Geek Posted December 8, 2013 Share Posted December 8, 2013 Hey all, first time poster, long time reader (and longer time crazy person). My cocktail has been in limbo for the last year. It became a cocktail when Lexapro pooped out on me and sent me spiraling into my first IP stay. Effexor at 300mg/day made a huge difference especially once augmented with Lamictal. In the last 4 months though I've gone from 100mg/day of Lamictal to 350mg/day. Each increase showed some improvement and I had no side effects until the most recent 50mg (makes me sleepy during the day even though I take it at bedtime). My pdoc is concerned that I still have feelings of hopelessness/helplessness. She wanted me to think about trying an MAOI in place of the Effexor. Tapering off Effexor scares me. Tapering off to do a 2 week washout to start an MAOI is really scary (at least to the part of me that wants to be safe). I asked her about a TCA, she's amenable, but says she's found the MAOIs more effective with less side effects (a big issue for me) for those who can tolerate the diet. AAPs are off the table - I'm heavy enough that she's concerned about weight gain and the diabetes deal. Are there other options I'm not seeing that wouldn't involve an MAOI? Am I overly anxious about doing some kind of fast Effexor taper and washout to get on Nardil/Parnate? I don't know if I can stay safe during the washout. I live alone which doesn't help anything and augments my worries about Effexor withdrawal symptoms. Link to comment Share on other sites More sharing options...
Unstrung Harp Posted December 8, 2013 Share Posted December 8, 2013 Hi Geek. I'm curious --are you also doing therapy? I don't know how intensely you're experiencing the "feelings of hopelessness/helplessness,"but I guess I'm wondering how realistic it is to try to knock all of those feelings out pharmacologically. But maybe that's my own feelings of hopelessness and helplessness talking Med-wise, I can see why you'd be concerned about dealing with both the Effexor taper and washout period. I went off Effexor years ago and it definitely wasn't fun for me, but everyone's different. I think your asking about a TCA is totally reasonable. I had a consultation with a mood clinic last year and the doctor was really enthusiastic about putting me on an MAOI, but he and my regular pdoc agreed it made sense to transition me first from the Zoloft to a tricyclic both to make the transition smoother and also just to see if the tricyclic worked out. Long term I don't know, but I've gotten a decent 9 months out of the tricyclic, and sense there are so many issues that go along with an MAOI it seems like it would be worth a try. Link to comment Share on other sites More sharing options...
Parapluie Posted December 8, 2013 Share Posted December 8, 2013 (edited) Tapering off Effexor honestly scares me too (I may taper off it one day), and you have legitimate concerns about staying safe. Did you tell your pdoc that you are worried about safety during the taper/washout? Do you have a tdoc that could watch you during the process or could you get more frequent check-in's with your pdoc? However, I agree with Unstrung Harp that a TCA might be the way to go, if your pdoc agrees and you are more comfortable with it. It's worth a try, for sure. The MAOI is worth a try too, but to me it just seems like "the big guns" or "last resort" compared to a TCA. But hey, it's up to you and your pdoc. Edited December 8, 2013 by Parapluie typos Link to comment Share on other sites More sharing options...
Geek Posted December 8, 2013 Author Share Posted December 8, 2013 I'm wordy, sorry for the length. Hi Geek. I'm curious --are you also doing therapy? I don't know how intensely you're experiencing the "feelings of hopelessness/helplessness,"but I guess I'm wondering how realistic it is to try to knock all of those feelings out pharmacologically. But maybe that's my own feelings of hopelessness and helplessness talking Good question! Yes, I am in kind of a lot of therapy actually. I am currently in a DBT IOP program, and attend a weekly group therapy aftercare thing from the CBT-based IOP I did in February. I also have a tdoc I see every 2-3 weeks. Honestly, I'm not sure more/different meds are the answer/solution. My pdoc and I occasionally have conversations about how/if meds can actually change thoughts. She says my insistence that they can't is an example of black and white thinking (my favourite primary cognitive distortion!). I suspect she's right to some extent, I'm just not sure drugs can completely fix it. A lot of my current helplessness/hopelessness feelings are highly situational. The level of uncertainty in my life and potential/default change in my living situation I feel justifies my hopelessness... but again, that could be b&w thinking. I think if my situation changed, my current cocktail would be okay. I dunno. Tapering off Effexor honestly scares me too (I may taper off it one day), and you have legitimate concerns about staying safe. Did you tell your pdoc that you are worried about safety during the taper/washout? Do you have a tdoc that could watch you during the process or could you get more frequent check-in's with your pdoc? I have a tdoc but we're not connecting well/at all anymore. I should've switched from her 18 months to a year ago, but it felt like too much to find and train a new tdoc and then my health spiraled out of control. Now I think I'm just putting it off because it's hard (but I can justify all kinds of reasons for not doing it!). These days I get better therapy from my 25 minute weekly pdoc appointments than my 50 minute every-other-week tdoc. I did tell my pdoc that I was concerned about safety during the taper/washout and that I should probably be IP. She's okay with that and says that if I were IP they could take me off Effexor and put me on the MAOI faster because of monitoring or something. Downside (aside from being IP, which sucks) is pdoc doesn't have privileges so it would be someone else handling my care. I'm shy and really struggle with that. I had concerns about starting Effexor a year ago, knowing that one day I'd have to taper off... but it really did pull me out of a very, very deep hole. I guess I'm anxious because, like you said Parapluie, MAOIs feel like the big guns. I'll try to talk more with pdoc about the need/utility of a med change, more info on the process of switching to MAOI while maintaining safety, and possibly doing a TCA first. I'm still interested to hear from others with ideas, experiences, etc. Link to comment Share on other sites More sharing options...
Voyager.01 Posted December 15, 2013 Share Posted December 15, 2013 I just did a washout from trazodone and latuda to start parnate... It was super hard and I thought I was going to have to go inpatient cuz of the anxiety and suicidal ideation... I've been on the parnate since Wednesday... I was on it for 15 years and then my idiot pdoc at the time took me off of it cuz he didn't like maoi's. I got a new pdoc and told him how good I did on it and finally he started it back... I just have to go back to watching what I eat and drink... Don't be afraid it is doable!... Just be sure your doc goes over the stuff you should avoid and educate yourself and you'll do fine... Good luck! Link to comment Share on other sites More sharing options...
mcjimjam Posted December 16, 2013 Share Posted December 16, 2013 Could you go inpatient while you're tapering, washing out and getting started on a MAOI? If you're tolerating the Effexor okay you could ask your pdoc about a dose increase instead of changing to a MAOI. My old pdoc said he had people on up to 450mg. Since Effexor has helped another option could be to try another SNRI like Cymbalta or Pristiq. Link to comment Share on other sites More sharing options...
Geek Posted December 26, 2013 Author Share Posted December 26, 2013 Just wanted to post an update: I talked with my pdoc about my concerns as far as the taper and washout. I also shared concern about starting that kind of big deal when I've got a big life change coming up and may end up having to move and not get to work with her anymore. She agreed with that and is willing to put a switch on the table until we know if I'll be staying in the area after February. The current deal is watchful waiting. She got me into a dbt-based IOP program that meets 3 mornings a week. I keep going to that, seeing pdoc weekly and my tdoc every other week (ish). Lots of questions about safety from all sides and I'm routinely asked to commit to safety for short periods. Come February if my living situation doesn't change we'll re-discuss a switch to an MAOI. It would have to be done at least partially inpatient - I don't know if insurance would cover the whole taper, washout and restart while inpatient? Or if it can all be done faster when supervised? So yeah. No change yet. Link to comment Share on other sites More sharing options...
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