SlimDunkin6o4: in a rut after a fast taper

[SlimDunkin6o4]

Hey there! This is my first time posting on this platform, so I hope you'll forgive me if I'm in breach of any protocols or haven't used the space appropriately. I tried to read as much as I could before diving into this, but frankly, there's a lot of stuff to sift through, and it got overwhelming at points. So, if I've erred, please, don't hesitate to let me know so that I might make amends.

 

Anyway!

 

My signature pretty much says it all. I've used Venlafaxine (Effexor) to treat social anxiety disorder and chronic depression since I was about 21-years-old (I'm now 30), often bouncing between 150mg and 225mg to varying degrees of success, and with little issue save for some of the nastier side-effects. In my case, those side-effects were weight gain, loss of energy, libidinal ones, and if I miss my dose by even a few hours, the worst brain zaps imaginable. There's been very little interruption of this medication, save for one spell of going cold turkey for a few months, and a few quick run-ins with Fluoxetine (Prozac) and Escitalopram (Cipralex).

 

Ultimately, I kept coming back to Venlafaxine because it worked better than any other medication I'd tried, and I could live with the side-effects even if I'd rather not. So from about 2017 onward until the spring of 2021, I kept on Venlafaxine at about 150mg without interruption.

 

The side-effects really started to weight on me in the months leading up to that spring, particularly the weight gain. I figured that there had to be a better way, and I'd heard great things about Desvenlafaxine (Pristiq), so I thought I'd give that a shot. I consulted with my doctor who said that we could do this without issue, but would rather I tried Vortioxetine (Trintellix) instead because of the prohibitive cost of Desvenlafaxine. His plan was to taper off of 150mg of Venlafaxine over a month, and then immediately switch to Vortioxetine. It seemed like a good enough plan to me because, well, I didn't know any better. This, of course, was when my life got ruined, it seems almost irreversibly at times.

 

Simply put: I did not take well to the Vortioxetine. It was an awful, awful experience. I had more panic attacks in my first two weeks on that medication than the rest of my life combined. I'd lost the capacity to think or to speak or to remember anything. I was in constant discomfort. It was like my life had been turned completely upside down. Worse still, I started to develop pure obsessive compulsive disorder, something that hadn't really been a thing for me to this point in my life. I tried and I tried to stick it out, but I had to quit after a month. I couldn't bare to live like that. And my doctor threw in the towel and told me to talk to a psychiatrist.

 

So I did precisely that. I had to wait a month, though, at which point I was without any medication and I suffered such debilitating withdrawals that I had to go to the hospital. I didn't really know what was going on at the time and I'd never felt worse in my life. But, eventually I got through that, and I spoke with a psychiatrist at the hospital. They told me that Vortioxetine was a terrible choice on my doctor's part, and my experience was pretty much par for the course. She said it's by far the worst medication for people with anxiety or social anxiety. She also wasn't particularly fond of me tapering off of Venlafaxine for a month when I'd been using it for the better part of a decade.

 

I started taking Desvenlafaxine on June 1, 2021, with a dosage of 50mg for two weeks, and then up to 100mg. And it didn't really do much for me, which was devastating. I'd wake up having panic attacks. I'd have regular panic attacks throughout the day. On top of it all, I'd developed tinnitus. My social anxiety was in an awful place. I tried to stick out for as long as I could before I threw in the towel on that and switched back to Venlafaxine -- the devil you know, right?

 

The switch back to Venlafaxine offered some relief, but I didn't feel anything like I used to before this whole ordeal. I was still an anxious mess. My pure OCD compulsions remained, another devastating blow. I felt spaced out constantly. It was a better experience than I'd had on Vortioxetine or Desvenlafaxine, but hardly a good one. This would still register as the worst I'd felt from a mental health perspective at any point in my life prior to last spring, when this medication SNAFU turned my life upside down.

Worse still, I couldn't really get my dosage up to a helpful level. I seemed to feel worse when I moved up to 75mg. It was like my body and my mind couldn't handle this drug that at one point was a feature of my every day life for years at a time. So, I went back to 37.5mg, feeling awful constantly. Anxious, depressed, suffering pure OCD compulsions... it felt at times like I'd lost my mind. And as it became clear that this wasn't doing much for me, I started to slowly wean myself off of Venlafaxine, one half-bead at a time. I'm now down to one bead, which is about 12mg, if I'm not mistaken.

 

I've felt better as I've weaned down, if only slightly, which is both good and bad. I still feel awful relative to where I was before this medication ordeal started last spring. And I really do need this medication to get through day-to-day life.

 

My situation feels hopeless. I'm watching personal and professional relationships deteriorate because I can't handle even the most rote social engagements without freaking out completely. I've contemplated taking my life on a few occasions, and came very close to doing so last November.

 

I've spoken to a psychiatrist who wants me to try starting Sertraline, but frankly, I'm kind of terrified given my experiences the last few months. I just don't have anymore room for my life to get worse before, well... I don't even know.

 

Any advice on what to do? I'm totally at a loss here, feeling failed by my doctors, and in a hopeless loop that leaves me feeling awful on day-to-day basis, unable to live the life I did at this time a year ago.

[Erell]

Hello @SlimDunkin6o4, 

 

And welcome on SA. Thank you for your signature, it will help us to see your history at a glance.

 

I'm very sorry that you went through a rough time.

 

We often see that after repeated exposures to drug changes, doses changes, discontinuation and reinstatements, the nervous systems seem to become hypersensitive and the dose that was accepted by the central nervous system is not necessarily accepted anymore.

Really, you're not alone in this situation, we see it all the time.

The good news is that our nervous systems seem to have great healing abilities, but regaining stability can take time.

 

It's good news that you've seen some improvement since you started lowering your dose.

After all the changes your nervous system has gone through in the last few years, my suggestion would be to take a long break and not touch your dose for several months. 
It may take some time to regain a certain stability, I invite you to read these links to better understand:

 

-> the-windows-and-waves-pattern-of-stabilization

-> stabilizing-what-does-that-mean

 

On SA, we recommend slow and progressive tapering, with drops of 10% maximum every 4-6 weeks.
I know that's a lot to read, but if you feel you're getting there, I invite you to check out these links that will help you see things more clearly: 

-> how-psychiatric-drugs-remodel-your-brain

-> why-taper-by-10-of-my-dosage

-> tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine

 

Your situation is definitely not hopeless : unfortunately, your testimony is similar to many others, and it seems that your nervous system is destabilized. But this situation is not permanent and, with time, our nervous systems can regain stability.
I invite you to take a look at our Success Stories section when you need to remind your mind that things can and will get better.

 

 

 

 

Keep us updated, take care.

 

[Blossom71]

On 1/31/2022 at 8:09 PM, SlimDunkin6o4 said:

I tried to read as much as I could before diving into this, but frankly, there's a lot of stuff to sift through, and it got overwhelming at points.

Hi @SlimDunkin6o4

 

Don't worry, i was pretty overwhelmed when i started here but just ease yourself in.  There is so much brilliant info here but it's impossible to read everything in and take it all in straight away, and not everything will be applicable to you anyway.

