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CharlieBrown13: Reducing venlafaxine and escitalopram


CharlieBrown13

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Hello everyone, a quick update.  

Three days ago I was hospitalized with a serotonin syndrome, I was literally poisoned  by my psychiatrist (thanks again, Altostrata, for your great help over many thousands of kilometers).  
Without exception, all the doctors here in the ward shook their heads about both the dosage and the drug combination, they really couldn’t believe it. 

I think this was malpractice and if at some point I am well enough and have the strength to do so, I will consider suing her.

 

The medication was discontinued immediately (escitalopram 25 mg / venlafaxine 50 mg).  


Maybe or probably I was too naive not to question that at the start of therapy, but that's why I started reducing it already 4 weeks afterwards, because I felt so badly with and about it.  


Now I'm on the third day without anything.  Yesterday and the day before yesterday were good days, my body literally breathed a sigh of relief. Today is not like yesterday , but ok.  
 

I have strong brain zaps when it comes to symptoms, but these began at the same time as the overdose symptoms two weeks ago, so I do not consider this a withdrawal symptom but a toxicity symptom.
I have DP mainly in the mornings, it fades in the afternoon. This also started two weeks ago and is sometimes more, sometimes less, more today.  
Today also slight nausea, abdominal cramps, feeling of anxiety, like a much smaller wave of the symptoms of the last two weeks.  
And unfortunately my brain is not working well at the moment, more complex thought processes are hardly possible.  Not at all nice, but I think many of you know that. It was much better yesterday afternoon, that is reassuring, the mind is still there, just blocked. 


I still have a lot of that dreadful stuff in my body, of course. 

Of course, I am very afraid of what happens when my body and brain register that the medication intake has gone from 300 to 0.  Like a Formula 1 crash.  

But I don't see any alternative at all right now. The doctors are extremely nice, everything is being observed now,  nobody pushes me to do anything. 

But still, I’m very very afraid.


The chief doctor said whether we should perhaps re-dose a low (very low!) amount of escitalopram or fluoxetine in order to alleviate any withdrawal symptoms, in the further course, not now.  


I don't have any withdrawal symptoms at the moment, although it is certainly difficult to distinguish where toxicity symptoms end and when do withdrawal symptoms begin.

 
I'm really very, very insecure about re-dosing, I have the feeling that every new manipulation makes the stormy sea in my brain even more stormy.


I am happy to hear your opinions on this, otherwise I will keep you up to date.

And stay strong , everybody, I think of all of you and your daily struggles- your great!!

3 Jan 2021 5 mg escitalopram 

Beginning of March dose increase to 40mg, additionally venlafaxine 50 mg, every 5 days increase to max 150 mg (this dose ca 4 weeks)

Tapering:

Venlafaxine: 15.Apr. 112 mg, 22.4. 100 mg, 6.5. 87,5 mg, 20.5. 70 mg, 4.Jun. 62,5 mg,20.6. 50 mg, 21.10. 46.37 22.10. 37 mg

Escitalopram: 30.Apr. 35 mg, 23. May 30 mg, 29.Jun. 25 mg, 28.Jul. 27,5 mg, 2.8. 25 mg, 20. Sep. 25.3 mg, 30.Sep. 25.5 mg 15.Okt. 25.35 mg 16.10. 25.25 mg 18.10 25mg

 

magnesium, omega3  

Metoprolol 23 mg 2x/d

 

           Better days- Dermot Kennedy
 (listen to it - wonderful song for dark days)

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Good to hear from you, @CharlieBrown13   You did the best you could. At last, the hospital took your symptoms seriously. Your adverse drug reaction was bad and getting worse, quitting the dr

Dear Charlie, I am glad you are now in good hands at the hospital. Acknowledging fear is to be brave. You are very brave! 

2020/2021 Imovane (zopiclone) Nov 7.5 mg, 4 Sept 2021 5 mg, 22 Sept 2021 3.75 mg (current dose)

2020/2021 Mirtazapin (30 mg) 16 Dec 2020, 7 Jan 2021 0 mg (ended).

2021 Sertraline 11 Jan 25 mg, 22 Jan 50 mg, 7 Febr 2021 0 mg (ended). 

2021 Olanzapine 13 Jan 2021 5 mg, 2 Febr 0 mg, 9 Febr 2021 5 mg (reinstated), 5 March 0 mg, 2 March 2.5 mg (reinstated), 16 March 0 mg, 30 March 2.5 mg (reinstated), 13 April 0 mg (ended). 

