vyhurz: Introduction, tapering off Effexor

[vyhurz]

Hi everyone. You can call me vyhurz. I realize this forum likes to know the history of one's medications, but I've actually never kept track. I've been off and on many, and I'm still working with my psychiatrist to find a good mix. Right now, and within the past several months, we've been working to treat bipolar II, depression, fatigue, anxiety, and ptsd. My issue right now is the Effexor I'm on. I started it maybe 2 years ago and got up to 150mg daily. Then I started to taper all the way down to 37.5mg daily. When going off it, I experience headaches, anxiety, irritability, and stomach aches if I remember correctly. So now I've been taking 37.5mg every other day for about 6 months. Yesterday, Friday 10/22, I spoke to my psychiatrist about recently missing a dose and how I had extreme anxiety and headaches. She said I may have to count the granules out and taper that way. I'm nervous about doing this because I don't know how to break it down. Just half and then half again? How do I keep track of the granules? Where do I put them? It just, well, gives me anxiety. On reddit I saw someone mention liquid Effexor. I also thought maybe I could go on regular Effexor instead of the XR and cut the pills that way. In any case, I'd like to know your experiences and advice.

 

I'm 33, no children, with a partner of 3 years, and living with my sister. I have a good job that I like, but my biggest issue is getting to work. My anxiety gets in the way. I decided to go back into the office instead of working from home some months ago because I thought it would help. I used to really enjoy my commute. But unfortunately, it didn't change anything, except that perhaps I've gotten worse. Working from home wasn't meant to be permanent and isn't feasible for me as I don't have room for a dedicated workspace. As it was, I was crammed onto my small kitchen table. With work, I'm currently on an intermittent leave of absence. I may go on short term disability after the new year in order to enter a DBT therapy group.

 

With my medications, I take all of them at the same time in the morning. I experience virtually no side effects when I don't miss doses. The second dose of Metformin I take in the evening with dinner.

[Altostrata]

Welcome, @vyhurz

 

On 10/23/2021 at 4:58 AM, vyhurz said:

So now I've been taking 37.5mg every other day for about 6 months. Yesterday, Friday 10/22, I spoke to my psychiatrist about recently missing a dose and how I had extreme anxiety and headaches.

 

Please do not do this. Skipping doses can cause odd symptoms, including extreme anxiety and headaches. These are withdrawal symptoms. You think there was no effect, but your practice of skipping doses for such a long time may have generated those symptoms you call bipolar II, depression, fatigue, anxiety, and PTSD. See NEVER SKIP DOSES TO TAPER

 

It's worth noting you are taking 5 psychiatric drugs plus metformin. That is a hefty drug cocktail, with drug effect duplication. Two, lamotrigine and topiramate, are from the anti-seizure category. Effexor and trazodone are both antidepressants. (You're also off bupropion??) Some of your symptoms may from drug interactions. Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

What is your current daily drug schedule, with times o'clock and dosages? Why are you taking metformin?

 

Your psychiatrist has shown unusually good knowledge about tapering Effexor XR. Yes, if you're taking the type of venlafaxine XR that comes in a capsule containing tiny beads, counting the beads is the best way to taper. See Tips for tapering off venlafaxine (Effexor)

 

But before you taper, you need to take a steady dose of Effexor EVERY DAY, taken at the same time EVERY DAY. These drugs cause problems when you take them irregularly. Now that you've gotten extreme anxiety and headaches from skipping doses, your nervous system may be quite sensitive to further dosage changes, or irregular dosing.

 

You need to figure out how many beads are in your 37.5mg capsules. Tips for tapering off venlafaxine (Effexor) explains how to do this. You probably will need a dark cloth to keep the beads from bouncing around when you take them out of the capsule to find an average number of beads per capsule. Another way to do this is to weigh them with a digital scale.

 

When you find out how many beads are in a capsule, if I were you, I'd start taking half a capsule every day, at the same time each day. That would be 18.75mg Effexor XR, in bead form. You can put counted or weighed beads in empty gelatin capsules for your daily doses. You can also pay a compounding pharmacy to do this, which requires a prescription from your doctor.

 

There is no liquid Effexor XR. If you get a compounded liquid made, it would be immediate-release and need to be taken twice a day.

 

It probably will take several months for your nervous system to stabilize from the irregular dosing. When you have absolutely no symptoms related to inconsistent dosing, it may be time to try reducing very carefully by counting beads.

 

Your psychiatrist probably will see the sense of this. She's probably kicking herself for not realizing your symptoms may be from inconsistent dosing. Or maybe not, if she's the source of that humungous cocktail.