I started by reading the links that the Mods send me (bit by bit) then gradually as i got the lay of the land then started reading more as things cropped up.

Wecome by the way! x

[SlimDunkin6o4]

Hey @Erell!

 

Thanks so much for the response, and for the helpful links. I'm going to make sure that I dive into each of them in due time and look them over.

 

I don't suppose there's any way we can put an even semi-reliable timeline on recovering from this sort of thing, can we? And on the topic of continuing to taper down, I've been on 12mg (one bead in my 37.5mg Venlafaxine) for about 1.5 months at this point. I'm thinking about dropping down to 0.75 beads, in accordance with the 10 percent drops at a time that you cited as a guideline. Does that seem like a reasonable course of action or should I stay on the 12mg/one bead program for a bit longer? I'm guessing that I should avoid starting the Sertraline (Zoloft) program that the last psychiatrist I spoke to recommended? Truthfully, I'm so desperate to get my life back, I'll try anything.

 

I hope you'll forgive my hastiness, and even more so if the answers to these questions lie in some of the links you shared. I'm just creeping up on a year of this hellish existence, and I'm really trying to do whatever I can to expedite the process and get on with my life as it once was.

 

One more question... I'm really not under any delusions about where I'm at with my mental health. I absolutely need medication to get through day-to-day life with my social anxiety as bad as it's been for much of my adult life. My whole plan here wasn't to stop taking medication... it was to try and find medication that didn't sap my energy, add to my waistline, and maybe find something a little less harmful on the libido front. I guess I just want to know if there's a pathway back to feeling as I did before I messed up my nervous system last spring, one which I would imagine requires being on this medication (Venlafaxine) or some alternative.

 

Looking forward to getting your thoughts

 

-SlimDunkin

[getofflex]

On 2/6/2022 at 10:08 PM, SlimDunkin6o4 said:

I don't suppose there's any way we can put an even semi-reliable timeline on recovering from this sort of thing, can we?

Unfortunately, no there isn't.  I know you are overwhelmed by all the information here, but here is another link that goes into how long withdrawal may take.  It is different for various people, and depends on many factors - age, how long you've been on the drug, circumstances in your life while you are tapering, your own individual nervous system, your attitude towards your WD symptoms (acceptance vs non acceptance),  how many psych drugs you've been on the past, how many times you have gone off and on psych meds, etc.  

 

How Long is Withdrawal Going to Take?

 

On 2/6/2022 at 10:08 PM, SlimDunkin6o4 said:

I'm thinking about dropping down to 0.75 beads, in accordance with the 10 percent drops at a time that you cited as a guideline. Does that seem like a reasonable course of action or should I stay on the 12mg/one bead program for a bit longer

 

As @Erellsuggested, if it were me, I would wait a while before I made any more drug changes.  Looking at your signature, you've had quite a few drug changes in the past 12 months.  It is likely that your nervous system is destabilized from this, and really needs some stability (no drug changes) for at least several months.  It needs time to adjust, and find equilibrium.  Trying to rush a taper is not something we suggest.  There is a significant risk of further destabilizing you, and causing major discomfort, and in the long run, the whole situation would actually take even longer to recover from.  Patience and time are the keys to getting off these drugs. 

 

 

 

On 2/6/2022 at 10:08 PM, SlimDunkin6o4 said:

One more question... I'm really not under any delusions about where I'm at with my mental health. I absolutely need medication to get through day-to-day life with my social anxiety as bad as it's been for much of my adult life. My whole plan here wasn't to stop taking medication... it was to try and find medication that didn't sap my energy, add to my waistline, and maybe find something a little less harmful on the libido front. I guess I just want to know if there's a pathway back to feeling as I did before I messed up my nervous system last spring, one which I would imagine requires being on this medication (Venlafaxine) or some alternative.

I assume you are asking what would be a good alternative drug to be on?  I cannot answer that question for you - that is a question for your doctor.  Perhaps there are non drug ways to cope with and reduce social anxiety.  

[SlimDunkin6o4]

@getofflex

 

Thanks for the reply!

 

On 2/8/2022 at 2:55 PM, getofflex said:

Unfortunately, no there isn't.  I know you are overwhelmed by all the information here, but here is another link that goes into how long withdrawal may take.  It is different for various people, and depends on many factors - age, how long you've been on the drug, circumstances in your life while you are tapering, your own individual nervous system, your attitude towards your WD symptoms (acceptance vs non acceptance),  how many psych drugs you've been on the past, how many times you have gone off and on psych meds, etc.  

 

 

On 2/8/2022 at 2:55 PM, getofflex said:

As @Erellsuggested, if it were me, I would wait a while before I made any more drug changes.  Looking at your signature, you've had quite a few drug changes in the past 12 months.  It is likely that your nervous system is destabilized from this, and really needs some stability (no drug changes) for at least several months.  It needs time to adjust, and find equilibrium.  Trying to rush a taper is not something we suggest.  There is a significant risk of further destabilizing you, and causing major discomfort, and in the long run, the whole situation would actually take even longer to recover from.  Patience and time are the keys to getting off these drugs. 

 

That's a bit of a bummer. Patience has never really been my strong suit, and here I am going on a year of feeling awful and suffering the worst mental health of my life without a clear exit ramp or a timeline -- not that this is your fault, obviously... just bummed by it, I guess. I suppose that this advice also applies to my psychiatrist's recommendation that I start taking Sertraline (Zoloft), too?

 

Which, I suppose, leads me to another question... why is it that the hospital psychiatrist that I spoke to when I visited one in November has such a drastically different take on all of this? I'm saying this because I'd become familiar with some of the ideas floated on this medium way back when -- I would read some of what was posted here, particularly the bits about nervous system destabilization, etc. -- and brought them up, and for that I was looked at and even spoken to like a complete crackpot. Even the one I'm speaking to now doesn't seem to quite share the opinion of some of the people in here who work in the field. And for posterity, I ask that question in good faith, wholly curious, and not with any preconceived notions about who is or isn't right on my end. Frankly, the hospital psychiatrist was awful throughout my process and did little to gain my confidence. Just genuinely curious where and why the disconnect there occurs, if anyone has insight into that.

 

And I suppose the next question is, how many months is reasonable on my one bead (12mg or so) of Venlafaxine? I'm at about 1.5 now.

 

On 2/8/2022 at 2:55 PM, getofflex said:

I assume you are asking what would be a good alternative drug to be on?  I cannot answer that question for you - that is a question for your doctor.  Perhaps there are non drug ways to cope with and reduce social anxiety.  

 

Apologies, as I wasn't particularly clear there... What I meant to say was, is there a pathway to just getting back to where I was before I tried switching medications? Because, truthfully, I would give literally anything in the world to get back to that place, taking 150mg of Venlafaxine, side effects and all, just to feel the way I did before this medication switch up nightmare. If you still can't answer that -- fair enough! I just wanted to clarify the point I was trying to make on the odd chance that you might be able to with a better understanding of what I was striking at.

