LovingSupport: Helping partner come off Effexor/already successfully off Ativan

[LovingSupport]

Hi SA Community,

 

I am the core support for my long-time love and life partner, and joined so that I can ask questions related to him coming off of Effexor.

 

Very, very long story short, 1 year ago my high-functioning partner started having HIGH anxiety, extended insomnia, , ER visits, etc.

 

Prescribed Ativan 1.5mg/day (on first ER visit), then Effexor XR to stablize (first 75mg then upped to 150mg after 2 weeks)

 

After 5 months, he did a slow 3 month titration off of Ativan (10% at at time, going down 10% each week), finished 2 months ago. Had a compounding pharmacy make troches (basically, edible waxy cubes) in small Ativan amounts to create an easy way to reduce slowly. NO withdrawal symtoms!

 

He is about to start reduction-toward-elimination of the Effexor. We just found this site recently.  Will be following the precise 10% method that this SA site suggests. Just bought a Gemini 20 scale to weigh out the 10%.

 

Current naturopath has him taking the following daily:

Total Amino Solution

DLPA

GABA

DHEA

 

He has also started taking daily:

2000 IEU Fish oil

2000 IU Vitamin D

 

I actually believe that the Effexor is causing many of the current problems he's now experiencing--poor memory, complete lack of motivation, sleeping 12-15 hrs/day, etc. Yes, some of these occurred at start of this 1 year-so-far journey, before starting to take the Effexor a month of so into it. However, I believe a number of his current symptoms will lift as he comes off the anti-depressant. If they don't, then at least we'll know what is really HIM and not the drug, to better deal with what's going on underneath.

 

Thanks!

LovingSupport

[mammaP]

Hi and welcome to SA.  I think it might be better to wait a little while longer before starting to taper effexor.

3 months is actually quite fast for a benzo taper and his nervous system will  still be stabilising. 

Are there any new symptoms since stopping or while tapering the ativan? 

You have obviously done your homework here, well done for that, there is so much information to take in!

 

Here is the topic for tapering effexor, http://survivingantidepressants.org/index.php?/topic/272-tapering-off-effexor-venlafaxine/

 

Thank you for filling out the signature, and thank you for looking out for your husband and helping him through this,

support of family is everything when getting off psychiatric meds. Side effects are generally dose related and tend to

get better as the dose drops.  The thing for a successful taper is to listen to the body, and make cuts only when he

has stabilised from each cut. That can mean anything from 4 weeks to several months between cuts. It can be daunting

thinking of the time it takes but we get there in the end and it saves some very distressing withdrawal symptoms from 

cutting too soon.  Keep us posted, I hope the taper goes well for him, I'm sure it will as long as he keeps to the 3 K I S's 

you can see the thread about that here. http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

[Rhiannon]

Yes, I absolutely agree with mammaP, that benzo taper sets off my alarm bells.  He hasn't been off long enough yet for you to be sure he's escaped withdrawal. There's a lag time. Now, if he has no prior history of any psych med use at all, and these two are the only he's ever used and he only used them since the beginning of 2014 sometime, it's not impossible that he could escape relatively easily. But it's not a sure thing either, for anyone. I've seen a guy take a year and a half to get off what started as three weeks of a benzo, because he kept going too fast each time and having to go back on. So please be cautious. 

 

If you were my kids I would say, wait till after the holidays to start that Effexor taper.

[LovingSupport]

Thank you for your thoughtful posts, mammaP and Rhi. We will take your suggestions into full consideration. I had no idea that withdrawal symptoms can start  2 months (or even longer?) after a benzo taper is completed.

 

MammaP: Great advice and reminders about always first stabilizing and listening to the body to gauge when to start the next dosage cut each reduction period.

 

I am reconfirming that there were no symptoms while withdrawing and none after stopping completely either. When you write "I think it might be better to wait a little while longer before starting to taper effexor", how long might you suggest? My partner and I are both ready to start the slow reductions; the anhedonia is very hard for him to bear, and he feels like he's in limbo. However, I am now pausing to figure out if we really should hold off longer.  If he is not having any negative symptoms from the benzo titration, then when would we know when to start the reduction of the Effexor?

