SimonSays: fatigue from Effexor and Nortriptyline - my journey

[SimonSays]

Hello Everyone,

 

First of all, thanks to all the people contributing to this community.

And special thanks to @Altostrata for initiating this much needed place of support.

 

I will hereby try to give you guys an overview of my treatment history.

 

Medical history:

• One episode of major depression (5 years ago)
• Fully cured by antidepressants after 8 months

 

Medication history:

• Nortriptyline up to 50mg and now 0mg
• Venlafaxine up to 225mg and now 62.5mg

 

Current symptoms:

• Fatigue, sedation, lethargy
• Gastro intestinal pain (since tapering)
• Muscle pain (since tapering)

 

My story

My journey with antidepressants started 4 years ago. I got into a serious depression and was hospitalized for 5 months with no improvements whatsoever.

 

At the end of my hospitalization the doctor put me on Venlafaxine. Af first no results, but on higher dosages (225mg) my mood improved slightly.

 

After a couple of weeks, Nortriptyline was added to the mix. This made an enormous difference, my depressive mood almost completely vanished two weeks into this 50 year old antidepressant.

 

But the cure of my depression came at a cost: a daily fatigue, sedation and lethargy became part of my life. Although not necessarily unpleasant, this fatigue was very outspoken. I could sleep all day, wherever and whenever I wanted.

 

I could still perform though and be 100% focused, but only for a short amount of time. Every 24 hours contained 16-18 hours of lying down, no negotiating.

 

Two years into the treatment, we started the tapering process. First the Nortriptilyne, consequential the Venlafaxine. Nortriptilyne was a succesful taper from 50mg to 0mg in 12 months, but not without severe withdrawals. Now 4 months out of the Nortriptyline, I can still feel some of the withdrawal symptoms. Venlafaxine is now an ongoing taper from 225mg to 62.5mg in the past 10 weeks. Venlafaxine withdrawal is quite a journey as well, as we all know.

 

I would think that - since my medication is now almost completely tapered - my fatigue would be less outspoken, but I can still sleep like a baby. It makes me doubt the origin of the fatigue. I would really like to hear your 2 cents about this!

 

Just to add: The withdrawal caused me a lot of physical discomfort, but mentally I'm still doing well. No recurrence of the depressive feelings in these 4 years.

 

Many greetings from Belgium,

And good luck to all of you,

Simon

[Altostrata]

Welcome, @SimonSays

 

On 5/13/2022 at 10:04 AM, SimonSays said:

Now 4 months out of the Nortriptyline, I can still feel some of the withdrawal symptoms. Venlafaxine is now an ongoing taper from 225mg to 62.5mg in the past 10 weeks. Venlafaxine withdrawal is quite a journey as well, as we all know.

 

What withdrawal symptoms do you feel? For the time being, I would stop tapering, you are at high risk for worse withdrawal symptoms.

 

Good to hear your sleep is still intact. 

 

Nortriptyline is known to cause fatigue. It's possible that venlafaxine caused this, too, but we can't tell because you were taking them together. Fatigue can be a drug adverse effect or a withdrawal symptom.

 

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

[SimonSays]

Hi @Altostrata,

 

Thanks so much for your reply, hereby an update from my past two weeks.

 

The past 14 days have shown a slight improvement in my fatigue. I still feel limited physically, but it’s a small step in the right direction.

 

Next to the fatigue, my withdrawal symptoms are very flu-like:

• Stomach pain
• Nausea
• Muscle pain
• Headaches (mostly when my stomach is struggling)
• Irritability

I have also had severe night sweats but this has lowered significantly in the past 4-6 weeks. The frequency has been going down and now only occur 1-2 nights a week.

 

Thanks for your advice to stop tapering for a while, I also feel that this is the right thing to do. So I’m still at 62,5mg Venlafaxine with no intention to lower.

 

P.S. Updated my signature.

 

Good luck to you all,

Simon

[Altostrata]

Your symptoms should gradually reduce. This could take weeks. I would not reduce venlafaxine again until they all settle down. Please let us know how you're doing.

[SimonSays]

Hi @Altostrata,

Hi everyone,

 

Now 6 weeks from my last post, hereby an update.

 

I’ve further lowered my Venlafaxine from 50mg to 41,75mg in my all encompassing effort to overcome the fatigue.

 

Withdrawal is still strong, changing its shape and colors. My muscle pain and nerve pain have gotten to a whole new level. My stomach is doing better, the nausea as well. My legs seem to hurt a lot, I notice myself reaching for chairs.

 

The past 2 weeks I felt in a daze, confused. Almost a “high” feeling.

