Alltimegreat1 Withdrawal or Relapse?

[Alltimegreat1]

 I would be incredibly grateful for some advice about antidepressant withdrawal. I don't trust my doctors or psychiatrists anymore.

 

I am 40 years old with no history of mental illness until about 11 months ago, when I began overreacting to a number of problems in my life like skin issues and threats of lawsuits, and this led to a two-month period of psychosis that gave rise to severe depression (according to the doctors here). It was very intense. I live in Frankfurt, Germany.

 

Once I began to calm down and realize that these fears were unjustified (around February), the depression symptoms seemed to get worse, and I began to have physical problems like dizziness, vertigo, and derealization. This led me to think there was some neurological damage, and so I had an MRI and EEG done but with no findings.

 

I began seeing a psychiatrist around this time, who gave me a prescription for Olanzapine, but I didn’t take it due to my strong aversion to pharmaceutical medication. However, by mid-March I was feeling so awful and had starting having difficulty sleeping. I could fall asleep, but I would wake up after three or four hours and couldn’t fall back asleep.

 

I didn’t see any other option but to check into an inpatient clinic, where the doctors started me on 5mg Olanzapine and 50mg Sertraline. The Olanzapine helped me sleep, and I was hopeful that the antidepressant would begin working quickly. After a few days, the dizziness and derealization subsided. However, after about seven weeks (and increases to 100mg and 150mg), I was still feeling depressed, and the doctors switched me to Venlafaxine in late May, initially 75mg but quickly increased to 225mg.

 

It was at this time that I left the inpatient clinic with the intent of continuing Venlafaxine at home. Occasionally I tried skipping the Olanzapine, but whenever I did I couldn’t stay asleep. And after six weeks of Venlafaxine, I felt no better and decided to discontinue (against the advice of my psychiatrist). I tapered down to 150mg to 75mg to 37.5mg over a period of 15 days (each dose for five days). I completed the taper in mid-July.

 

I didn’t notice any withdrawal symptoms during the taper, but once I was off completely, the brain zaps, nausea, and restless legs began. But I also noticed that I no longer needed the Olanzapine to sleep well, as if the Venlafaxine had been causing the insomnia. The brain zaps were not painful and didn’t bother me too much since I was expecting them to go away soon.

And after about two weeks, the zaps were hardly noticeable and I was feeling much better. I was happy about this because it was just a few days before a vacation I had planned to Florida.

 

Throughout the entire 10-day vacation site-seeing and soaking up the sun, I hardly noticed any symptoms at all and my mood was great. It was as if I was completed cured.

 

Unfortunately, the very day I returned to Germany at 7am from a long overnight flight (this past Sunday), I began feeling unwell again, like nauseous or a queasy feeling in my stomach and chest accompanied by low moods. I was hoping it was due to jet lag, but it’s been an entire week now and there hasn’t been any improvement. I can still sleep well fortunately but I have a pronounced feeling of being unwell most of the time and I feel very fatigued and unmotivated to do much. No dizziness, pain, or cognitive issues.

 

Given that I felt virtually symptom-free while in vacation, are my current symptoms are more likely to be a continuation of the withdrawal or some sort of (travel-induced) depression relapse, or something else?

 

Could I already be going through windows and waves just a month after stopping the antidepressants?

 

Just to summarize, I was on antidepressants from mid-March to mid-July, including the two-week taper. So about eight weeks on Sertraline (mostly 100mg) followed immediately by eight weeks on Venlafaxine (mostly 225mg). I was also taking Olanzapine for most of that time, occasionally taking Pipamperone instead.

 

Thanks in advance for the help and insight!

[hayduke]

Hello and welcome @Alltimegreat1

 

Sorry to hear you've been having a bumpy road on these drugs.

 

It sounds like you've tapered the venlafaxine way too quickly.  There is usually a delayed reaction before a withdrawal really affects the body, which would explain why you felt ok for a time.

 

Please create a signature with dates, dosages and changes to your drug history

 

Why taper by 10% of my dosage?

