BlackBetty: Hello and Venlafaxine XR and Prozac Bridge approach

[BlackBetty]

Hello all,

 

I don't know if this is the right place to post, so please, let me know if I need to put this elsewhere. . Here is a brief history, but please feel free to skip to the end for my questions on the Prozac bridge.

 

History: TW for SI

 

I have been working on my psych med taper for 2 years now. (Overview of history is in my sig line). I started tapering my Clonazepam, as I felt that all things being considered, the benzo was causing the most worrisome side effects. I also tapered off the Viibryd - yay! Then in October of 2020, things changed, and as with any plan, I had to make adjustments, so I held my Clonazepam and starting tapering the 150 mg of Venlafaxine XR, using an average weight of 10 capsules and then doing a "weigh and recapsule". I started with a 1% reduction, gradually working my way up to 5% reduction every 2 weeks. I found that this was my 80/20 sweet spot, where I could reduce and continue working, staying within the 10% guardrails.

 

In March 2021, I had to hold at 75mg VXR due to situational work crisis (extremely toxic work environment, culminating in termination in April 2021) and these last few months have been hell. Hard to say what is discontinuation syndrome and what is life, but either way, I have to deal with the symptoms. I struggle with suicidal thoughts and ideation daily. The rage and irritability is worse than the benzo rage! I also struggle with cognitive issues and chronic fatigue. DBT helps. My doctor convinced me to try the Prozac bridge approach and it hasn't been quite 2 weeks yet since I started. 

 

I have read the post on the Prozac bridge and I am not sure if I should attempt a cross over or start tapering my Venlafaxine XR again? I definitely do not want to run the risk of Serotonin syndrome (although I seemed to do ok when my previous dr had me on 40mg of Viibryd with the 150mg of Venlafaxine XR, wtf).

 

I have sent my current Dr the article from this site, asking what her plan / approach is. She has stated that I'm to stay on the 5mg of Prozac, but I've not received any further guidance, ugh. And that's not my understanding of how it works or what is safe, so I am asking for your guidance and help. Any reassurance and encouragement is also greatly appreciated!

 

I meet with her tomorrow, so the timing is good.

 

Prozac Bridge Questions:

 

• Should I start tapering the Venlafaxine XR? I'm almost at 2 weeks of 5mg of Prozac
  • Pros: Get it done, I'm unemployed. "Go as fast as possible, as slow as to be safe"
  • Cons: Will it make what I'm going through worse
  • I think this is the Foster 2012 method for Prozac switch approach?
• Should I insist on transitioning / crossing over to Prozac and tapering from there?  The Prey 2012 method for Prozac switch
  • Pros: seems to the be preferred method
  • Cons: The devil I know and I'm scared

 

Big Love,

Lisa 

 

Edited July 27, 2021 by manymoretodays

[Altostrata]

Welcome, @BlackBetty

 

Why were you taking Viibryd and venlafaxine together? Please put the dates you started each in your signature.

 

How did you change from clonazepam to Valium? How did you feel after this switch? Did these symptoms occur before, during, or after the switch?

On 7/8/2021 at 10:38 AM, BlackBetty said:

In March 2021, I had to hold at 75mg VXR due to situational work crisis (extremely toxic work environment, culminating in termination in April 2021) and these last few months have been hell.

 

Does your venlafaxine XR come in capsules filled with tiny beads? Why did you think a switch to Prozac was needed?

 

How do you feel after the addition of 5mg Prozac?

[BlackBetty]

Hi,

 

I've tried to answer your questions, as best I can. I will call my former doctor's and get my history - if they still have it. I really wish I could recall when I was put on each antidepressant and the dose changes.