 

Rhi: How long of a lag time is typical if one is going to experience latent withdrawal symptoms? I am reconfirming that he has absolutely no prior history of any psych med use at all, and these two are the only he's ever used. He has only used them since the beginning of 2014 (Ativan started in January 2014, and Effexor in February 2014).

 

Thanks again, mammaP and Rhi. Also, if there are any other members who have additional thoughts about how much time to consider as appropriate before beginning the Effexor tapering, I greatly appreciate your imput.

 

Sincerely,

LovingSupport

[Meimeiquest]

The hard part is that the symptoms that are so troubling right now could remotely be benzo withdrawal symptoms. Although symptoms vary, signs of an "unhappy brain" are often the same, whether side effects or withdrawal effects.

[Rhiannon]

Thanks for the additional info. Well, under the circumstances (no prior history of psych med use and only short use, and no withdrawal symptoms) he may be okay with the benzo taper. People often do fine with coming off meds the first time or two. We don't often meet those people here on this forum; we tend to get the horror stories, so we're not used to hearing good news. :-)

 

With benzo withdrawal what you see is what you get, more than with AD withdrawal. So I'm thinking maybe he really is okay. (That is, with AD withdrawal people often do fine and then get hit hard suddenly some months out. I haven't seen that with benzos; usually benzo withdrawal kicks in within a couple of weeks at most.)

 

I'd say if you want, go ahead with that first 10% cut of Effexor. 150 mg is not a low dose (it's generally easier to cut at the high doses) and he sounds stable now. Please do keep a daily journal ranking any symptoms he may get on a scale of 1 to 5 or so, and please do wait the full four weeks after the cut just to make sure you get the full picture. After the first two or three cuts if you find you can go a bit faster, that will be an option.

 

Good luck! Happy tapering (uh...hm. Whatever that is.) Please keep us posted!

[LovingSupport]

Thanks for your extra input. Will do as advised, really stick to the first 2-3 cuts for a full month each.
 
Regarding tracking any symptoms, I've downloaded the Glennmullen PDF for him to use. I've also created a separate sheet for his tracking and recording of progress. I am happy to share this simple sheet with the SA community.  Can someone explain to me how to upload the attachment? I tried figuring it out using the "My Media Library" button above the Reply text box, but it looks like I need to upload from somewhere else on this site but not sure exactly where. If this isn't the best place to pose that question, please let me know where I should do that for an answer.

 

Thanks again for your encouragement and long-term perspective. I appreciate you sticking around on the forum to help guide us newbies so we avoid the pitfalls if at all possible.

[bubble]

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[LovingSupport]

Update: 1 month into the 10% titration. Using a scale, weighed out each capsule amount to get to the reduction amount of 135mg Effexor XR. Only withdrawal symptom so far was one night about 2 weeks in, when he was awoken with a few small brain zaps. 

 

Tomorrow partner starts on next 10% down, to 121.5 mg of the anti-depressant for another 4 week period.

[LovingSupport]

Update: Feb 4, 2015

 

My partner continuing on slow titration of Effexor XR, from starting point of 150mg. On third reduction of 10%; have had two individual months of 10% reduction, now on day 11 (of 21 days) of third 10% reduction. He's currently taking 109.35mg of Effexor XR.

 

Reactions so far: One "brain zap" during first month, which woke him out of a sound sleep. Second "brain zap" occurred a few days ago; he called it "relatively minor".

 

He says he's still depressed and anxious, and continues to sleep a lot of the day. I don't notice much change from the reduction so far, though possibly more mentally coherent. Not really sure; it's sometimes harder to see change when one is in the midst of the day to day experience, even as the support person.

[Altostrata]

Thanks for checking in, LovingSupport. It sounds like your partner's tapering is going normally.

 

If the brain zaps increase, he may wish to reduce by smaller amounts.

[JanCarol]

Hey Loving - 

 

I just posted in the http://survivingantidepressants.org/index.php?/topic/656-5-htp-5-hydroxytryptophan-and-tryptophan/ thread about the Total Amino product.  

 

Seriously, it contains Tryptophan, Tyrosine, Glutamine, and Aspartic Acid, which could contribute significantly to his symptoms.  By now, he's been on it long enough that he may need to taper it, if he needs to quit.  But - better that than a benzo - you can save it until last.

