenach

[Rhiannon]

 

Don't know if this explains the long withdrawal process but it does at least acknowledge it, which you may find useful. 

 

I've written on here quite a bit in the past describing my hypothesis about how taking drugs that affect neurotransmitters will cause the brain to try to regain homeostasis by remodeling itself around the "shape" of the drug, like a plant growing around the shape of a trellis, so that when you remove the drug suddenly, things get pretty messed up.  I think there is a thread about the Horowitz paper in the same section as the one above (From Journals And Scientific Sources) where he acknowledges something of the kind is likely. (You may like Horowitz, as a med student; he's a physician who, like most of them, dismissed the anecdotal evidence of withdrawal, until it happened to him.)

 

I highly recommend reading Anatomy of an Epidemic by Robert Whitaker for a good overview of the development of psych drugs and why physicians have been so dramatically miseducated about them. Robert Whitaker also discusses this kind of neuroplastic adaptation to drugs.

 

Good places to start, at least.

[Gridley]

1 hour ago, Rhiannon said:

shape of a trellis

Rhiannon,

 

Very good to see you back here.  Sorry about the uptick in symptoms.  

 

I use your piece about the trellis in every post about withdrawal.  It is excellent!

 

Gridley

[Terry]

@Rhiannon  I'm on alprazolam (Xanax), but haven't started tapering it yet.  First I have to be finished with sertraline (Zoloft).  I see that you're down to 0.008 Xanax.  I'm wondering how far you have to go before "jumping".  Also, are you tapering several drugs at once?  I would like to do that too, but have taken the advice of mods to do one at a time.

 

Thanks in advance if you choose to answer.

[Gridley]

Anse PM'd me with a question.  I'm posting her question and my response so other mods can see.

 

Gridley,

 

I'm really needing advice with my current situation. (I posted it on my page).

 

A quick summary is: 

unfortunelty took doctor's advice at healthcare to reinstate at 10 mg. 8/15 started. 5 days on 10mg completely felt worst (than before reinstatement)--more amplified symptoms more muscle tightness /headdiscomfort/ headpain. I went down to 5 mg--another 4 days. And still felt really more muscle tightness/head discomfort/ head pain/ still worst. So, 2 days ago I stopped. 

Since stopping I'm still feeling those symptoms and the effects of those days is still with me.  Truthfully, I feel worst than before reinstatement and it feels like I've almost done more damage. 

 

So, I really want advice to know what's the best direction--with the worsen symptoms I'm feeling---

Is the response my body giving basically a sign that reinstatement isn't going to work for me and that I just should stop and not take anymore medicine b/c it doesn't work with my body (after 4 months off) ?

Or is it possible there still may be a window of reinstatement, but  just the doses were to high?  

 

Also, is it possible the last (week and a half) I could have done more damage that could be permanent--or is likely if I stop and not take anymore I could return at least back to where I was before reinstating?

If you were me, what would you do?

 

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Gridley

Replied: 16 minutes ago

Please post this in your topic so other mods can see.  This is important.  

 

It appears that you you have reinstated too high, not that reinstatement isn't going to work.   That is very probably the cause of your bad reaction.  

 

The window of reinstatement is not firm.  Four months off is not ideal (reinstatement works most predictably within 3 months, but four months is possible.)  It is your decision whether or not to RI.  If you don't, you will need to wait it out until you stabilize.  For some this happens fairly quickly, while for others it can take months or longer.

 

I would recommend that you reinstate at 1 mg and see how the works.  Please keep us updated on how you're doing. 

 

The damage is not permanent.  What we are after now is getting you stabilized on a low reinstatement dosage.

 

Again, please continue this conversation on your thread with @Gridley so I don't miss it it.

 

 

[Giulietta]

Hi Anse. Welcome to SA. I'm a fellow taperer and having about the same symptoms you described yesterday and today. From my experience it takes time to stabilize after too quick a drop - about 1.5 months. I am moving down about 10% a month - I'm pretty sensitive to meds - and take other neuro meds for another illness. I have not been posting my symptoms according to a schedule like I quoted below - which would help the moderators. I'm doing a better job documenting now. They are really great and I wish I had found SA before I started my taper. I hope you are feeling better soon. 

 

On 8/27/2019 at 1:47 PM, Sassenach said:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 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 (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

[Altostrata]

Hello, anse, how are you doing?

[anse]

On 10/20/2019 at 10:30 PM, Altostrata said:

Hello, anse, how are you doing?

Hi ! Thanks so much for reaching out, it means a lot. Right after posting I went into a very deep "wave" that sort of brought me down to my knees. I had to take a break from even trying to figure out what is going on/ visiting the site/ looking for proper supplementation because it was leading me down obsessive paths and heavy anxiety. I took the time then to accept my situation in its' current form and try and focus on my actual life more. I've actually been way better since then! 

 

As you recommended I've taken my nootropic mix daily around the same hour, supplemented with 1600mg Magnesium Glycinate, Calcium, Fish Oil( 1500mg EPA) daily. Piracetam seems to help also.

I also took the time to observe my symptoms on a larger scale and as far as I can tell windows have been getting larger; waves have been getting more shallow. In fact, I had a couple of days during the last month where I felt 95% of pre-Venlafaxine.

 

I know this goes against site recommendations, but I've since had 2 experiences with magic mushrooms. Obviously I don't condone doing this seeing as everyone reacts differently, but I feel like it's been an absolute huge help in reducing PAWS symptoms. Not only that but I approach the difficult times with a more positive attitude. Usually there is an after effect of around 2 weeks where symptoms are reduced a lot. When they do come back, they're not nearly as bad as they were before. Again, this is 100% anecdotal and I have no idea what the long term consequences are. 

 

I was actually looking for a sort of "form" I remember seeing around here that people would use to track their symptoms and windows/waves but can't seem to find it anymore. I'd love to be directed towards it.

 

Again, thanks for the help and advice

[Sassenach]

Hi Anse

 

Is this it?

dr-joseph-glenmullens-withdrawal-symptom-checklist/

 

Sassenach

 

[anse]

That's it! Thanks so much!!

[Altostrata]

Good to hear you're doing better, anse. It sounds like your recovery is proceeding "normally" for withdrawal syndrome. What are your current most prominent post-acute withdrawal (PAWS) symptoms?

[anse]

Well the worst right now are in no particular order:

 

Pins and needles all over my body: this one mostly comes on at night, makes me highly irritable and doesn't let me meditate/ fall asleep

Veritgo that evolves into brain zaps depending on how intense it is

Horrible eyesight( this one actually comes and goes. I can be seeing perfectly one day, seeing tracers or moving letters the next) 

Horrible sleep( waking up 2,3 times a night; night terrors)

Depression ( although this one just feels like my baseline depression and feels like childs play compared to withdrawal- very easy to manage)

Fatigue and weakness/ GI symptoms

 

Here's some stuff that's gotten way better:

Anxiety- I no longer obsess about my health. I've accepted my situation as is. I know when to act and when to let go

Derealisation/Depersonalisation: These with anxiety bother me the most. Recently I've been feeling like I'm actually inhabiting my own body and that my personality is coming back. The world and things around me have started feeling real again

Head pressure/ Tight cervical muscles: Almost completely gone since I've been wearing a corrective mouth guard all day given to me by my orthodontist

 

If anyone has any idea how to manage the eye sight/ paresthaesias I would be so happy. Antihistamines seem to barely touch it. If I've forgotten anything ( and I'm sure I'll have, I'll come back and edit the post)

[Altostrata]

Hello, @anse, how are you doing?