2021 Escitalopram 30 March 5 mg, 5 April 10 mg, 28 April 15 mg, 20 May 10 mg, 18 June 7.5 mg, 7 July 7 mg, 14 July 5 mg, 28 July 0 mg, 7 October 0.25 mg (reinstated), 11 October 0.10 mg (reduced reinstatement dose), 12 October 0.125 mg, 13 October 0.175 mg, 17 October 0.20 mg

Other medications: melatonin 5 mg at night 

Supplements AM: B vitamin, D vitamin, probiotics, turmeric and ginger, omega 3 

Supplements PM: C vitamin, magnesiumbisglycinat, omega 3, l-teanin 

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Thank you very much for your kind words, MirandaN, that really means a lot to me !!

3 Jan 2021 5 mg escitalopram 

Beginning of March dose increase to 40mg, additionally venlafaxine 50 mg, every 5 days increase to max 150 mg (this dose ca 4 weeks)

Tapering:

Venlafaxine: 15.Apr. 112 mg, 22.4. 100 mg, 6.5. 87,5 mg, 20.5. 70 mg, 4.Jun. 62,5 mg,20.6. 50 mg, 21.10. 46.37 22.10. 37 mg

Escitalopram: 30.Apr. 35 mg, 23. May 30 mg, 29.Jun. 25 mg, 28.Jul. 27,5 mg, 2.8. 25 mg, 20. Sep. 25.3 mg, 30.Sep. 25.5 mg 15.Okt. 25.35 mg 16.10. 25.25 mg 18.10 25mg

 

magnesium, omega3  

Metoprolol 23 mg 2x/d

 

           Better days- Dermot Kennedy
 (listen to it - wonderful song for dark days)

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9 hours ago, CharlieBrown13 said:

I have strong brain zaps when it comes to symptoms, but these began at the same time as the overdose symptoms two weeks ago, so I do not consider this a withdrawal symptom but a toxicity symptom.

 

Serotonin toxicity is dose-related.  Having been on the doses of the drugs for the length of time you were on them it is highly likely that you are/will experience withdrawal symptoms, and I think what you are experiencing now, after stopping the drugs, is WD and not due to the serotonin.  Because of the relation to dose, the serotonin toxicity should be reducing after stopping the drugs.

 

9 hours ago, CharlieBrown13 said:

The chief doctor said whether we should perhaps re-dose a low (very low!) amount of escitalopram or fluoxetine in order to alleviate any withdrawal symptoms, in the further course, not now.

 

Starting Prozac / fluoxetine might not be a good idea because it has a very long half life and can be difficult and long process trying to work out a suitable dose, which can involve having to endure discomfort for a week or more if you take too much and then having to endure more whilst you wait for the dose to diminish in your system.

 

I have asked Alto if starting a small dose of citalopram, a gentler sibling of escitalopram and easier to get non standard doses.

 

My suggestion would be to NOT start another drug until you hear from Alto.

So close to the end!!!

🏁

Current from 16 October 2021:  Pristiq 0.005mg

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.  I do not provide tapering advice via PM.  Please post questions in your Introduction topic.  Please do not tag me for any reason.  I am an unpaid volunteer and assist members if I am able to and when I have the time.  Thank you for your understanding.

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Good to hear from you, @CharlieBrown13

 

You did the best you could. At last, the hospital took your symptoms seriously. Your adverse drug reaction was bad and getting worse, quitting the drugs was justified.

 

Most of the venlafaxine and escitalopram has been metabolized by now. All in all, it doesn't sound like you're doing too badly. But in these situations, the lowest effective dose of a long-acting benzodiazpine, taken as sparingly as possible, may be helpful.

 

If you take it daily, it's likely you would have to taper off, but we can help you with that.

 

How's your sleep?

 

10 hours ago, CharlieBrown13 said:

The chief doctor said whether we should perhaps re-dose a low (very low!) amount of escitalopram or fluoxetine in order to alleviate any withdrawal symptoms, in the further course, not now.  