 

[vyhurz]

Thank you, @Altostrata. I really appreciate your response. I hadn't even considered I was skipping doses, just that my dose period (if I can call it that) had been extended. I happened to email my psychiatrist early Saturday morning regarding the Effexor, so I will bring this up to her as well. I do get all my medications from her, except the Metformin which is from my PCP. It's for blood sugar/diabetes. She is very responsive and proactive. I believe she'll listen to me about the Effexor and needing to go back to taking 37.5mg daily. It may be hard for me to know when I'll have no symptoms related to the inconsistent dosing unless I simply start to feel better regarding my fatigue and anxiety. You said it may take several months. That's a bit disheartening, but I have already been on it for this long.

 

Here are the interactions.

 

I take my medications together every morning when I wake up, usually right before or after breakfast. When I wake up varies, but I could take them between 6:30am at the earliest and 11am at the latest. Every morning I take Metformin 500mg, Lamictal 300mg, and Vraylar 1.5mg. When it's an Effexor day, I also take it (37.5mg) at the same time. I take a second Metformin 500mg at dinnertime, usually between 6:30pm and 8pm. Before bed I take Trazodone 50mg and Topiramate 50mg, which is usually between 9:30pm and 10:30pm.

 

 

[Altostrata]

What did you think of your drug interactions report?

 

3 hours ago, vyhurz said:

When I wake up varies, but I could take them between 6:30am at the earliest and 11am at the latest.

 

I'm sorry, you cannot continue to keep taking your drugs on a variable schedule. This can also generate the symptoms you believe are bipolar II, depression, fatigue, anxiety, and PTSD. You need to take your drugs on a regular schedule, at the same times every day.

 

I would not go back to taking 37.5mg Effexor every day. You should try 1/2 of 37.5mg -- 18.75mg -- every day. Because you have been skipping doses for so long, your nervous system may be somewhat adapted to a lower daily dose. If you start taking 37.5mg per day, you may initiate a kindling reaction because your nervous system does not expect that higher drug load.

 

Furthermore, if you take 37.5mg Effexor every day again, the higher dose may exacerbate any drug-drug interactions.

 

At what point did you develop diabetes? You do know psychiatric drugs tend to increase risk of diabetes, correct?

 

3 hours ago, vyhurz said:

Before bed I take Trazodone 50mg and Topiramate 50mg, which is usually between 9:30pm and 10:30pm.

 

Why do you take these 2 drugs together?

 

[vyhurz]

The interactions made me feel very nervous and think about the various reasons why I'm on these medications. Trazodone and Topiramate were listed several times, and these are meds I may be able to stop completely. I've been on Topiramate for a very long time. It's a low dose to treat migraines that a psychiatrist gave me because I didn't have another doctor. So it's been rolled over to each new psychiatrist I've seen. I used to get migraines and headaches a lot, and while I do occasionally get headaches, migraines are rare. Perhaps that's the medication doing what it's supposed to do, or maybe my body has changed and the med has no affect anymore. I just don't know. The interactions are frightening. Trazodone I literally only take to help me sleep. I don't know if it'd be worth it to go off these meds just to be on less meds. I take them at the same time at night before bed to help me sleep. My psychiatrist has said Topiramate can cause drowsiness for some.

 

The earliest I wake is days I go into work, so that's not changeable. I will start making an effort to get up and out of bed early in the day even if I'm not going into work. I can always go back to bed.

 

Thank you for clarifying the Effexor dose. I do have a digital scale so I can use that. That may be better for me than counting the beads.

 

I've been overweight my whole life and my diet has been especially terrible during the pandemic, but I was officially diagnosed in April of this year. (I hadn't previously been diagnosed with pre-diabetes.) My a1c at that time was about 7.2. I worked with a nutritionist and three months later it was about 5.5. Since that appointment, my diet has been terrible again. I have an issue with food I think and thinking about what I'm eating is difficult for me. I didn't know about the increased risk while on psychiatric drugs. No one ever mentioned that to me. Because my a1c dropped so much, my PCP was obviously happy, but wanted to keep me on the Metformin and see me in another three months.

[Altostrata]

That's a good reason for taking topiramate at night. I'd question all the other drugs.

 

I am just a peer counselor on the Internet, but in my humble opinion, you are taking way too many drugs and the symptoms your psychiatrist claims are of bipolar II, depression, fatigue, anxiety, and PTSD (as well as actual diabetes and sleep problems) may very well be adverse drug effects or the result of your taking your drugs inconsistently for a long time. In other words, iatrogenic. 

 

It is a wonder you can work under that drug burden. 

 

Please let us know when you've stabilized on a consistent drug schedule and 18.75mg Effexor XR each day, we can start to talk about reducing Effexor. You might as well start with that. You will have to taper anything you've taken for more than a month.