[getofflex]

On 2/6/2022 at 10:08 PM, SlimDunkin6o4 said:

I'm guessing that I should avoid starting the Sertraline (Zoloft) program that the last psychiatrist I spoke to recommended?

I can't make this decision for you.  But, if it were me, I would not go on yet another psychiatric drug.  From what you describe, it sounds as though your nervous system is pretty sensitized already by all the previous drug and dose changes.  By doing this, you run the risk of making your situation even worse.  

 

19 hours ago, SlimDunkin6o4 said:

why is it that the hospital psychiatrist that I spoke to when I visited one in November has such a drastically different take on all of this? I'm saying this because I'd become familiar with some of the ideas floated on this medium way back when -- I would read some of what was posted here, particularly the bits about nervous system destabilization, etc. -- and brought them up, and for that I was looked at and even spoken to like a complete crackpot

Because the vast majority of these doctors do not recognize that there is such a thing as withdrawal from these drugs that lasts more than several weeks.  I can't tell you why the hospital psych had a different take on things.  The healthcare professionals have been hoodwinked by the drug manufacturers to believe these drugs are mostly safe and harmless by intense marketing for decades.    The drug companies make billions of dollars on these drugs.  When a patient suffers from withdrawal, it's easy to say that it's their mental illness, or it's all in their head, because there are no tests that prove they are in WD.  It's a corrupt situation.  

 

19 hours ago, SlimDunkin6o4 said:

And I suppose the next question is, how many months is reasonable on my one bead (12mg or so) of Venlafaxine? I'm at about 1.5 now.

Please listen to your body, and wait until you feel stable before you make another dose reduction.  Give it all the time it needs.  I can't say for sure.  Have you been feeling any improvement at all yet, since the last reduction?  

 

19 hours ago, SlimDunkin6o4 said:

is there a pathway to just getting back to where I was before I tried switching medications? Because, truthfully, I would give literally anything in the world to get back to that place, taking 150mg of Venlafaxine, side effects and all, just to feel the way I did before this medication switch up nightmare.

The more we go on and off various drugs, etc, the more sensitive our system becomes, and what used to work for us may now no longer work.  So, I cannot give you a pathway to get back to how you felt then.  

 

Here is my philosophy:  When I was on these drugs, I felt like half of a person.  Much of my emotional and spiritual life was numb.  I've decided, for myself, to go off all psych meds, very carefully and slowly, and use non drug techniques for coping with anxiety and depression when it comes up.  I would rather be a whole person, and have some anxiety and depression, than be half a person.  Thankfully, most days I'm free of anxiety and depression.  You said you were given psych meds for social anxiety and depression.  There are ways to deal with this besides drugs.  Here is a link for you to think about:  

 

Chemical Imbalance is a Myth

[FindRest]

Please be aware that the mini-tabs in your capsule are not the same as “beads”. Capsules of venlafaxine with “beads” usually contain many, many beads. My 37.5 capsules have from 120-140 beads in each. With mini-tabs, there are usually like 3 in a 37.5 capsule.

 

What this means is that you need to follow the guidelines for tapering from a “mini-tab”. Essentially, cutting a mini-tab makes it instant release as it messes with the extended release properties. They must be crushed and half your dose taken twice a day, 12 hours apart. This means you’ll need to get a mg scale. You can search SA for more info.

 

I just wanted to point this out as you mention taking 75% or 50% of your “bead” (really mini-tab). If you do not take half your new dose twice a day, the withdrawals can get real nasty real fast, as the half-life of ven is so short. Also, know that this last 12.5 is the hardest part to get off of. It gets harder the lower we go, not easier. That’s why it’s also essential that you precisely weigh your new dose.

[SlimDunkin6o4]

Hey @FindRest,

 

Thanks for the pointer! Like I said, pretty new to this whole deal -- well, new to the specifics of what's going on even if these withdrawal symptoms are ongoing for close to a year now... -- so I just kind of assumed that the beads were the individual capsules (mini-tabs, I suppose...) in my 37.5mg pills. I'll change my signature to reflect this new information, and I hope you'll forgive me any confusion.

 

Just out of curiosity, is the need to crush the mini-tabs a means of ensuring the dosage is correct? I guess I'm just not entirely certain why they would need to be crushed, particularly if I have a pill splitter that's doing a pretty good job of cutting them in half without too, too much variance there.

 

Appreciate your insight!

 

- SlimDunkin

[SlimDunkin6o4]

Hey @getofflex,

 

Thanks again for the thoughtful, thorough answers. I really appreciate it.

 

On 2/10/2022 at 3:05 PM, getofflex said:

Please listen to your body, and wait until you feel stable before you make another dose reduction.  Give it all the time it needs.  I can't say for sure.  Have you been feeling any improvement at all yet, since the last reduction?  

 

 

So, funny enough, I really did start to feel improvement, if only slight, every time I stepped down one half-mini-tab at a time. This last week, though, not so much. Just feeling very spaced out, some headaches, and my pure OCD symptoms and anxiety have been off the charts bad in spots. Apparently, this could be the result of my taking my last mini-tab all in one shot, rather than spacing it out in halves taken every 12 hours, putting myself through mini-withdrawals regularly. I'm going to give splitting my dose up by 12 hours a shot and see how that goes.

 

I guess it's just difficult for me to know what stabilization even looks like at this stage, hence my asking. It's been so long since I last felt good... basically, right before my doctor assured me that switching medications would be easy, at which point my life was seemingly ruined. I'll have some good days, a good week or two even, and then even the most minor stressor and I'm feeling just as bad as before for a few days or a week. Which, I suppose, tells me I'm nowhere near stabilized yet anyway...

 

On 2/10/2022 at 3:05 PM, getofflex said:

I can't make this decision for you.  But, if it were me, I would not go on yet another psychiatric drug.  From what you describe, it sounds as though your nervous system is pretty sensitized already by all the previous drug and dose changes.  By doing this, you run the risk of making your situation even worse.  

 

... which kind of explains why I was curious about whether to give my psychiatrist's recommendation to try Sertraline out a try. I just... I'm really struggling to find the strength or the patience to deal with this much longer. Talk about a Catch-22. No clue whether to risk making my situation worse with the small chance that trying Sertraline could make it better or to just ride this thing out, feeling miserable all the while, but in a devil you know sort of sense. I guess I just want something, anything to snap me out of this nearly year-long funk before the damage is too severe to ever claw back from.

 

On 2/10/2022 at 3:05 PM, getofflex said:

The more we go on and off various drugs, etc, the more sensitive our system becomes, and what used to work for us may now no longer work.  So, I cannot give you a pathway to get back to how you felt then.  

 

Here is my philosophy:  When I was on these drugs, I felt like half of a person.  Much of my emotional and spiritual life was numb.  I've decided, for myself, to go off all psych meds, very carefully and slowly, and use non drug techniques for coping with anxiety and depression when it comes up.  I would rather be a whole person, and have some anxiety and depression, than be half a person.  Thankfully, most days I'm free of anxiety and depression.  You said you were given psych meds for social anxiety and depression.  There are ways to deal with this besides drugs.  Here is a link for you to think about:  

 

Well, that's kind of a bummer. Not sure I would've ever made the call to try out new drugs if I'd any idea that returning to them would be so perilous, which says nothing of the absolute hell I've had to endure since this whole ordeal started.

