KayJayBee: post venlafaxine anxiety and akathisia

[KayJayBee]

Hi - I finally decided to join up after first discovering this site in April 2020 when googling for info on antidepressant withdrawal problems. I was on venlafaxine 75mg for 5 years for anxiety and wanted to come off it as I was having terrible sleeping issues which my GP believed was due to this drug. I knew about withdrawal issues so tapered off slowly. However I was soon in a bad way with severe anxiety and unbearable akathesia. I tried Valdoxan but this made me feel worse. I reintroduced venlafaxine on a low dose of 25mg and tapered off again, even more slowly. I have now been off completely since September 2020. I have continued to struggle with anxiety symptoms particularly in my stomach and tingling restless feelings in my legs and sometimes my arms. These symptoms have become worse since I’ve stopped the venlafaxine. I feel as though it is the physical symptoms that are making me feel anxious rather than anxiety causing them. I really struggle some days to not feel completely overwhelmed. I am totally convinced my problems are due to stopping venlafaxine rather than a return of anxiety problems. I never had these constant physical symptoms before. I take 1mg Ativan a few evenings per week when I just can’t bear it. It helps a little bit. I have also been on CBD oil for 6 weeks but don’t feel as if it helping me. I’m considering talking to my GP about lamactil but he’s not been much help so far. This all just really sucks.

[Gridley]

Welcome to SA, KayJayBee.  Thank you for completing your signature.  I'm sorry you're feeling bad.  

 

Two questions, please.  

 

1. When you tapered the Venlafaxine ending in May and when you tapered ending in September, at what rate did you taper?  How fast did you reduce the drug?

 

2. Are you taking regular immediate release Venlafaxine tablets or the XR extended release with the little beads inside a capsule?

 

You're experiencing withdrawal, as you've already realized. The symptoms you describe are typical of withdrawal.

 

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.  

 

We don't recommend taking another psychiatric drug to deal with withdrawal from a previous drug.  

 

These explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

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. Get supplements that are single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

 

 

 

Edited November 3, 2020 by Gridley

[KayJayBee]

Thanks Gridley. I was on the extended release venlafaxine and my first tapering was done by removing one of the 6 pellets from the capsule and then taking about 2 weeks before reducing by another pellet. When I went back on, I stayed on 2 pellets for about 2 months before dropping to one pellet. I then stayed on 1 pellet for probably another 6 weeks before stopping completely (I’m not sure about my time frame but this is an estimate).
 

Thank you for the suggestion of magnesium and fish oil. I will definitely try those. 

[Gridley]

6 hours ago, KayJayBee said:

my first tapering was done by removing one of the 6 pellets from the capsule

Please be very careful with the Ativan.  You can become physiologically dependent with 10 days of regular use and also with intermittent use.

 

If I understand you correctly, you're taking the Venlafaxine mini-tablets.  Reinstatement of a very small dose of the original drug is the only known way to alleviate withdrawal. Please read:

 

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

 

One option to alleviate withdrawal is reinstating with a portion of one of the mini-tablets.  This is tricky though, as cutting the mini-tablets turns them into immediate release, and there's a risk of adverse reaction or dosage dumping .  It might be better if you could switch to the same dose you were taking with the mini-beads and reinstate 6 mini-beads (this is described in the excerpt) from Tips for tapering off venlafaxine (Effexor).  

 

 

Extended-release venlafaxine capsules: Open and count out mini-tablets

Some generic types of Effexor XR are gelatin capsules containing smaller tablets. Depending on the manufacturer and dosage, there may be 3-12 tablets in a capsule, for example Vanlalupen XL https://imedi.co.uk/vanlalupen-xl-75mg-prolonged-release-capsulesor  http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1438318470327.pdf (PDF) or Venlablue http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con062651.pdf(PDF).

 

In the UK, generic Vensir (similar to extended-release or ER) comes in 75mg, 150mg, and 225mg "modified release" capsules. About the 75mg capsules:

  Quote

Prolonged release capsules, hard. The capsules are peach opaque / peach opaque size '1' hard gelatin capsules having thick and thin radial circular band on the body in red ink and thick and thin radial circular band on the cap in red ink. The capsule is filled with 6 white to off-white round biconvex film coated mini tablets of 12.5mg.

 

A gelatin capsule has no time-release effects. To make the drug extended-release, the modified-release ingredients such as povidone and microcrystalline cellulose are integrated into the core of each mini-tablet (not the tablet coatings).

 

(There are many such generic versions from many manufacturers in Europe, Asia, other parts of the world. Check with the manufacturer of your generic extended-release venlafaxine that the capsule is made of gelatin. If it is, the time-release quality is in the mini-tablets.)

