Norseman: a long time coming

[Norseman]

Dear all,

 

This has been put off for all too long. I am a 40-year-old male living in Scandinavia. Over the last twenty years I have been prescribed various SRI’s mainly to counter anxiety that debuted as a major panic attack in my early twenties during a stressful time in my life. It is like this experience opened a door that I have never been able to shut again. The anxiety has been there in varying degrees since that day. I am sure some of it is fueled by the fear of anxiety, but it feels like something broke that day.

 

The switching between different drugs over the first ten years was mainly done to counter side effects like fatigue and feeling like a zombie most of the time, not wanting to get out of bed in the mornings, not being able to keep up any good habits and failing to establish structure in daily life. This has put me out of the job I used to love so much, and I am now on social welfare.

 

The fatigue, flattened/decoupled feelings and the sleep disturbances has been interpreted by the doctors as depression, dysthymia, bipolar depression and so on. I have been in treatment for this over the years, but nothing has been successful over time. I have suggested doing a tapered withdrawal over and over but have always been told to postpone. Well, now I cannot wait any longer. I feel like my life has been put on hold for way to long already.

 

I have been on Venlafaxine since 2012. 75 mg in the beginning. The anxiety was somewhat held in check, but I felt like a zombie. The only thing that would momentarily burst me out of this bubble was drinking some beers on the weekend. (Dopamine?) The dosage was increased to 150 mg to activate the noradrenergic component of the SNRI. I ended up in the Emergency Room with an ECG due to the feeling of unregular hearth rhythm.

 

A blood test revealed that I have a CYP mutation that makes my liver metabolize more of the active compound than the average, so 37.5 mg for me might be a normal maintenance dosage.

 

Over the last eight years I have been varying the Venlafaxine dosage between 75, 50 (removing beads) and 37.5 mg. Sometimes up to counter increasing anxiety, then down again to try to counter the side effects. In 2017 I was determined to taper off and I asked for a switch to Citalopram that I weaned off two times before several years ago.

 

The switch was done directly replacing 37.5 mg Venlafaxine with 10 mg Citalopram. It felt like a shadow had been lifted and my energy levels increased severely. After a few days, the anxiety really set in. After four weeks, the dosage was increased to 20 mg and the anxiety decreased but I mostly laid in bed. A week later the dosage was decreased again to 15 mg, but I felt even more depleted. The doctor concluded that I had to low levels of serotonin and recommended to switch and back track to Venlafaxine steady state. So, I did.

Thinking there is never really the right time to go through a tough withdrawal, I started reading up on the subject now. My wife is very supporting, and we agree that the lingering questions we have had over the years, asking how much of my troubles are due to side effects of SRI’s needs to be answered.

 

Googling a transition to Fluoxetine (Prozac) for the longer half-live and an easier(?) withdrawal led me to this forum. If I ever forget to take the Venlafaxine one night I get electric zap's and nervousness around noon the next day.

 

 I am a bit overwhelmed now by all the information, the stories of people still in recovery for several years after their last dosage and to be honest I am really scared.
 

[Gridley]

 

Welcome to SA, Norseman.  We're happy to help you with your taper.

 

You mentioned a transition to Prozac from Effexor.  As the following link states, there are risks associated with a switch or bridge and unless a member is finding it impossible to taper their original drug, we recommend tapering their original drug.  Please read the following link.

 

The Prozac switch or "bridging" with Prozac

 

We recommend tapering by no more than 10% of your current dose every four weeks.  

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Effexor.

 

Tips for tapering off Effexor (venlafaxine)

 

 

We don't recommend varying doses to counter symptoms.  Your central nervous system needs a stable dose.

4 hours ago, Norseman said:

I have been varying the Venlafaxine dosage between 75, 50 (removing beads) and 37.5 mg 

 

 

We don't suggest 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 oil)

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

[Norseman]

Thank you so much Gridley. After reading up on the recommendations I will try to do the tapering without a switch. I will follow the recommended 10% dosage reduction every 4 weeks with 10% calculated on the last dosage.

 

Can you have a quick look at my calculations?

 

--------------------------------------------------------------------------

My calculations are based off on 37,5 mg depot capsule Venlafaxine as the starting dosage:

 

Counting beads in 10 capsules gave an average of 139 beads.
One bead must then be: 37,5 mg / 139 = 0,270 mg

10% reduction of the original dosage: 37,5 * 0,9 = 33,75 mg

 

X equals the new number of beads:

0,270 X = 33,75 mg 

X = 125

--------------------------------------------------------------------------

 

I have started 50 mg of magnesium looking to increase this as I hopefully get accustomed to them. I have also bought an Omega-3 supplement but holding off for a week to see how I tolerate the magnesium.

Parallel to this I'm working on my sleep schedule and being moderately physically active by doing 20 minute walks in the mornings as a start.
I want to take up Mindfulness as well, but now that I'm writing this I can see that maybe I'm throwing to many balls up in the air, so this might come in later.

 

I will try to keep you posted.

Thanks again Gridley.

[Gridley]

@Norseman

 

I think you've made a good decision about the switch.

 

Math is not my strongest suit, but it looks like your calculations are correct.

 

You are doing everything right regarding the supplements.