 

Thing is, I'm kind of in the opposite spot. I felt like half of a person without the drugs, largely because I just couldn't cope with life on its terms without them. Trying to maintain a job, a social life, maybe even a relationship... these things were all brutally difficult if not impossible before I started medication, and my life was so much richer for having made the call to start Venlafaxine all those years back. I never thought I'd be saying this, but what I'd give to just be back on 150mg, living my life as I always had before last spring...

 

-SlimDunkin

[getofflex]

42 minutes ago, SlimDunkin6o4 said:

So, funny enough, I really did start to feel improvement, if only slight, every time I stepped down one half-mini-tab at a time.

I'm glad to hear this.  It means you were on the road to healing and stabilizing. 

 

42 minutes ago, SlimDunkin6o4 said:

Apparently, this could be the result of my taking my last mini-tab all in one shot, rather than spacing it out in halves taken every 12 hours, putting myself through mini-withdrawals regularly. I'm going to give splitting my dose up by 12 hours a shot and see how that goes.

Yes, that could have been what caused your symptoms.  I'm glad you are going back to splitting your dose.  I assume you are on the immediate release venlafaxine? Venlafaxine has a half life of about 12 hours, so this is probably best, if you are on immediate release. 

 

42 minutes ago, SlimDunkin6o4 said:

I guess it's just difficult for me to know what stabilization even looks like at this stage, hence my asking.

These links explain more about what stabilization means:

 

Stability - What Is It?

 

WD Normal

 

42 minutes ago, SlimDunkin6o4 said:

... which kind of explains why I was curious about whether to give my psychiatrist's recommendation to try Sertraline out a try. I just... I'm really struggling to find the strength or the patience to deal with this much longer. Talk about a Catch-22. No clue whether to risk making my situation worse with the small chance that trying Sertraline could make it better or to just ride this thing out, feeling miserable all the while, but in a devil you know sort of sense. I guess I just want something, anything to snap me out of this nearly year-long funk before the damage is too severe to ever claw back from.

I think the key for me, is to look at the big picture.  As an example, often, people will take a drink in WD because they feel better for a few hours.  But then, the next day, and maybe for days and weeks after that, they actually feel worse because the alcohol has further destabilized their nervous system.  Sometimes, it is advantageous to put up with discomfort for a while, so that in the long run, we are better off.   Instead of going onto another drug, have you considered the possibility of a small updose of the venlafaxine?  This may help lessen some of your withdrawal symptoms.  I believe it would be less risky than going on yet another drug.  Or, it could be that if you go back to dosing it twice a day, this may help you, and you won't need to do anything else.  Could you possibly update your drug signature with the details of your recent venlafaxine tapering since November 2021?  I would feel better about suggesting an updose amount if I knew more specific details.  

 

Psychiatrists are almost always going to want to put people on a different drugs, or more drugs.  That is how they are trained.  I have seen more people come in here, and more often than not, they get more messed up when they try yet another different drug.  I'm not telling you what to do - it is your decision.  I'm just telling you what I've seen.  

 

As far as "the damage being too severe to claw back from", I doubt that this would happen.   We have seen people here who were on some major drug cocktails eventually recover.  Shep is a great example of this.  Try reading here success story.  It is phenomenal.  

 

Leaving Plato's Cave - Shep's Success Story

 

 

Edited February 13, 2022 by getofflex

[FindRest]

1 hour ago, SlimDunkin6o4 said:

Just out of curiosity, is the need to crush the mini-tabs a means of ensuring the dosage is correct? I guess I'm just not entirely certain why they would need to be crushed, particularly if I have a pill splitter that's doing a pretty good job of cutting them in half without too, too much variance there.

The reason you need to crush it is because the active ingredients aren’t evenly distributed in the mini-tab. By cutting it, you may or may not be getting your correct dose. Part of this has to do with how the core of the mini-tab is made. Also, even if cutting it would be an option, you still need to weigh it. Even being off a little bit at this low of a dose can cause a big increase in symptoms. Your CNS is wanting stability, which includes stable, precise doses. Also, remember that any cutting/crushing of a mini-tab makes it immediate release requiring taking half your dose twice a day, 12 hours apart.

[getofflex]

Since anxiety was mentioned several times in your intro post, I'd like to give you some ideas on managing anxiety.  Non drug coping strategies can be very powerful, but they take time and effort to learn and practice.  I believe personally that psych meds are not necessary for me if I can cope with my anxiety and depression using natural non drug techniques.  

 

Audio:  First Aid for Panic (4 minutes)

 

CBT Course:  An Introductory Self-Help Course in Cognitive Behaviour Therapy

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Emotional Spirals

 

Acknowledge Accept Float

 

Music to Calm Anxiety

 

Breathing Technique for Anxiety

 

Meditation

 

 

[SlimDunkin6o4]

@getofflex

 

21 hours ago, getofflex said:

Yes, that could have been what caused your symptoms.  I'm glad you are going back to splitting your dose.  I assume you are on the immediate release venlafaxine? Venlafaxine has a half life of about 12 hours, so this is probably best, if you are on immediate release. 

 

So, I'm actually not. I'm on the Venlafaxine XR, which I have to imagine stands for extended release.

 

21 hours ago, getofflex said:

I think the key for me, is to look at the big picture.  As an example, often, people will take a drink in WD because they feel better for a few hours.  But then, the next day, and maybe for days and weeks after that, they actually feel worse because the alcohol has further destabilized their nervous system.  Sometimes, it is advantageous to put up with discomfort for a while, so that in the long run, we are better off.   Instead of going onto another drug, have you considered the possibility of a small updose of the venlafaxine?  This may help lessen some of your withdrawal symptoms.  I believe it would be less risky than going on yet another drug.  Or, it could be that if you go back to dosing it twice a day, this may help you, and you won't need to do anything else.  Could you possibly update your drug signature with the details of your recent venlafaxine tapering since November 2021?  I would feel better about suggesting an updose amount if I knew more specific details.  

 

 

Just curious, but is the implication here that I shouldn't drink? Like, at all? I've really cut down on my drinking (and my smoking of the devil's lettuce...) since the whole withdrawals ordeal started, both in terms of my daily consumption and how often I let myself tie one on for a night.

 

As for titrating my dose, I'm kind of in a tough spot there. Among the many awful physical symptoms I've endured has been a knot or a tightness in my chest that has been more or less constant since this whole ordeal started. Not necessarily painful, just uncomfortable and annoying and constant; I would wake up with it, go to sleep with it, and carried it around with me every waking moment of my life. It only seems to have lessened as I've continued to taper down, which I've kind of taken as a positive sign.

 

Basically, I was operating on the assumption that I may need to taper down for a while or stop taking Effexor completely for some time to stabilize, with the hopes that I might be able to start it again in a few months, and hopefully, get my life back on track and end this constant misery.

