jr1985: Effexor / venlafaxine taper

[jr1985]

53 minutes ago, Altostrata said:

If I were you, I'd let my nervous system settle down for some months before making any more drug changes, and then MAKE ONLY ONE VERY CAUTIOUS DRUG CHANGE AT A TIME.

 

What exactly are you taking now, at what times of day and dosages?

 

9am:

- Omega-3 600mg

- Vitamin D 10ug

- Propranolol 2.5mg (recently 5mg because it helps with akathisia)

- Vyvanse 30mg 

 

9pm:

- Omega-3 600mg

- Effexor 35.6mg

- Phosphitadylserine 35mg of the total powder, not sure mg of active ingredient but it’s a tiny amount of the overall capsule

- Zinc 15mg (Mon, Wed, Fri)

- Finasteride 0.25mg (Mon)

 

Midnight:

 

- Melatonin 1mg

- Recently Benadryl 6.25mg - 25mg (I started 25mg but found smaller doses helped too - I took 6.25mg last night), but not regularly.  I was thinking of trying Propranolol 2.5mg at 9pm to see if it helped with akathisia without interfering with sleep, then I wouldn’t need to bother with Benadryl.

 

[jr1985]

So I am all for your staying still for months until everything settles, but last time I spoke to psychiatrist she talked about trying a lower dose of Vyvanse to see if it was any better.  I’m worried if I tell them I just want to stick to dose I’m on they’ll think I’m addicted or something.  I will request to stay where I am but do you think it will be an issue? I’ve never had a history of drug abuse.

 

Also, the other concern I have over Vyvanse is the fact that apparently micro-doses of amphetamine (see https://www.ncbi.nlm.nih.gov/m/pubmed/2440058/  I’ve also read that includes <3mg Adderall) can behave differently to standard doses.  They can cause your dopamine receptors to upregulate, potentially leading to issues down the line.  I don’t know what this means in terms of withdrawal once you get down to lower doses?  Should I just go to 5mg (that’s way less than 3mg Adderall - it weighs more because of the lysine attached) or even 10mg and hop off?

 

 

[Altostrata]

I would not overthink the purported action of Vyvanse on various neuroreceptors. It is a stimulant.

 

You do not have to have a history of addiction or inclination towards it to become physiologically dependent on a drug. You are well into dependency on your cocktail now, that's what the withdrawal symptoms demonstrate.

 

What is the effect of the Vyvanse on your activation symptoms, i.e. akathisia?

 

It is very odd that you're taking an accelerator, Vyvanse, together with a brake, propanolol.

 

When did you start finasteride? Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php did
and copy and paste the results or a link to them in this topic.

 

If you want to experiment with your drugs at various dosages, no one can predict what will happen. That's why it's called an experiment, and why we advise moving very cautiously and slowly. However, it's your nervous system, your choice.

[jr1985]

The effect of Vyvanse on the akathisia isn’t immediately obvious, it doesn’t suddenly get worse once it kicks in or anything.  But my best guess is it must help it because the akathisia gets worse in the evening when the Vyvanse wears off.

 

Well I was prescribed Propranolol a few years ago for anxiety.  I just take a tiny dose every morning.  Then I opted to take Vyvanse a few months ago because I was getting overwhelmed with life due to my inattentive ADHD - I’ve had symptoms since childhood, so not drug induced.  In terms of their interaction, the propranolol mainly works on physical anxiety and Vyvanse is mentally stimulating.  The mental stimulation actually makes me feel calm, almost too calm, which is why it was suggested to try a smaller dose.  It’s fairly common for stimulants to calm down people with ADHD.  Some of the neurons in the prefrontal cortex have inhibitory projections into other parts of the brain.

 

Finasteride I started a couple of years ago.

 

I will put the drugs into the interaction thingy and see what comes out.

 

When the “Effexor incident” happened, I was too terrified to take anything else. I stopped Ritalin, etc.  What was odd was I stopped Ritalin cold turkey and felt tired for a couple of days and that was it.  I had felt more or less stable for a while now, so I guess the fear left me and I expected Vyvanse to be the same as Ritalin - try it, if it works, great, if not, feel tired for a day or two and recover, but that didn’t exactly go according to plan.  I was also desperate because I was struggling a bit and my disability allowance was taken away.

