Effexor dilemma.. Really stuck/confused

[Vadar]

Hi Folks,

Long time reader, first time poster. I've found myself in a rather tricky situation and I honestly don't know where to turn to for advice/guidance. I'll try and be as brief as possible :)

Back in 2010 I was placed on Lexapro for depression/anxiety (due to cognitive perfectionism), this worked great at the start but over the course of 4-5 years I felt it ran it's course with me. I approached my family doctor and asked if he could place me on Effexor as I wanted to avail of the 'N' part of SNRI. 

Like Lexapro it worked great at the start but over the past 4 years it has (I think) ran it's course for me. As I'm sure many here would know the side effects of this SNRI is unforgiving and for the past few months I felt I was only getting a few hours of freedom from the depression/anxiety every day. Being dependent on the medication didn't bother me at the time but the cycle of feeling crap in the morning before taking it, then feeling awful to feeling a bit better in the afternoon to feeling good in the evening just took it's toll on me.. It's no way to live to be honest.

I discussed with my doctor to come off the medication for good but here is where it starts to get tricky. I'm on 150mg XR which is a capsule with 12 tiny tablets in it. I'm currently taking out 1 of those 12 tablets every week until I'm finished with them, that will take 3 months in total.

The good part is I'm not feeling horrible side effects, but what I am feeling is strong depression, lifeless, tired, no motivation, brain feels like it had a lobotomy, forgetfulness, low energy and pretty sleepy all the time.

This is (I think) what I was feeling like back in 2010 but it's such a long time ago I'm not too sure. So is this the return of the original symptoms or another side effect of coming off the medication.. 

I'm 1/3 the way into weaning off the drug and I just feel wiped out, everything is a struggle and I'm starting to question my decision. I know it's quite early to pass a proper judgement but jesus, I'm exhausted over nothing...

This might not ring any bells with anyone but I kind of wanted to put it out there anyway

Cheers for reading, 

Vadar :)

[DogMan]

Discontinuation runs deeper than feelings of withdrawal. Effexor can take years to feel normal, particularly if you are transitioning to nothing. 

But, it is increasingly supported to come off meds, for straight up MDD.

Having said that, this site is strongly pro med. And I doubt many here will support that.

There are other anti depressant options that you could wean onto. They will all poop out over time, then you get a new one. 

Unfortunately there is no option that is all around wonderful. Brain cooties suck.

You've done well to reach out.

[Vadar]

Thank you for the reply. 

I know it sounds like a cliche but I've simply had enough of them. They are essential in recovery but I think I've come to the cross roads where I need to start training my body and brain to try and survive on their own. 

I need to look into that "supported to come off meds, for straight up MDD". A few in the past have mentioned it to me but I brushed it off as they never backed it up. 

As I've mentioned above I honestly don't know if the depression and especially the anxiety is coming back in the form of the original state or is it the medication all along, I'm leaning towards it being the medication. It's just wears you down.

"Brain cooties", they honestly are the worst thing ever.. you end up in a state where you don't know if the meds are positive or negative for your memory and right around the time you think you've an answer you forget what was the question in the first place...

Lastly, what you wrote above is what I dread the most. Being shuffled about from med to med for the next decade, just to see if one suits me better. I've lost touch as to what normal (feeling, emotions) is it's impossible for me decide what is good or bad at this stage. 

[DogMan]

Finding out what your unmedicated baseline is might be beneficial. From there, you can better judge, with strong professional support, if you can manage with the non med options (lifestyle, therapy, exercise, diet etc)

That is of course provided you are not considering harming yourself or others. 

