maddog: 3 scripts, unsure how to proceed

[maddog]

Hello friends!

 

My name is Mads, and I am currently on 225mg Effexor, 150mg Wellbutrin, and 20mg of Ritalin 3x/day.

 

I have struggled with depression and anxiety since I was a teenager. After a suicide attempt at 15 I was diagnosed and put on Prozac in the hospital. It was a few months before I got settled with a therapist and a psychiatric nurse practitioner (who will be referred to as Susan from now on).

Over a year or so, my dose was increased. When I (at the pushing of my mother) expressed concern over the weight gain I was experiencing that we attributed to the medication, Susan put me on Effexor and took me off Prozac (I don't remember this process - it might have been stopping Prozac CT and immediately starting Effexor). 

Over a couple years, my dose was increased eventually to the max: 225mg. 

At one point, Susan diagnosed me with Inattentive ADHD (aka ADD) and put me on Ritalin. This dose over time was increased to the max: 20mg 3x/day. 

This April, I slipped into a depressive state due to Covid (losing my job, withdrawing from college classes, isolation from friends and partner, etc). My mom suggested I talk to Susan about adjusting my medication. At this point I had also started DBT therapy. Susan put me on 150mg of Wellbutrin.

 

Since starting the Effexor, I have struggled with sexual dysfunction. Because I started ADs at such a young age and initially while I wasn't sexually active, it didn't occur to me to express my concern over the issues I was having. I was very aware that they were likely caused by my medication, which I felt and still feel is doing its job otherwise, so I didn't want to mess with what I felt was working for me. 

As of starting the Wellbutrin, the sexual dysfunction has increased in severity and has become unbearable. It has caused issues in my relationship that we can no longer ignore. I expressed my concerns to Susan last week. She said that the Wellbutrin was not likely to be the cause of the side effects. She suggested that I skip my Friday and Saturday doses since I see my partner on Saturdays usually, and that might help curb these symptoms. She said that I would likely experience brain zaps as a result of these drug holidays. 

 

Friday I forgot to skip my dose, so I skipped it Saturday morning. By the afternoon I had a splitting headache, and by the evening had chills and aches like I was coming down with something. All night long I had nightmares. I would wake up from one just to fall asleep and into another. I woke up with a headache and feeling like I hadn't slept at all. That morning I took my regular dose because I could not drive myself to work in the state I was in.

 

Experiencing the effects of this drug holiday, and realizing how much my relationship is hurting because of these side effects, I am itching to get off of the Effexor but in a way that won't cause such debilitating WD symptoms. I have an appointment with Susan tomorrow to talk about tapering the Effexor and if needed increasing the Wellbutrin (if I find my depressive symptoms returning). 

 

I am not one to dismiss the advice of a professional, but it makes me nervous that Susan would advise me to stop cold turkey for a couple days a week when I am on the highest dose allowed to be prescribed... it also makes me nervous that I am on the highest dose of both Ritalin and Effexor at all. I can't help but imagine she would tell me to taper way too quickly or even advise me against stopping the Effexor at all. My medications have definitely done what they were prescribed to do, so I am reluctant to make changes, but I just can't keep going on they way I have been. I am hoping that by joining this group, I will find some support and guidance in adjusting my medications, navigating the psychiatric healthcare world, and dealing with the fallout of such.

 

Thank you for reading my very personal and in depth intro post, I hope no one fell asleep out of boredom 😊

[Gridley]

Welcome to SA, maddog.  It's very good you came here before starting your taper.

 

To start, we strongly recommend against skipping doses.  This causes the amount of the drug in your blood stream to go up and down, battering your nervous system and producing withdrawal symptoms.

 

Thanks for completing your drug signature,  Using the following link, please indicate which type of Wellbutrinyou're taking, SR, XR or XL.

 

Account Settings – Create or Edit a signature.

 

We'll be happy to help you taper off the Effexor XR.  We recommend tapering by no more than 10% of your current dose every four weeks.  As you've guessed, medical professionals almost invariably try to taper their patient much too fast, resulting in the type of withdrawal symptoms you experienced when you skipped your dose.

 

Why taper by 10% of my dosage?

 

Brain Remodelling 

 

What is withdrawal syndrome.

 

The following link is specifically about tapering Effexor, including detailed instructions about how to taper XR by very gradually removing beads from the capsule.

 

Tips for tapering off venlafaxine (Effexor)

 

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 oil) 

 

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 your way here.

 

 

 

 

 

 

 

 

[ChessieCat]

Hi maddog and welcome to SA,

 

Please add the dates you started your drugs.  You state that you are currently not tapering but if you have ever made any dose changes please include those (dose and date) too.  Thank you.