 

• I do not recall when I was put on Viibryd.  I do not recall I was on it for long, maybe started in 2018? - but I'm really guessing when it was added - my memory is not the greatest. I was prescribed it because I was having depressive symptoms and the "venlafaxine xr stopped working" and my doctor at the time said that it could help and she'd had "good luck" with that combination. Sounds so familiar right?  
• I've been prescribed one antidepressant or another, starting with Prozac since the mid-1990's until one "stops working". The only constant has been the clonazepam. 
• I crossed over to Valium in April 2021 because I was having terrible body pain and muscle pain issues. Of course, it could have also been the Venlafaxine XR taper. When I first found my supportive doctor, in 2019, she wanted to cross me over to Valium initially, but I wanted to see if I could taper the clonazepam. The crossover was initially rough - just a "stop taking the clonazepam and start valium", it was rough few days during the washout period, but I felt so much better overall within a week. I really felt physically better and pain free.  I felt GOOD.
• My Venlafaxine XR comes as beads in a capsule - which is why I have to use the "weigh and recapsule" method. Because it's a generic, the beads are not of consistent weight or size, so I got the average of 10, 150mg capsules and used that as my base weight and started my taper. (I shouldn't have been surprised at how much variation between capsule weights, but I was). 

 

The SI started after my Valium crossover, but not immediately. It was towards the end of May 2021, beginning of June 2021 - but I wasn't capable to journal, so I do not have the exact dates, I'm sorry.

 

I have considered that the SI may or may not be related to the Valium crossover, although I did have these thoughts with the clonazepam, although not to this degree. It's like BBQ - comes in different regional styles and flavors ugh! If I had to describe it, when it occurred when I was on clonazepam, it was more of a "sharp, stabbing thought" that would go away and return at random times. On Valium, the thoughts are more of a "low, persistent, achy toothache that lingers all day". 

 

The SI and depression may be a cumulative effect of the Venlafaxine XR taper, the Valium crossover, a combination of my toxic work situation and unemployment, or a combination of all 3. I may never truly know, but I suspect it may be a perfect storm of all 3. 

 

My current Dr is one of the few that I would call "supportive / wise" - she's an addiction specialist and understands the dependency components of antidepressants and benzos. This is a patient driven taper, supported by her. I have the option of going back on the clonazepam, if we think this is the Valium. Honestly, I'm not quite sure, since there are several compounding factors: the Venlafaxine XR taper, the Valium crossover, the toxic / stressful / hostile work environment and subsequent unemployment.

 

When I spoke with my Dr about my symptoms on June 10th, her thoughts were that it was the Venlafaxine XR reduction, as she stated she has seen this with others on this medication - and that we have to get the SI to stop!  I thought about it for a week, researched, and then started taking 5mg of Prozac around June 22nd. After adding the 5mg of Prozac, in the past few days - a bit past 2 weeks since starting it - I have started feeling better (physically, mentally, and emotionally), the thoughts are abating, and so is the crushing depression.

 

Since I wrote this, a member of the AD support group I'm in stated they had they same with Venlafaxine XR and the Prozac bridge helped them get off. I've tried to read if this is a common symptom of Venlafaxine XR, but...and this may be my cognitive issues....I'm not quite sure what the consensus is.

 

I met with my Dr  on Friday to check in and what the plan would be moving forward. I don't feel stable enough to continue my Venlafaxine XR taper yet, so I'm giving it a bit more time. The current plan is that when I do feel more stable and ready to taper again, we will do the Prey 2012 method. She'd like me to go up to 10mg of Prozac and I'm considering it. I meet with her again in 2 weeks.

 

[Altostrata]

Your current doctor is not the one who prescribes Viibryd with venlafaxine, is that correct?

 

"Depression" also can be an adverse effect of benzodiazepines. 

 

11 minutes ago, BlackBetty said:

After adding the 5mg of Prozac, in the past few days - a bit past 2 weeks since starting it - I have started feeling better (physically, mentally, and emotionally), the thoughts are abating, and so is the crushing depression.

 

It takes about 2 weeks for Prozac to reach steady-state.

 

What is your sleep pattern? What is your daily drug schedule (times o'clock), with dosages?

[BlackBetty]

Correct! My current Dr is NOT the same Dr who put me on both Venlafaxine XR and Viibryd! I started tapering the benzo and found a more supportive and knowledgeable Dr. to help me taper off these meds. I've been very lucky to find her and she's on the Benzo Information Coalition site now. 