 

Tips for tapering off olanzapine / zyprexa

 

Tips for tapering off venlafaxine (Effexor)

 

[Alltimegreat1]

It seems like the taper was indeed too quick. The psychiatrist suggested a taper that went straight from 75mg to 0mg, which would have been even worse.

 

I was only on Venlafaxine for about five weeks (four weeks at 225mg), and I didn't think that would cause much in the way of withdrawal. I didn't become aware of this website until after I completed the taper.

 

Could the Sertraline taken prior to the start of Venlafaxine be contributing to the withdrawal symptoms?

 

I guess it wouldn't make any sense to restart medication at this point after five/six weeks of being off it.

[FireflyFyte]

On 8/20/2023 at 6:56 PM, Alltimegreat1 said:

Given that I felt virtually symptom-free while in vacation, are my current symptoms are more likely to be a continuation of the withdrawal or some sort of (travel-induced) depression relapse, or something else?

 

 

I agree with hayduke that your symptoms are most likely delayed withdrawals. It is not uncommon for withdrawal symptoms to surface weeks, or even months, after dropping too fast.

[littlebird]

On 8/20/2023 at 3:56 PM, Alltimegreat1 said:

Throughout the entire 10-day vacation site-seeing and soaking up the sun, I hardly noticed any symptoms at all and my mood was great. It was as if I was completed cured.

 

Unfortunately, the very day I returned to Germany at 7am from a long overnight flight (this past Sunday), I began feeling unwell again, like nauseous or a queasy feeling in my stomach and chest accompanied by low moods. I was hoping it was due to jet lag, but it’s been an entire week now and there hasn’t been any improvement. I can still sleep well fortunately but I have a pronounced feeling of being unwell most of the time and I feel very fatigued and unmotivated to do much. No dizziness, pain, or cognitive issues.

Hello, welcome! Not a mod or a health expert, just been where you are. Is it possible you have a vitamin d deficiency? Wondering if the Florida sun was part of why you felt better. I've also noticed that sometimes it's really hard to return home after a trip, the problems I have at home seem bigger and more intense and I always wonder if I just need to move away. Is it possible you're not enjoying living where you live and feeling like you want to make big life changes? Not suggesting making any big life changes when you're experiencing symptoms, just wondering if these symptoms you're feeling are partly something in you saying, "There are things in my life that aren't working for me anymore and I need something different."

[Altostrata]

Welcome, @Alltimegreat1

Quote

 

March 15 to July 15, 2023: Olanzapine/Zyprexa (alternating periods of 5mg and 10mg)

March 15 to May 25, 2023: Sertraline/Zoloft (100mg, 150mg)

May 25 to June 1, 2023: Venlafaxine/Effexor (75mg, 150mg)

June 1 to July 3, 2023: Venlafaxine/Effexor 225mg

July 3 to July 17, 2023: TAPER: Venlafaxine/Effexor (150mg, 75mg, 37.5mg)

 

 

Did you feel odd after any of these drug switches? How did you feel while you were on venlafaxine May 25-July 17?

[Alltimegreat1]

I never felt very good while on the drugs, other than they helped me sleep (presumably the Olanzapin). I felt depressed and strung out on the Venlafaxine. It didn't help me at all. I decided to go off the drugs since I felt depressed anyway, but then after stopping them, I felt great for nearly two weeks.

[Alltimegreat1]

5 hours ago, littlebird said:

Hello, welcome! Not a mod or a health expert, just been where you are. Is it possible you have a vitamin d deficiency? Wondering if the Florida sun was part of why you felt better. I've also noticed that sometimes it's really hard to return home after a trip, the problems I have at home seem bigger and more intense and I always wonder if I just need to move away. Is it possible you're not enjoying living where you live and feeling like you want to make big life changes? Not suggesting making any big life changes when you're experiencing symptoms, just wondering if these symptoms you're feeling are partly something in you saying, "There are things in my life that aren't working for me anymore and I need something different."

I began taking 10,000 IU Vitamin D3 about the same time I started the taper, after reading that antidepressant use can cause vitamin and mineral deficiencies that in turn can lead to or worsen depression. I have no reason to be depressed in my life. I have a high-paying, safe, and cushy job that I enjoy and I'm happily married with kids and lots of good friends.

