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I'll just preface this with info: I've tried about 30 different meds, many combos, including Cymbalta in the past (3 yrs, mixed results), It didn't greatly improve my depression, mainly made me numb, sweaty, nauseous, a bit restless/wired with sleep issues. The crazy withdrawals if I took a bit late were horrendous, so went off.

Despite this, my pdoc really wants me to start Effexor (even though withdrawal is even worse). Can someone please reassure me that it worked well for you? My symptoms are: chronic, treatment-resistant depression (with some crying/mood lability), very intrusive negative ruminations, anhedonia). Is it really worth trying despite my unremarkable/mixed experience w/ Cymbalta, and fear about withdrawal syndrome? Also what were the negatives for you (i.e any weight gain, anxiety, restlessness, paranoia, insomnia?) Thanks all.

Edited by Blahblah

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Effexor was one of the most effective antidepressant I've ever taken but it eventually popped out. Main side effective was sexual dysfunction. I was lucky also that I didn't have the hellish quitting process that effexor is notorious for. Blahblah I'm on my phone and can't see your diagnosis but if you are bipolar, you have to be cautious about triggering mania. I'm schizoaffective bipolar type however and did not get manic.

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blahblah -

You're in the same boat I'm in, with refractive Double Depression, and Effexor is the only thing that has ever laid a glove on it for me. We believe it works because it's one of the multiple neurotransmitter reuptake inhibitors, working on serotonin in the low range, norepinephrine in the mid-range, and dopamine on the high end. I have taken a very high dosage (450mg) every friggin' day for over eight years now, and it still keeps the suicidal ideation at bay. You might talk to your pdoc about adding release agent appropriate for the dosage range you'll be taking - for instance, in my case we target dopamine by dosing Effexor at the level where it acts as a dopamine reuptake inhibitor, and then my pdoc gives me a supplement of Adderal or Vyvanse, which act as dopamine release agents as well. I get more of the neurotransmitter I'm not making naturally, and it sticks around longer for me to use it. Life is still a suckapalooza, but at least I'm functional now.

Withdrawl symptoms can be a bear, there's no denying it, but there's an upside - they're bad enough that they act as an incentive to keep on schedule with your meds! If I miss more than one dose, I'll start getting brain zaps as a warning, and if I miss two dozes I'll get nausea that lasts all day. If I were to miss three doses... well, I don't miss three doses. Ever. I generally don't get withdrawal symptoms until the second day, but your mileage may vary.

Personally, the only side effect I ever had beyond the first week or two of getting used to it was some sexual oddness, but nothing that limited me.

I might add that my Effexor has not beaten the Anhedonia Monster. Nothing tames that beast for me.

Given your history of attempts with other meds, I would encourage you to give it a try.

Edited by Cerberus
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Like Cerb said, don't miss your dose!  If I went more than an hour beyond normal time, I knew it.  I don't think I would have made it more than 4 hours beyond dose time.

Brain zaps during withdrawal were so bad that I told my current quack that I would kill myself before taking it ever again.  I was literally breaking open the capsules and counting out the beads to titrate down.  It took me almost a year to get off 75mg.

YMMV

Edited by sbdivemaster

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I took Effexor back in 2004-2007.. worked well , very well. Then it stopped working. But , let me tell you.. do not miss your dose.( learned my lesson..dry heaving and sweats etc) It sort of has the same effect as Cymbalta. I lost weight on Effexor like crazy and it did trigger my mania at first. 

But overall , not a bad drug.. if I had to rank it on the psych award scale I give it 6.5 stars out of 10.

Edited by KnickNak

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6 hours ago, CeremonyNewOrder said:

Effexor was one of the most effective antidepressant I've ever taken but it eventually popped out. Main side effective was sexual dysfunction. I was lucky also that I didn't have the hellish quitting process that effexor is notorious for. Blahblah I'm on my phone and can't see your diagnosis but if you are bipolar, you have to be cautious about triggering mania. I'm schizoaffective bipolar type however and did not get manic.

Seems many people get "poop out" ... My current doc says she does not think I'm Bipolar, I've never been hypo/manic, but I have often spells dysphoria, paranoia and anxiety weirdness if I miss out on sleep.