 

But I guess I didn’t account for the fact that amphetamines are much more potent and harsher than methylphenidate.  MPH is a pure dopamine and noradrenaline reuptake inhibitor, whereas amphetamine does the same thing, plus forces dopamine and NA out of the neuron AND has some kind of effect on serotonin.  Oh well....

[jr1985]

Here is the link to the drug interactions:

 

https://www.drugs.com/interactions-check.php?drug_list=2296-1523,1956-0,1475-2533,1091-0,896-1617

 

Main one is Effexor - Vyvanse, as was already pointed out.  However, my feeling on that is it may not be a huge issue at the doses I’m on.  The increase in anxiety, etc is likely due to the fact Effexor begins to effect noradrenaline (norepinephrine) at higher doses, so it’s like combining 2 stimulants at that point.  But the dose I’m on should only be hitting serotonin.  And serotonin syndrome I guess it’s dose dependent - I’m on half the starting dose of Effexor and on the starting dose of Vyvanse. Plus I imagine I’d know by now if I had serotonin syndrome.

 

Im not trying to justify staying on them or anything, the plan is still to gradually wean myself off Vyvanse.

 

 

Last night I took 2.5mg Propranolol and no Benadryl and it dampened down the akathisia enough so I was able to sleep.

[jr1985]

I’m wondering if what I have is actually akathisa or something else. Paraesthesia was mentioned before but I thought that was just pins and needles.

 

The symptoms I’m having are:

 

- My muscles almost feel like they're vibrating at a low level

- Sometimes it feels like the nerves in my legs are stinging and burning

- The above causes insomnia

- I get hot flashes and start sweating, which feels like surges of adrenaline - it’s the same heat you get when you’re anxious 

- sometimes I get anxiety 

- Teeth chattering

 

I don’t (yet) feel the need to get up and start pacing or anything.  I work in an office seated all day and can still sit for hours.  The main issue is getting to sleep.  It feels like my legs are vibrating and electrified, which makes it difficult to drift off.

 

So I wonder if it either isn’t akathisia or is but at a low level?

 

 

[ChessieCat]

akathisia-vs-restlessness-anxiety-agitation

 

akathisia-vs-restlessness-anxiety-agitation

 

 

 

[jr1985]

So it seemed like the extra propranolol was helping but I had a bad flare up of akathisia yesterday and today.  Hoping it’s just windows and waves.

 

I’m wondering about what your opinion is on the 15mg zinc every other day.  I know you say anti-depressants should be taken daily and not on alternate days (I.e the “doctor approved” way of tapering these things), but I wonder if it’s the same for supplements?  I’ve been taking zinc that way for about 2 years and not noticed any major issues, but now I’ve sensitized myself again I wonder if it could cause issues.

 

Basically, it seems some days are better than others and I’m theorising it could be related to the zinc.  I need to track it more carefully - I.e do I feel better on the days after I take zinc? Zinc has been shown to potentiate stimulants, or at least make it possible to lower the effective dose of the stimulant.  So on the days I don’t take it, it would be like lowering the dose of Elvanse.

[ChessieCat]

27 minutes ago, jr1985 said:

I’m wondering about what your opinion is on the 15mg zinc every other day.

 

I take some of my supplements every 2nd or 3rd day.  B12, folate, iron.

 

Here's SA's topic:  supplementing-with-zinc

 

[jr1985]

Thanks ChessieCat.

 

I'm starting to wonder though if the main issue was me switching to brand name Effexor.  See the previous brand the beads were all pretty much the same size, but with Effexor they're all different sizes.  According to https://onlinelibrary.wiley.com/doi/full/10.1111/j.1755-5949.2010.00210.x 

 

"The one‐size spheres of Novo‐venlafaxine XR compared to the three‐sizes spheres of Effexor XR were hypothesized as being responsible for a pharmacokinetic profile more representative of an “intermediate” release formulation than of a true extended release."