 

I'm really hoping this is some sort of delayed withdrawal that will subside after a few more weeks. I have constant (albeit non-specific) thoughts of ending things.

[Alltimegreat1]

7 hours ago, FireflyFyte said:

I agree with hayduke that your symptoms are most likely delayed withdrawals. It is not uncommon for withdrawal symptoms to surface weeks, or even months, after dropping too fast.

 

17 hours ago, hayduke said:

It sounds like you've tapered the venlafaxine way too quickly.  There is usually a delayed reaction before a withdrawal really affects the body, which would explain why you felt ok for a time.

 

Thanks for this insight! Can you share any sources of information about the phenomenon of delayed withdrawals? I'd really like to look into this.

[hayduke]

13 hours ago, Alltimegreat1 said:

 

 

Thanks for this insight! Can you share any sources of information about the phenomenon of delayed withdrawals? I'd really like to look into this.

 

Have a read through the links I replied with, particularly "Why taper by 10% of my previous dosage".

[Alltimegreat1]

I started on Effexor in late May, and went from 75mg to 150mg in the first week, before increasing to 225mg for the next four/five weeks. This seemed like a very short period of administration to me, compared to the other patients I met at the clinic who had been on their meds for many years (some for decades). My psychiatrist was against me going off Effexor, and she wanted to increase the dosage and add Abilify.

 

When I insisted on going off, she suggested a two-week taper, one week 150mg, one week 75mg, then zero. I thought I was being extra cautious by obtaining 37.5mg pills, and including them in a 15-day taper.

 

At the time, I just didn't think being on a med for that little time could cause withdrawal symptoms, although I was on Zoloft for about eight weeks prior to that.

 

Could the Zoloft I took prior to the Effexor be making the withdrawal worse? I have nausea/malaise/fatigue and low mood, accompanied by occasional muscle spasms in my arms/shoulders and legs. It sure feels like physical withdrawal to me, but I have the idea of a possible depression relapse in the back of my mind.

 

If it is indeed withdrawal that I have, would it make any sense trying to reinstate a drug now five/six weeks after stopping Effexor, and then tapering down more slowly?

[FireflyFyte]

55 minutes ago, Alltimegreat1 said:

I started on Effexor in late May, and went from 75mg to 150mg in the first week, before increasing to 225mg for the next four/five weeks. This seemed like a very short period of administration to me, compared to the other patients I met at the clinic who had been on their meds for many years (some for decades). My psychiatrist was against me going off Effexor, and she wanted to increase the dosage and add Abilify.

 

When I insisted on going off, she suggested a two-week taper, one week 150mg, one week 75mg, then zero. I thought I was being extra cautious by obtaining 37.5mg pills, and including them in a 15-day taper.

 

At the time, I just didn't think being on a med for that little time could cause withdrawal symptoms, although I was on Zoloft for about eight weeks prior to that.

 

Could the Zoloft I took prior to the Effexor be making the withdrawal worse? I have nausea/malaise/fatigue and low mood, accompanied by occasional muscle spasms in my arms/shoulders and legs. It sure feels like physical withdrawal to me, but I have the idea of a possible depression relapse in the back of my mind.

 

If it is indeed withdrawal that I have, would it make any sense trying to reinstate a drug now five/six weeks after stopping Effexor, and then tapering down more slowly?

 Alltimegreat1, I moved your post in another forum here as we ask that members keep all of their questions under their introductory post.

 

hayduke has shared some great resources that you might find helpful.

[Altostrata]

You were on at least 75mg venlafaxine May 25 to mid-July.

 

What times o'clock do you take your drugs, with their dosages? 

[Alltimegreat1]

The final five days were 37.5mg. I always took it in the morning.

[Altostrata]

1 hour ago, Altostrata said:

You were on at least 75mg venlafaxine May 25 to mid-July.

 

How did you feel while you were taking venlafaxine May 25-July 3?

[Alltimegreat1]

Depressed. By early July I figured the pills won't help me and I need to get off them.