5 hours ago, Cerberus said:

blahblah -

You're in the same boat I'm in, with refractive Double Depression, and Effexor is the only thing that has ever laid a glove on it for me. We believe it works because it's one of the multiple neurotransmitter reuptake inhibitors, working on serotonin in the low range, norepinephrine in the mid-range, and dopamine on the high end. I have taken a very high dosage (450mg) every friggin' day for over eight years now, and it still keeps the suicidal ideation at bay. You might talk to your pdoc about adding release agent appropriate for the dosage range you'll be taking - for instance, in my case we target dopamine by dosing Effexor at the level where it acts as a dopamine reuptake inhibitor, and then my pdoc gives me a supplement of Adderal or Vyvanse, which act as dopamine release agents as well. I get more of the neurotransmitter I'm not making naturally, and I sticks around longer for me to use it. Life is still a suckapalooza, but at least I'm functional now.

Withdrawl symptoms can be a bear, there's no denying it,

Personally, the only side effect I ever had beyond the first week or two of getting used to it was some sexual oddness, but nothing that limited me.

So you take Adderall to increase the Dopamine release of the drug? I am also taking Ritalin, which I assume could do something similar. Yes, I'm crazy scared about accidentally missing a dose (I travel around alot and often wake up at different times everyday) But I think I've been very compliant with lamictal, so we'll see.

 

3 hours ago, sbdivemaster said:

Like Cerb said, don't miss your dose!  If I went more than an hour beyond normal time, I knew it.  I don't think I would have made it more than 4 hours beyond dose time.

Brain zaps during withdrawal were so bad that I told my current quack that I would kill myself before taking it ever again.  I was literally breaking open the capsules and counting out the beads to titrate down.  It took me almost a year to get off 75mg.

YMMV

I had the same horrible withdrawal from Cymbalta (had to remove beads) my pdoc said if I need to come off she will taper with Prozac, this should help quite a bit right?? Due to the notorious withdrawal, I've had several pdocs say that they do not recommend Effexor. How long were you taking Effexor?

3 hours ago, KnickNak said:

I took Effexor back in 2004-2007.. worked well , very well. Then it stopped working. But , let me tell you.. do not miss your dose.( learned my lesson..dry heaving and sweats etc) It sort of has the same effect as Cymbalta. I lost weight on Effexor like crazy and it did trigger my mania at first. 

But overall , not a bad drug.. if I had to rank it on the psych award scale I give it 6.5 stars out of 10.

I'm surprised that if you are Bipolar, a pdoc would put you on Effexor? Anyhow, I guess I'll try it and keep a close eye to see if it even helps me or not.

Thanks everyone for your comments!!! I really appreciate it.

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Effexor didn't work for me, but I think the problems I had with it are avoidable. It was the second med I was prescribed and at that point I had a really hard time remembering to take meds so I got plenty of side effects due to missed doses. Then because I was frustrated with that and generally making terrible decisions I went off it cold turkey on my own. I would not recommend that. Since you're used the the psych med routine I think you can limit a lot of that and tapering with Prozac should also help.

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6 hours ago, Blahblah said:

I had the same horrible withdrawal from Cymbalta (had to remove beads) my pdoc said if I need to come off she will taper with Prozac, this should help quite a bit right?? Due to the notorious withdrawal, I've had several pdocs say that they do not recommend Effexor. How long were you taking Effexor?

I was on it for more than a year.  It made me nauseated for the first couple of weeks but that went away.  I felt like it barely did anything.  It did seem to lift depression a bit, but I was still just "there".  Completely flat affect.  I stayed at 75 because when I went up to 112.5, I started to get insomnia and kind of buzzy feeling, so that quack (who diagnosed me with MDD), said to just drop back to 75.  She missed it.  Even though I had told her about several family members who were bipolar, she missed the sign.

Anyway, back to the Effexor.  I finally told her I wanted off the Effexor.  She set a taper schedule of drop to 37.5 for 2 weeks, then stop.  Took two days at 37.5 to realize that wasn't going to work!  I told her about the awful withdrawal; she just said that it would go away...  I took matters into my own hands and started dropping 10% of the current dose at each step down, i.e. 67.5 for two weeks, 60.8 for two weeks, 54.7 for two weeks, etc.  When my scale reached its lower limit, I started counting the beads and putting them in gel caps. The first 3-4 days after each step down, I was pretty much useless.  I could barely stand up I was so dizzy, and the zaps were so bad any movement caused buzzing/vibrating sensation in my head and a strobe kind of effect to my vision.  Then it was less severe with just a general malaise until the next step down.  Even the last jump from a few beads to none took a month or so before the worst of it finally went away.  I still felt odd for months after that...

Your pdoc told you the same as my current quack:  2-4 weeks of Prozac while tapering off Effexor.  Just pay close attention to how you feel and don't drop down the next step until you are ready. If it takes a month or two, it takes a month or two.  Don't rush it.