[echolocation]

hi vader! welcome to the posting side of CB! i hope you stay with us.  

you and i have similar med histories. i struggle mostly with low mood, anxiety, and perfectionism, and was put on lexapro for my first med a few years ago. it didn't work as well for me as it did for you, though. i had a brief zoloft interlude, and now i've been on effexor for a couple years. effexor has been fantastic for anxiety for me, but it never really boosted my mood the way i would have liked. my baseline has been mildly depressed/low normal for the time i've been on it.

it sounds like you've been on meds long enough that a trial without might be really helpful in assessing where you are unmedicated. just make sure you're under doctor supervision to look out for return of symptoms! i'm currently reducing the meds i'm taking, and i know my new pdoc wants to reduce my effexor, but i'm not so sure about that. that said, i'd be interested in hearing updates from you about how you're coming along as you taper off. 

i've heard of some folks doing a cross-taper with prozac (i think, don't quote me) while getting off effexor. effexor has a short half-life, which means the drug leaves your system very suddenly, instead of slowly wearing off. this is why a lot of people feel the effects of going down quite strongly. prozac has a long half-life, which makes coming off of it smoother and easier. the idea is that you switch to prozac from effexor to keep the AD in your system while getting off effexor, and then taper off prozac until you're AD-free.

the question really is always "is it me, or the meds?", isn't it? to me it sounds like the effexor is still giving you a bit of a boost. if you're just focused on getting off of it right now, this might not be helpful for you, but have you considered taking it twice a day? my old pdoc who initially prescribed it to me preferred dosing it twice a day to keep people at a more even level of all-day coverage instead of one big spike in the morning or evening.

anyway, please keep us updated on how you're doing! it was brave of you to reach out. that first post is always intimidating. 

[Blahblah]

Hi @Vadar Welcome to Crazytown (j/k). I can totally relate to everything you say here. Been medicated (on&off) for 20 years now, tried pretty much every med category. Currently settling on Effexor (with others in my signature). This is my 2nd trial on Effexor. But haven't been on it more than a year. It for sure helps with the severe depression/anxiety and labile moods....But am I free from my mood disorder? No...in fact, Effexor adds to my apathy, anhedonia, a bit of a band-aid. So I understand, it's always a catch-22.

The worst part though is when a med "poops out" and it flat out stops working. Then you try to replace, but nothing else works the same. It's like your brain seems permanently re-wired, like it will never be the same, just totally dependent on drugs. I feel the pain and frustration there. And going off is one Hell of a ride...it's so difficult to tell whether you are going through withdrawal, or a resurgence of your illness, or some wierd "retractable withdrawal" that pops up months later....WTF knows! Withdrawal can actually last a long ass time if you've been on it for 2+ years!

Personally, I too, would want to get a handle on my baseline mood (whenever you can get there!) and weigh out the pros/cons...Bottom line, if I am not functioning, coping, and I'm having suicidal thoughts, for sure I'm gonna take a med. However, sometimes, it's this gray area, where you are functioning, but still clinically low-grade depressed, I don't know. Some have the dedication to completely do this life overhaul: intense exercise every single day, perfect diet, supplements, therapy, social support, etc etc. Maybe that all works for some.

I will add from personal experience (withdrawing from both Cymbalta and Effexor) I highly recommend doing the Prozac bridge - it takes the edge of the withdrawals. I recall "counting every single bead" of Cymbalta (don't recommend that!) Cross taper with Prozac is a much smoother landing. So no answers here, but it's normal to want to see what life is like on the "unmedicated" side. Just be sure to taper slowly & safely and have a support team at close reach!

Edited August 1, 2019 by Blahblah

[BrianOCD]

Personally I loved Effexor XR and wish I could afford the Brand again cause it not only wiped out my issues, it gave me confidence and a conquer the world feeling.

I took the same drugs as the OP, from Lexapro to Effexor XR, I just switched over to Pristiq.

Coming off Effexor is no picnic, I ended up cycling through a lot of different drugs trying to find stability which I still haven't got.  I got all the symptoms you're describing there.  The whole world seems different now.

Hopefully Pristiq works, /fingers crossed

If you feel like things are going too bad, just go back on Effexor until a different point, slower the better.  I was on Effexor for 8 years or so.