 

You can taper by removing these mini-tablets:

• Ascertain how many mini-tablets are in each of your capsules. Open a few and count the mini-tablets.
• Divide the dosage of each capsule by the number of mini-tablets in each capsule. That is the dosage of the mini-tablet.

(For example, every dosage of Venlablue contains some number of 12.5mg mini-tablets; 37.5mg contains 3 12.5mg mini-tablets while 150mg contains 12 12.5mg mini-tablets.)

 

Calculate the amount of your decrease, such as 10%, on your current daily dosage.

 

If necessary, you may split a mini-tablet into smaller doses. For more precise dosing when splitting mini-tablets, see Using a digital scale to measure doses

 

The venlafaxine in a mini-tablet fragment may become immediate-release venlafaxine as it can be absorbed easier. Remember that doses in immediate-release tablet form have much shorter half-lives than those made from extended-release venlafaxine.

 

Taper with extended-release venlafaxine tablets

If the extended-release tablets are cut, the extended-release quality is compromised. It is likely the tablet pieces will be quickly absorbed as immediate-release venlafaxine. If you are accustomed to extended-release venlafaxine, you may experience this as uncomfortable "dosage dumping" or a significant adverse reaction.

 

If you're taking extended-release venlafaxine tablets, you might switch to the same dosage in the capsules containing tiny beads, if available, and use the bead-counting method, or switch to the same dosage in immediate-release tablets, if available, and follow the tips above for tapering with immediate-release venlafaxine.

 

If you have no choice but to taper by cutting up extended-release tablets, you may wish to convert your dosage into the smaller 37.5mg XR tablets, and taper by splitting only one of the smaller tablets. The combination may cushion the effects of a more immediate release of the drug. Note that doses in immediate-release tablet form have much shorter half-lives than those made from extended-release venlafaxine and may need to be spread out over the day.

 

For example, if you're taking 150mg XR per day, request that your prescription be filled with one 75mg XR tablet and two 37.5mg tablets per day (for insurance coverage, your doctor probably will have to write the prescription as a spilt dosage of 112.5mg in the a.m. and 37.5mg in the p.m.). You can then take your daily dose as 112.5mg XR in the morning and start tapering by cutting the 37.5mg tablet for a smaller dose later in the day.

 

For more precise dosing when splitting tablets, use a digital scale to weigh tablet pieces.

 

Edited November 4, 2020 by Gridley

[KayJayBee]

I was on a generic version which are very similar to the UK Vensir description in your post. When deciding to drop down from 1 pellet I thought about cutting the pellet but when I realised that doing so obviously messed with the coating on the pellet I decided not to as I was nervous about what effect that might have. So I just dropped from 1 pellet to zero. I’m not sure about trying a cut pellet but at this point it’s worth a try! Thank you very much for all the info. I sincerely appreciate your time. I hope you’re doing well.

[Gridley]

6 minutes ago, KayJayBee said:

I’m not sure about trying a cut pellet

It's risky.  I don't know any more than what is in the excerpt..  Can you get the small bead version in your same dose or switch to the immediate release version as described in the excerpt?  If not, and you decide to cut the pellet, please follow the advice in the excerpt very carefully.

[ChessieCat]

There may be other members who have discussed this generic mini tabs issue in the tips for tapering venlafaxine topic.  I will try and find them by searching and let you know.

[ChessieCat]

From a quick glance at the preview results when the mini tabs are cut up they become immediate release.

 

https://www.survivingantidepressants.org/search/?q=mini&quick=1&type=forums_topic&item=272

[KayJayBee]

Thanks. I have had a look at this info and that suggested by Gridley. I am not sure what to try - I think I’ll talk to my GP about getting some immediate release venlafaxine so I can do a liquid and control taking 2 very small doses per day.

[ChessieCat]

You might find some helpful info in this topic:

 

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

 

I suggest to members that they write down what and how they want to ask/tell a doctor beforehand and rehearse it.  If the doctor comments that the dose you are taking is non-therapeutic, you can say something like I realise that it might be possible to reduce faster but I'd rather be careful and do it slowly.

[KayJayBee]

I have a good relationship with my GP but I just don’t think he’s terribly knowledgeable about the discontinuation syndrome. So the DSM5 info will be helpful. I’ll let you know how things go.

[ChessieCat]

Well hopefully he is willing to learn from you and will be able to help others and maybe "train" his peers.

 

I suggest printing this one out too or referring him to it:   "Stopping antidepressants" leaflet

 

And if he's interested you could share Alto's new podcast interview with him.  The link's in my signature.