Other weird symptoms: I can drink 10 coffees and not feel a thing.

 

The muscle and nerve pain are the most serious though. My days starts and ends with a sensation of pain. I’m meeting a pain specialized doctor next week.

 

I’m also thinking about using a low-dose SSRI like Prozac or Sertraline to aid the Venlafaxine withdrawal. What are your thoughts on this?

 

Last week my doctor prescribed me 12,5mg of Trazodone for better sleep. Trazodone also seems to be a serotonin inhibitor (in higher dosages).

 

Good luck to you all,

Thanks @Altostrata.

Simon

[Altostrata]

On 5/20/2022 at 3:47 PM, Altostrata said:

For the time being, I would stop tapering, you are at high risk for worse withdrawal symptoms.

 

Did you reduce venlafaxine since May 20? How have you tapered venlafaxine? Which symptoms have gotten worse and which better?

 

Did you also start trazodone? What effect does it have on you?

[SimonSays]

Hi @Altostrata,

 

I reduced the Venlafaxine from 50mg to 41,75mg in the beginning of June.

I went from 4 beads to 3,5 beads all at once. I cut the one bead in half.

 

Symptoms that worsened:

Muscle pain, nerve pain, fatigue, feeling dazed

 

Symptoms that got better:

Stomach pain and nausea

 

I'll keep you posted on the Trazodone.

 

Greetings,

Simon

 

 

[FindRest]

Do your capsules have many tiny beads (37 to 150+) or just 4? If 4, then what you are taking isn’t considered to be “beads”. They are considered to be “mini tablets”. If you are cutting one of the mini-tabs, it no longer is considered extended release. It becomes immediate release. The portion you’re cutting must then be divided in half and taken twice a day. If you don’t do this with the cut portion, then you are essentially dumping extra Venlafaxine into your system all at once and could have more side effects then … as well as more withdrawals towards the time your dose is due again.

 

SA recommends tapering no more than 10% per month. You’ve tapered almost twice that amount. This could very well be the reason you are experiencing more withdrawal symptoms.

 

I am not a mod, but wanted you to have this information in case it took awhile for one to respond.

 

I’d encourage you to read this link:

 

 

[Altostrata]

Please add trazodone to your signature.

 

As @FindRest inquired, do your venlafaxine XR capsules contain mini-tablets? What is the dosage of one entire capsule?

[SimonSays]

Hi @FindRest,

 

Oh thank you for your remarks, I am indeed taking mini-tablets and not beads.

So I am taking 3,5 mini-tablets - which is 41,75mg of Venlafaxine XR.

 

Thanks for pointing out the SA recommendation of 10%, I went too fast.

I feel like my (nervous) system is really struggling at the moment, or even trying to figure out what is happening.

 

One moment I'm in pain, the other moment I feel high. I should go really slow on this Venlafaxine.

 

Greetings,

Simon

[Altostrata]

The half-tablet has become immediate-release. Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

[SimonSays]

Hi everyone,

Hi @Altostrata,

 

Another 2-3 weeks have passed, I'm still in a severe state of withdrawal.

Nothing much has changed in symptoms.

 

I started a muscle relaxant - Baclofen - 2 days ago to ease some of the pain. I'll keep you posted on this.

 

As I was watching Breaking Bad, I heard about antiemetics for treating chemotherapy induced nausea.

Do you have any experience in antiemetics for withdrawal symptoms?

 

I was also wondering - is there anything else that I can do to improve the withdrawal timeline?

Apart from the basic guidelines such as a healthy diet, plenty of rest, and so on.

 

Greetings,

Simon

[Altostrata]

On 7/29/2022 at 4:51 AM, SimonSays said:

As I was watching Breaking Bad, I heard about antiemetics for treating chemotherapy induced nausea.

Do you have any experience in antiemetics for withdrawal symptoms?

 

No, sorry.

 

On 7/13/2022 at 9:52 AM, Altostrata said:

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

 

I've requested this information to better understand your situation.

[SimonSays]

Hi @Altostrata,

 

I'm happy to provide you with my daily notes.

In the past week, every day kind of looks like this. There's not much variation between the days.

 

- 8h: I wake up. Nausea, abdominal pain

- 9h: Venlafaxine 50mg, 1000mg vit B12, 75 mcg vit D, 10mg Baclofen, 1g Paracetamol

- 10h: 20mg Domperidone but to no avail.

- 10h-13h: Inability to eat, bloatedness, nausea. I can drink one-two cups of coffee.

- 13h: 10mg Baclofen, 1000mg fishoil. I'm able to eat small portions from now on.