 

That is a very interesting remark, because the only source for recommending very low dose reinstatement is this site and the paper I wrote, 

Framer, A. (2021). What I have learnt from helping thousands of people to taper off antidepressants and other psychotropic medications. Therapeutic Advances in Psychopharmacology. https://doi.org/10.1177/2045125321991274
 
However, I would not anticipate any kind of antidepressant reinstatement. It may be your nervous system is so relieved, you will feel a lot better now.
 

Fish oil and magnesium supplements can be helpful, see

 

https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

 

https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Fish oil in particular seems to reduce brain zaps. You might try a little bit of one at a time to see how it affects you. Please let us know how you’re doing.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Charliebrown13 wow I’m so glad you are ok!  The actions taken were amazing!  You and Altos brainstorming - You new you needed to go to hospital and you got yourself there - the drs recognized the medication toxicity-  the dr stated low dose for withdrawals WOW! WOW!
 

Having the hospital regonize toxicity and withdrawals I thought that was only in dreams ! 
Thanks to Alto and everyone involved ! Prayers for healing Charliebrown13! 

2000-2013 Paxil - 1 year fast taper

2013-2018 drug merry go round with dr. 
zoloft, cymbalta, lamictal, Prozac.

 Nov. 2018 lexapro 15 mgs,

Started taper Dec. 2019 to  Mar. 2020 lexapro 10mg. Jul 2020 to October 2020 8.5 ml.
Oct 2020 reinstated to 9 ml.
Apr 2021 to Jul 2021 7 ml. 10/02/2021 6.90 ml, 10/09/2021 6.80, 10/16/2021 6.70, Oct 24 2021 6.60 ml, 

present Celebrex 200 - 400 mg daily as needed, Pepcid 20 mg, zinc L carnosine , Prilosec very rarely if desperate 

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@Altostrata

7 hours ago, Altostrata said:

 

Most of the venlafaxine and escitalopram has been metabolized by now. All in all, it doesn't sound like you're doing too badly. But in these situations, the lowest effective dose of a long-acting benzodiazpine, taken as sparingly as possible, may be helpful.

I think there is still a lot of escitalopram in particular in me, as it has a significantly longer half-life than venlafaxine.  
This morning, I had the same symptoms as yesterday, fear, sweating, abdominal cramps, DP, Diarrhea, skin burning, but not very severe, just quite uncomfortable. And my mind is still not working very good, that is the greatest burden for me right now..😟

If it comes to severe wd, I will ask for for a benzo, maybe diazepam. 

 

7 hours ago, Altostrata said:

That is a very interesting remark, because the only source for recommending very low dose reinstatement is this site and the paper I wrote.

 

Maybe he read your paper. It would be nice if it caught on in a few minds. Or a few more.

If not, I will recommend it to him. This hospital (TUM in Munich) has a very good reputation. Maybe he could talk to some of his colleagues about it.

 

7 hours ago, Altostrata said:

How's your sleep?

I sleep much better now, 6-7 hours again.  Waking up (probably also because of the high cortisol levels in the morning) and the hours afterwards are the main problem.
 

7 hours ago, Altostrata said:

Fish oil in particular seems to reduce brain zaps. You might try a little bit of one at a time to see how it affects you. Please let us know how you’re doing.

The brain zaps are still very violent.  I have been taking high doses of fish oil for 8 weeks now, as well as magnesium glycinate.   

 

7 hours ago, Altostrata said:

However, I would not anticipate any kind of antidepressant reinstatement. It may be your nervous system is so relieved, you will feel a lot better now.


Yes, I am not currently taking any new medication either.  I'll just wait and see now.  And hope. What a year.

3 Jan 2021 5 mg escitalopram 

Beginning of March dose increase to 40mg, additionally venlafaxine 50 mg, every 5 days increase to max 150 mg (this dose ca 4 weeks)

Tapering:

Venlafaxine: 15.Apr. 112 mg, 22.4. 100 mg, 6.5. 87,5 mg, 20.5. 70 mg, 4.Jun. 62,5 mg,20.6. 50 mg, 21.10. 46.37 22.10. 37 mg

Escitalopram: 30.Apr. 35 mg, 23. May 30 mg, 29.Jun. 25 mg, 28.Jul. 27,5 mg, 2.8. 25 mg, 20. Sep. 25.3 mg, 30.Sep. 25.5 mg 15.Okt. 25.35 mg 16.10. 25.25 mg 18.10 25mg

 

magnesium, omega3  

Metoprolol 23 mg 2x/d

 

           Better days- Dermot Kennedy
 (listen to it - wonderful song for dark days)

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3 hours ago, Heath said:

Charliebrown13 wow I’m so glad you are ok!  The actions taken were amazing!  You and Altos brainstorming - You new you needed to go to hospital and you got yourself there - the drs recognized the medication toxicity-  the dr stated low dose for withdrawals WOW! WOW!
 

