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How do you know when to come off?


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Basically this is my question - how do you know the difference between 'I'm better' and 'they're working'?

I'm on venlafaxine XR (Effexor) 150mg and have been for what seems like a ridiculously long time but is probably less than a year, which won't seem much to you hardcore Crazyboarders out there, I'm sure. It's been fine - great really, especially compared to every other AD I tried - and for many months I haven't really had more than a mild attack of the unexplained sads. What I have had is the occaisional crazy, not-sleeping, bipolar-friends-start-chanting-'one of us' spell, but it seems like I always get that on antidepressants, and this one has been much better than any of the others I tried. Summary - citalopram (Celexa) makes me a twitchy, jittery, self-harmy insomniac, zoloft makes me fucknuts pseudo-maniac, Remeron turns me into the Sleepwalking Zombie Girl, and Effexor just *works*.

So. I guess the main reason I'm thinking about this is because I know two bipolar-y people who are currently doing fine without meds, plus I suck at remembering to take it... But meh. I don't know what's the normal length of time to take it anyway.

K

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If you've had more than one episode of severe depression, your risk of relapse is well over 50%. After 2 episodes, it's over 80%. So if this is only your first or second episode, a trial without meds may be worth discussing with your doc. Otherwise, you're most likely to relapse.

Why mess with a good thing anyway?

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The decision to go off meds has to be made between you and your pdoc and therapist. You should not go off meds alone. When you are ready, your pdoc will taper you off the meds while keeping a watchful eye on you in case you relapse. We are often not objective enough to decide by ourselves when to go off meds.

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You do realize that psychiatric meds are a treatment, not a cure? You take the meds, you weigh the side effects against the original symptoms and decide. If you go off your meds now you'll most likely crash and eventually level out about where you were, maybe with a bit more of the sads.

Muriel said her percentage majigger, if you were put on all these meds after one episode then I'd say talk to your doc, maybe its worth looking into, but if this has been a recurring struggle I would strongly suggest that you stick to your guns, or change a med if you have to.

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how do you know the difference between 'I'm better' and 'they're working'?

Approx how many episodes have you had in your lifetime? The more episodes, the more likely it becomes that you have a chronic or relapsing illness, in which case, the more likely it is that if you feel ok, then it's not that you're "better," as in finally free of the underlying illness, but rather the meds are working on the symptoms.

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Indeed, with mild depression, tx for 6 mo to a year makes sense, and then a trial without meds. This may or may not precipiate a relapse.... If it does, my personal opinion is that you are then better off taking them for life... to avoid future episodes, brain shrinkage, life stuff and whatnot.

I'm kind of confused though as you say you are bp? Are you only taking an AD? That confuses me.

BP is a much more chronic illness and it's really not recommended to stop meds, ever, in almost all cases. Your friends may have been misdx, or there may be other things going on, if they are doing oh so great. I suppose with really mild BP II, it might be possible to stop meds, but it would still cause me hesitation.

That said, I am SUPER BP, I've seen my life without meds, and it ain't pretty.

Also, if you are forgetting your AD, it isn't really benefitting you or causing repair in your brain anyway, so I'd advise being thoroughly med compliant for like a year without even CONSIDERING going off, if you want the AD to work in the sense that it is causing brain repair to avoid future episodes.

Anna

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Yeah I guess this was my first episode if a single episode can last over a year (that's a year prior to going on the meds, so it's been about two years since I first saw a dr about it). It was just a long, probably not mild one. I'm not bp - my official diagnosis is Depression NOS, but I have bipolar-like symptoms from most antidepressants (and occaisionally, from nothing at all), hence the NOS.

I'm kind of between shrinks at the moment, so I'll see what the new one says when I get one.

I don't know if maybe there isn't the same expectation over here (UK) that crazy people will usually stay on meds for life? Not in the doctors I've encountered anyway.

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Hi,

I'm in the UK and there isn't the expectation that a crazy person should be on medication for life, it's not in the culture over here.

That being said, I trialed coming off my medications this summer and it didn't work out. If you work out a safe trial with your pdoc and stick to it whilst doing lots of self care stuff, you could try it with minimal to low damage. There is nothing to stop you. That said, you have to weigh up the impact of disrupting the functional life that you have now f you relapse. You could say agree to try in another 12 months, if you felt that now was too fragile to test with a taper down.

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That being said, I trialed coming off my medications this summer and it didn't work out. If you work out a safe trial with your pdoc and stick to it whilst doing lots of self care stuff, you could try it with minimal to low damage. There is nothing to stop you. That said, you have to weigh up the impact of disrupting the functional life that you have now f you relapse. You could say agree to try in another 12 months, if you felt that now was too fragile to test with a taper down.

Yeah, I think part of the problem may be that there is no good time to try coming off Effexor. :\ Especially since you have the same problem with do I feel sucky because I shouldn't have quit, or because I am quitting.

Might talk to the shrink when/if I get one about seeing how a lower dose feels - I'm told that (say) 75mg is pretty much subclinical levels for venlafaxine, but I might be able to avoid horrible withdrawal symptoms on top of everything else that way.

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That being said, I trialed coming off my medications this summer and it didn't work out. If you work out a safe trial with your pdoc and stick to it whilst doing lots of self care stuff, you could try it with minimal to low damage. There is nothing to stop you. That said, you have to weigh up the impact of disrupting the functional life that you have now f you relapse. You could say agree to try in another 12 months, if you felt that now was too fragile to test with a taper down.

Yeah, I think part of the problem may be that there is no good time to try coming off Effexor. :\ Especially since you have the same problem with do I feel sucky because I shouldn't have quit, or because I am quitting.

Might talk to the shrink when/if I get one about seeing how a lower dose feels - I'm told that (say) 75mg is pretty much subclinical levels for venlafaxine, but I might be able to avoid horrible withdrawal symptoms on top of everything else that way.

Effexor can be a bitch to come off. However, the withdrawal effects will probably disappear in a week or two, while a relapse of depression will likely take longer (it will certainly last longer). So I think it should be possible to differentiate between the two. For what it's worth, when I tapered Effexor I initially thought I was relapsing because I felt god-awful (mentally), to the point of suicidal ideation, but now that I've been off it for about a month and a half I've gone back to my usual mild to moderate depression sx. If you do decide to taper, you can lessen the withdrawal by opening up the capsules and removing a couple of beads at a time (the XR mechanism for Effexor is in the beads themselves, not the capsules, so opening capsules is okay), so you don't have to drop down by 37.5 mg at a time. It's kind of a pain, but if you take it very, very slowly, you may not get many withdrawal symptoms at all (though individual results may vary...).

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