All that said, if you feel it might help, give it a shot.

--GENERAL ADDENDUM--

The more I think about the entire experience with that quack and the more I tell others, I realize I should try to protect other people from her incompetence.

DO NOT see Marjorie Gies, M.D., California Physician's & Surgeon's Certificate No. G 69796

And, while looking up her license number just now, I found this tidbit:

http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=\DIDOCS\20160229\DMRAAAFC14\&did=AAAFC160229232122519.DID

Public reprimand for over prescribing benzos, along with other sedatives, to a known abuser of drugs, AND failing to get a complete diagnostic workup of that patient.  This was 10 years after she treated me... still not very competent.

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17 hours ago, Blahblah said:

 

I'm surprised that if you are Bipolar, a pdoc would put you on Effexor? Anyhow, I guess I'll try it and keep a close eye to see if it even helps me or not.

Thanks everyone for your comments!!! I really appreciate it.

Right? I wasn't dx until 2015 

Silly docs!

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Effexor is the best drug I've been on for my symptoms.

However it destroyed my sex drive completely and I'm still struggling with it.

Also, tapering down has not been funny.

It gives you a lot of great energy while you're on it, but I'm drained now, and in a bit of a depression.

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@BrianOCD Is it your plan to go off of it completely and just stay on Seroquel? What if you get much worse while off it, would you start up again?

Started 37.5mg yesterday, and I can already tell it is doing something. Palms are a bit sweaty, my jaw is sort of clenching, muscles feel a bit tense/keyed up, but my mood is ok/relaxed. I don't think I've ever had a med start doing anything within the 2nd day of taking?? It's crazy to me.

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5 minutes ago, Blahblah said:

@BrianOCD Is it your plan to go off of it completely and just stay on Seroquel? What if you get much worse while off it, would you start up again?

Started 37.5mg yesterday, and I can already tell it is doing something. Palms are a bit sweaty, my jaw is sort of clenching, muscles feel a bit tense/keyed up, but my mood is ok/relaxed. I don't think I've ever had a med start doing anything within the 2nd day of taking?? It's crazy to me.

I'm really at a weird place right now in that I don't know what I'm going to do...The problems with sex drive and Effexor were why I began tapering down but it hasn't been fun, lot of mood swings.

I had a bit of an anxiety attack earlier tonight at work and haven't had those for years...So I know Effexor is definitely good for anxiety.

The last two times I went up on Effexor I had a bad reaction, didn't feel right on it, so I doubt I'll go back up again, I'll likely try something new.

I think you should definitely give Effexor a chance though blahblah, when it was working for me it was so so good.  I felt calm, collected, and confident.

My biggest suggestion is to go up and down on Effexor as slow as possible cause it's a pretty heavy hitter, but it looks like you're doing that.  It also took me about a month to feel the effects either direction.

Also, let me know if you feel any muscle twitching on it...That something that's happened to me on effexor or it could be seroquel.

Edited by BrianOCD

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On 11/10/2017 at 3:43 AM, Cerberus said:

We believe it works because it's one of the multiple neurotransmitter reuptake inhibitors, working on serotonin in the low range, norepinephrine in the mid-range, and dopamine on the high end.

@Cerberus Do you have an idea of the dose ranges that correspond to the different neurotransmitters? Like for example: Serotonin (37mg-75mg), Norepinephrine (75mg-200mg) and Dopamine (?) I didn't know this about Effexor. Sounds like depending on the dose, it can act completely different?

@BrianOCD Yeah, I actually haven't had any anxiety issues in over a decade, just depression. I'll admit I'm sort of concerned that if it works for me, I will never be able to go off of it without getting a terrible withdrawal + new added diagnoses. What I DON'T need is a new anxiety/panic disorder dx triggered by going off a medication :( But I suppose, I should just stop thinking that far ahead and think positive like: what if it does help and stop my intrusive negative thought spirals? What if it does brighten my mood? Only time will tell.

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On 11/10/2017 at 2:04 AM, Blahblah said:

So you take Adderall to increase the Dopamine release of the drug? I am also taking Ritalin, which I assume could do something similar.

No, Effexor is not a release agent, it's a reuptake inhibitor. My problem, apparently, is that I don't produce enough dopamine naturally and my system doesn't hold the dopamine I do produce long enough for my neurons to use it. The Effexor ensures that any dopamine I produce stays in my system long enough to be available to my neurons when needed. The Adderal or Vyvanse are dopamine release agents that cause my system to produce more dopamine. So I make more, and keep it longer. What a system - I can't even get high on speed. :brooding:

I'm not sure about the dosage thresholds for the various effects; I'll check and see what I can find.

