Pinchy vs. Trintellix Dependence - introduction

[Pinchy]

Hi. 

 

I am a 39 year old female with a history of major depression, anxiety, agoraphobia, excoriation disorder, PMDD, and PTSD. 

 

Took Zoloft from 2014 thru 2018. Switched to 20mg Trintellix in March 2018. Had two suicidal episodes in Feb 2017 and Feb 2018 (2nd prompted the switch).

 

Trintellix helped greatly with anxiety,  suicidal ideation, motivation, and cognition. Had mild GI discomfort for 1st few weeks that resolved with taking the med before bed.

 

Fatigue and emotional blunting became noticeable in Summer 2019. Fatigue got significantly worse until I noticed that I forgot to take the medicine for 5 or 6 days in a row in early November 2019. I was falling asleep on the couch night after night and unable to take medicine, bathe, or do basic self care after 8pm.  Also had brain fog that was impairing my functioning (was preparing to move house, ugh) and the diminished emotional range became distressing. Either the drug had pooped out or the side effects were mimicking my condition; idk & idc, it was time to try and get better.

 

Resumed med on 6th or 7th day, but a half dose of 10mg, since I had already passed the half-life and any mild withdrawal symptoms (flu-like symptoms and irritability) came and went.

 

Fatigue improved somewhat and after about 2-3 weeks I began alternating doses to 10 mg every other day. The fatigue has returned and some days are better than others. Today I am anxious, restless, and befogged. It's hard to get motivated to do anything. This, too, shall pass, is my motto at this point.

 

Searched the internet this week for tapering guidelines and came up short. I would like to continue tapering according to this community's guidelines of 10% per month. 

 

Trintellix pills are tiny and almond-shaped, which makes them supremely unsuitable for tapering. Altering my daily dose will mean either pulverizing, weighing and portioning, or pulverizing and dissolving in vodka. Scales that measure to 0.001 g are affordable but my (VERY limited) science background tells me that these measures will only be reliable for amounts above 10 mg because of the uncertain digit principle. 

 

I am at around 3 weeks since moving from 10 mg per day to 10 mg every other day, and I'm not sure what to do next. Keep on my alternate dosing schedule, or resume daily dosing at something like 6 or 7 mg? 

 

A year or more to get from 10 mg down to 0.8 mg seems incredibly daunting, but still better than risking withdrawal syndrome, so I'm committed to letting time take time.

 

Any advice is greatly appreciated, especially with regard to dividing the stupid 20 mg pills safely and accurately. 

[Gridley]

Welcome to SA, Pinchy.

 

We don't recommend tapering by alternating doses.  It causes the amount of the medication in your bloodstream to go up and down, battering your nervous system, and makes withdrawal worse.  As you've read, we recommend reducing by no more than 10% every four weeks.

 

Why taper by 10% of my dosage?

 

The following link gives specific instructions about dividing the pills to get the small non-standard doses you'll need for your taper and methods of tapering (weighing, liquid, etc.).

 

Tips for tapering off Trintellix (vortioxetine), previously called Brintellix

 

If you choose to use the scale, many members use the AWS Gemini-20 scale, available on Amazon.  It is accurate to 4mg pill weight.  Because much of the pill is inactive filler, the scale is accurate to a much lower amount of active ingredient. 

 

Using a digital scale to measure doses

 

How are you feeling?  Do you feel any different now than when you were taking the 10mg every day?

 

I suggest you delay your taper by one month to allow your system to stabilize from skipping doses.  During this hold, resume your daily dosage at 8mg.  If after a month you are feeling stable, you can begin your 10% taper off 8mg.  Take the same 8mg every day at approximately the same time.

 

Yes, it is sometimes hard to wrap your mind around how long it takes to taper.  But going faster runs the real risk of withdrawal symptoms and the necessity to updose, which ends up taking longer than you would've at 10%.  In other words, slower is faster.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found you way here.

 

 

 

 

 

 

 

[Pinchy]

Thanks for your quick reply!

 

I feel mostly ok and my complaints are small and manageable. The biggest issue is anxiety, and it is pretty transient. This is probably circumstantial and due to being off my routines after leaving a job and moving. I have an Rx for prn Klonopin, but I tend to reserve it for only the severest and most obvious kinds of panic. (I have a profound respect for benzos that borders on fear, so the bottle remains perennially full.) After that are the fatigue/amotivation and the brain fog. This also seems to be intermittent and occurs in brief fits that last a day or two and then improve, so... manageable. 

 

8 mg daily is a good suggestion, thank you!  I need to get back to daily dosing but I dont want to lose my "progress" from the last few weeks and this seems like a good middle ground. It might be a good time to begin transitioning to liquid dosing, too. 4 mg solid, 4 mg liquid to start, maybe? 

 

I hadn't factored in the weight of the actual pill and I have no idea how much one weighs! No wonder I was so frustrated by the tiny pill/inaccurate scale problem. Thank you for seeing clearly into my error. Somehow I totally discounted the inert ingredients. If my algebra skills are still intact, then the dose calculation for 8 mg would look like this, right?