[Cerberus]

If you started Effexor because you wanted its effect on norepinephrine and now you're finding that it's not as effective any more, it may be that you need a higher dose. Effexor is actually a MRI, a multiple reuptake inhibitor, affecting serotonin, norpinephrine, and dopamine as the dosage increases. A dosage of 150mg is only the low end of the therapeutic range for norepinephrine; you could go as high as 300mg and see if you don't experience a resurgence of its positive results against your MDD.

I do have to ask, however, whether you have the benefit of the care of a mental health specialist. You mention that you're asking your GP for these prescriptions, but deciding on a medication strategy to treat your personal flavor of MI should include the help of a psychiatrist who can properly assess your current state and make sure the meds regime you're on is chemically sound. If you haven't consulted a pdoc, I really would recommend it.

[Vadar]

Hi All, 

Thanks very much for all the replies. 

@Hume's doona I know there it's risky to first establish my unmedicated baseline and go from there but the way I'm looking at the situation now is, if I don't do it now I never will. 

Another thing is, years ago when I was Lexapro, I tried to wean off it myself but I did it way too quickly and ended up in a bad condition, so much so I quickly rushed back onto the medication. I think since then I'm very skeptical when approaching the topic of coming off any medication. 

@echolocation

Thank you so much for your reply. It sounds to me like you are my long lost cousin

I know hindsight is great n all but looking back on it, where I think I went wrong is after the initial dosage of medication I spent too long getting used to it. Then I tried my best to manage my life around the medication and not the disease, it has now gotten to a point where I cannot separate the side effects of the medication vs the disease/condition.

I have mentioned to my GP that the Effexor gives me a simmering feeling of anxiety and I am not sure whether it is supposed to be like this or not. Is this due to a low dose, high dose or is it just the depression/anxiety coming back, who knows..

The funny part is with perfectionism you can’t even perfect/predict your feelings on the matter and this in itself causes some more anxiety. Not a whole pile but enough for you to take notice. This is another reason I want to try and establish my baseline. It would  be worth mentioning that I’ve done CBT for several months and I found it useful, I just need to apply it more on a daily basis while not being heavily medicated.

Re Medication: Oh I’m sure there is a huge combination of medication available to me that might mitigate the side effects. My GP suggested I take Seroquel again like I did in the past. Only a tiny dose, 12.5mg. In the dark days I used to take this to get a good nights sleep but sadly in the morning I felt stoned for a few hours. Then that would put me into a state of not knowing if I’m still on the medication or not. That led to confusion, brain fog and a touch of anxiety around noon. I didn’t want to go down that path anymore.

I think if I approached my doctor, who I might add is very easily accessible and helpful, he would suggest an alternative. But then that would leave me in a situation where I can’t assess my baseline.

It’s interesting that you say it gives me a boost. At this stage I’m unsure about that, I just want it to keep me at an even level so I can give myself a boost. A boost doing bring productive, able to articulate appropriately, read for long duration and be able to plan properly. As you can tell from that sentence the bad days are the days I can’t organise my breakfast let alone plan the day/week.

So far, I’m doing pretty good. The anxiety is lower which is allowing me to think more clearly. When that is raised everything goes out the window and I can’t think at all. Can’t think, can’t plan anything, can’t raise my mood, can’t function, day wasted, anxiety back up. You get the picture J

I will certainly keep you informed, I’m currently down to 9/12, next Tuesday it will be 8/12 of 150mg.

@Blahblah

 

Thanks for the reply. You are right, it does give you a catch 22 situation but after a while you’re unsure what side of the “catch” you’re on. 50/50, 30/70, 20/80 etc. If we could lock in place exactly what it is doing for us I’m sure we wouldn’t be seeking out all this information.

I’ve no idea if it pooped out for me or it’s all in my mind. The one thing I did know was that it was causing me far too many side effects.  Brain fog, anxiety, zero sex drive, lethargy, anhedonia, slight weight gain, weakness in muscles, poor quality sleep and dry mouth. The combination of all of them just wore me down.

“it's so difficult to tell whether you are going through withdrawal, or a resurgence of your illness, or some wierd "retractable withdrawal" that pops up months later....WTF knows”

This is the worst part for me, just sailing along not knowing what exactly am I feeling.  