- 13h-18h: Extreme fatigue (lying down the whole afternoon)

- 18h: 10mg Baclofen, 1000mg fishoil

- 18h-20h: Able to focus and do a little bit of work. Nerve pain is rising. Still nauseated.

- 20h-22h: I need to take short naps to ease the pain

- 22h: 5mg Trazodone

- 22h-24h: I’m able to eat a little more now

- 24h-8h: Sleep (sleep is ok)

 

Greetings,

Simon

[Altostrata]

When did domperidone make an appearance? Please add when you started it and baclofen to your signature.

 

You are aware that domperidone is an antipsychotic? 

 

What is your question related to tapering psychiatric drugs?

[SimonSays]

Hi everyone,
Hi @Altostrata,

 

It’s been a couple of months now and I’ve made some small improvements.

 

I started Lamictal (up to 10mg) and it has improved my pain symptoms a lot. I also improved my lifestyle: healthier food, daily walks, weekly massage and osteopathy. I’ve cut coffee and alcohol.

 

Because of my improvements in the last 6 months, I tried to lower my Nortriptyline again with a small reduction of 5% but my body reacted badly. I did not expect this. After a couple of days I became very ill with a very painful stomach / digestion and after struggling for 3 weeks I had to go up again.

 

I don’t know what to do next. Should I just wait another 6 months before I reduce any further? Or should I retry to make a smaller cut to find my rhythm?

 

Any tips, insights, suggestions are welcome 🌟

 

Greetings from Belgium,

Simon

[Altostrata]

In August, you were taking 50mg venlafaxine, now you're taking 187.5mg, plus you've added lamotrigine?

[SimonSays]

Hi @Altostrata,

 

I went up with the Venlafaxine and did a small reinstatement of my Nortriptyline because the withdrawal was just too heavy.

This has made a significant difference but did not erase all the withdrawals. Lamotrigine did the rest.

These adjustments were made 4 months ago.

 

I still have some withdrawal issues and fatigue but it is minor. I can now focus on tapering slowly but my body seems to be hypersensitive to even small reductions.

 

Greetings,

Simon

[Altostrata]

Have you tried to reduce venlafaxine?

[SimonSays]

Hi @Altostrata,

 

Because I was feeling better the last 4 months, I indeed tried a small reduction but I chose the Nortriptyline because of its sedating effects. I lowered by 5%.

 

I experienced pretty heavy withdrawals (peaking 10 days after the drop) and had to go back up finally.

 

Greetings,

Simon

[Altostrata]

Suggest you try reducing venlafaxine instead.

 

We're about reducing your drug burden, you tend to increase it. Given your complicated drug cocktail, your situation may be beyond peer support.

[SimonSays]

Hi @Altostrata,

 

ok I’ll work on the Venlafaxine now.

 

The other thing you said makes me worry a bit. What do you think makes my case extra complex? Is there anything I could have done differently? I’m asking just to learn. 
 

I can drop the Baclofen, its no longer of importance.

 

Greetings,

simon

[Altostrata]

What makes it extra complex? You're taking a ridiculous cocktail of 4 psychiatric drugs AND YOU'VE INCREASED THE DOSAGE out of the belief that venlafaxine has miraculous properties.

 

Increasing is the opposite of decreasing. We offer peer support for decreasing. If you're working against that, there's no reason for us to put in any effort to counsel you about reducing your drug burden.

[SimonSays]

Hi @Altostrata,

 

I’m already feeling your frustration for a couple of posts.

 

The overall tone of voice I read in your comments makes me feel genuinely bad actually.

 

Every reply gets a portion of negativity bigger than the one before. It somewhat stuns me that you talk to a member like this.

Every patient’s taper is a journey with mistakes and false beliefs and it’s no different for me.

I really hope to still be welcome here in the future since your knowledge is unique and truly valuable. But you’ll have to drop the negativity.

[Altostrata]

This is a site for tapering off psychiatric drugs. Since you joined in May 2022, you have added 4 drugs -- trazodone, baclofen, lamotrigine, domperidone -- and increased your venlafaxine dosage.

 

Not only are you taking at least 4 psychotropics at time, you are trying others intermittently. We cannot counsel someone about tapering off their drugs if they keep changing and adding drugs. If you don't want to stop changing your drug cocktail, you don't have to. Please take problems with your drugs to your doctors and do not engage the staff, they're all volunteers and they could be doing something that's more productive or fun for them.

 

You seem to be working on creating an ideal drug cocktail for yourself. This is too complex for peer support. If you also want to taper as you mix and match your drugs, here are our tips for tapering various psychiatric drugs.