Lb11: Effexor and Prozac

[Lynnardgirl]

2 hours ago, Altostrata said:

Nobody said anything about serotonin syndrome.

 

 

 

The sensation you call "depression" and then enlarge upon it by worrying about it is likely a normal effect of taking antidepressants. Your occasional drinking probably exacerbates the adverse drug effects.

 

This is a site for going off drugs. We do not treat "depression". If you think you need drugs for depression, continue to see that psychiatrist. If you want help reducing or minimizing your drugs, we can answer your questions.

 

It could possibly be (I personally think that it is highly likely) serotonin syndrome from taking both Effexor and Prozac.  The only way to treat this is to reduce the drugs.  It is best to only reduce one drug at a time
From one of the Moderators! Above 

She is just sacred and  wants to know if she does do the bridge if that would be better ! 
she never had depression before the drugs ! 
She stop doing the bridge because everyone told her to wait until she stabilized 

[Lb11]

yes someone did mention serotonin syndrome in the previous comments. I was never depressed before I began effexor and since I cut back I’ve been really depressed. I bridged and added Prozac and was going to taper the effexor after I stabilized but since I have not stabilized I’m wondering if I need to go up on the Prozac and then maybe I’ll stabilize and taper? I know no one knows exact answers. I am just very unsure and ultimately I would love to be off all of this medication. I’m not happy about bumping the dosage but I’m just trying to figure out the best and safest way I can stabilize and finally get off of this stuff 

[Altostrata]

I believe I already covered this:

 

On 10/27/2019 at 10:00 AM, Altostrata said:

I agree with Erell, even a small, very normal amount of alcohol will trigger an upset in a person whose nervous system has been sensitized by withdrawal.

 

If you don't drink alcohol -- not even a little bit -- my guess is you'll stabilize from the Effexor reduction without complications. It could be that adding the Prozac was unnecessary.

 

That leaves you on this Effexor-Prozac combination. Here are your choices:

 

- Effexor can be difficult to taper, doctors often substitute Prozac because it's somewhat easier to taper. (But your doctor forgot to get you off Effexor.)

 

- Generally, doctors should never prescribe an SNRI, such as Effexor, with an SSRI, such as Prozac, the combination can be too stimulating. So taking the two drugs together is probably not a good long-term plan. Besides, you're not seeing any benefit from the combination.

 

- You've been taking Prozac for less than a month, your risk of withdrawal from that is theoretically lower. Theoretically, you could gradually go off Prozac over a few weeks, then taper Effexor more slowly using bead-counting Tips for tapering off Effexor (venlafaxine)

 

BUT, you might find backing out of Prozac is not that easy, your nervous system has become accustomed to it.

 

- However, you might want to complete the switch to Prozac to go off Effexor, then taper Prozac. Tips for tapering off Prozac (fluoxetine) This means a fast taper off Effexor. Again, you may find this difficult even if you're taking Prozac.

 

I cannot predict the best route for you. What you need to do for now is not drink at all or do anything else that will rock the boat for a week, let your nervous system settle down. Keep daily notes of when you take your drugs, their dosages, and your symptom pattern in this format Keep daily notes of drug schedule and symptoms to track patterns and progress

 

Please let us know how you're doing.

 

You may notice that the option of increasing Prozac was not included. This is because if you are having an adverse reaction (short of serotonin syndrome) from the Prozac-Effexor combination, increasing Prozac could make it worse. That would be the opposite of stabilizing.

 

If your "depression" occurred after you started Effexor, it is a reasonable assumption it was caused by Effexor (possibly in combination with alcohol). If it's gotten worse as you've gone up and down with your drugs, you can assume going up and down with your drugs (and possibly alcohol) has upset your nervous system further.

 

I asked for your daily symptom pattern 7 months ago to see if your symptoms were caused by the drugs. Still have not seen your daily symptom pattern. I can't tell if Effexor is causing problems or Prozac is causing problems. I have nothing to add until I see that daily symptom pattern.

[Lb11]

@Altostrata @ChessieCat

Night before tossed and turned. Slept from 11pm -8:30 am

6/16

8:30 am woke up anxious 

Felt some anxiety before meds. Not too bad

9-10:30 felt ok, ate breakfast 

10:40 took Prozac 10mg effexor 37.5 mg

12-3 little anxiety 

3:30-5:30 bad anxiety

6-8 pm felt depressed 

8:30 -10:30 Some anxiety but not as bad- seem to calm down more at night and feel better

 

11:30 pm  slept good 11:30- 9am

6/17 woke anxious and depressed 9 am

10 am calming down some eating breakfast 
10:35 took both meds 

[Altostrata]

In my opinion, one or both of those drugs is causing anxiety in the afternoon. Which do you want to taper?

