Medindexer: venlafaxine - my personal journey

[Medindexer]

I have been on venlafaxine 150 from about 2004 and had stayed on it (more for preventive use as I felt quite well). In 2016, I visited a GP at my usual practice, as I was feeling a little low and was switched, very abruptly I thought (he said venlafaxine was quite an old choice of first line therapy), to fluoxetine (which a later specialist I met at the Royal Edinburgh suggested was probably a poor decision on the GP’s half – he reckoned I should have first tried upping the dose). I was also rapidly, tapered off the venlafaxine (2-3 weeks). I now know this is considered very short withdrawal time (and am aware that prolonged or very prolonged tapering (a year or more) is being advised. Venlafaxine has a very short half life and therefore rapid withdrawal means one has very quickly, very little left of the drug in one’s system.

 

Anyway, over the following 2-3 weeks of withdrawal, I very rapidly descended into my worst ever experience of depression. I will never know exactly the cause – possibly venlafaxine withdrawal syndrome or the fluoxetine not working at all or a reaction to fluoxetine – or whether it would have happened without the drug change. The latter is unlikely in my view as when I was put back on to venlafaxine I made a decent measure of recovery (albeit at a higher dose than before). Mirtazapine was added later on (I take 22.5mg) . This last combination appeared to work but I have now slid back somewhat it feels – overall, much of the time, I feel pretty poor. I don’t feel like trying yet another drug as it means facing for the second time, the venlafaxine discontinuation syndrome.

 

I’ve noticed that the research literature increasingly talks about the seriousness of antidepressant withdrawal and how common it is. Incidentally, I have also read about brain zaps, which I only discovered existed after having 2 or 3 occurrences of them myself (I hadn’t a clue what they were at the time). Now I notice that missing one daily dose can have some notable unpleasant effects as well as the brain .

 

I now wonder if the venlafaxine has lost its efficacy after 17 years – perhaps I’ve become tolerant to it (I can’t accept raising the dose!). I’m also concerned about the long-term health effects of taking the drug – not many studies of long-term effects of antidepressants exist I believe.

[Kiasofia]

Welcome @Medindexer

It was most likely withdrawal from venlafaxine that caused your worst ever experience of depression. Withdrawal induced depression tends to be much worse than natural depression. It is also normal for the body to build up tolerance to drugs and that they then no longer have the same effect. We understand this well when it comes to illegal drugs, like heroin, yet don't tend to see that it's the same with drugs used as medicine. Trying different drugs and higher doses will have limited effect, and result in the same outcome over time.

 

I found this post helpful to understand what is going on:

 

How Psychiatric Drugs Remodel Your Brain

 

I also highly recommend reading  Anatomy of an Epidemic by Robert Whitaker as well as A straight talking introduction to psychiatric drugs by Joanna Moncrieff to better understand these drugs and their effects. The Council for Evidence based Psychiatry also has a lot of good information.

 

Once you feel that you are in a good place in life, it can be worth considering tapering off the drugs or getting to less harmful doses. Make sure you know about tapering:

Why taper by 10% of my dosage?

 

NEVER SKIP DOSES TO TAPER

Taking multiple psych drugs? Which drug to taper first?

Coming off these drugs can cause many different withdrawal symptoms, often leading to doctors thinking the original condition is returning or that another mental illness has emerged.

What is withdrawal syndrome?

 

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

To give members the best information, we ask them to summarize their medication history in a signature following these instructions:

How to List Drug History in Signature

 

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

Edited November 16, 2021 by Kiasofia
Added link

[Medindexer]

Thanks for that useful advice. It mainly confirms much that I thought. It seems that venlafaxine has quite a bad withdrawal reputation compared to other antidepressants (would you agree?). I'd like to be in a better place to taper off, but I fear that I can't  get to a better place because venlafaxine is doing me no good. I wonder if it's not just doing nothing (after 17 years), but actually hindering my recovery. So few long-term studies it seems.

 

BTW I do lots of other things for mental health, therapy, mindfulness, exercise. I'm currently reading "the Body Keeps the Score" by Bessel van der Kolk, and finding it rings a lot of bells - I did not mention in my account here, that the depression I fell into was likely the result of a specific long-term traumatising events. I managed to keep myself together throught it all, and it was when it came to an end that I succumbed to the depression.

[Kiasofia]

It does seem that venlafaxine is among the harder ones. When tapering, the goal is to go slow enough that we remain functional. Your mental health/life situation doesn't have to be perfect when starting a taper, just not right when switching jobs, moving or other major life stressors. (I learned this the hard way.)

 

Taking multiple psych drugs? Which drug to taper first?

About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

Tips for tapering off mirtazapine (Remeron)

Tips for tapering off venlafaxine (Effexor)

 

If you do decide to taper and want advice and support from us, please summarize your medication history in a signature following these instructions:

How to List Drug History in Signature

 

Please stay in touch and let us know how you are doing.

[Altostrata]

Hello, @Medindexer, how are you doing?

[Medindexer]

How nice of you to think of me!

So much has happened. I've spent a fair amount of time in different therapies/books/mindfulness. After all, the trauma I've experienced (and it's taken a lot of time to acknowledge that I've been traumatized) are part of what's lead to my mental health problems. BUT.......... venlafaxine, bloody venlafaxine and it's withdrawal problems. I've wanted to reduce it as much as possible, as after 20years on it, I'm still suffering. I've asked myself has it stopped working, has it long-term adverse effects (very few long term studies or what?

I've come across tapering, not just from laypeople, but from recognised scientific studies, where the topic of tapering (hyperbolic) regimens,8 is much discussed.

I, with help from GP am presently trying to reduce the dose, using tablets plus liquid preparation delivered orally. But I've had to work it out, deciding my own regimen.

At end of March I was on 225. Presently, I've just reached 202.5. three steps of 7.5 mg in 2 months.

And I was surprised to learn that it can be the v last steps nearing complete withdrawal that are very hazardous.

 

It's being suggested that in time, antidepressant withdrawal, particularly the short half life ones, paroxetine and venlafaxine, will be seen on a par with benzodiazepines and opiates.

It's terrible that there are no long term studies of this

 

[Altostrata]

I'm sorry you've been caught up in this. Please let us know how your taper is progressing. How do you feel after each reduction?

 

Please follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[Medindexer]

Hi Altostrata

How do I feel....hmmmm. I'm not sure how I feel. It's been not a good few days

For the last few years I've been in this kind of sine wave of mood, where I feel ok for a few days roughly, then decline being low for a few days then recover for a few days - the cycling seemed uncontrollable.

Now, since I started the reduction, it's been a bit more volatile, the curve...my low mood feels different but I can't describe it in any obvious way.

I've been on 225 of Ben. At end on March, I took my first step of 7.5mg using a syringe on liquid venlafaxine. I've just taken my third step (3 X 7.5) = 22.5mg off the 225. 

 

Oh yes, I take mirtazepine too, 22.5. for some reason, I don't demonise mirtazepine - maybe that's because my sleep has been good since I took it - partly why I was prescribed it.

 

Thank you for your comments. It's a lonely journey (depression and anxiety and attempts at recovery), and I live alone, following some continuing (chronic) traumatic events happened (from 2011 to 2015). When the trauma ended and I found myself on on my own, that's when my mental troubles began.

Cheers for now.

[Altostrata]

If you find your withdrawal symptoms are bothersome and last more than a few days, you may wish to stop tapering for a bit, then taper by smaller amounts. See Tips for tapering off venlafaxine (Effexor)