kevsood: venlafaxine withdrawal

[kevsood]

Hello, I am in Republic of Ireland and would very much appreciate any help anyone here could offer me. I am almost 4 weeks off venlafaxine now, on 75mg from Jan of this year for 5 or 6 weeks before coming off myself as I felt I was over my anxiety and depression. I went back on again in May and stayed on until recently when I tapered down for 2 weeks on 35mg..my reason for writing here is because of how I feel now, almost 4 weeks off this drug and it is horrible!.. and I just want to know is this normal???!!!.. dizziness, confusion, forgetfulness, slight nausea, detached feeling like almost spaced out!.. I've battled anxiety for as long as I can remember, since I was 6 and I'm 43 now and last year saw me venture into, as my doctor said, depression..is there a time line to withdrawl symptoms and am I experiencing normal symptoms?..i hope someone can help me.. thank you, Kevin 

Edited October 6, 2020 by Gridley

[Gridley]

Welcome to SA, kevsood.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly. Please be sure to include your original dosage (was it 75mg), the date 5-6 weeks later when you stopped it, the dosage when you topped it, the dosage you reinstated in May,  the dosage and date when you tapered down for 2 weeks and the dosage and date when you stopped it 4 weeks ago.  This information is very important to us in order to advise and help you.

 

Account Settings – Create or Edit a signature.

 

You are experiencing antidepressant withdrawal from your too fast taper of Venlafaxine.  It is completely normal.  The symptoms you describe--dizziness, confusion, forgetfulness, nausea, detached feeling (known as depersonalization/derealization)--are very typical withdrawal symptoms.  Anxiety and depression are also typical withdrawal symptoms.  There is no timeline to withdrawal and no way to predict how long it will last, though we can say you will heal and recover but it can often be a frustratingly slow process.  So that you'll have a better idea of what you're experiencing, here is some information on withdrawal and the healing process.

 

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain the healing process really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Brain Remodelling 

 

Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  

 

Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.  If your last dose ws four weeks ago, you're still well within in the time period where reinstatement predictably works, up to 3 months after last dose.  It is best to reinstate as soon as possible after withdrawal symptoms occur. We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, your system has become sensitized and If you take too much it may be too much for your brain and can cause you become more unstable.  Then, once you've stabilized on the reinstated dosage, which can take several months,  you can begin a 10% per month taper down to zero.  

 

Why taper by 10% of my dosage?

 

Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

If you are interested in reinstating, complete your drug signature as requested, including the dose you were on when you quit 4 weeks ago, and we can suggested a reinstatement dosage.  Please do not reinstate without allowing us to suggest a reinstatement dosage.

 

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.

 

Here are some links to help you deal with anxiety.

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes
 

VIDEO:  Peace from Nervous Suffering - Claire Weekes (1 hour) (http://sendvid.com/vgquc1dg)
 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help …

 

10 minute Restorative Yoga for Relaxation | Up the wall

 

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

 

 

 

 

 

[kevsood]

Thank you very much 

[kevsood]

Was on Prozac August 2019 for 2 months and stopped no ill effects

Was put on 75mg Venlafaxine per day early Jan 2020 and stopped 6 weeks later. 

Restarted Ven. 75mg early May and stayed on that until 2 week taper of 35mg first 2 weeks of Sept. 

 

I would be keen to know how to reinstate as the withdrawl is pretty intense in terms of it really testing my anxiety and specifically the old feeling of depression creeping in over the last 2/3 days..

 

Thank you for your help 

[Gridley]

10 minutes ago, kevsood said:

stayed on that until 2 week taper of 35mg first 2 weeks of Sept. 

What was your final dose before you stopped taking the drug?  What was the date of your last dose?

 

Are you on Venlafaxine IR (immediate release) or XR (extended release) and how many times a day do you take it?

[kevsood]

was on 75mg extended release, once a day, every morning. 

final dose was 35mg approx. 15th Sept (not sure of exact date) 

 

[Gridley]

9 minutes ago, kevsood said:

 

was on 75mg extended release, once a day, every morning. 

final dose was 35mg approx. 15th Sept (not sure of exact date) 

 

 

 

I'd suggest a reinstatement of 3mg.  Though this doesn't seem like a lot, as I said earlier these drugs are powerful, your brain is sensitized and you don't want to overwhelm it with too high a dose.  I'm assuming your XR contains beads and you were tapering using 75mg XR . The following link explains  how to count beads to get a 3mg dose by counting beads.  This will require some patience, but after you've figure out how many beads constitute 3mg, it should be simple to get your daily dose.  Save leftover beads to use for future doses.

