Tapering off Venlafaxine too steeply (and beta blockers)

Treatment and medication
1

Thank you to all who have shared their experience.  It's so helpful to have some insight into how people came off this medication and to have an idea of how long the withdrawal symptoms will last.

I have to admit I had read various things about coming off gradually but my sleeping was terrible, I'd wake up at 3, 4, or 5am and be unable to sleep again so I came off it too fast.

I was on the slow release XL stuff.  2x75mg a day for 25 days.  I know this isn't long (I was on them for 8 years from 2001-2009).  I reduced to 37.5mg once a day for a week, then two days of 25mg/day (by removing one of the pills inside the capsule.

It seems I had WRONGLY assumed than since I wasn't having much of the symptoms I would be ok to come off.  Big, big mistake.

I need to say I had also been on beta blockers (10 days of Propanolol, Atenolol, Propanolol) which I also had to come off as the side effects were horrendous.  I believe I tapered off these too quickly too.

I tapered to 37.5mg of Venlafaxine on the 15th day of being clear of beta blockers.  Again, I think this was a mistake too.  I probably should have tapered off the beta blockers more gradually and left more time before the Venlafaxine tapering. 

Today is 31 days off beta blockers and 10 days off Venlafaxine.  Coming off the Venlafaxine I had the fuzzy head, electrical shocks down my left arm, weird electrical thing when I turn too quickly, lack of coordination (fumbling things and many many typos), chest pains, temporary isolated pains elsewhere (thankfully these have gone), crying, anxiety.

What has really concerned me is that the heavy thumping pulse has returned along with an elevated heart rate.  I have also started having nightmares but only 20 or so minutes after falling asleep - then waking up in a panic. These I can deal with but the heart stuff is a real worry.

When I came off the BBs my pulse rocketed up to 120 at rest.  Unbeleiveable.  I have lost my level of fitness over the past couple of months but by resting rate is under 60.  It took 23 days off the BBs for my pulse to get to normal at 58.

Five days after that (four days ago) the heart rate and heavy pulse has returned.  Now 120 when I woke up this morning.  I was able to get it down to 67 through focussed left-nostril breathing but as soon as I 'unfocus' it went back to anywhere between 75 and 90.

I had my blood pressure checked tonight after a really bad turn in the late afternoon where I felt terrible in every way.  I can't really decribe it, I think my body was trying to go to sleep but I was at work so couldn't do that.  The BP was 140/100 which I'm told is high but not blue light high.

I read that Ven withdrawal can cause spasms around the heart muscles which limits oxygen intake.  That, to me, explains the high blood pressure and high heart rate - it's having to work harder.  The trouble is I am completely terrified that there is some sort of permanent damage and ultimately that my life is threatened by this.

I appreciate that coming off these pills can spike anxiety so I can see the relevance in that.  I've tried keeping a "thought diary" to balance out fears against evidence for and against.  It helps a bit but ultimately I know I have an underlying fear of death.  I know my body and I know that all of these things over the past two months are out of the ordinary for me and I'm scared, terrified.

Sorry for the long post - it's actually quite short for me!  What I wanted to share with people is that:

(a). The mix of coming off beta blockers and then coming off venlafaxine is not a good one.

(b). If you are in a similar position I would not be on both to begin with and if you are, ensure that you give enough time to taper of each of them despite how stubborn you are or how bad you feel now versus how you imaging you will feel in two weeks.

What I wanted to ask was:

1. Whether anyone has had the chest pain/spasms and how long these lasted?

2. Whether anyone has had the elevated heart rate and blood pressure and how long these lasted?

Bets wishes and stay strong.

2

I've been tailing off a higher dose. Lots of horrible side effects but I didn't consider that a horrible sense of fearfulness when coming in or out of sleep and palpitations. From reading your post I now realise that these were yet more side effects. The palpitations have been for a few days and I hope are passing. Hope you are on the way out of the symptoms soon. 