 

As I said before, Effexor tends to be activating, but Prozac can be too. If I were you, I would go off Effexor first, completing your switch to Prozac, which would probably be easier to taper off later.

 

We don't treat "depression" here, you'll have to cope with that as you get your drugs straightened out. My guess is it's caused by some life circumstance you might work with a psychotherapist to change.

[Lb11]

So you don’t think the “depression” is due to withdrawals? Like I said I never have had depression until as soon as I changed my dosage. I am currently on 20 mg of Prozac since June 17 and 37.5 of effexor still. So do you think it would be good to taper effexor?  

[ChessieCat]

You've been taking both Effexor and Prozac since September last year.

 

Q:  Did the "depression" start after starting the Prozac at 10mg or after you increased the dose to 20mg?

 

It may be related to taking 2 antidepressants.

 

Please update your drug signature with the date and dose for 20mg Prozac.

[Lb11]

Ok, I just updated it. And no the depression was before Prozac at all. The depression began 3 days after I cut my effexor dose in half and I’ve had the depression ever since. I only added Prozac hoping it would give some relief but it hasn’t much. The depression comes and goes randomly. And seems to without reason 

[Altostrata]

17 hours ago, Lb11 said:

Ok, I just updated it. And no the depression was before Prozac at all. The depression began 3 days after I cut my effexor dose in half and I’ve had the depression ever since. I only added Prozac hoping it would give some relief but it hasn’t much. The depression comes and goes randomly. And seems to without reason 

 

Yes, this sounds like a withdrawal symptom. Can you describe this "depression" in more detail?

[Lb11]

The “depression” feels like I will be fine then out of nowhere I’ll just start to feel really really upset and unhappy- kind of emotional too and sometimes I can pull myself out of it sometimes I can’t. It’ll happen randomly during the day even at times when there’s nothing to be upset about. I’ll start to feel worked up and I just feel really miserable. Then it’ll go away and I feel fine again. Sometimes it’s kinda like a mood swing almost. But then I’ll have days where it doesn’t happen at all. It’s very random and only started when I changed my dosage 

[Altostrata]

That sounds like a drug-related symptom. Does it feel like a surge? Does it happen at any particular times of day? How did your symptom pattern change after you increased Prozac to 20mg in June?

 

You are still taking a combination of antidepressants that is not recommended.

 

Do you take any other drugs? Drink caffeine? What is your drug schedule, with times and dosages?

[Lb11]

No I don’t not take any other drugs. Yes I drink coffee every morning. I take my meds at different times depending on if I’m working that day or not.  I work 3 days a week so those days I take both meds (Prozac 20mg and Effexor 37.5mg) at 6:40 a.m.  the four days a week I’m off I take both meds around 9-10 after I’ve woken up and ate breakfast. And I guess it can slowly feel it start happening then it’s like a surge. Just hits me and I feel miserable. Usually it takes a couple hours after I wake up to start feeling bad. Most mornings I wake up feeling fine. Maybe 5 Hours after I take meds I feel bad. But like I said, it varies. Sometimes I have a good day and don’t feel bad at all. Sometimes I feel bad most of the day. But it usually does hit like a surge I guess out of nowhere. Feels overwhelming. And I know I am taking two meds not recommended together but honestly I am very afraid what to do next to get off of one. I am afraid it will get even worse if I try to taper again. But I know I need to get off. I just don’t know the safest way. I swear I know I was never anything like this even a year ago. Never even slightly struggled with depression and was a happy person now I feel crazy honestly 

[Artistic1]

@Lb11 Hi. I've been reading your thread. I know the fear about tapering and the fear of not knowing how you will feel when you do. That fear is stopping you from taking the first step. You cannot possibly predict what will happen. What if you feel a whole lot better? That could happen, too. I was scared, too, but I just decided I wanted off the Zoloft and back to my normal life. You want that, too, and the only way to get there is to take the first step.

 

If you are prepared with the knowledge that yes, you may have some side effects, but also the knowledge that they don't last forever, then you can do it. Coping skills with therapy can really help, and your psychiatrist should be able to help you find the right therapy. I couldn't be doing my taper without Cognitive Behavioral Therapy. 

