Coming off venlafaxine??

Treatment and medication
1

I have been on venlafaxine for around 20 months at 75mg per day. Basically I am wanting to come off it as I have some unpleasant side effects and just want to be drug free. I have explored natural anxiety relief and feel this works just as well.

I moved to the UK 10 months ago and here they only prescribed the instant release tablets, so 37.5mg in morning and again at night. Which isn't ideal as I forget the evening pill half the time, although never get any side effects from this.

Anyway... In November I'm wanting to go to my Dr and ask to withdraw. I say November because in between now and then I have a very stressful few months moving country again and travelling. I feel it would be better to begin the weening process when I am in one place and settled.

Does any one have any tips?? I have only heard horror stories about coming off this drug, which makes me very anxious. However, I just want to be free of this medication

2

Hi Kiwifruit, you are wise to get prepared before embarking on a taper.  How often would you say you remember the second 37.5 mg per week?  You could try just taking the AM only and seeing if you do ok with that.  You might be like me.  I had my genome sequenced and learned that I have a SNP that prevents a lot of ven from crossing the blood brain barrier.  It takes me a couple of days without to start feeling off, though in hind sight I think I'd get cranky the first day.

However, that doesn't mean withdrawal won't hit you eventually!  I came off too fast a few years ago, and at first I didn't notice any problems, though I began to have severe sweats and developed really bad concentration, brain fog, memory lapses.  I'd also come off the BCP and was of menopause age so blamed these symptoms on that. Six months later, I began to have severe anxiety, insomnia and depression to a degree I'd never experienced before, but since it was such a long time from when I came off, I didn't connect the dots.

By month 10, I was back on Effexor since I had become so despondent and had suicidal ideation.  I'd never been like that before in my life!  Within one hour of taking that first pill, the clouds parted and the sun shone again!  That's a sure sign of addiction/dependency!  I knew from then on that it was WD all along and vowed to get off the wicked ven!

So, I've been doing the a slow taper for nearly two years.  I was also thrown on Remeron during the worst period before going back on ven because I couldn't eat or sleep, and so I have actually gone slower, averaging 5% per month, because I am also tapering Remeron.  It has gone very smoothly, with a few blips of anxiety and low mood when I tapered too aggressively.  I am now down to 12 mg of Ven.

However, I was always on the extended release which is easier because the capsules have little beads inside and you reduce by counting beads.  Technically, you are to take the immediate release twice a day, as you know, which makes it trickier when you want to taper.

So, if you are missing half or more of your evening doses then you might try seeing if you can just get away with the moring only.  You may be a slow metabolizer who clears it out more slowly and then the AM dose holds you to the next day.

It may be possible to get a liquid version of ven when you relocate.  Then you can dose with a syringe quite easily.  You can also make your own liquid from the immediate release tablets.  

If you find that going with only one dose a day becomes problematic, then you may just swtich to the extended release when you move, if available, and then start counting beads if you are able to get the kind with little balls in the capsules.  A 10% taper is the safest for the majority of people.  This topic includes a link about the 10% taper:

https://patient.info/forums/discuss/depression-resources-298570

Some folks are able to go faster, but given the nature of how the drug occupies receptors, it becomes necessary to really slow down when you get lower in dose, and not jump off from too high a dose.  I plan to jump off when I get down to about 1 mg, maybe 1/2 mg!

If you take your time and go very slowly, it allows your nervous system to adapt back to life without the drug rather smoothly so nothing to fear!

3

Hi Kiwi

Great call to wait until a more stable period in your life to begin the taper.

To give you an idea of how it works: IF your initial symptoms have been successfully managed by the medication over the first year of therapy and after 12 months began to withdraw altogether you are less likely to suffer major withdrawal issues. The more stable you are the better able your brain is to shift gears more smoothly. If you still have some of your initial symptoms then your chance of complications like relapse or major withdrawal increase notably.

You were treated only for 20 months which makes it very unlikely that you have reached equilibrium yet in case you had moderate to severe anxiety or depression.

Typically you would need to be in therapy for a minimum 4 years between starting therapy and attempting a taper. It usually takes about 2 years to reach equilibrium and total symptom remission  in the best case and then another couple of years of maintenance to ensure the brain is 'retrained' and you develop positive experiences and confidence. After this the taper can be quite easy but still needs to be done slowly.

But as you would rather manage any left-over issues in a different way you have to make sure you are confident, patient and disciplined. You are at a relatively low dose so your taper is simpler. Your doctor will advise but ideally you will attempt 37.5mg drop (stopping the tablet you tend to forget) and maintaining that dose for at least 3 months AFTER any withdrawal symptoms subside - preferably 6 months to give your brain sufficient time to settle into a  new equilibrium.

You can theoretically also halve the evening tab and take 1 in the morning and half at night  and maintain this for at least 3 months before stopping the night dose altogether for another 3 after ALL withdrawal symptoms stop. If any worsening is noted in that time you need to prolong this phase. Then you would halve your morning pill and follow the same protocol.