3

Thanks.  Ironically the doctor had diagnosed me with anxiety (I was in a panicked state about a calf injury when he saw me, I thought it was a clot/CNS issue) but I was not struggling with anything remotely like this before I went onto the pills, worried yes but not waking up into these physical symptoms.  Tells me that's from the pill withdrawal.

Hope you are on the mend too.

 

4

Thought I would post an update.

Went to the GP yesterday and had blood pressure read as 135/97.  A slight reduction on the previous day.  He was not immediately concerned about this but I am on the waiting list for a blood pressure monitor so he can see a week's worth of readings.

Today was day 33 off beta blockers and day 12 off Venlafaxine.  So just over 4 weeks and just less than two weeks.

I awoke last night with the inner shaking and trembling I've had for weeks but thankfully when I woke up in the morning I didn't have it.  Resting heart rate was 57-58 this morning, a big improvement.

I recognise I have been having anxiety-related responses to a lot of this, worrying that there is some long-term damage or that I will never get better.  My girlfriend has been exceptionally patient with me.  I'm glad I have shared the information I found on here and elsewhere as I am just not in control of some of these rampant fears.

In relation to the length of time the symptoms last, I have been doing some 'research'.  It woudn't stand up to being classed as such but may be helpful to others in trying to see an end point to all of these things.

Research (e.g. medical journal articles)

2 sources

1-2 weeks

Guidance (websites, summaries of experience)

5 sources

1-3 weeks

Testimonies (posts on here and elsewhere of patient experience)

26 sources

2-8 weeks

There were also some other outliers of people describing some issues months later but many of these appeared to be (apoligies if I have misunderstood) related to depression or the original reasons they had been prescribed Venlafaxine.

What this has helped me with is answering the questions I'd posed about how long to expect these things for.  Everyone is of course different, on different doses for different lengths of time but hopefully helpful to others too.

5

Thanks that is helpful. I'm definitely not as bad as this time last week but have been very emotional/ tearful today. I put this down to my body getting feelings back and think given time that I will get back to a situation where I feel more balanced 

6

I think it's imporant to hold on to any improvement so a change from last week is a good thing.  Likewise for me I am far, far less groggy in the morning (it had been taking me up to 3 hours to get up) and I am having less of the electrical shock sensations.

I too have been more emotional the past few days, crying a few times.  I've noticed this has always been towards the end of the day so tiredness may be related or contributing, who knows.

I've been tempted recently to go back onto the pills in the hope it will resolve the high heart rate and chest pains but I'm holding off.  There's not really any guarantee it will work and I feel like I'd be throwing away 13 days of torture only to have to relive them in the future.

I read a couple of interesting theories about gut flora and fat cells holding on to various toxins and plan to investigate that a bit more.  Will share if I find anything relevant.

7

Another update from me, hopefully of help to others ...

Yesterday I awoke feeling like myself.  I was elated. My resting heart rate was 58 again (even lower with controlled breathing actually). I felt good for most of the day too. 

I was acutely aware that I'd had good days in the past but that there'd been a number of false dawns so I help off from celebrating.

Both wise and debilitating.  I had a horrendous night, unable to stay asleep, pusle thumping through my body, chest pains back with a vengeance and the internal shaking back too.

Despite how good I felt physically and mentally yesterday I could not shake off the fear that somethign serious was wrong or that I will be like this forever.

Heart rate varied between 72-89 when I got up and checked it.  I felt so groggy I couldn't actually get up for two hours, drifting in and out of poor quality sleep.

Still feeling bad in the morning I went out at lunch into the sun and decided to go get my blood pressure checked.  I've been in two minds about this, worried it could be higher or the same.

The good news is that it's down slightly to 130/93 (was 135/97 last Wednesday), heading in the right direction and according to the Pharmacist, not to be worried about.

I am still experiencing the increased skin temperature (comes on more in the afternoon) but the body temperature always checks out ok.

I've been looking for more information on the blood pressure issues and found a lot of documentation that suggests that blood pressure can be increased by venlafaxine and that this is also a withdrawal/discontinuation effect.

Of all the stuff I've read, this one, an very frank story from a drug rep says a lot: http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html  

8

Hope this is of help to those in a similar situation.

