SaltoftheEarth: Tapering Trintillex - Seeking Advice

[SaltoftheEarth]

Hello, 

 

I am a 26 year old Canadian student currently on exchange in Australia. I started tapering down from my prescribed dose of 10mg to 5mg approximately 2.5 weeks ago. I also currently take 20mg of Vyvanse daily for ADHD. 

 

I have been taking trintellix for 2-3 years (not quite sure exactly how long). I started taking antidepressants in 2016. I originally was prescribed 10mg of escitalopram and made the switch over to trintellix at some time around 2019. 

 

In 2016, I was feeling very overwhelmed with school etc. At the time, I hadn't been diagnosed with ADHD. I started taking Vyvanse around 2018. 

 

I had thought of tapering off trintellix for a while but it never quite seemed like the right time. My undergraduate degree has dragged on from 2015-present and I'm set to graduate at the end of 2023. 

 

My lifestyle has been pretty healthy recently. I've been exercising regularly, eating well, not drinking alcohol. It seemed to me like a good time to try tapering down. I wanted to taper because I don't want to be on antidepressants all of my life. I also heard that it can be more difficult to work through psychotherapy etc. while on antidepressants. 

 

I've definitely been feeling symptoms of tapering / withdrawal. It takes a lot longer to get out of bed in the morning... something that I hadn't struggled with in a while (vyvanse does help me get out of bed). I've been feeling depressed. I've been more irritable. I'm having difficulty concentrating on my school work. My anxiety has been worse. I've been having odd + vivid dreams. The weather has just started to change into winter as well (cold and rainy Melbourne). 

 

I'm at a point now where I'm not sure whether or not to reinstate to my prescribed dose or just wait it out. My psychiatrist from back home mentioned to me that if I ever wanted to taper down off of trintillex, I could cut my pills in half. However, I made the decision to do this on my own without any doctor supervision. 

 

I'm not sure if now, when I'm halfway around the world, with no support network, is the best time for me to make this change in my life. Perhaps it might be better to do this when I'm back home and finished my degree. 

 

My primary questions for you all are: 

 

1) What are the risks of going back up to 10mg now and tapering down at a later date? If I were to start this again, I would most likely take a more conservative (ie. 10%) tapering schedule. 

 

2) Is it best for my brain to just wait it out on 5mg? Has anyone had experience with 10mg - 5mg Trintellix? Could I balance out soon and adjust to 5mg? If I stay on 5mg longer, will it be more difficult and/or more harmful for me to go up to 10mg? 

 

3) I really want to avoid any longterm harmful outcomes. I want to do what's best for my brain. 

 

Thank you! 

 

Edited April 10, 2023 by Gridley

[Gridley]

Welcome to SA, SaltoftheEarth.  

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  Please keep it simple, with no symptoms.  Be sure to include the date you dropped from 10mg to 5mg Trintellix.  Also the month in 2018 when you started the Vyvanse along with the dose.  A list format, as opposed to a paragraph format, is best.

 

Account Settings – Create or Edit a signature.

 

As you might know, we recommend tapering no more than 10%of your current dose every four weeks.  Your drop of Trintellix from 10mg to 5mg was a 50% drop, accounting for the withdrawal symptoms you're now experiencing.  The symptoms you describe are typical withdrawal symptoms.

 

Why taper by 10% of my dosage?

 

What is withdrawal syndrome.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

To answer your questions:

 

1) Risks of going back up to 10mg.

 

The risk is that you could overwhelm your brain and nervous system and become more unstable.  If this happens, it can take a long time to regain stability.  Your nervous system is very sensitive right now in withdrawal and needs to be treated gently without big changes in drug dose.  In the time since you dropped to 5mg, your nervous system has become accustomed, at least to some extent, to being at the lower dose.  A radical doubling of that dose could be too much for your system to handle.

 

So we would never recommend you return to your original dose of 10mg.  Because of your drop to 5mg, your brain is a different brain now from when your were previously on 10mg.  If you wanted to updose a very small amount, that might help alleviate your withdrawal symptoms, but that would depend on when your dropped to 5mg.  Updosing works most dependably if done within 3 months of the dose change.  Once you've answered my question about when you dropped to 5mg, we can talk about the advisability of a very small updose and we can make a suggestion about how much to updose. Definitely do not updose without letting us suggest a dosage.  Updoses sometimes work, sometimes they don't, and sometimes they make matters worse.  Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

Also, there is a major drug interaction between Trintellix and Vyvanse, which would definitely argue again a large updose to 10mg.

Interactions between your drugs

Major

lisdexamfetamine  vortioxetine

Applies to: Vyvanse (lisdexamfetamine), Trintellix (vortioxetine)

Talk to your doctor before using vortioxetine together with lisdexamfetamine. Vortioxetine may increase the effects of lisdexamfetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported. Combining these medications can also increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms while taking the medications. It is important to tell your doctor about all other medications you use, including vitaminsand herbs. Do not stop using any medications without first talking to your doctor.

 

 

2) Is it best just to wait it out?

 

That's always the question in these cases.  The alternative to a small updose is waiting it out until you stabilize.  Unfortunately, there's no way to predict how long this will take.  While some recover fairly quickly, others take much longer.  Another factor is the severity of your withdrawal symptoms.  From what you've written, it appears that your symptoms, though certain unpleasant, are tolerable.  If so, that might be an argument for waiting it out.  The purpose of an updose isn't to eliminate withdrawal symptoms entirely, though it can do that, but rather to make them tolerable.  

 

Updoses are best done as soon as possible after the reduction in dose, some you're taking that course, the sooner the better--but again, not to 10mg.

 

3)

That's why we recommend a very conservative approach, either waiting it out or a very small updose.  Whichever course you choose, you'll need to stabilize before beginning a 10% taper of the Trintellix down to zero.  This can take several months.

 

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited April 21, 2023 by Gridley

[Gridley]

@SaltoftheEarth

 

Please make all your posts about your situation here in your Introduction topic.  That way, all your information is in one place.

[Nypeaches89]

On 4/10/2023 at 9:15 AM, SaltoftheEarth said:

also heard that it can be more difficult to work through psychotherapy etc. while on antidepressants. 

Never heard that, it’s interesting, mind telling me where you heard this? 
 

Also how are you? x

 

 

[Emonda]

Hi @SaltoftheEarth 

We are dealing with the same drug, assuming Trintillex = Vortioxetine.

 

Dropping from 10mg to 5mg in 2.5 weeks sounds fast, based on my personal experience. Before finding this website, I did something similar, and it felt like an elephant was sitting on my chest; anxiety ramped up, I was irritable, and I had all the WD symptoms you described. I’d gone from 15mg to 5mg over 4-6 weeks, then upped to 7.5mg to allow things to settle for several months.

 

I’ve since followed the recommendation on this site (Brass Monkey slide) and am sitting at 3.65mg, down from 15mg over 17 months. I’ve found that the lower I go, the more sensitive to WD I become. It’s taken me four weeks to recover from my most recent 2.5% reduction.

 

Did you ride it out at 5mg? I’ve come close to reverting to a higher dose twice, but I am glad I have ridden it out. Doing this without a close support network and on the other side of the world from your family would be an added challenge.

 

Once you are stable and ready to taper again, the smallest Vortioxetine pill I've found in Australia is 5mg. I crush it / chop it into very fine particles between two spoons on a piece of paper, fold the paper into a funnel to get the particles into a 20ml syringe, add 10ml of water, shake for 30 seconds and remove 2.5% of the liquid with a 1ml or 0.5ml syringe….I hope this helps.