42 minutes ago, Norseman said:

doing 20 minute walks in the mornings as a start.

That's excellent.  

 

Please keep up updated as is convenient to you.

[Norseman]

About seven months into my taper now. I've not been very active here at the forum, but it's time to seek some of your support again. More than once my writing has never made it to an actual posting. Always getting stuck in fiddling with words and grammar as English is not my primary language. A bit of OCD there.

 

So, the last months have been challenging, with both ups and downs. For withdrawal symptoms, I tend to feel an increase in anxiety about a week after tapering, mostly lasting three or four days. At the same time I can see changes in mood that has happened more gradually. My tendency of worrying has gotten quite worse. I worry about my health, my wife’s health, my kids health, social relations, the future, you name it... But also I have had days where I don't feel as emotionally decoupled/flat. I've been able to cry from sad and upsetting things, also feeling emotionally moved from music, books and movies.

 

This autumn has been though. Feeling flat, indifferent, fatigued. Sleep has never been worse. Here in Norway the days are surely getting shorter during these autumn months, and I guess seasonal affective disorder (SAD) could be playing it's part. The reduction in the SRI probably makes me more vulnerable now. Yeah, those vitamin D stand there in the kitchen cabinet but I just can't seem to remember to take them in this fog.

 

I try to keep a shortlist to maintain focus. I call this my KISS list (keep it simple, stupid):

 

1. Physical activity. I've been able to do an hour walk every second night. But raising heart rate and shortness of breath triggers anxiety, so I've been increasing the pace slowly of time.

 

2. Sleep. I have a really disturbed relationship with sleep now, and just thinking of going to bed makes me anxious. It's difficult to calm down at night and actually break loose from what I'm doing. Often I'll be lying in bed for at least two hours before falling to sleep. And then it's very hard to get out of bed the next day. It's like I'm lying there in a daze, just not fully waking up, snoozing the alarm for hours. 

 

3. Alcohol. Before starting the taper I concluded that for this period of time it was best to reduce alcohol consumption to zero. Knowing that even a single glass of beer or vine can affect ones mood and feelings over the next day or so. But during the last month I've opened up for have "a couple" of beers in the weekends and sometimes when watching a hockey match in weeknights. Feeling that this is one of few things that lift my mood a bit. Dopamin? But the next day might be bad.

 

Writing and putting this into words I can see how I error. For example at sleep and alcohol. I've read books! A book on what physical activity can do for mental health, a couple of books on sleep, several books on diet, books by David A. Carbonell on anxiety, books on mindfulness and CBT.. It is like: I know what to do, but it's so hard to do it!

 

Currently I'm not taking any supplements. I want to take magnesium, vitamin D and Omega-3, but in this chaotic lack of structure I can't manage to keep up any regularities at the time.

 

 

Brain fog salute from Norseman

 

 

[Norseman]

@Gridley

@Altostrata

 

Now the anxiety is here. Heart pounding, not getting enough oxygen and afraid of going into panic. Sleep is chaotic. Eating also, one maybe two meals a day.

 

It has been slowly increasing during this autumn. I cannot say exactly when, at what dosage it happened. So, how to interpret this? Is this also withdrawal symptoms that should fade away over time, or have I done the tapering to fast? Should I back track again upping the dosage, and to what? During this pandemic my primary doctor has quit her job, and my psychiatrist are just doing phone consultations. I feel alone and afraid.

Please advise.

[ChessieCat]

15 minutes ago, Norseman said:

Eating also, one maybe two meals a day.

 

This is something that may be causing or making your anxiety worse.  It's important to keep your blood sugar level throughout the day.  You don't have to eat a lot but having small, nutritious amounts of food throughout the day might make a difference with how you feel.

 

From https://www.newhealthadvisor.org/symptoms-of-not-eating-enough.html

 

Symptoms of Not Eating Enough:

 

1. You Have Low Energy

5. You Experience Quick Mood Shifts

8. You Cannot Sleep Comfortably

9. You Feel Depressed

12. You Experience Headaches

 

and

 

This webpage has a diagram showing where and how the body can be affected:

 

https://www.healthline.com/health/low-blood-sugar-effects-on-body#1

[Norseman]

Thank you @ChessieCat

 

This was interesting. I did not know low blood sugars could actually cause these symptoms. It of course makes sense when I read it. I guess a proper diet should be on my KISS-list from now.

 

[ChessieCat]

Sometimes it can be a bit tricky especially during the times when you really don't feel like eating.  I have fluctuations in my appetite and sometimes I just seem hungry all the time.  Other members have posted about the same things.  Sometimes I just keep looking for things to eat which does not always seem to be caused by boredom.  It may be more related to being a bit anxious.  I've only just realised that so I will have to try and remind myself about that.

[Gridley]

13 hours ago, Norseman said:

It has been slowly increasing during this autumn.

If your symptoms are worsening, it is likely that you are tapering too fast fast.  I would hold where you are for three months then reassess.

[Norseman]

21 hours ago, Gridley said:

If your symptoms are worsening, it is likely that you are tapering too fast fast.  I would hold where you are for three months then reassess.

 

Thank you for your insights @Gridley. I will hold at this dosage now with focus on reestablish the good habits in mi KISS-list.