 

As for my tapering, it's hard to really add much more text to my signature given the line constraints. Basically, I've gone down half of a mini-tab every four weeks or so up until the last one (about 12mg), which I've been stuck at for about six to seven weeks.

 

21 hours ago, getofflex said:

As far as "the damage being too severe to claw back from", I doubt that this would happen.   We have seen people here who were on some major drug cocktails eventually recover.  Shep is a great example of this.  Try reading here success story.  It is phenomenal.  

 

 

I sure hope you're right. I'm just nearing a year of this hell, on the verge of having to take stress leave from my job, watching my personal relationships deteriorate, and it's just... it's starting to feel like this will never end. I hope you'll forgive the tone of despair there, but it's where I'm at after nearly a year of this. This whole deal kind of sucks. All I wanted was to switch to a medication with less onerous side-effects, my doctor told me it wouldn't be a problem, and now it feels like my life is ruined.

 

[getofflex]

21 hours ago, SlimDunkin6o4 said:

So, I'm actually not. I'm on the Venlafaxine XR, which I have to imagine stands for extended release.

Are you on the tablet?  If so, cutting it makes it immediate release.  

 

21 hours ago, SlimDunkin6o4 said:

Just curious, but is the implication here that I shouldn't drink? Like, at all? I

Yes, and yes.  Alcohol and other mind altering substances (devils lettuce, I assume to be marijuana) tend to further destabilize your system, and can cause big problems for many people.  I would definitely avoid this if it were me.  

 

21 hours ago, SlimDunkin6o4 said:

Among the many awful physical symptoms I've endured has been a knot or a tightness in my chest that has been more or less constant since this whole ordeal started.

I hear this a lot, so it is common in people who are withdrawing.  It wouldn't hurt to have it checked out by the doctor to make sure it isn't something else, like your heart.  

 

21 hours ago, SlimDunkin6o4 said:

Basically, I was operating on the assumption that I may need to taper down for a while or stop taking Effexor completely for some time to stabilize, with the hopes that I might be able to start it again in a few months, and hopefully, get my life back on track and end this constant misery.

I don't understand this.  If you want to get back on the Effexor, why are you tapering off?  

 

22 hours ago, SlimDunkin6o4 said:

All I wanted was to switch to a medication with less onerous side-effects, my doctor told me it wouldn't be a problem, and now it feels like my life is ruined.

The various drug changes and switches will tend to destabilize and sensitive your nervous system.  We call this kindling.  It can take months to years to recover from this.  Also, going back on any psych med has less of a chance of working after we have gone off and on drugs in the past.  Then there is tolerance, where the drug no longer works after we have been on it a while.  That is why most of us here on this forum are tapering off psych meds.  Psych meds are given to people based on the idea that there is a chemical imbalance, but there has never been evidence to show that this is true. 

 

We are learning to deal with our mental health issues in other ways besides drugs.  Here are some links that pertain to this.  

 

Post Withdrawal Nervous System Hypersensitivity and Kindling

 

Tachyphylaxis or Tolerance

 

Chemical Imbalance is a Myth

 

 

 

 

[SlimDunkin6o4]

@getofflex

 

On 2/15/2022 at 8:42 AM, getofflex said:

Are you on the tablet?  If so, cutting it makes it immediate release.  

 

Correct. I wasn't aware that it became instant release at that point, so I was just taking one mini-tab a night. I'm now taking half a mini-tab 12 hours apart, twice a day. Which, of course, has made for a very strange few days. I find myself feeling more or less fine (all things being relative given my whole deal...) for the first like eight to 10 hours between doses, and then just totally spaced out and anxious and barely even human in the two hours preceding my next dose. Which, I guess, speaks on some level to the instant release affect of the medication in that form, I suppose.

 

On 2/15/2022 at 8:42 AM, getofflex said:

Yes, and yes.  Alcohol and other mind altering substances (devils lettuce, I assume to be marijuana) tend to further destabilize your system, and can cause big problems for many people.  I would definitely avoid this if it were me.  

 

Now, that's a bummer. Not sure I'm prepared to cut it out of my life entirely (I'll take my lumps if it means I can have a normal, fun night every once in a while...) but I'll stop having the odd drink at the end of my day and cut down on how often I tie one on.

On 2/15/2022 at 8:42 AM, getofflex said:

I hear this a lot, so it is common in people who are withdrawing.  It wouldn't hurt to have it checked out by the doctor to make sure it isn't something else, like your heart.  

 

Yeah, eventually it occurred to me that this might not be withdrawal related, so my doctor ran a bunch of blood tests, etc. I also found myself in the hospital a few months ago with a migraine so bad that it made the right side of my body numb. Of course, I didn't know it was a migraine doing this, so I went to the hospital, and they ran a bunch of heart tests. Turns out, totally fine. Which, of course, means it's probably withdrawal related.

On 2/15/2022 at 8:42 AM, getofflex said:

I don't understand this.  If you want to get back on the Effexor, why are you tapering off?  

 

My whole medication ordeal isn't especially straightforward, so I don't blame you for being a bit confused here. Basically, I never wanted to stop taking medication. I just wanted to try something new to see if the side effects weren't so onerous, and I was under the impression (thanks to my now former doctor) that this wouldn't be an issue. If it didn't work out, I could always go back on Effexor, and so on. So, it didn't work out with Vortioxetine (Trinellix) to an extreme degree. I found myself without drugs for more than a month, and then placed on Desvenlafaxine (Pristiq), which also didn't work.

 

So, I thought I'd just get back on Venlafaxine (Effexor), and get my life back on track, but my body and mind just did not respond as well as it once did. I felt awful on 75mg. Someone from this forum, talking to me then on Reddit, suggested that I needed to get back to lower doses to stabilize. I was under the impression that I could lower the dose, stabilize, and then eventually, hopefully, work my way back up to my old dose of 150mg. That's why I'm tapering down right now. Hell, even prepared to cut the chute for a few months to get back to square one and try starting again from scratch.

 

Obviously, a life without medication would be just fantastic, and I've made some moves towards that end. I'm in talk therapy with a wonderful doctor. I'm doing bits of CBT here and there. And this weekend, I'll add reading some of the links you've offered up to that work.

 

-SlimDunkin

[getofflex]

On 2/16/2022 at 2:03 PM, SlimDunkin6o4 said:

I was just taking one mini-tab a night.

This indicates to me you have the capsules, not the tablets.  Are there capsules with mini tabs in them?  If so, what you are taking is still extended release.  

 

On 2/16/2022 at 2:03 PM, SlimDunkin6o4 said:

I'm now taking half a mini-tab 12 hours apart, twice a day.

This is fine.  

 

On 2/16/2022 at 2:03 PM, SlimDunkin6o4 said:

Not sure I'm prepared to cut it out of my life entirely (I'll take my lumps if it means I can have a normal, fun night every once in a while...)

It's totally up to you.  However, we have seen people on here have just a couple of drinks, and then suffer from the effects of it for several weeks, because it destabilizes the sensitized nervous system.  Using alcohol, even occasionally, can wreak havoc on a nervous system recovering from psych meds.  