Today is 25 days off venafaxine.  As despondent as I am that the side effects of discontinuation have not completely gone there has been some improvement along a very bumpy road.  I had hoped I would be back to myself by now but for me it's taking longer than the 1-2 weeks that are described in many sources.

Gone: chest pains, major depressive episodes, crying, dry mouth, sweating, trembling/shaking inside when I wake up, sense of not being 'me', extremely high heart rate (above 100bpm), agitation and restlessness, nausea.

Still have but has reduced: anxiety, higher heart rate when waking*, frequency of headaches, indigestion and heartburn, insomnia, a swelling/lump in the neck, electrical shocks in the brain, breathing issues/wheezing, feeling too warm (body temp somehow normal), higher than normal blood pressure.

* sometimes the heart rate is ok at 58-60, other times it's in the 60s or 70s 

Increased/new:

- The elctrical shocks have got worse over the past few days.  Started after I tried some red wine (to see if this woud help me sleep and reduce the blood pressure).  I had thought they had more or less gone but now I am getting them much worse at night when trying to sleep.

- Nightmares are bad.  Really bad.  Obviously they have a knock on effect on my ability to get back to sleep after waking up, chest pounding, body alert.  They're not every night and not all night, 2-3 a night over 3 days in the past week.

- Fatigue/tiredness/desire to sleep - this has been up and down throughout but lately there have been waves of it that sweep over me and I feel the need to lie down.  Not ideal when you are in an open-plan office...

Things that have helped:

- Mindfulness/relaxation/meditation CDs/youtube.  The nights I've done this before bed I've had the best sleeps, often unbroken and with little movement.  Sometimes fall asleep during them.  There are many on youtube.

- Apple Cyder Vinegar - the indigestion was so bad one night I could no longer lie down flat.  I was awake for three hours, tried some with some water and within an hour I managed to get back to sleep.  I now take a tablespoonful with some honey in lukewarm water befor eeach meal.

- Tracking progress - i use a spreadsheet to track the symptoms and with the wonders of conditional formallting can see a very, very visual depiction of how the number of side effects and th eseverity are reducing over time.  This has been invaluable to me in providing hope for coming out of this.

- Yoga and hot yoga - these have given me a focus on something and taken my mind away from the variety of sensations I might be experiencing at the time.

- Exercise - I'm very limited in what I can do due to an ongoing calf injury issue but when I've made it to the gym and lifted weights it's been a real buzz and I've felt the benefit afterwards for a prolonged period.

- Omega 3, 6, 9 capsules.  I used to take one a day, now take three.  These helped to reduce the electrical shocks in the brain.

I really want to sleep more but have been finding that when it gets late the brain shocks get worse and stop me from sleeping.  I'm taking an omega cap before bed but it's not clearing it.

I'd be interested to hear of other people's experience and where you are in your journey coming off these.

9

Hi again folks, it’s day 31 off venlafaxine for me and I thought an update might be helpful to others in the future.

The nightmares are gone.  So happy about this.  It sounds bizarre to write that but it wasn’t the content it was the effect they had on me that I’m glad to see the back of.

The electric shocks in the head have almost gone too.  Still there when I move quickly at times or shift my eyes too quickly but far less ‘voltage’ than before.

I still feel too warm pretty much all the time and the indigestion and heartburn are there a fair bit.

The groggyness in the morning has gotten a lot worse unfortunately and is accompanied by headaches.  I can’t get out of bed for hours some days.

It also takes hours to shift, sometimes it’s gone by the afternoon, sometimes it’s longer.  I generally feel a bit better in the evening.

It’s hard to see any progress in this process but it is there.  Overall things are better than four weeks ago but it just feels like one thing gets better and another takes its place.  So debilitating and really brings you right down.  At times I don’t feel there’s any hope.

Fortunately there are some windows of feeling ‘ok’, never fully better but less of the stuff mentioned above.

One thing that I thought might be helpful is a quote from a mindfulness cd - “If you’re breathing then there’s more right with you than wrong with you”.  I’m trying to hold on to that.