 

Stop thinking about the depression coming and going. Now that you know you have a cycle of those, you can get through them when they happen. I know my cycles, and after months of dealing with them, I know how to ride them out. I don't like them, but I've stopped fearing them.

 

Your psychiatrist has already recommended you start a taper with Effexor. GO FOR IT! But do it slowly until you know your reactions to the reductions. All the information you need to do it is on this group. FYI:  I do a 10% taper as recommended on this site. I don't do it all at once....I lower my dose slowly over 2 weeks. Then I hold that dose for 7-8 weeks. This allows my body plenty of time to adjust and heal. If you start really slowly, your body will tell you what you can handle. Then you can make adjustments.

 

Best of luck.

 

[Lb11]

Thank you. I needed that encouragement. I do think I should go ahead and start tapering effexor. I want to do it very very slowly at first like you said and make sure I’m taking enough time. I do think I’ll feel much better one day off this drug 

[Altostrata]

58 minutes ago, Lb11 said:

I take my meds at different times depending on if I’m working that day or not.

 

This is not a good idea! It may very well be what's causing your symptoms, particularly the variation in Effexor schedule. Why did you increase Prozac in June?

 

Please take your drugs at the same times each day. If I were you, I'd take the Effexor first, to see what it does, and take Prozac several hours later. Taking them together also confounds your symptom pattern. Separating them will allow you to understand what's happening as you reduce Effexor.

 

Please stay on schedule for a week before starting to reduce Effexor. Please let us know how you're doing in that week.

[Lb11]

Okay I will start taking meds at the same time every day. And I will try to start separating when i take them too

Do you think it’s okay if I still have caffeine?

also I was thinking you were asking about antidepressants if I was taking any more drugs but I also take Prilosec- for heart burn and also take birth control

dont know if that matters but i was gonna add if it does 

[Lb11]

Also do you think I am not stabilizing since I’m on both Prozac and Effexor? Or just still withdrawals 

[Lb11]

I added more Prozac to see if it would relieve the depression.

[Lb11]

@Altostrata

[Altostrata]

I cannot answer questions without context. I need to know your drug schedule for the last week. When did you make changes? List each day on a line.

 

Also, if I were you, I'd stop fiddling with the drugs. When I said keep to the same drug schedule and dosage each day, that's what I meant. It can take at least a week for any drug change to take full effect. With Prozac, it's several weeks. You might have increased Prozac unnecessarily.

[Lb11]

Since last Saturday 8/1 I have taken both medicines (Prozac and effexor) at 10 am everyday. I have had a slight window for 2-3 days this week but started feeling some depression again yesterday and today. I would take one med later than the other but at work I am very busy and don’t think I could find time to effectively do this. Im running around all day at work and doing different things at different times. But I make sure to find time to take at 10 each day 

[Lb11]

I was planning to start my taper tomororw 

[Lb11]

@Altostrata

[Erell]

How are you feeling currently ?

 

[Lb11]

Same as I have been. Random periods throughout the day of moods swings/ depression 

[Lb11]

@brassmonkey hello, I am planning to start my taper of 37.5 mg effexor tomorrow. I was only going to taper 2.67 percent (1 mg). A friend on the forum told me to reach out to you first for steps on how to safely taper. She said you know a lot about the taper system. I am planning to use a scale to taper and I have the capsule with the beads inside 

[brassmonkey]

Hi Lb-- I'm so glad you're starting your taper, it's a good decision to make. If you are tapering Effexor with the beads in the capsule then your scales won't be a lot of help because the beads are hard to crush and break into smaller pieces. You are in luck though, one medium bead just happens to contain about 1mgai (milligram active ingredient) of medication. So reducing by 1 bead will be about the 2.67% you are planning.  This method will work well until you get down to the 10mgai dose level, then there are some adjustments that need to be made. Please be aware that this is a linear taper so each reduction is getting a touch bigger percentage wise. By the time you get to 10 beads or 10mgai you will be doing a 10% reduction each time. The thing is to pay attention to how you react to each reduction and adjust the hold time accordingly or possibly consider switching to a liquid taper so you can continue to make smaller reductions.

 

For right now this is a good plan.