 

On 2/16/2022 at 2:03 PM, SlimDunkin6o4 said:

So, I thought I'd just get back on Venlafaxine (Effexor), and get my life back on track, but my body and mind just did not respond as well as it once did. I felt awful on 75mg. Someone from this forum, talking to me then on Reddit, suggested that I needed to get back to lower doses to stabilize. I was under the impression that I could lower the dose, stabilize, and then eventually, hopefully, work my way back up to my old dose of 150mg. That's why I'm tapering down right now. Hell, even prepared to cut the chute for a few months to get back to square one and try starting again from scratch.

I don't think it works like that.  If you want to stay on Effexor, you don't need to taper all the way off, stabilize, then go back on again.  We are not a forum for how to get back on psych meds, so I cannot advise you about this.  

 

As we go on and off various psych meds, there is a tendency of our nervous system to become kindled, or sensitized.  So, a drug that worked well for us in the past, may cause problems for us in the present and future.   

On 2/16/2022 at 2:03 PM, SlimDunkin6o4 said:

And this weekend, I'll add reading some of the links you've offered up to that work.

This will shed light on why drugs that used to work in the past, may not work in the future.  

[SlimDunkin6o4]

@getofflex

 

51 minutes ago, getofflex said:

This indicates to me you have the capsules, not the tablets.  Are there capsules with mini tabs in them?  If so, what you are taking is still extended release.  

 

I was taking the 37.5mg Venlafaxine XR pill (it reads VXR 37.5 on the pill itself), which had three mini-tabs in them (I thought they were beads, but apparently they're mini-tabs).

 

So should I be taking them one half mini-tab every 12 hours apart?

1 hour ago, getofflex said:

It's totally up to you.  However, we have seen people on here have just a couple of drinks, and then suffer from the effects of it for several weeks, because it destabilizes the sensitized nervous system.  Using alcohol, even occasionally, can wreak havoc on a nervous system recovering from psych meds.  

 

Fair enough! I will say that I seem much more resilient on this file than I did a few months ago. Certainly, back in the summer and early fall, when I'd really tie one on, I noticed that it resulted in at least a few days of the work anxiety of my life. Which, based on what you're telling me, makes a fair bit of sense!

 

I guess, on the bright side, there's an indication there that I'm on the road to stabilizing. You know, what with a night of drinking with my pals not launching me into the worst anxiety of my life as a default.

1 hour ago, getofflex said:

I don't think it works like that.  If you want to stay on Effexor, you don't need to taper all the way off, stabilize, then go back on again.  We are not a forum for how to get back on psych meds, so I cannot advise you about this.  

 

As we go on and off various psych meds, there is a tendency of our nervous system to become kindled, or sensitized.  So, a drug that worked well for us in the past, may cause problems for us in the present and future.

 

Well then, thanks for the correction on that. I was kind of operating under the assumption that once I stabilized at a much lower dose, then I'd have a chance to get back up to 150mg or 225mg on Venlafaxine (Effexor). Of course, I'd love to just get back to where I was before this medication switch SNAFU, but my body and mind just did not respond well to even 75mg when I tried that out back in September, and it sounds like that may be a sign that it's just not going to work for me with Venlafaxine (Effexor) again. Which, damn, really knew that was a possibility when my doctor assured me that it would be easy to switch medications, and if it didn't work, I could always go back on Venlafaxine (Effexor).

 

Increasingly, based on what everyone is saying here, it seems like the best path is probably just sticking it out at one mini-tab (12mg) split up in two doses, 12 hours apart, every day for a few months, and then continuing to taper down maybe one quarter tab at a time for a month until I'm off these drugs. And then, I guess, I'll just reevaluate from there.

 

Can't thank you enough for your counsel on this file! Really appreciate it. Like I said, my first maybe six or seven months of this whole ordeal was just unmitigated suffering with very little in the way of answers. Even if I'm not thrilled with a lot of what I'm hearing (certainly, not anyone here's fault, by any means...), it's good to at least have some idea of what's going on with me.

 

On a slightly different note...

 

I'm meeting with my psychiatrist next week, and as part of that, I'm going to test for ADHD. I've gone through much of my life suspecting I have ADD or ADHD or whatever, and I just now have the opportunity to test for it officially for the first time in my life.

 

Is there any sort of interplay with attention deficit medication and my whole withdrawal syndrome ordeal that I should be aware of? Like, on the odd chance I get prescribed something to treat this (assuming I test positively for it...), do I need to proceed with additional caution or even stave off medication for the time being because of this?

 

-SlimDunkin

[ChessieCat]

38 minutes ago, SlimDunkin6o4 said:

Is there any sort of interplay with attention deficit medication and my whole withdrawal syndrome ordeal that I should be aware of? Like, on the odd chance I get prescribed something to treat this (assuming I test positively for it...), do I need to proceed with additional caution or even stave off medication for the time being because of this?

 

As getofflex has already said, SA is a site for getting off psychiatric drugs.  We are not able to assist you with starting a new drug.  This is your doctor's/psychiatrist's responsibility and what you are paying them for.

 

However, there some things to be mindful of:

 

My first suggestion would be to make sure that you read the links that have already been provided

 

Do you own research about side effects

 

Also do your own research about drug interactions:

 

Drug.com Interactions Checker

Medscape Drug Interaction Checker

 

AND

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

[SlimDunkin6o4]

@ChessieCat

4 hours ago, ChessieCat said:

As getofflex has already said, SA is a site for getting off psychiatric drugs.  We are not able to assist you with starting a new drug.  This is your doctor's/psychiatrist's responsibility and what you are paying them for.

 

I'm well aware, which is why I didn't ask for any assistance potentially starting a new drug. I was just curious if anything that might be prescribed for ADD or ADHD has the potential to contribute to the nervous system dysregulation that I'm currently experiencing with my medication switch SNAFU of the last year or so. With that information, I could make an informed decision of my own.

 

The doctors and psychiatrists I'm seeing aren't operating on the same wavelength as many of the people in this forum. I was greeted with nothing short of hostility when I so much as broached the possibility of nervous system dysregulation to the hospital psychiatrist in November, so you'll have to forgive me if I'm not quite as comfortable speaking on these terms with my psychiatrist should they recommend a medication to treat ADD or ADHD.

 

Anyway, this is all hypothetical at this point, I just didn't think it hurt to be prepared in the event that I find myself recommended medication to treat ADD or ADHD.

 

Apologies if I was in breach of protocol, accidentally or otherwise. I'm just trying to lean on the expertise of the people on this forum as I try to navigate this awful situation I find myself in.

 

-SlimDunkin

[getofflex]

On 2/17/2022 at 4:43 PM, SlimDunkin6o4 said:

I was taking the 37.5mg Venlafaxine XR pill (it reads VXR 37.5 on the pill itself), which had three mini-tabs in them

Then it would be called a capsule.  

 

On 2/17/2022 at 4:43 PM, SlimDunkin6o4 said:

So should I be taking them one half mini-tab every 12 hours apart?

Yes, I already said this was fine in a prior post.  

