Piglet: Which way do I go?

[Piglet]

New member but I have been reading here for a couple of months. Currently at 90 mg Effexor tapering 10% every month. I got this direction from this site. So far so good I believe. My pdoc just changed me from 4.5 mg Ativan daily to 2 mg clonazepam daily. Also this month I went on and off 80 mg Fetzima. I had a week of high energy, got out and did things I like to do and really felt normal. That energy is now gone and I am so depressed. My pdoc wants to start me on Brintellix but I'm just not sure I want to keep going down the AD path. I've been on them since 1997 and at first they worked but don't seem to be anymore. I'm afraid to go without them as I don't know what I will be like. I just started crying again today which is my birthday and I can't make myself do anything. My hubby is trying to get me going but I bit his head off. I'm struggling and confused. Please help me...

[brassmonkey]

Hi Piglet-- welcome to the group, joining is a nice birthday present to yourself. (BTW Happy Birthday).  I can see why you're having some problems lately.  The Effexor taper sounds like it is going well, but the other changes you have made lately are probably causing you trouble.  First off, well don't on getting off of the Fetzima, it reacts very badly with Effexor and they should not be taken together.  Just the start up and stopping of it could be part of the current problems.  Switching the benzos will also add to the pain.  I agree with you that adding the Brintellix is not the way to go, more AD won't do anything but make the problem worse.  What you are feeling are common WD symptoms;

 

What is withdrawal syndrome?

 

For right now I would suggest just sitting tight and give everything a few weeks to settle out and then you can pick back up on your Effexor taper.  In the meantime, it would be a good idea to start researching various coping strategies so that when you are finally drug free  you can handle what life throws at you.

 

Thank you for filling in a signature block, it really helps us see what is going on.

 

Beautiful country around Amaconda, I lived several years in Bozeman.

[Piglet]

Silver Star thank you so much for your reply. I will read the link you sent to me. Looks like there are a lot of links about withdrawal. I was diagnosed with clinical depression. Does that make any difference to stayin on ADs or not?

Yes Anaconda is beautiful! When it gets too cold in the winter we pack up and go to Arizona. It's the best of both worlds!

[Piglet]

Sorry, you're not Silver Star, you're Brass Monkey!

[Altostrata]

Welcome, Piglet.

 

Brassmonkey is right, please keep an eye on drug interactions. Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and copy and paste the results in this topic.
 

Your psychiatrist seems to like to experiment with new drugs. Many more careful doctors would wait years to see what kind of problems Fetzima or Brintellix might cause.

 

Personally, I would avoid such a doctor.

 

When you say that antidepressants don't work anymore, what do you mean?

[Piglet]

I am not getting out of my depressive state with antidepressants now. That meaning: I no longer work, I am paralyzed and in bed many days, I can only walk 8 blocks when I make myself get outside, I am not interested in any of the hobbies I once had, I do not want to be around people and especially do not want company in our house, I cry a lot, smoke a lot and am not my old outgoing self that I used to be. I have also gained 30 pounds and people don't recognize me-which makes me not want people to see me this way. I have no confidence or self esteem. I have a large appetite especially for carbs. I go from antidepressant to antidepressant and nothing 'kicks in' and makes me feel better or gives me any energy.

[Altostrata]

Some of the side effects of long-term antidepressants are demotivation, emotional anesthesia, and weight gain.

 

It sounds like you have blood sugar dysregulation, possibly from the drugs.

 

You might be interested in a book called Your Drug May Be Your Problem.

[Piglet]

Alto strata I am having problems. My computer won't let me cut and paste my info from drugs.com. Do you want me just to type in what drugs I'm taking right now?

[Piglet]

The clonazepam is making me hyper. My pdoc wants me to go back on Ativan now. I just changed from Ativan to clonazepam on 8/19. Is this too soon to make the change?

[Altostrata]

Can you copy and paste the link from drugs.com that gives your drug interaction results?

 

Please discuss benzos here  http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/

[Piglet]

http://www.drugs.com/drug_interactions.php?interaction_list_id=44482230

 

What is listed is what I take everyday.  When I have migraines I take naproxyn 500 mg, Zomig Nasal Spray, promethazine.