 

So even with weighing I wonder if it causes variations, i.e. if most of the weight comes as the smaller beads, then you're going to get more of the drug released earlier.  I thoought maybe there would be a ration of small:medium:large beads I could work out but it's actually very difficult to tell the difference between small/medium and medium/large, it seems like there's maybe more of a range of sizes thtn just 3.

 

I'm not sure what to do tbh.  Just keep holding and hope things settle down eventually?

[jr1985]

Having a bad night tonight.  Any advice or thoughts on above would be much appreciated

[ChessieCat]

From your drug signature:

 

Quote

 

21st June 2019 - 12th July: Cross tapered from venlafaxine brand Rodomel to Efexor (1/4 > 1/2 > 3/4 weekly before ditching Rodomel); 13th July 2019: Cut Vyvanse dose to 15mg; 15th July 2019: Akathisia returned after years of being free; 16th July 2019: Went back up to Vyvanse 30mg

 

 

 

 

What dose of Vyvanse were you taking before you increased?

 

So you've gone from 15mg to 30mg Vyvanse?

 

How soon after taking the 30mg Vyvanse did your symptoms worsen?

Interactions between your drugs

Major

venlafaxine lisdexamfetamine

Applies to: Effexor XR (venlafaxine), Vyvanse (lisdexamfetamine)

Talk to your doctor before using venlafaxine together with lisdexamfetamine. Venlafaxine may increase the effects of lisdexamfetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported. Combining these medications can also increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms while taking the medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Edited August 16, 2019 by ChessieCat

[ChessieCat]

SA recommends only make one change at a time.  In a period of just under 1 month you have made various changes.  Making more than one change makes it difficult to work out what is causing any problems if they happen.  Keep it Simple, Slow and Stable

[jr1985]

Hi ChessieCat,

 

I was on 30mg Vyvanse for about 2 months or so.  I cut it down to 15mg for 3 days and then went back up to 30mg.  I’ve then been staying on 30mg for about 1 month now.

 

- April 2019: Switched venlafaxine brand from Rodomel to Venlor and got withdrawals

 

- April/May 2019: switched back to Rodomel and felt more stable

 

- May/June: Started 30mg Vyvanse and felt fine in terms of withdrawals

 

- June -> July 2019: over the course of 3 weeks I cross-tapered from Rodomel (discontinued) to Effexor by reducing one by 1/4 and increasing the other by 1/4.

 

- 12th July: I dropped Rodomel completely for Effexor AND dropped Vyvanse to 15mg (stupid I know  )

 

- 15th July: Akathisia and insomnia came back with a vengeance

 

- 16th July: I increased Vyvanse back to 30mg but it made no difference.  I’ve stayed on 30mg ever since though.

 

- 22nd July: I increased propranolol from 2.5 to 5mg to help with akathisia.  It did help for a while but not as much anymore

 

5th August: it seemed to settle for about 2 weeks but started getting worse last week again.  It seems to fluctuate though, like yesterday I didn’t feel as bad whereas tonight I feel awful.  I’ve started keeping records of how I feel each day to see if there’s a pattern.

 

 

[ChessieCat]

My apologies, I got the months muddled up.

 

31 minutes ago, jr1985 said:

I’ve started keeping records of how I feel each day to see if there’s a pattern.

 

Good idea.

 

It's important to understand that stabilising isn't linear.  You might feel improvement for a bit and then feel a worsening of the same symptoms or get a different symptom.

[jr1985]

So I don’t have enough info to draw any conclusion yet, but Thursday and Friday were the worst I’ve felt in a while. Then Saturday and Sunday were the best days I’ve had in a while.  Seems like it might be coming back now, it started midnight on Sunday.

 

I also discovered that the impact of being fasted vs fed on the bioavailability of Effexor XR is much greater than the impact on the other brand I was taking.  What exactly does “fed” mean in the context of taking medicstion?  I take mine at 9pm, so would toast or a yogurt or something count?

[jr1985]

Hello all, hope you’re keeping well during this crisis. I have to admit one of my biggest fears is having to be hospitalised and not having access to my medication.  I know the hospital has a pharmacy and all that but it’s the fact I’m

not on a dose they’re going to have available as such.  I didn't react well when I tried going back on the full dose a few years ago.  Do they let you bring your own meds in with you?