Having the hospital regonize toxicity and withdrawals I thought that was only in dreams ! 
Thanks to Alto and everyone involved ! Prayers for healing Charliebrown13! 

Dear Heath,

thank you for your words, that touches me very much.  On Sunday I just had my back to the wall and was so desperate that I was so happy to have a contact person in Altostrata.  

And that I came across an extremely nice admission doctor who listened to everything for a long time and in detail and took the right measures, I am also very happy about that.  I hope so much that some of the symptoms will now subside again, especially the impaired cognition and brain zaps and those stupid feelings of fear.  I guess I'll just have to wait and see now.  Thank you very much again !!  

Warm greetings

 

Charlie

3 Jan 2021 5 mg escitalopram 

Beginning of March dose increase to 40mg, additionally venlafaxine 50 mg, every 5 days increase to max 150 mg (this dose ca 4 weeks)

Tapering:

Venlafaxine: 15.Apr. 112 mg, 22.4. 100 mg, 6.5. 87,5 mg, 20.5. 70 mg, 4.Jun. 62,5 mg,20.6. 50 mg, 21.10. 46.37 22.10. 37 mg

Escitalopram: 30.Apr. 35 mg, 23. May 30 mg, 29.Jun. 25 mg, 28.Jul. 27,5 mg, 2.8. 25 mg, 20. Sep. 25.3 mg, 30.Sep. 25.5 mg 15.Okt. 25.35 mg 16.10. 25.25 mg 18.10 25mg

 

magnesium, omega3  

Metoprolol 23 mg 2x/d

 

           Better days- Dermot Kennedy
 (listen to it - wonderful song for dark days)

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11 hours ago, ChessieCat said:

nd I think what you are experiencing now, after stopping the drugs, is WD and not due to the serotonin.  Because of the relation to dose, the serotonin toxicity should be reducing after stopping the drugs.


Hi, @ChessieCat

the symptoms i have now are the same as before the discontinuation, only in a much weaker intensity.  Only the brain zaps and the tinnitus are still very pronounced, but I think it is slowly getting a little better.
And I hope that this continues to subside.  In this respect, I believe that these symptoms can actually still be traced back to the serotonin toxicity, as they started with the acute events 14 days ago.  Unfortunately, I have relatively few doubts that I will get withdrawal symptoms ...

 

11 hours ago, ChessieCat said:

 

Starting Prozac / fluoxetine might not be a good idea because it has a very long half life and can be difficult and long process trying to work out a suitable dose, which can involve having to endure discomfort for a week or more if you take too much and then having to endure more whilst you wait for the dose to diminish in your system.


I think you are absolutely right, at the moment I don't want to take any new / different drugs at all.  And before I even consider doing that, I'm going to do a genetic test to see if I'm a poor metabolizer.  That would perhaps explain why I do not tolerate so many drugs well or why I often only need very small doses (e.g. Metoprolol)

 

Thank you very much for your input and your effort, I really appreciate that!

3 Jan 2021 5 mg escitalopram 

Beginning of March dose increase to 40mg, additionally venlafaxine 50 mg, every 5 days increase to max 150 mg (this dose ca 4 weeks)

Tapering:

Venlafaxine: 15.Apr. 112 mg, 22.4. 100 mg, 6.5. 87,5 mg, 20.5. 70 mg, 4.Jun. 62,5 mg,20.6. 50 mg, 21.10. 46.37 22.10. 37 mg

Escitalopram: 30.Apr. 35 mg, 23. May 30 mg, 29.Jun. 25 mg, 28.Jul. 27,5 mg, 2.8. 25 mg, 20. Sep. 25.3 mg, 30.Sep. 25.5 mg 15.Okt. 25.35 mg 16.10. 25.25 mg 18.10 25mg

 

magnesium, omega3  

Metoprolol 23 mg 2x/d

 

           Better days- Dermot Kennedy
 (listen to it - wonderful song for dark days)

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