 

My current Dr was the one who said "WTF - we have to get you off the Viibryd asap please" and so we did. 

 

Benzo's and Antidepressants: it's a Venn diagram of medication side effects / symptoms. Ugh. Add in situational, genetic pre-disposition, poor resilience skills and low tolerance, PTSD / trauma, and viola. 20 years of being medicated. If I knew then what I know now....I strongly advocate for DBT / CBT. I have found that the skills I learned in DBT are helping me through this.

 

My sleep pattern has been better since switching from clonazepam. With clonazepam, I had terrible insomnia, as well the body pains, twitches, restless legs, "gasping for air", and my arms doing the nightly "disco dance" when trying to relax. I also had terrible fatigue, but it is a different flavor of fatigue than what I experience now. 

 

Currently, on Valium, I am sleeping and the issues I described above are rare. While I do have some mild insomnia occasionally, it is better than before. The fatigue is still there, but feels much different. I sleep a lot more, which may also be depression, plus the fatigue, or a combination.

 

Of course, I struggle with lots of other discontinuation symptoms in this journey.

 

Dosing schedule - I'm trying to keep ~12 hours between my Valium doses:

 

9AM: 5m Prozac, 75mg Venlafaxine XR, 5mg Valium

9PM: 5mg Valium

 

 

 

 

I hope I am not being too wordy - I know how limiting forum communication can be and how difficult it can be to really get the "big picture" in such a setting. I really appreciate your time!

 

 

 

[BlackBetty]

I have increased my Prozac to 10mg today. The anxiety is high, yay me.

 

I need guidance and help. Inspiration that this is possible. Positivity.

 

Do I start tapering my 75 Venlafaxine XR again and by how much??? 

[BlackBetty]

I haven't found or had any response about Prozac bridge approaches, but I will share what I have found in case others are in situations like myself. I got myself into an unfortunate situation and tapered down too much, too quickly, due to not having much / any information on how to bridge and miscommunication from my physician.  I wasn't able to find protocols, except for one from a Danish site. (Approach 2)

 

When you see instructions to "drop the antidepressant", please think "taper".  Fortunately, I am feeling much better and am on the right track again.

 

The Prozac : Venlafaxine XR rate is:

 

20mg Prozac : 145mg VXR

10mg Prozac: 75mg VXR

 

 

Approach 1: (this is the one I prefer, based on consultation with my physician, my experience, and keeps you within the 10% 'guardrails')

 

75mg Venlafaxine XR

• Take 5mg of Prozac for 2 weeks
  • Depending on how you respond, you may begin tapering from 5mg or go up to 10mg
• Take 10mg of Prozac and begin tapering your other medication (10% per month, depending on what you can tolerate)
• Continue to taper your other medication. Your Prozac dose may or may not need to be adjusted to a lower or higher dose, depending on how your taper goes.
• Once finished the original antidepressant, taper the Prozac.

Approach 2:  (Based on tapering strips site - Dr. Groot)

 

I was able to drop from 75mg of VXR to 37.5, but was not able to drop to 0mg of VXR. I'm stabilizing at 37.5mg and tapering from here.

 

• Take 5mg of Prozac for 2 weeks
• Take 10mg of Prozac and drop your VXR to 37.5 for one week
• Take 10mg of Prozac and cease the last 37.5mg
• Take 10mg of Prozac for one week
• Take 5mg of Prozac for one week
• Cease Prozac

 

Approach 3:  YIKES

 

This is based on the only other approach I found and is incredibly aggressive / harsh. This is based on one person's experience of 150 Effexor for 15 years.

 

• Drop to 112.50 (75 mg plus 37.5) for 7 days.
• Drop to 75 for 7 days.
• Drop to 37.5 for seven days. (may get hard at this point, hang in there)
• NOW, add in 10 mg Prozac WITH the Effexor, for 7 days.
• Stop Effexor. Continue on Prozac 10 mg for 7 days and STOP.

 

Good luck. You can do this.