[Lb11]

Thanks for this great info. How will I be able to precisely calculate each taper if I can’t weigh it while I’m removing beads? The first one I understand will work because I can just take out a medium one but what would you suggest after that. I want to make sure I am being as precise and accurate as I can 

[Lb11]

I am getting confused on the tapering/ scale process. I read on the forum to take the average of the beads in however many capsules and divide and that is your average capsule. So this morning I took 5 capsules and weighed the contents of the beads and got an average of 107.8. Since I am only tapering 2.67 this month I multiplied 97.33 percent by 107.8 which means I should be taking 104.9 mg to have a 2.67 percent reduction. This confuses me though because what do I do for example when I have a the amount of beads in a capsule that weighs below this average like a 102 mg? I then do not know how to accurately reduce because it will not be the same weight as the average? Or should I simply for the time being just take one medium sized bead out of every capsule? I apologize for so many questions I just want to make sure I am doing this the way it is supposed to be done so I can safely get off this med. Thanks for all the help. I really appreciate it

@Altostrata @brassmonkey

[brassmonkey]

There are two primary methods for tapering capsules with beads. Reducing dose weight by a percentage and counting beads.

 

Reducing the weight of the dose by a percentage is done just like you calculated. The variations in the weight of individual capsules cancels out after the initial reduction because you are then working to a specific weight for each reduction not an average weight. the pile of beads from the capsule now become a stockpile that you take a specific weight from. The big drawback is that the weight of the beads often doesn't correspond evenly with the desired dose weight. So the number of beads needs to be rounded. It does, however, give a hyperbolic reduction which is preferred.

 

Bead counting is just that. Counting the number of beads that make up the dose. Many people do it by counting the beads removed from the dose, which is less accurate because of the different number of beads in a capsule. The more accurate way is to use the average number of beads in a capsule and determine how many beads you need to take and count those. The reduction can be made by decreasing by a percentage of the total or by a set number of beads. Using a percentage is preferred because it gives the hyperbolic taper. Decreasing by a set number of beads gives a linear reduction that increases the size of the reduction each time and will cause too large a reduction very quickly.

 

Both weighing and bead counting are good methods of tapering if done correctly. It's up to you as to which you feel more comfortable with.

[Lb11]

So you are saying if I had five capsules worth of beads I should pile them all together and then separate them to each weigh 104.9?

 

[Lb11]

I prefer to weigh, I want to be as specific as possible. Also I feel like I have never stabilized in the past year since I have went from 75 mg to 37.5 mg.... why do you think this could be. I’ve been trying to stabilize for a year and now I’m just trying to slowly taper since I can’t stabilize. I am wanting to go so slow and precise since I already am not stabilized and am taking more out I don’t want to get even worse. I don’t understand what the cause of the continued depression is though because like I said I was not depressed before this med and I have been ever since the dose change. I was only on this med for 1 year and I am only in my early 20s- have never taken an antidepressant before this so I thought I would stabilize fairly quickly. I haven’t been the same since making my first dose change last year and it worries me this is permanent. Again sorry for so many questions there is just so much about withdrawals I truly don’t understand and wish I knew what was going on and why so I felt like I at least had some control on things. 

[Altostrata]

On 8/17/2020 at 5:16 PM, Lb11 said:

Same as I have been. Random periods throughout the day of moods swings/ depression 

 

Are you taking drugs for anything else? What times of day do you take your drugs? It's important to take them consistently.

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

[Lb11]

I posted daily symptom pattern on June 17 but I can make another one if you’d like. Also I take all my medications at 10 am consistently now each day including the Prozac 20 mg, Effexor 37.5 mg, then a heart burn medication called Prilosec 20mg, and a birth control pill called Nikki. I take all 4 pills at the same time 10 am each day. Also I can do a daily symptoms pattern but the last few days I have been feeling pretty good and very little symptoms (thank goodness). Usually when I do have symptoms it starts around 1/2 pm and goes through the afternoon. Mornings are usually good. Afternoons into evenings are usually the worst time and night time I usually feel better. But sometimes those symptoms don’t come at all some days and sometimes I can feel depressed the majority of a day. But I would say a typical day is mostly just afternoon. Sorry for my vague examples. But if you want to read the post on June 17 I tried to keep it specific that day with my patterns 

[Lb11]

So I can add a big pile of the beads from for example 10 different capsules and just divide them all into 10 desperate doses of 104.9? Is that what you’re saying @brassmonkey

[brassmonkey]

That's what I'm saying. I use the standard rules or rounding for the partial beads, but some people always suggest to round up.  So your 104.9 becomes 105.