 

As of 6/21/15 I was completely tapered off predisone, which I was on for 3.5 years for my migraines.

[Altostrata]

Interactions between your selected drugs

clonazepam ↔ venlafaxine

Applies to: clonazepam, Effexor (venlafaxine)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

 

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
2. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The effect of fluoxetine on the pharmacokinetics and psychomotor responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9

View all 34 references

Switch to consumer interaction data

hydroxyzine ↔ venlafaxine

Applies to: hydroxyzine, Effexor (venlafaxine)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

 

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
2. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
3. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The effect of fluoxetine on the pharmacokinetics and psychomotor responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9

View all 34 references

Switch to consumer interaction data

hydroxyzine ↔ formoterol

Applies to: hydroxyzine, Dulera (formoterol / mometasone)

MONITOR: Beta-2 adrenergic agonists can cause dose-related prolongation of the QT interval and potassium loss. Theoretically, coadministration with other agents that can prolong the QT interval may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s). Clinically significant prolongation of QT interval and hypokalemia occur infrequently when beta-2 agonists are inhaled at normally recommended dosages. However, these effects may be more common when the drugs are administered systemically or when recommended dosages are exceeded.

 

MANAGEMENT: Caution is recommended if beta-2 agonists are used in combination with other drugs that can prolong the QT interval. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

References

1. "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals, East Hanover, NJ.
2. Whyte KF, Addis GJ, Whitesmith R, Reid JL "The mechanism of salbutamol-induced hypokalaemia." Br J Clin Pharmacol 23 (1987): 65-71
3. Larsson S, Svedmyr N "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis 116 (1977): 861-9

View all 30 references

Switch to consumer interaction data

venlafaxine ↔ formoterol

Applies to: Effexor (venlafaxine), Dulera (formoterol / mometasone)

MONITOR: Additive or synergistic effects on blood pressure and heart rate may occur when serotonin-norepinephrine reuptake inhibitors (SNRIs) are combined with sympathomimetic agents such as nasal decongestants, adrenergic bronchodilators, ophthalmic vasoconstrictors, and systemic vasopressors. The use of SNRIs alone has been associated with sustained increases in blood pressure and heart rate, and cases of elevated blood pressure requiring immediate treatment have been reported in postmarketing experience.

 

MANAGEMENT: Caution is advised if SNRIs are used with other drugs that can increase blood pressure and/or heart rate. Blood pressure and pulse should be measured prior to initiating SNRI therapy and monitored at regular intervals thereafter. Dose reduction or discontinuation of the SNRI should be considered in patients who experience a sustained increase in blood pressure or pulse rate.

References

1. "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals, St. Louis, MO.
2. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals, Raritan, NJ.
3. "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.

View all 6 references

Switch to consumer interaction data

hydroxyzine ↔ tiotropium

Applies to: hydroxyzine, Spiriva (tiotropium)

GENERALLY AVOID: Theoretically, the potential exists for additive anticholinergic effects such as mydriasis, blurred vision, heat intolerance, fever, dry mouth, tachycardia, urinary retention, constipation, and glaucoma (onset or exacerbation) when inhaled anticholinergic agents are used with each other or with other agents that possess anticholinergic properties. Although systemic effects are uncommon due to the poor absorption of quaternary ammonium compounds from gastrointestinal and nasal mucosa, worsening of urinary retention or angle-closure glaucoma has been reported with the use of orally inhaled anticholinergic agents. Increased intraocular pressure and precipitation or exacerbation of angle-closure glaucoma may also occur due to inadvertent contact of the eye with aerosolized or nebulized drug.