I've a sneaky suspicion that I will reach this "low grade depression" and then find myself back at the crossroads wondering whether to back on something or not. I plan to get a physically fit as I can between now and then so I can really can make a proper decision. 

Thanks for the experience, it seems like using a medication for bridging is popular/the way to go. I might go down that route but I think a slow 3 month withdrawal is safe enough option, painfully slow but a must.

@BrianOCD

Now this is a world that I'm not familiar with, being unable to get what ever Brand you want. Over here in Ireland medication is pretty cheap, about 30 dollars a month. Most of the time when you hand in your prescription to the Pharmacy they will let you know if X drug is now available in the generic form or not, they will always recommend you getting the generic form as it's the same here and costs a fraction of the price. 

It's funny, the exact medication you're taking at the moment is what was suggested to me. PRN Seroquel. 

Are you free from Effexor now? 

 

@Cerberus

Thanks for the reply and information on the medication. I've known about the dosages and what affects each mg can provide. My GP and I was always cautious about going near the 225mg area as it's clear norpinephrine area. 

I currently don't have a mental health specialist. I did in the past but that was a long time ago. I know relying on the GP and GP alone is risky but I have a very good rapport with him and he knows my full history. 

I might approach him for a referral if I feel the need to go back on something as by then I might have some idea of my unmedicated baseline. 

I will get back to you on this, thanks! 

 

Edited August 2, 2019 by Vadar

[argh]

if you want the N, but are ok with losing the S, there is always wellbutrin. that can be paired with an SSRI if you want SNDRI.

effexor + remeron is known to be an efficacious combo. I've never been on effexor at all, let alone remeron in combination, so i'm not sure if that is the elephant tranquilizer that remeron is alone.

Edited August 2, 2019 by argh

[echolocation]

i see what you mean about the fluctuating moods through the day. i agree that it's a lot easier to deal with one steady mood, even if it's a bit low, than down in the morning, up in the afternoon, down at night, or whatever's going on. it sounds like a med vacation will be the most useful thing for you in figuring out where you're at and where you want to go.

i'm glad CBT is helpful for you! therapy is really good for perfectionism, in my experience. it seems like the only way to make it better is to be able to understand what the triggers for the perfectionist spirals are, and how to pull yourself out of them. it's hard work to unlearn that stuff! i'm also working with a therapist right now. my hope is that with enough therapy, i can get off the meds.

clear head is good! it's so hard to just do basic things like make food when there's anxiety and fogginess clouding up your brain. i hope that gets better as you taper down. steady as she goes, hey?

[BrianOCD]

Quote

Now this is a world that I'm not familiar with, being unable to get what ever Brand you want. Over here in Ireland medication is pretty cheap, about 30 dollars a month. Most of the time when you hand in your prescription to the Pharmacy they will let you know if X drug is now available in the generic form or not, they will always recommend you getting the generic form as it's the same here and costs a fraction of the price. 

It's funny, the exact medication you're taking at the moment is what was suggested to me. PRN Seroquel. 

Are you free from Effexor now?  

No not really, I switched over to Pristiq which is very similar to the Effexor.

If I had the option though I would go back to Effexor XR Brand in a heartbeat, it felt like that drug was made for me.   While on Effexor I had those moments where I said, this is the person I was meant to be...I even fantasized about cutting off the pharmacy suppliers and grabbing some just to let you know how much of a hold that drug has on me.

But without insurance a 1 month supply of Effexor XR is $2900

Edited August 2, 2019 by BrianOCD

[Vadar]

@echolocation

Hey, whenever I think of moods I automatically think of being happy and sad, crying or laughing but for me it’s being confused, ‘brain fogged’ or not. The latter just brings me down a bit more than usual.

The past few days I’ve been feeling pretty good, clear minded etc. I’m not too sure if this is me going to the gym a lot again or the reduction in medication or both. I’m not going to overthink it for now.

The CBT was so long ago I’m not too sure if it’s still working for me. I know its good for perfectionism so I might need to brush up on it again.