Tips for tapering off venlafaxine (Effexor)

 

It takes around 4 days for a reinstatement to reach full strength in your bloodstream and a few more days for it to register in your brain.  You might get some relief after a couple of days or it may take longer.  If 3mg is enough, it still may take some weeks or months for your nervous system to settle down. You probably will continue to have waves and windows (ups and downs), but symptoms won't be as intense. If it seems you need a higher dose, it will be easy to very carefully increase it.  But be patient and give the 3mg a chance to work.  Keep in mind that reinstatement doesn't necessarily eliminate all withdrawal symptoms (though it does for some) but rather it makes the symptoms tolerable.

 

It's a good idea to keep track of how your doin with daily notes on paper.

 

Please let us know how you're doing.

 

 

 

 

 

 

[kevsood]

thanks a million, I'll give it a go.. I very much appreciate your help 😊

[Erell]

Hello Kevsood, 

 

and welcome on SA  

 

Could you please add a signature ?  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

I understand that you have given the info in you posts above but this will appear below every post you make, and allow other folks to see your history at a glance  

 

 

[kevsood]

thanks, I'll do that now

 

[kevsood]

Hello

I spoke to my doctor today about my withdrawl symptoms and he said I shouldn't have them after 4 weeks! He suggested I go back on 35mg to taper again and reduce it after 4 weeks by 35mg every second day and extending it out like so!..I asked him about smaller doses to taper on % and he said there wasn't anything smaller than 35mg..is there a way to get smaller doses? Still getting waves of nausea and dizziness and non clarity mentally. My anxious mind is trying to tell me something is wrong but I'm also aware, thanks to info here, that I have withdrawl symptoms.. are doctors really this ignorant to the true symptoms of withdrawl?..thank you for help 😊

[kevsood]

 

On 10/6/2020 at 11:07 PM, Gridley said:

 

I'd suggest a reinstatement of 3mg.  Though this doesn't seem like a lot, as I said earlier these drugs are powerful, your brain is sensitized and you don't want to overwhelm it with too high a dose.  I'm assuming your XR contains beads and you were tapering using 75mg XR . The following link explains  how to count beads to get a 3mg dose by counting beads.  This will require some patience, but after you've figure out how many beads constitute 3mg, it should be simple to get your daily dose.  Save leftover beads to use for future doses.

Tips for tapering off venlafaxine (Effexor)

 

It takes around 4 days for a reinstatement to reach full strength in your bloodstream and a few more days for it to register in your brain.  You might get some relief after a couple of days or it may take longer.  If 3mg is enough, it still may take some weeks or months for your nervous system to settle down. You probably will continue to have waves and windows (ups and downs), but symptoms won't be as intense. If it seems you need a higher dose, it will be easy to very carefully increase it.  But be patient and give the 3mg a chance to work.  Keep in mind that reinstatement doesn't necessarily eliminate all withdrawal symptoms (though it does for some) but rather it makes the symptoms tolerable.

 

It's a good idea to keep track of how your doin with daily notes on paper.

 

Please let us know how you're doing.

 

 

 

 

 

 

I have some 75mg left and will count out beads as suggested.. thank you

 

Just opened 75mg I have, and this is what's in it! 

 

[Gridley]

@kevsood

I'm going to bring your situation to the attention of the other staff members.  Is it just one tablet inside the capsule?

Edited October 8, 2020 by Gridley

[kevsood]

yeah.. thanks

[Gridley]

@kevsood

 

I haven't heard from the other staff, so I'm going to give you my thoughts.  You have several options as described in the excerpt below from the link

Tips for tapering off venlafaxine (Effexor)

 

If you want to use the 75mg Effexor capsule/tablet you have, you could call the manufacturer and see if the time-release portion of the tablet is in the coating or is in the matrix of the pill.  If it's in the coating, you can crush the tablet.  This changes extended release to immediate release.  You'd need to dose twice or more each day, as the excerpt indicates. The excerpt below tells you your options at this point.  If the time-release is spread throughout the pill (in a matrix) this makes using the pill you have more problematical.

 

Or you could see if Effexor XR is available with the beads.  That would be a better option..

 

The excerpt contains several other possibilities.  Please read the excerpt carefully and see what option you're most comfortable with.

 

 

EXCERPT

 

Taper by cutting up regular venlafaxine tablets
Regular Effexor tablets come in 25mg, 37.5mg, 50mg, 75mg, and 100mg doses. Because it's half-life is so short, it is taken 2 or 3 times a day.