[Alltimegreat1]

Thanks so much to everyone for the information and support. I made the decision today to reinstate Venlafaxine at a very small dose, 2.5mg, as this seems like the recommended method for people who tapered off too fast and have been off the drug for a while (in my case, six weeks). I've been opening up the 37.5mg capsules, which have 136 beads, and removing all but 9 of them. I started today.

 

I plan on doing this for a week to see if it provides any relief. My symptoms haven't been horrifying (compared to some other people), but I'm just in a constant state of discomfort, malaise, and low mood.

 

If the 2.5mg dose provides relief, how long should I keep taking it before tapering off? And what should I do if it doesn't provide relief?

[Altostrata]

2 hours ago, Alltimegreat1 said:

If the 2.5mg dose provides relief, how long should I keep taking it before tapering off? And what should I do if it doesn't provide relief?

 

Let's see how you do first.

[Alltimegreat1]

Alright, good deal. Already feeling a bit better two days in.

 

One thing I forgot to ask: Are all the beads in a Venlafaxine XR capsule the exact same? Or is it possible that some of the beads are more potent or release more slowly than others?

[Altostrata]

 

5 hours ago, Alltimegreat1 said:

Already feeling a bit better two days in.

 

Good to hear. This is what we expect from reinstatement -- with very gradual improvement afterward.

 

The beads may vary in size. At this point, if you take a random 9 beads, your dose will be consistent enough. You won't be able to be exact. It's crucial to keep to a regular daily schedule on such a small dose.

 

22 hours ago, Alltimegreat1 said:

I've been opening up the 37.5mg capsules, which have 136 beads, and removing all but 9 of them.

 

Please save the rest and continue to take 9 random beads daily at the same time each day for at least a month.

[Alltimegreat1]

Nearly a week now after reinstating about 2.25mg Venlafaxine, I feel a massive improvement, both physically and mentally. But I still have brief periods during the day with a suppressed mood, so I know I'm not 100% yet.

 

Can I expect this improvement to continue gradually over the course of the next month, or will I feel the full effect after just a week?

 

Would you still recommend stabilizing on 9 beads for an entire month, even though I'm already feeling much better?

 

Somehow, I feel like I should have reinstated at an even lower dose, like just 1mg.

 

Another thing I've been ruminating about is whether any adverse symptoms I feel from now on could be from the low dose of the drug rather than the withdrawal.

 

Any thoughts?

 

Thanks again for your support!

[Altostrata]

7 hours ago, Alltimegreat1 said:

Another thing I've been ruminating about is whether any adverse symptoms I feel from now on could be from the low dose of the drug rather than the withdrawal.

 

What new symptoms do you feel that might be from the drug?

[Alltimegreat1]

Very dry eyes and excessive yawning. I didn't have that while off the drug. Sleep seems to be a bit worse as well. I can handle all of that though.

My worry is that I may have reinstated at too high of a dose and that the time I spend stabilizing for a whole month at 9 beads will increase my dependency on the drug, and make it harder to come off it later.

Every time I have a low mood I get very concerned. I know I need to be calm and remain patient, but I could use some reassurance that I'm doing the right thing. I fully realize that you're the expert here and not me, and I'm very grateful for your advice and insight.

[Alltimegreat1]

Forgot to mention that I began have mild leg aches upon reinstating, in the thighs.

 

Also, I made a donation today to support this great website.

[Altostrata]

Thank you!

 

What times o'clock do you take your drugs, with their dosages? Does the Effexor make you tired? At what times of day are your symptoms worse or better?

 

 

[Alltimegreat1]

I take no drugs other than Venlafaxine (9 beads; approx. 2.25mg) once a day at 11am. I take it with some food.

 

I don't feel tired after taking it. I usually feel the worst in the late afternoon and early evening.

 

Reinstatement certainly seems to have worked despite some lingering symptoms, which could potentially be attributable to the drug and not withdrawal.

 

I'm concerned about my sleep. Last night I woke up after only six hours of sleep. I feel that this is the effect of the drug, despite the low dose.

 

Do you offer phone consultations?

[Alltimegreat1]

It's clear now that the low dose of Venlafaxine is disrupting my sleep. I'm considering taking a low dose of Pipamperone (15mg) at night as a sleep aid, possibly throughout the tapering period. That helped me sleep when I was on the regular doses of antidepressants. Any thoughts on this idea?