 

On 2/17/2022 at 4:43 PM, SlimDunkin6o4 said:

Increasingly, based on what everyone is saying here, it seems like the best path is probably just sticking it out at one mini-tab (12mg) split up in two doses, 12 hours apart, every day for a few months, and then continuing to taper down maybe one quarter tab at a time for a month until I'm off these drugs.

The first part if fine, but when you taper, we suggest tapering no more than a 10% decrease of your current dose.  

 

On 2/17/2022 at 10:19 PM, SlimDunkin6o4 said:

I was just curious if anything that might be prescribed for ADD or ADHD has the potential to contribute to the nervous system dysregulation that I'm currently experiencing with my medication switch SNAFU of the last year or so.

Yes, you do run the risk of further nervous system dysregulation if you go on another psychoactive drug, which ADD and ADHD drugs are.  

 

 

[SlimDunkin6o4]

Hey there,

 

Just wanted to offer a quick update, seeing as it's been a minute since my last note.

 

Per the advice of everyone in this space, I've continued to take a half of a mini-tablet of Venlafaxine 37.5mg every 12 hours (about 6.25mg per half of a mini-tablet) since early February, and so far, so good. In fact, I'd say that I feel better than I have in a long time.

 

The annoying chest tightness that's been a constant for me since I started my prolonged bout with post-acute withdrawals is episodic at its most frequent, and I can now go entire days without feeling it; that's always kind of been a baseline meter for how I've felt throughout this given its seeming permanence. My social anxiety (the reason I first started taking medication...) is better, albeit, far from perfect. In general, the trend line just keeps on moving steadily in the right direction.

 

I'd say the same is true of the pure obsessive compulsive disorder symptoms I've been enduring since this protracted bout of withdrawals. There are entire days where it seems like that's just a thing of the past, and it only seems to be an issue in high pressure or high stress situations -- primarily ones that trigger my anxiety/social anxiety. It gives me some hope that I may return to a point in my life where it's not a factor at all, as was the case for my entire life prior to this withdrawal episode.

 

Another testament to how much better I'm doing is that I'm using my 0.5mg sublingual Ativan far less frequently than I had been since this ordeal started. It had become something of a crutch to get through high pressure, high stress scenarios, taken as a default ahead of those encounters. I'm at a point now where that's not really a thing anymore. I'll maybe use a quarter of my pill (we're talking 0.125mg) maybe once or twice a week of late.

 

Basically, splitting my last mini-tablet dose in two rather than taking it in one dose has done a world of good for me.

 

The only real new symptom that I can speak to is that I sometimes feel... almost kind of speedy? Like, I can't focus on anything, and it's not even just a matter of my attention. I just can't seem to keep my eyes locked onto anything. It's like my brain is running at a million miles an hour and I can't stay on any one thing with any degree of focus or attention. I only feel this way sometimes, but damn, is it ever debilitating.

 

Has anyone else encountered that sort of mind-racing, inability to focus, feeling kind of speed-y thing before? If so, any idea what that's all about? A pretty new phenomenon for me.

 

Thanks for your help everyone! Have really appreciated the pointers and words of encouragement. Even something as simple as splitting my dose seems to be making a world of difference, and for the first time since last May, I have some hope that I'll get through this mess and be myself again.

[getofflex]

I'm very glad to hear that you are doing better.  

 

As for the speedy feeling, when we are tapering off SSRI drugs, our nervous systems tend to become activated.  So it is probably just another symptom of withdrawal.  Nervous system activation symptoms can include anxiety, restlessness, agitation, mind racing, insomnia, etc.  This should eventually resolve itself in time.  

 

Here is a thread where other members talk about this: 

 

Repetitious Mental Agitation

[SlimDunkin6o4]

Hey @getofflex,

 

Just following up on our conversation about tapering down on the last mini-tablet in my Venlafaxine (Effexor) 37.5mg pills. I've taken the advice of a few people in this thread and some of the threads I've been directed towards and bought a Gemini mg scale to measure out precise doses. I'm down to about 6mg every 12 hours at this point, the precise version of the cut-up half-mini-tabs I was on previously. The transition to these precise doses was... surprisingly difficult, seeing as they were, in theory, the same dosage. By that same token, I guess 

 

Having said that, I have a little concern/curiosity about where I go from here? I'm going to be down to 5mg every 12 hours, probably starting on June 1st, and then down to 4mg in July. It's not the exact 10 percent method, but it's the best I can do with this scale. In fact, this scale doesn't even go any lower than 4mg... so what do I do at that point? How exactly do I measure out 3mg and 2mg and eventually 1mg in the months that follow?

 

As always... sorry if this information is already out there! I do try to search for a lot of this stuff, and often just get completely overwhelmed (my ability to focus since my PAWD started ain't so great!) and struggle to find exactly what I'm looking for. Your help is super appreciated.

 

Best,

 

SlimDunkin

 

 

[getofflex]

You can make a liquid out of them, which will allow you to dose and taper in very precise, small amounts.  That is what I would do.  This link will tell you how: 

 

Tapering and Dosing Venlafaxine

[ChessieCat]

I've moved your new topic to the existing topic about weighing tablets:

 

using-a-scale-to-weigh-and-measure-doses

 

[brassmonkey]

Hi Slim-- CC asked me to take a look at your taper. I saw the pictures you posted and have an idea about what is going on, but I need some information first.

 

What is the strength of your capsules as listed on the package?

How many minitablets are in each capsule?

What is the average weight of the minitablets?

 

Before you started using the scale you mentioned that you were taking 1/2 of a minitablet twice a day and were fine on that dose. By your thinking that was a dose of 6mg twice a day. But when you weighed 6mg on the scale the pile of powder was a lot smaller. The reading on the scales display was 0.006?

 

Let's get this dose sorted out, then we can work on how to measure the smaller doses that will be coming up later.

[ChessieCat]

@brassmonkey

 

Putting this here for member's history:

 

  

4 hours ago, SlimDunkin6o4 said:

@ChessieCat

 

I think that I got to the bottom of this. Apparently, my pills don't weigh the amount that they're listed as on my bottle. Turns out, half of a mini-tablet within my 37.5mg Effexor XR is actually about 10 or 11mg as opposed to 6mg. I even tested out a few of my half mini tablets to be sure, and I got the same reading. The full mini-tablet is about 23mg, so this more or less checks out. Which is to say, I accidentally just about halved my dose for nearly three weeks.

 

Obviously, I'm pretty upset by all of this. I was doing so damn well (relatively speaking...) on the roughly cut up half-mini-tablets, and I've just felt awful since I accidentally halved my dose. The worse anxiety I've felt in months and the recurrence of panic attacks (even as I wake up...), moments of confusion, generally spaced out, and about a week-long migraine. I basically couldn't work for about two days there at one point. Awful, awful stuff.

 

I made the correction on Monday, and I'm on 10mg, twice a day, and I can sort of feel myself slowly getting better. I'm not necessarily qualified to comment confidently on any of this, but my hope is that I'll get back to where I was before this dosage SNAFU, and in about as long as it took me to get to this place, too -- which is to say, three weeks. That's my hope, anyway. I'm curious to get people's thoughts on this though!