(Important note: No psychiatrist would advise this second approach because they are adamant that 37.5mg is the correct increment and anything smaller is clinically insignificant. Most users here will beg to differ but the choice is yours. You can't go too slow. Most of issues occur when weaning is done too fast or in too large increments ... or too soon in therapy)

However you look at it this will or should take a minimum of 1 year to complete and will reduce chance for a relapse in your case at 75mg. Proper taper from more substantial dosage (150mg and up) require a minimum 2 years taper. 

One tip: between now and November make sure you do not miss ANY doses to help keep your brain chemistry balanced - this will actually help you taper. If the brain is reeling from being jerked around then taper will be more difficult.

Good luck and let us know how it goes!

4

By the way - from experience (own and other users) relapses are  worse than the initial condition you were treated for.If your doctor is not supportive of your early weaning there is a good chance he has a reason. If your doctor is a GP, please do get a second opinion from a qualified psychiatrist before beginning your taper. It would be a shame to end up in a worse place you were before taking medicine by improper approach or faulty advice. x

5

Hi betsy0603,

Thanks for your helpful reply!

Whenever I forget a dose at night, I can do so for a few days and then I think I'd better take it again. But I never feel any side effects.

Just over a year ago, i ran out of prescription and went without any for 2 days. The symptoms I experienced were slightly nauseous, dizzy like I couldn't walk straight and slightly wound up and anxious. I know something was definitely off because I found it hard to walk up and down stairs, so I went and got the prescription that day and felt better.

That was on the slow release.

I only changed to immediate release when I moved to the UK because they told me they are the only ones that that government funded.

Can I ask, when you began to taper down, did you feel any positive effects increase? For example, I am always exhausted, did you feel any less tired when you were on a lower dose?

I never imagined it would take so long to ween off this drug! I expected 3-4 months given my small dose! I'm a bit nervous as when I go home in November, and start weening then, it will be Christmas season and I dont want to ruin this great time of the year with my family whom I haven't seen in a long time sad

Thank you again for your helpful advice smile

6

Hi Purpledobermann,

Thank for your helpful reply!

I noticed you said after 2 years I would have reached equilibrium. In August, it will be 2 years on the drug. And I don't return home until November.

I plan to visit my Dr straight away to make a plan for coming off. I'm already so desperate to not feel so exhausted and lifeless all the time!

In nz, where I am from, through the public health system, you can only be referred to a psychiatrist. So I am unsure if I would be able to get seen by one sad however, I can go to the family Dr whom is very good at dealing with my anxiety and seems knowledgeable.

I was so shocked it would take a whole year to withdraw from such a small dose! However if it means little or no side effects, I am willing to be patient.

Thanks again smile

7

Hi Kiwi

it is not a set time-frame but an average. You are in equilibrium when all your initially presenting abnormal symptoms are gone and any remaining coping difficulties do not make you freeze but instead you progress and deal with them steadily. From that point it is wise to maintain the dosage for at least a year or two. So no matter what, 2 years is rarely enough.

Regardless, if you would rather pick up the 'reigns' at this point, I would do it very patiently and slowly if I were you, to give you the best chance of smooth transition. Many GPs will drop much faster but unless there is a medical urgency experience has shown that slower is always better for the brain and your long-term outcome. The brain needs a few months to completely rebalance after each drop. GPs rush through and rarely have good results - this is why I advised a psychiatrist. As this is not possble, discuss options with your GP.

Let us know how it goes please.

8

Dear Kiwifruit I was on Venlaraxine for about two and a half years as I had a debilitating depression and couldn't get back into normal life. my withdrawal was successful by reducing from 75mg to 37.5mg ( only once a day) It took one month during which I had what I refer to as " brain zaps" these were like double pulses in my head -a bit like I would imagine Tinnitus sufferers experience These began to ease off and we're almost gone by about the fifth week I wear hearing aids and my Gp suggested that I was getting this as a kind of Tinnitus but finally they went away and also my experience of talking too much faded down. I have not had any further trouble from this side-effect and my depression no longer troubles me. I wish you well and think you should leave the withdrawal to the time when you anticipate being less stressed as you said.

9

UPDATE

I went to my Dr and he tapered me straight from 75mg to 37.5mg! I'm so anxious this is too soon, however it is day 4 now and so far now side effects.

I really don't want to experience bad, if any, withdrawals.

Am I out of the woods for withdrawals for this first taper? Or can they even come on after first week?

10

They can come later but there is no guarantee they will. I personally went from 75 to 37.5 without too many issues--I just got sad and felt down but it subsided fairly quickly. I had none of the intense physical side effects people refer to. So it's possible you're one of the lucky ones too smile

What did your doctor say about the rest of the taper? How long are you going to stay on 37.5?

Best wishes,

Élora

11

HI kiwi,

I was reading your post and I hope you don’t mind me commenting.  If you are recucing your dose to 37.5 please do so via a 37.5 extended release tablet not one 37.5 immediate release tablet per day.  The IR tablet only have a half life of 12 hours and you go up once taken and then will crash 12 hours later and will feel terrible plus it’s dangerous.  The 37.5 ER tablet is designed to last 24 hours. Some GP’s do not know this as mine didn’t and I crashed so badly.