 

~ they/them ~

Effexor XR | 225mg

Wellbutrin | 150mg

Ritalin | 20mg 3x/day

Not currently tapering

 

Edited August 26, 2020 by ChessieCat

[maddog]

4 minutes ago, ChessieCat said:

Please add the dates you started your drugs.  You state that you are currently not tapering but if you have ever made any dose changes please include those (dose and date) too.

Ok this seems like a weird question, but how would I find that out? Would I be able to access that information from my pharmacy instead of my prescriber? Unfortunately I have no clue when I started/when the dose was changed besides the most recent one. It sounds wimpy but I feel weird asking Susan about it lol I feel like she'll question me as to why I want to know

[ChessieCat]

It is okay and you have the right to ask you prescriber about your drug history.  You don't need to say why you want to know but if she brings it up just say that you were talking to someone and they asked about your drug history (which is true).  You don't need to tell her who.  It might have been somebody you got chatting to or a friend or relative.  Remember you are the "customer" and you are wanting the information so that you can look after yourself.

 

If you have always taken the prescribed dose and your tablets were changed by the doctor to get that dose so the prescription would have been supplied with the dose on the label, then the pharmacist should be able to provide that information.  Do you always get your scripts filled at the same chemist?

[maddog]

2 minutes ago, ChessieCat said:

Do you always get your scripts filled at the same chemist?

I do! It will probably be faster to ask the pharmacy since Susan has notoriously limited business hours, and she's going on vacation next week. 

 

It's definitely hard for me to feel comfortable taking the initiative in my psychiatric care. I'm not usually very skeptical of medical professionals, so the idea of making these changes against the advice of, or without telling my prescriber is really nerve wracking lol. But as I read more, and make the connections to my own experiences, I am starting to better understand the people who have given up on the doctors who put them on their meds...

[ChessieCat]

We have members here who have not told their doctors that they are tapering.

 

I have told mine and he knows that I am tapering at no more then 10%.  I have no idea whether he thinks that I am being overly cautious but he is okay about it.  When I made the comment that I realised that there are probably people who can get off their drug fast with no problems he very quietly replied whilst shaking his head and said "not many".  So he may be silently observing how things work for me.

 

The main thing that members need is a doctor who will prescribe what they need.  This can be a bit harder if you need to get lower dose tablets or liquid for tapering.  Members discuss what they do/say and their experiences in this topic:

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

[maddog]

6 hours ago, Gridley said:

The following link is specifically about tapering Effexor, including detailed instructions about how to taper XR by very gradually removing beads from the capsule.

So I guess I'm on the generic kind of all of my meds, and the venlafaxine ER doesn't come in capsules, but in a tablet. 

First question is, do you want me to change the names of my meds in my signature to the generic names?

Next question is, is there a way to cut the tablets so maybe I take half the dose in the am and half in the pm? If theyr'e cut in half does that cancel out the extended release effects?

[ChessieCat]

You are asking some excellent questions.  It is really good that you are trying to learn as much about the process before you start.

 

Oh, and just in case you don't know, it is best to only taper one drug at a time.  Depending on the interaction between drugs, some members taper one drug for a while and then taper a different drug for a while so that the interaction is keep more balanced.  For example, some drugs increase/decrease the effectiveness of a different drug.

 

You might find this topic helpful too:

 

Before you begin tapering what you need to know

 

Yes please.  If you are taking generic it is better to use the drug name not the brand name.

 

And something to remember.  Try to get the drug by the same manufacturer each time.  It is a good idea to make sure you don't leave it until the last thing to get your script filled so that if you have no choice but to change manufacturer you will have some of the old manufacturer tablets and can do a cross over.  You do 3/4 + 1/4 for about 3 days, 1/2 + 1/2, then 1/4 + 3/4.  If issues arise you hold for longer on that combination.  The same goes for changing form of drug.  For instance tablet to liquid.  Doing this is much gentler on your nervous system.  And you only make one change at a time.  So you don't make a reduction when you are doing the cross over.  And you don't introduce a new supplement.

 

7 minutes ago, maddog said:

venlafaxine ER doesn't come in capsules, but in a tablet.

 

You could ask your pharmacist when you see him.  Ask him if it is an extended release tablet and if you break it in half will it become immediate release.  You could also ask about the half life for ER and immediate release.  If it does become immediate release then you will probably need to split dose so as not to experience interdose withdrawal.