 

The lesson here, I suppose, is not to trust the measurements on the pillbox. 

 

My questions about how to precisely measure out doses as I work my way down from 10mg remain, though. My scale just cannot pick up anything lower than 4mg. I went through some of the threads out creating a liquid suspension, but none of them seemed to deal with how precisely to do that with Effexor XR -- unless I missed something, which is totally possible.

 

[SlimDunkin6o4]

Hey @brassmonkey,

 

@ChessieCat shared my followup post, and I think that answers some of your questions.

 

I'll go ahead and tackle the ones you fired off anyway just for posterity though:

 

The pills that I'm splitting are Venlafaxine 37.5mg XR. When I open the pill, there are three mini-tablets within each one, all of them equal in size. They should be, based on my rough math, about 12.5mg in volume each, but I've since learned (the hard way...) that the actual number is closer to 22-23mg.

 

I've been giving myself 10mg doses in gelatine capsules twice a day since I found out that I'd mistakenly halved my dose. I seem to be, slowly, stabilizing a bit again, but it hasn't been a pleasant process by any stretch. Going on 1.5 weeks of feeling spaced out, supremely anxious, irritable, and uncomfortable, which says nothing of the migraines, the stomach pain, etc.

 

I'm honestly kind of at the point where I'm beginning to wonder if I wouldn't be best served by just stopping the medication entirely. I'm not really getting any therapeutic relief of my social anxiety at this point; I take the medication to stave off acute withdrawals, and that's it. Even when I was feeling better the last few months, I didn't feel anything like myself before my PAWS started. I also read somewhere on this site that sometimes your body just can't take to the medication it once used, which only contributes to my feeling that I perhaps shouldn't even be bothering with a slow taper.

 

Having said that, I'm pretty frustrated and emotional after the last month or so (and the last year, really...) so I may not be in the soundest state to make that call. Curious for your thoughts on that one!

 

Really appreciate all your help.

 

Best,

 

Slim Dunkin

[brassmonkey]

Thank you Slim, that information is quite helpful.

 

All tablets are manufactured using filler material so they can be the right size and shape. In this case each of your mini tablets has about 10mg of filler. This gives each mini tablet a strength of 12.5mgai (milligrams active ingredient) and a total pill weight of 22mgpw (milligrams pill weight).

 

When we talk about what dose we are taking we are referring to the strength or the mgai number. When we are measuring the dose on the scale, we use the mgpw number. They are directly related so a change in one makes an equal change on the other. From the sounds of it you are talking about the pill weight of your dose and not the strength when you say you are taking 10mg two times a day.

 

A quick calculation says that you are getting 0.568mgai per 1mgpw. For future reference this is called the AIC (Active Ingredient Concentration).

 

If you are taking 10mgpw for each dose this is giving you a dose strength of 5.6mgai. Which you take twice a day for a total daily dose of 11.2mgai.

 

DO NOTJUST STOP taking your medication. From this dose it would be considered a CT and for this medication you would more than likely be facing several years of intense symptoms.

 

Right now, you need to stabilize on this dose. Everything involved with tapering ADs takes much longer that we would like. To really stabilize is going to take a minimum of two months and possibly longer. It is a very good sign that you are feeling better after just a week and a half, but you need to let things really settle before tapering. Once things start to get good and stable, we can work out a good tapering plan.

[SlimDunkin6o4]

@brassmonkey

 

Strictly curious, have you read my whole background story? Because I'm pretty much stuck on 13 months now of just feeling awful after my doctor told me that a medication switch would be no problem at all, and had me taper down for a month before switching me to a drug that didn't work -- everything just kind of fell apart from that point. From Venlafaxine to Vortioxitene to Desvenlafaxine and back to Venlafaxine until now. Not a fun ride lol.

 

I guess I'm just having a hard time seeing the benefit in me taking this medication right now when it's not staving off the PAWS feeling, and only keeping the acute withdrawal at bay.

 

It's just tough. I've felt awful for 13 months, and in that time, I've had to watch my life slowly but surely fall apart in nearly every fashion. There's a part of me that can't help but wonder if I'd be better off ripping the bandaid off, dealing with the two-to-three weeks of acute withdrawal, and going from there. It's pretty clear at this point that my body just can't handle Venlafaxine the way it used to -- I was on 150-225mg for about a decade, and now I can barely handle the small dosages I've been on to stave off hardcore withdrawals.

 

Anyway, I'm probably just ranting/venting at this point, so forgive me. I desperately want to get off this ride that I started unwittingly to begin with, and it just breaks my heart to have to read that that's not an option. Appreciate all your help and your advice throughout all of this. I'm going to stick with my current dosage until at least July, and then I might drop to 0.9mg, twice a day.

[SlimDunkin6o4]

Hey everyone,

 

It's been a few months since I last checked in, so I wanted to provide a quick update on how things have gone since my last post.

 

So, for the most part, I'd say that my condition is slowly but surely improving, one minor decrease in dosage at a time. There was a small blip in late-April and early-May where I accidentally halved my dosage and that took about a month or so to fully recover from as I got back on track, but otherwise, relatively smooth-sailing on the tapering front.

 

Granted, I've been fighting with a pretty nasty bout with Covid since early-July (part of the reason I haven't been especially active here...), but not much I can do about that.

 

Because of that small blip, I've kept on 10mg (two doses daily, once every 12 hours of 5mg) through the summer, only very recently switching to 8mg (two doses daily, once every 12 hours of 4mg). I've since moved on to getting my prescription filled by a compound pharmacy, seeing as I don't quite trust my Gemini scale for as low as my doses are getting.

 

Now, granted, this a little bit faster than is recommended (most of what I've read suggests tapering in increments of 10 percent), but this was the best I could do with my doctor. If he had his way, I'd drop to 5mg total, once a day, and just see how that goes before ultimately going cold turkey. Getting him to sign off on shrinking my total daily dose by only 2mg (1mg less every 12 hours) was the best I could do.

 

So for the most part, I just wanted to give everyone a status update, and while we're here, if any of you have any suggestions or thoughts on how to manage this final home stretch of my taper, I'd love to hear them. From what I've read thus far, it sounds like the final 10mg are the hardest, and I'm now onto step two of getting through that process.

 

Thanks for all of your help/support, and all the best,

 

Slim-Dunkin

[FindRest]

Will your compounding pharmacy be using the same manufacturer as your current manufacturer? This is very important to find out. If not, it could cause a big increase in symptoms.

 

You are in the hardest stretch as far as ven tapering goes. Many of us cannot taper more than 5% at this stage. You may be one of the lucky ones, or maybe not. Since you are tapering much more than that, it could be to your benefit to wait a few extra weeks between tapers.

 

As far as your dr wanting you to come off quicker than is safe, you may want to search this site for the updated NICE recommendations out of the UK regarding antidepressant withdrawal and give a copy to your dr. It’s not worth allowing your dr to thwart the progress you have made. You are paying them to do what’s best for you. Stick to your guns and be firm. 

Edited September 27, 2022 by FindRest