 

MANAGEMENT: Inhaled anticholinergic preparations should preferably not be used in combination with other anticholinergic agents or agents with significant anticholinergic effects such as antihistamines, antispasmodics, neuroleptics, phenothiazines, skeletal muscle relaxants, tricyclic antidepressants, and class IA antiarrhythmics (especially disopyramide). Caution is advised if concomitant use cannot be avoided, particularly in the elderly and those with significantly impaired renal and/or hepatic function. Measures should be taken whenever possible to minimize ocular exposure to these drugs, such as keeping eyes closed during oral inhalation or use of a mouthpiece rather than face mask during nebulization. Patients should be advised to contact their physician if they experience excessive anticholinergic adverse effects or signs and symptoms of angle-closure glaucoma (e.g., eye pain or discomfort; blurred vision; visual halos; colored images in association with red eyes from conjunctival congestion or corneal edema).

References

1. Cole JM, Sheehan AH, Jordan JK "Concomitant use of ipratropium and tiotropium in chronic obstructive plmonary disease." Ann Pharmacother 46 (2012): 1717-21
2. "Product Information. Anoro Ellipta (umeclidinium-vilanterol)." GlaxoSmithKline, Research Triangle Park, NC.
3. "Product Information. Combivent (albuterol-ipratropium)." Boehringer-Ingelheim, Ridgefield, CT.

[Altostrata]

You can see for yourself your drug combinations may tend to make you sluggish and unfocused.

 

Do you think the many drugs you take might have an effect on your mood?

[Piglet]

Yes, they probably do. I have gone off a few different meds already and am looking at going off a few more in the near future. With my tapering of Effexor I'm not going to attempt going off benzos right now but that will be my next major taper. It just seems whenever I go to the doctor I walk out with an rx in hand and it's only lately I have questioned the meds and not taken them.

I just feel that I have such an uphill battle on my hands. The prednisone taper was horrendous. Now I'm going off Effexor which isn't a picnic and then the benzos. I don't see a light at the end of the tunnel...

[Altostrata]

I think you need a new doctor. Those are too many drugs.

[Piglet]

I am seeing a few different doctors for different medical conditions and they each prescribe their own meds. Just recently I've taken my health into my own hands because its deteriorating and I need to get off of this pharma merry go round.

[Altostrata]

Yes, your health situation sounds complicated.

 

You may wish to work with a dietician or integrative doctor on the gastroparesis, see http://www.mayoclinic.org/diseases-conditions/gastroparesis/basics/definition/con-20023971Given the migraines, you might have a food allergy or sensitivity.

 

Please also note that a side effect of benzos is depression. I think they may also cause digestive problems.

[laineyk]

Piglet, I agree with Alto....you need a new Dr. this one has no idea wht he/she is doing. you should not be jumping from one benzo to another and back again. TAKE IT FROM ONE WHO KNOWS

 

You say you were dx with depressive disorder. I see that you are/were taking Ativan for sleep but also taking it all day long...so you have anxiety also?

 

I guess that I would sit back and take a break from this until your brain can adjust to the clonazepam, then start back to tapering the Effexor.

 

adding more drugs to the mix is probably just going to keep you hostage for longer...

 

I am no poster person for how to do this right, I just have had a long hx with both these drugs and at my age (56) I want to be drug free once and for all.....you can be too some day

[Piglet]

Yes I have GAD and social anxiety as well as depression. I also suffer chronic migraines from lesions on my brain. The changes in meds is very hard on me and my poor head. I agree that I should just let my body and brain settle down for awhile and not jump around.

Interesting that benzos cause a depression. I didn't know that.

Boy am I all messed up with the meds I'm on!

[Piglet]

Has anyone ever tried tapering off 75!mg Effexor XR 1 bead per day? Had any luck?

[KarenB]

Hi Piglet, I'll move this to you own thread soon.

 

I'm tapering effexor like this:  I remove 1 bead per week for 4 weeks, then hold for 4-6 weeks.  (Don't worry too much - few people are as sensitive as me )

 

Reducing every day like that will catch up with you.  Have a look at this thread for micro-tapering:  http://survivingantidepressants.org/index.php?/topic/2878-micro-taper-instead-of-10-or-5-decreases/ It's got all the details of how to do it properly.

 

Effexor is sneaky little so-and-so.  You want to stay in control .

 

KarenB

[KarenB]

Bump