 

When splitting your dose you move a part of your dose later by 1 hour each day.  Keep an eye on your symptoms, especially your sleep.  If sleep gets affected move the dose back 1 hour.

[maddog]

TW/CW: sex, menstruation

 

Update!!

 

So the week before last I had an appointment with my prescriber, and expressed my desire to taper off of the venlafaxine slower than would normally be recommended. She was actually very supportive of this - said my depression was basically in remission (idk why she didn't tell me that when I first expressed issues with the medication??) - and suggested I go down by 37.5mg each week. I know this is a lot faster than is recommended on here, so I am carefully monitoring how it affects me. 

 

Tuesday 9/1 was my first lower dose of 187.5. That night I had some very vivid dreams that bordered on scary but never quite got bad enough to be called "bad dreams." (I'll also add that I am very used to having vivid and strange dreams so I wasn't bothered at all by them, and I was still able to maintain my agency within them and recognize that they were dreams, which is normal for me). The next day I woke up with a headache and took a Tylenol and then it went away for the rest of the day. Since then, I have not experienced any negative side effects. Sunday I was very emotional and irritable at work, however this also corresponds with my menstrual cycle and typical symptoms of it. 

 

SUPER DUPER TMI but Sunday I was actually able to be intimate with my partner... I cried afterward lmaoo but I was just so ******* happy that I was able to enjoy it in a way that I haven't been able to for a really long time. It was like I was frozen and had begun to thaw out. I noticed while we were kissing that it actually *gasp* felt good???? For so long I thought that I just didn't care for kissing... because it just didn't make me feel all warm and fuzzy inside most of the time. And yesterday I actually got to feel that, which I didn't know if I'd ever be able to do... 

 

So far, so good.  Wednesday I will be moving down to 150mg so we will see how that goes. As the dose lowers, I do anticipate more withdrawal symptoms showing up, but as long as they are manageable I don't mind. 

[ChessieCat]

How long have you been taking venlafaxine?

 

Please try to get the information about when you started your drugs.  It is difficult to offer suggestions if we don't have this information.

 

Thank you.

[ChessieCat]

SA's recommended taper rate is NO MORE than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug. 

 

If you continue reducing venlafaxine by 37.5mg as your prescriber seems to be advising, each time you decrease by 37.5mg the percentage decrease will get larger:

 

225mg to 187.5mg = 16.6667% decrease

 

187.5mg to 150mg = 20% decrease

 

150mg to 112.5mg = 25% decrease

 

You might find that because of the high dose of venlafaxine you have been taking that the first couple of reductions might not cause too much of an issue symptom-wise.  However, from what we have observed here at SA, at some time in the future your fast taper will most likely catch up with you.

 

If you check out the SERT occupancy curves you will see that the recommended SA taper rate follows that curve.  There is explanation of what this is here:  why-taper-sert-transporter-occupancy-studies-show-importance-of-gradual-change-in-plasma-concentration

 

This might help you to understand what I mean:

  

On 4/24/2014 at 8:52 AM, Altostrata said:

 

Here are examples of the fit curves:

 

 

I am thinking this explains why some people do fine until they hit a certain point -- the dosage they're taking is excessive and pushes them to the right on the X axis. They have quite a ways to go to work off the excess before a decrease will cause a noticeable deficit -- the oh-oh point.

 

 

 

  

On 9/22/2017 at 6:56 AM, ChessieCat said:

 

This is a graph representing a "perfect" 10% taper of the previous dose with 4 week holds.

 

 

 

[Altostrata]

Hello, maddog.

 

Good to hear your first reduction of venlafaxine went well. Please be careful about further reductions.

 

These drugs have a lot of overcapacity, could be 225mg was always excessive for you and your system hardly noticed a reduction to 187.5mg. Your history of skipped doses suggests you might be vulnerable to developing withdrawal syndrome. Another risk factor is starting the drug at a young age.

 

14 hours ago, maddog said:

As the dose lowers, I do anticipate more withdrawal symptoms showing up, but as long as they are manageable I don't mind. 

 

Even mild withdrawal symptoms lasting more than a few days are not okay. When you have mild withdrawal symptoms already, reducing the dose again makes them worse. Eventually, you're set up for severe and prolonged withdrawal syndrome.

 

Please read the link @Gridley so kindly gave you Why taper by 10% of my dosage? We advocate the 10% reduction method to minimize risk of severe withdrawal syndrome. The reason this site exists is because people have been tapering by the packaged dosages, such as 37.5mg Effexor, and getting withdrawal symptoms. Those decreases need to be smaller to avoid upsetting the nervous system.

[Altostrata]

@maddog, how are you doing?