Like yourself its all about the clear head as that is our foundation. Without that we can’t use skills or action to feel better or do basic tasks, everything goes out the window.

Good to hear you’re also looking into the future with the possibility of coming off the meds.

 

@BrianOCD

I hope the pristiq works out for you. I don't know the make up of that med but if your Doctor says it's similar to Effexor I'm sure you think about that a lot, is it really or is he/she just pulling my leg and trying to buy enough time for me to feel better on it, after that point it'll be nearly impossible to compare the two  

Across the Atlantic here, we hear some stories of life saving drugs over in the US costing a small fortune like insulin and cardiac drugs.... if you were on some fancy experimental meds then you could justify a 'highish' price but 2900 for run of the mill meds is just sinful.. that's just ludicrous.

I just had a look there at the cost over here and I thought it was much higher, according to the website below its $6.21 per month for 150mg..

https://www.hse.ie/eng/health/hl/generics/ref/venlafaxine.html

It would be cheaper to come over here for the weekend, check out some tourist spots and go home with 6 months supply..

 

[Vadar]

Just a small update. Currently on 100mg, down from 150mg. Started that dose yesterday for one week.

No obvious side effects yet but I have to admit I had two really really awful days. Massive anxiety while transformed into severe brain fog.. so much so I felt unable to do anything.. best way to describe it was I felt I entered a zombie like state and no matter what I tried I couldn't break away from it. 

Day 1 was bad enough but when it lasted for two days I almost felt like throwing in the towel.. I had zero energy as well to do anything and I honestly felt like the medication was out of my system and the depression was back in full effect. 
 

Feeling pretty good today, not amazing but middle of the road I guess. I'm still going to go through with it but I'm starting to doubt me feeling happy at the end of it. I just can't picture my brain going back to pumping out serotonin again. 

I think I'll just be like the way I am now, quiet, semi reclusive, preferring to listen to others rather than speaking, confidence a bit low and all of this isn't me at all. I can't wrap my head around the brain going back to normal at this stage, I'm highly skeptical to say the least.. 

@echolocation Just thought I'd send you a short update

[echolocation]

thanks for checking in, vadar! middle of the road is pretty good. it sounds like you had a rough couple of days. hopefully the worst is behind you.

[Vadar]

So currently I'm down to 100mg of effexor and I don't really any withdrawal symptoms. 

After feeling quite depressed, sluggish and semi lifeless I have come to the conclusion that someone in my condition with major depression simply needs to find the right balance between meds,exercise and food.

I thought long and hard about it and I know when the time comes and I'm off the effexor nothing is going to change.. I'll just be lifeless and depressed..

 

Therefore I've decided to consult with my doctor about starting an SSRI, Prozac in particular. Something I've heard about a number of times, something I think has little side effects to SNRI's. I could be wrong about this but I really don't want to wait about until the shit hits the fan and I'm left with zero brain function to decide anymore.. 

I'm thinking about starting off on 20mg of Porzac whilst still weaning down on the effexor, 

Wise move or not? seems like I might be double dosing on the SSRI's

[echolocation]

the prozac bridge is a pretty popular way to get off effexor, so you're not treading in unknown water here. your doctor should know what titration schedule to use to make sure you're not double dosing.

i think it's a good idea to try a different med. i also have a goal of not needing to take any meds one day, but i don't think that day is here. working in better diet and more exercise is a great idea too. you certainly don't have anything to lose by trying.

glad you don't have any withdrawal symptoms. i hope your energy perks up soon.

[Vadar]

That's just it. My energy is up at the moment and my focus is far better than before. 

Looking back on it I think the dose of Effexor was just too high for me. I was experiencing far too many side effects and it just knocked me out each day. I really was only left with a few hours every day to function at 70%.. the rest of the day I was useless..

I've heard Prozac takes a long while to build up your system, hearing reports from 2 weeks to 2 months.. Either way I'll just wait and see, hopefully I won't feel awful when I get to the really low doses of Effexor.