[Altostrata]

If I were you, I'd reduce venlafaxine by one bead instead of adding another drug.

[Alltimegreat1]

Alright. I'll try that.

[Alltimegreat1]

I contacted the generic manufacturer of the Venlafaxine I'm taking and received an answer today.

 

In response to my questions, the representative (a "Junior Pharmacovigilance Manager") explained that the individual beads in the 37.5mg capsules vary in size from 950µm to 1100µm (micrometers), and that the amount of the active ingredient in a bead is proportionate to that bead's weight.

 

I guess I should be skeptical as to whether he's really certain that this is true (given the coating and fillers, etc.), but if it is indeed true, that would make tapering off of the last 10 or so beads a much more reliable process, and would allow patients who are down to one bead to take the larger ones first and progress down to the smaller ones before stopping completely.

[Altostrata]

On 9/4/2023 at 7:26 AM, Alltimegreat1 said:

would allow patients who are down to one bead to take the larger ones first and progress down to the smaller ones before stopping completely.

 

Yes, that is what people often do, if they are very sensitive to dosage reductions.

 

I wouldn't overthink it.

[Alltimegreat1]

Since I wasn't getting proper sleep, I decided to reduce my bead count from 9 to 7, even though you recommended removing only one.

 

Since then I've been feeling pretty lousy with a fast heart rate and queasy feeling. I think I was just too eager and really should have precisely stuck to your suggestions.

 

Would dropping from 9 beads to 7 around 12 days after reinstating be enough to cause symptoms like this?

 

Should I go back up to 8 beads? Or 9?

[Altostrata]

On 9/6/2023 at 6:03 AM, Alltimegreat1 said:

Would dropping from 9 beads to 7 around 12 days after reinstating be enough to cause symptoms like this?

 

Yes. 12 days is far too short for stabilization. Suggest you go back to 9 beads and stop adjusting your drugs.

[Alltimegreat1]

Thanks. I will do that.

[Alltimegreat1]

I feel better now back on 9 beads. The queasy feeling has diminished, which is pretty much direct proof that the drop to 7 beads was responsible for the symptoms (as Alto explained). I'm still having major difficulty with staying asleep though, and I think this is worsening my mood and making it harder for me to stay confident in staying out the long reinstatement/slow taper course.

 

I'm confident it's the small dose of the drug causing the insomnia, and not withdrawal. The entire 5-week period off the drug (including the good times and the severe withdrawal), I could sleep quite well. The insomnia only started up again a few days after going back back on the drug.

 

I would be very grateful for any suggestions from anyone here on how to improve sleep in this situation. Last night I took an OTC sleeping pill at 2am when I woke up, and although it did put me back to sleep until 8am, I have felt quite groggy and unwell today. I'm considering taking half a pill tonight if/when I wake up. If that works, maybe a quarter tomorrow night.

 

I realize that this would not be a safe long-term solution, but I really don't know what to do about the lack of sleep. Since these pills can also create tolerance and dependency, it's probably not a great idea to take them for extended periods of time. One idea would be, whenever I wake up in the middle of the night (which seems to be every night), to take OTC sleep aids for one week, then Promethazine the next week, Pipamperon the next week. All three in week-long rotations and at the lowest doses needed to get back to sleep. Then maybe I could add Benadryl as a fourth.

 

Any thoughts would be greatly appreciated. Thank you.

 

 

[FireflyFyte]

1 hour ago, Alltimegreat1 said:

I'm confident it's the small dose of the drug causing the insomnia, and not withdrawal. The entire 5-week period off the drug (including the good times and the severe withdrawal), I could sleep quite well. The insomnia only started up again a few days after going back back on the drug.

 

I would be very grateful for any suggestions from anyone here on how to improve sleep in this situation. Last night I took an OTC sleeping pill at 2am when I woke up, and although it did put me back to sleep until 8am, I have felt quite groggy and unwell today. I'm considering taking half a pill tonight if/when I wake up. If that works, maybe a quarter tomorrow night.

 

At what time are you taking the 9 beads of Venlafaxine?

Edited September 11 by FireflyFyte