 

Please remember to take it slow, it sounds like you are going by the 10% of current dose per month - but remember - it's important to become stable in between tapers!  So if he is complaining of symptoms, or there is additional stress in his and your lives, or there is illness - hold.  Just wait another month before tapering again.

 

I appreciate your desire, and his, to get off this stuff as quickly as possible - but - 

 

You've heard here that there can be a delay before symptoms kick in - sometimes that delay can be 4-6 months, or even 2 years (usually for a cold turkey, not a slow taper - but I'll bet it's not unheard of!) or more, before the complete effect of the withdrawal is felt.  So if you continue to taper while he is having symptoms, the process can take even longer.

 

As Alto says, slower tapers - microtapers we call them - can help.  Or long holds can also help.  Or both!  The goal is to have as few symptoms as possible - not to get to the finish line first, because you want him to be in good shape when he gets to that "finish line."

 

I wish my spouse took as much interest in my processes as you do in yours!  Does he take as much interest in all this stuff as you do?  

[LovingSupport]

Hi JanCarol,

 

Thanks for your detailed response and advice. Regarding the Total Amino product, he's been taking about 1-2 capsules a day on average now (4 were suggested by naturopath, but my partner usually forgets his afternoon supplements). We've run out of them, so he's on his last few this week, and we don't plan to get any more. Your evaluation of the "scatter shot" approach gives good perspective, and all the more reason to stop taking them.

 

He's had no other withdrawal symptoms since my last report on Feb 4th (total symptoms so far were two very minor "zaps", each on a different day, spaced far apart).

 

Today he started another reduction, down to 71.68mg of Effexor XR. This is the second round of two-week tapering intervals. I will pay close attention to the advice of micro-tapers when needed, especially as he gets down closer towards a "jump off" point. Will also follow your advice of "long holds" if and when necessary. Very good input.

 

Last week, for the first time in over a year, he said to me that he felt like he was "waking up" again. 

 

As for my care and attention to my husband's healing journey (together about 25 years), right now, he's not able to figure this all out on his own. The anxiety and depression he experiences are poor complements to self care. Sometimes we need the love and empathy of another to help us when we can't do it for ourselves. I consider my role to be that of a steward of his path toward well being again. Sometimes a partner walks beside us or behind us, sometimes they light the path up ahead. Often I feel like a cheerleader, reminding him of the slow but incremental progress he's making, reminding him that there is hope in his future.

[LovingSupport]

Celebrating a mini-milestone tomorrow--with the slow yet steady decreases, this next dosage drop takes my beloved below 37.5mg, the smallest capsule size that is made for Effexor XR.

 

Deep breath; pausing to appreciate all of you at SurvivingAntidepressants.org for your continued kindness, dedication, and wisdom.

 

Thank you,

LovingSupport

[LovingSupport]

Hi SA Community,

 

Here's the update: earlier this Spring, switched to beads from using a scale when weight of current dose (I think was .010 grams) was approx. equal to number of beads (10) and scale became inconsistent when measuring at this low weight.

 

Partner is currently down to 4 beads, and is continuing reducing by 1 bead every 2 weeks. Expecting jump off around autumnal equinox (later Sept). No withdrawal symptoms.

 

Partner still experiencing anxiety and depression.

 

Plan to start St. John's Wort tincture soon. At such a low current dose of Effexor ER, would you think it OK to begin taking before final jump off? He seems to think it would be fine to start now, given the "homeopathic" level of Effexor he's taking.

 

With much appreciation,

LovingSupport

[scallywag]

Thanks for the update.

 

Partner may wish to increase the time spent after each dose cut because the % cut increases quickly:

4 to 3 = 25%

3 to 2 = 33%

2 to 1 = 50%

 

We don't suggest that people supplement with St. Johns Wort because it is psychoactive. Please see St. John's Wort (Hypericum Perforatum) in the Symptoms and self-care forum.

[LovingSupport]

Good suggestions, Scallywag. I knew the cuts were bigger at these last beads, and taking more time between each reduction is smart.

 

Read the link info on SJW; partner may try the other two mentioned instead.

 

Thanks again!