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How would you guys compare Effexor with other SNRIs (Cymbalta) and the SSRIs? I tried those a long time ago, so I've forgotten a bit. *Also: Pdoc wants me to increase to 75mg in 1 week. If I feel good at that dose should i remain there? It's probably better to stay low if it is working, right? and only increase if it's pooping out or not helping symptoms?

So far, so good, only day 3 but my mind feels much clearer/emptier (less negative noise). It's like my brain can "breathe" and rest again. My palms are a little sweaty, jaw clenching, feet are twitching a bit, and my sleep was a bit crappy, but my mood def feels lighter. I feel neither stimulated or tired...I feel my mind is spacing/zoning out very easily, like there is a buffer between my emotions now. Like I'm removed, if that makes sense?

I hope it doesn't totally numb me out or make me dissociate into a zombie. SSRIs do that to me where I begin to feel like a robot: no sad/negative feelings, no good/happy feelings either. They also cause a lot of apathy. I guess this is better than crying over little things and "broken record" negative thoughts! I'm afraid that anhedonia is the most resistant difficult symptom to treat :-(

Edited by Blahblah

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I felt better on the higher dosages to be honest.  I was on 300mg for about 5 years.

But it really depends on you.

If you're not feeling good enough on that dosage than you could talk to pdoc about raising it.

Edited by BrianOCD
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@BrianOCD I actually feel super calm & collected on only 37mg! Like NOTHING bothers me, my mind is super clear (and empty) My mind/head is a bit detached from my body like it's floating in space...

The thing I worry about (which is the case for every antidepressant I've been on) is they flatten your emotions so that you feel nothing at all, no drive, no motivation, no sadness, but no excitement, joy or happiness either. I just feel sooo comfortable and lazy as Hell. I'm enjoying it for the time being, but I know this will become a major issue if I stay on it. It's like I am perfectly content to just lay around and do absolutely nothing. I used to be so sensitive & moved by music, art, novels, films, etc. Now I have no desires whatsoever, no impetus. I just don't care. Will this go away or will it it stay like this? I don't think I want to go above 75mg because I worry it will increase this apathy.

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When I started on the venlafaxine "duo" I actually started on desvenlafaxine (Pristiq) and I really liked it a lot. Only reason I switched to generic venlafaxine was because I lost my insurance, Pristiq was brand-only at the time, and my new insurance wouldn't cover it. Pristiq worked great but within a few months of switching from 50mg desvenlafaxine to 150mg venlafaxine, it pooped out on me. And I also noticed it was much less tolerant of differences in dose time. So like many others are saying, if you miss a dose by even an hour or two, it can be hellish. In contrast, I didn't feel that way at all on desvenlafaxine. It had a short enough half-life that if I missed a dose I would feel it later in the day but it wasn't like venlafaxine where you had to take it at the EXACT SAME TIME every day.

Also, I didn't notice as much sexual dysfunction with Pristiq as I did with Effexor. It was definitely still there but Effexor really killed my libido.

Compared to other SNRIs I found Cymbalta to be more stimulating.

As for the doses that would match up to the different receptors, at 37.5mg up until 150mg it's mainly just an SSRI, 150mg to 300mg is SNRI, and once you get to 300mg up to 450mg (and higher for some rare cases) would be an SNDRI. But even at those higher doses, venlafaxine's affinity for the dopamine transporter is still negligible relevant to its affinity for serotonin or norepinephrine, while it still may be clinically relevant and worth noting for some treatment-resistent cases.

Another note, apparently unlike venlafaxine at high doses, desvenlafaxine doesn't seem to have much if any affinity for the dopamine transporter at any dose.

Edited by browri

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17 hours ago, Blahblah said:

@BrianOCD I actually feel super calm & collected on only 37mg! Like NOTHING bothers me, my mind is super clear (and empty) My mind/head is a bit detached from my body like it's floating in space...

The thing I worry about (which is the case for every antidepressant I've been on) is they flatten your emotions so that you feel nothing at all, no drive, no motivation, no sadness, but no excitement, joy or happiness either. I just feel sooo comfortable and lazy as Hell. I'm enjoying it for the time being, but I know this will become a major issue if I stay on it. It's like I am perfectly content to just lay around and do absolutely nothing. I used to be so sensitive & moved by music, art, novels, films, etc. Now I have no desires whatsoever, no impetus. I just don't care. Will this go away or will it it stay like this? I don't think I want to go above 75mg because I worry it will increase this apathy.