 

(8mg x mass of pill / 20 mg) 

 

Today I am reflecting on some habits that need to change for a taper to be successful. Namely nutrition, exercise, and sleep. The kitchen here at my new place is out of order, so I've been eating for convenience and getting virtually no nutrition. I've quit my (admittedly very gentle) exercise routine completely. My sleep hygiene has tanked. And on and on. I really despise moving. 

 

I know from experience that it's tough to change habits, but it's even harder if you wait until you're in crisis to do so. In this case, time is on my side since these lapses are only a couple months established. Today I will get out my CBT notebook and start picking some small goals to work on for the week, even if I don't feel like it. 

 

Slow and steady wins the race....

 

[Pinchy]

Mod. note (merged introductions)

 

Titled:  Weird Event 3 months into Trintellix Taper

 

I had a feeling today. 

 

I started a new job and am also going back to school this week after being out for MANY years and I am trying to learn a lot. This morning I felt tired and groggy and I was... frustrated? (I think??) about not learning something fast enough on the computer for the job. I mean... it felt bad, but when I noticed that I had dropped a tear I had a moment where I recognized how remarkable it was to feel ANYTHING on that level, I was really impressed. Like, "Oh, look at that! I can still *do* that?!!?!" 

 

It has been so long since I've felt invested in much of anything, and when I have, it involved a monumental effort to make myself care. Even then, my efforts didn't seem to yield much more than a bystander sensation. 

 

In November I reduced my dose from 20 mg to 10 mg, and some smaller shifts have brought me down to 8 mgs.  I plan to start a cross taper, from solid to liquid, later this month, and after a period of stabilizing, continue tapering at a rate of 10% per month.

 

Before today I've had maybe a day or two of anxiety but virtually no unpleasant side effects. 

 

My dreams started coming back in November,  and my fatigue has gradually improved since then. In fact, I started noticing last week how much more energetic I was feeling.  I felt... lighter? And less groggy.  

 

I do still feel pretty mentally sluggish and foggy, but I am starting to remember how bad the fog was some days, so I might still be having cognitive effects or they might be diminishing very, very slightly. 

 

After today's FEELING, I felt pretty moody and sad and even a little self pitying throughout the day, but also really excited at the prospect of getting my emotions back, if that makes sense. And also a little apprehensive, too. What if all my emotions come back before I'm ready to manage them? What if I lose daily functioning again and return to depression? Can I survive if I have to give up my occupational commitments because of mental health issues? 

 

It's not all fear, though. I wanted to come off this drug so that I could live my life more fully and connect better with the people in it. I have hope that some day soon I will also feel the warmth of joy again, or maybe the electricity of wonder at something amazing, or the lightness of laughing for real vs. laughing for social appropriateness. Those things can't exist without a full emotional range and they are a reason to keep learning how to cope with the uncomfortable times.

 

In recovery from alcoholism and drug addiction, addicts talk about a so-called pink cloud during early sobriety, and other different phases of mental and emotional recovery while their bodies and brains heal from chemical dependence. I am starting to see similarities with what we're doing here.

 

I'd love to hear from anyone who has made it to 0 mg about how their emotional and cognitive health recovered during the process of tapering all the way down. 

 

Edited January 10, 2020 by manymoretodays
merged 2nd intro topic with 1st

[manymoretodays]

Hi Pinchy and welcome aboard, @Pinchy

Just one introduction topic per member.  I merged your 2nd one right on back here.  Very helpful to keep all your information in one place.

 

On 12/17/2019 at 11:44 AM, Pinchy said:

8 mg daily is a good suggestion, thank you!  I need to get back to daily dosing but I dont want to lose my "progress" from the last few weeks and this seems like a good middle ground. It might be a good time to begin transitioning to liquid dosing, too. 4 mg solid, 4 mg liquid to start, maybe? 

 

I'll also include our topic specific to tapering Trintellix today:

Tips for tapering vortioxetine/Trintellix

And it looks like you may have found the tapering topic, might be good to have it here now for reference too. 

Now is a great time to look at your options, for further tapering and switching to part liquid might be a great way to go.

We do count changes in formulations as dose change events too.   Sometimes members will experience a few more bumps than usual when doing formulation changes.

 

Might be best, for right now, to just HOLD steady.   Lets give your nervous system a chance to settle a bit more on the daily 8 mg solid dose.  For at least a full 6 weeks, if not longer.  Sounds like you are doing quite well.  Overall.

And I think it might be good to settle into the new job, and school again too,  before going further with the taper, or formulation changes of any kind.  How does that sound to you? 

 

12 hours ago, Pinchy said:

I'd love to hear from anyone who has made it to 0 mg about how their emotional and cognitive health recovered during the process of tapering all the way down. 

Take a look at the Success Stories forum.  Just go to the Home Page and you'll see the heading of Success Stories, about 3/4 way down.

Yes, most do recover cognitive and emotional health, while tapering and after.    You'll be amazed at the non-drug skills that you develop, along the way too,  to cope with anything.

Best,

L, P, H, and G,

mmt

 

Edited January 10, 2020 by manymoretodays