People taking regular Effexor taper by cutting up the tablets with a pill splitter. It's a good idea to keep the pieces you don't use in a clean pill bottle labeled with the dosage for future use.

 

Use an electronic digital jeweler's scale to weigh small amounts
If you are sensitive to dosage changes, you may wish to be more precise in your measurements so you can taper at a measured rate. A digital scale, which can be bought for about $30, is useful. See http://survivingantidepressants.org/index.php?/topic/1596-using-a-digital-scale-to-measure-doses/

(Converting to regular Effexor and making a liquid from it may be more convenient than weighing tiny amounts, see above.)
 
Convert from venlafaxine XL or Effexor XR to regular tablets
Especially in the last leg of your taper, when you might be down to a few beads of Effexor XR, you may wish to switch from an extended-release version to regular Effexor so you can make a liquid from it to make very small measured reductions.

 

You will have to track or estimate your current venlafaxine dosage to make the switch to liquid, so you can substitute equivalent dosage in liquid form.

 

If you are taking brand-name Effexor XR, you may want use the bead-counting method until you get down to 37.5mg, the smallest capsule, then convert to regular Effexor and make a liquid from it to finish the taper, taking doses at least twice a day.

 

Because of its short half-life, taking regular Effexor as a tablet or liquid necessitates taking the tablets every 12 hours.

 

For example, in the UK, generic venlafaxine XL (similar to extended-release or ER) comes in 75mg, 150mg, and 225mg tablets, per this pdf http://www.oxfordshirepct.nhs.uk/professional-resources/prescribing/prescribing-points/documents/PrescribingPointsVol18-15.pdf
This is a "do not split" tablet. To taper gradually, regular venlafaxine tablets may be substituted as below.
 

Dosed properly, the immediate-release form is equivalent to the extended-release form. From the FDA  http://www.fda.gov/ohrms/dockets/ac/04/briefing/2004-4050B1_20_Venlafaxine-IR-Label-peds.pdf:
 

  Quote

When equal daily doses of venlafaxine were administered as either an immediate release tablet or the extended-release capsule, the exposure to both venlafaxine and ODV was similar for the two treatments, and the fluctuation in plasma concentrations was slightly lower with the Effexor XR capsule. Effexor XR, therefore, provides a slower rate of absorption, but the same extent of absorption compared with the immediate release tablet.

 

and http://www.drugs.com/dosage/effexor-xr.html

  Quote

Depressed patients who are currently being treated at a therapeutic dose with Effexor (immediate release) may be switched to Effexor XR at the nearest equivalent dose (mg/day), eg, 37.5 mg venlafaxine two-times-a-day to 75 mg Effexor XR once daily. However, individual dosage adjustments may be necessary.

People who are very sensitive may have some difficulty with a switch from an extended-release form to regular Effexor. One technique to make the switch gradually would be to convert only part of the extended-release dosage to immediate-release tablets.

 

You would then be able to cut up the immediate-release tablet or make a liquid from it to reduce by 10%.
 
Use a liquid solution of immediate-release venlafaxine (Effexor XR cannot be made into a liquid)
Titrating using a liquid is very good for very small measured decreases in dosage, allowing more precise measurements.

• Have immediate-release venlafaxine made into a compounded liquid by a compounding pharmacy.
• Make a solution of immediate-release venlafaxine and water yourself.
  Technically, venlafaxine is water-soluble (http://chemicalland21.com/lifescience/phar/VENLAFAXINE%20HYDROCHLORIDE.htm ) There are reports that you can make a solution yourself (http://www.drugs.com/forum/featured-drugs/tapering-effexor-how-method-2-a-32338.html ) Also see How to make a liquid from tablets or capsules We don't know how stable a homemade solution would be -- how long it would last at full strength.
• Venlafaxine XR cannot be made into a liquid

 

Have a compounding pharmacy make capsules with custom dosages, or a liquid
Compounding pharmacies can weigh Effexor or Effexor XR and make up capsules for you of specific dosages. They can make a liquid of regular Effexor.
 
The only drawback is this can be quite expensive.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[kevsood]

thanks for the info, it's amazing to think doctors don't have the knowledge or won't give help in tapering from these drugs! I'll give the scales a go I think, ordered one.. so hopefully that works.. the various links you have given me seem so simple yet I had no idea where to look prior to SA, so again, thank you! 

[Gridley]

@kevsood

Sounds good.  Please keep us updated on how you're doing.