That's good to hear, it's honestly an awesome medication, I have to give it to effexor, it's brought be through years of remission.  There's a good chance I'll go back up on it too if my anxiety keeps up on Wellbutrin...

Biggest problem is when you stop taking it...I would just keep that in mind if you decide to go up on it, that the higher you go the harder it will be in the future to come off of it..Otherwise enjoy the peaceful mind. :)

Edited by BrianOCD

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For me Cymbalta withdrawals were way worse than Effexor. 

I had an okay result from Effexor. Helped my anxiety a lot. Wasn’t on it long, can’t say If it helped my depression. Found out I am bipolar, so discontinued. 

Have you tried lamotrigine?

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6 hours ago, Cyclingsarah said:

For me Cymbalta withdrawals were way worse than Effexor. 

I had an okay result from Effexor. Helped my anxiety a lot. Wasn’t on it long, can’t say If it helped my depression. Found out I am bipolar, so discontinued. 

Have you tried lamotrigine?

yeah according to the OPs signature it's a lamotrigine/venlafaxine/methylphenidate combo. Definitely a solid cocktail by any measure if it does work for you. Vyvanse is definitely a critical part of my own combo as well. Trintellix may be strictly a serotonergic antidepressant but it causes quite an increase in the release of norepinephrine and dopamine and Vyvanse amplifies that. Depakote makes sure things don't get too crazy and Rexulti does a little bit of everything mood stabilizer / anxiolytic / anti-depressant. I personally never went any higher on Pristiq or Effexor than 50mg and 150mg respectively, and I wasn't taking stimulants at that point either so can't speak to that effect.

@Blahblah still having issues with anhedonia?

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@browri Outside some monthly hiccups (usually 3-4 days per month where mood goes far downward). I have been stable/OK on my combo for the last 3 months. I just went up to 150mg Effexor - I really hope the Dopamine action kicks in, because i can tell it's mainly just Serotonin. The main startup effect I had was spaciness (and that anhedonia you get with SSRIs). Now, I feel absolutely no anxiety (though was never my problem). Lately, I seem to be having a bit of increased appetite/snacking (which I'm a bit worried about, because i hate meds that do that!)

So far, pretty good. the Effexor is neither activating nor sedating. I don't know. It's like I feel stable/normal & functioning, but its like I can't really tell whether the Effexor is doing alot or not?? I don't feel "happy" or "great" or "motivated" I just feel normal. I'm busy these days and getting stuff done. It's a decent baseline - which I guess is the goal? I just want to feel better than this. Maybe for someone with MDD, feeling really good...that is too much to ask.

Why did you guys stop Effexor?

Edited by Blahblah

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16 hours ago, Blahblah said:

@browri Outside some monthly hiccups (usually 3-4 days per month where mood goes far downward). I have been stable/OK on my combo for the last 3 months. I just went up to 150mg Effexor - I really hope the Dopamine action kicks in, because i can tell it's mainly just Serotonin. The main startup effect I had was spaciness (and that anhedonia you get with SSRIs). Now, I feel absolutely no anxiety (though was never my problem). Lately, I seem to be having a bit of increased appetite/snacking (which I'm a bit worried about, because i hate meds that do that!)

That still sounds like a real improvement for you though. I seem to recall anhedonia being almost a regular everyday thing for you so getting down to 3-4 days a month seems like a big stride. Now that you're at 150mg, this is where the norepinephrine effect starts to kick in. You might start noticing some stimulation in the next couple of days. However, as far as I know, effects on dopamine don't happen until 300mg at the lowest but usually closer to 450mg.

16 hours ago, Blahblah said:

So far, pretty good. the Effexor is neither activating nor sedating. I don't know. It's like I feel stable/normal & functioning, but its like I can't really tell whether the Effexor is doing alot or not?? I don't feel "happy" or "great" or "motivated" I just feel normal. I'm busy these days and getting stuff done. It's a decent baseline - which I guess is the goal? I just want to feel better than this. Maybe for someone with MDD, feeling really good...that is too much to ask.

Why did you guys stop Effexor?

I really liked desvenlafaxine actually. Only reason I switched to regular venlafaxine was because my insurance changed and they wouldn't cover brand-name Pristiq (wasn't generic yet at that point). I quit Effexor because it pooped out after less than a year and I was experiencing withdrawal effects very easily if I took it even 2 hours late. Pristiq never did that.

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