![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 81. Go back in thread:
Posted by winddancer on March 24, 2005, at 22:31:12
In reply to Re: About the Effexor XR Withdrawal, posted by gardenia girl on March 24, 2005, at 21:28:01
Jumping into the discussion is the best way to go, I think. "Scott" seems to know a lot about how the benedryl and other things work to help with withdrawal. I'm waiting for a reply from him for the same question.
I'm down to about 3/4 of a 75mg per day and have been breaking the capsules and dividing out into 4 piles and taking them at intervals as Scott suggested.
Do you have any tingling/numbness in your tongue/fingers/etc? Anybody?? Could it be the anxiety reemerging or is it a side effect of the drug or withdrawing from the drug.
Food doesn't have much taste. For the first time ever I'm having a difficult time maintaining my weight and I am suspecting the Effexor is the culprit - I am maintaining at about 10+ lbs over what my ideal weight is, and I feel that my activity level is about the same. At first I was experiencing constipation but am taking some Chinese herbs to combat that and taking some Mg supplement which helps also.
winddancer
Posted by SLS on March 25, 2005, at 7:02:47
In reply to Re: About the Effexor XR Withdrawal » tkmphd, posted by winddancer on March 24, 2005, at 11:40:02
Hi WindDancer.
How many days have you been tapering at this point?> Things are going pretty well. I just saw my dr and got the script for 25mg tabs.
Don't forget to fill it. :-)
> I've had a little bit of anxiety when I've left home and then got back later than I wanted to take the next dose.
when you leave home?> But I've managed it pretty well with deep breathing and conscious relaxation tape.
If the anxiety is being produced as a withdrawal symptom, it might not be necessary for you to experience it at all. The same could be said about the paresthesia if it too is a withdrawal symptom. Paresthesia is one of the more common ones.
> What's an example of an anti-convulsant?
Tegretol
Trileptal
Depakote
NeurontinThese are the ones that interest me so far.
> I have taken benedryl a few times - especially at night but I still don't get a solid nights sleep.Be sure to get the preparation of Benadryl that does not contain the decongestant.
> How does the benedryl work to alleviate symptoms? I don't quite understand that.
I don't either. I'm not sure whether to attribute its effectiveness to histamine receptor blockade or its strong anticholinergic effects.
I'm still confused as to extent to which you have been flexible with your dosing. I'm not sure how to interpret your statement at the top of this post. It sounds like you grasped the idea well enough, but just in case...
You should be able to take small amounts of Effexor as soon as you begin to feel withdrawal, but NOT before. This is why it is important to become familiar with how the withdrawal effects manifest for you as an individual. For now, don't worry too much about your total intake of Effexor for the day. The amount taken should become less and less naturally. Use Effexor sort of like aspirin. When the headache returns, take enough for it to go away. If you can estimate, try to take enough to last 6-8 hours but NOT longer. Carry Effexor with you wherever you go.
Effexor is your friend. Don't be afraid to continue to use it in a way that minimizes your suffering. It is a tool for you to work with. It might not be necessary for you to "go through withdrawal" the way most of the other people here do.
What are the signs and symptoms that alert you to when you are beginning to experience withdrawal effects? Does the paresthesia come and go with the other symptoms?
Do you have any questions? I am not sure I am expressing myself well enough.
I'm really rooting for you.
:-)
I would love to see the flexible dosing work for you. No guarantees, of course. If it becomes evident that you are getting nowhere, you can then go to a more rigid taper schedule and try to manage the withdrawal symptoms as they occur. Benadryl is one method. Others have claimed Claritin, another over-the-counter antihistamine, works as well. You can always cross-over to Prozac and allow its long half-life act as a gradual taper. I would point out that the flexible dosing of Effexor very much approximates the Prozac strategy.
You are a bit of a guinea pig at the moment. :-)
One step at a time.
* For anyone else reading this, flexible dosing is probably best used towards the end of the taper period when you get down to dosages of 75mg and less. It is still smart to take doses of Effexor more than once every day. 25mg x 3 times is better than 75mg x 1. Do not skip days. The extremely short half-life or Effexor or Effexor XR makes this practice imprudent for people vulnerable to withdrawal syndrome.
- Scott
Posted by gardenia girl on March 25, 2005, at 9:22:50
In reply to Re: About the Effexor XR Withdrawal » miracles, posted by SLS on March 25, 2005, at 7:37:53
Thanks to all for comments.
Scott - RE: I hope we can gather more anecdotes on this board to try and establish the efficacy of various methods of withdrawing from the SRIs.
My info:
Currently taking Claritin (allergies) – still having serious withdrawal
Common ingredients of Benedryl and Claritin must not be the key for my particular chemistryTook Benedryl last night, did sleep better.
Took Benedryl about an hour ago. Didn't go to work. Still experiencing vertigo issues, tightness in neck muscles, feeling of band around my head, confusion, and ears ringing. I AM NOT feeling the intense nausea, irritability, zapping noises in my head every time I move or look in a different direction, GI cramps, adrenaline rushes. Only some of these - some of the time - and certainly not to the degree of suffering over the last few days. Is it the Benedryl or the expected decline of symptoms on the seventh day of withdrawal?
Never took more than the 37.5 mg of E-XR, but took it for four years. I do know that I am the type (don't know if there is a technical or clinical name for it) of person that only needs half the recommended adult dosage of any drug to feel the results. Does that have anything to do with my having intense withdrawal symptoms?
Is there any documentation regarding possible permanent changes to the way our brains will function in relationship to chemistry production / non-production due to use of this type of drug? I used to work for the manufacturer of E-XR and I do still believe that it has tremendous beneficial value. I just want to know what to expect, how to manage my body for the rest of my life...
I guess my biggest question / fear is once these withdrawal symptoms go away, then what? Will I be the same person I was before E-XR?
Data:
Age 51, female, 37.5 mg for four years, highly susceptible to chemicals, tried cold turkey last fall - lasted four days - went back on same dosage, started weaning in November
1 month every other day - no symptoms, 1 month every third day - mild symptoms at end of second day. 1 month every fourth day - mild symptoms at beginning of third day getting progressively worse until next dosage. 3 weeks @ every fifth day - mild symptoms at end of third day getting progressively worse until next dosage
last dose seven days ago - don't want to take any more, don't want the roller coaster, am willing to lash myself to a post and ride out the hurricaneDon't have the same stress factors (1995 got divorced; son went away to college; 1998 company closed the division I worked in; transferred me to another state; 1999 sold home; built another in new state; 1999 mother, brother & father died within a year/I settled all their estates; 2000 trained for new responsibilities at work; 2000 remarried; 2002 got laid off; went back to school for IT cert; 2004 got new job) as when I started the drug and I want it out of my body. I want to have genuine emotions again. I want to laugh and cry, feel joy, sadness, all those things that make humans – human. Found other coping methods (exercise, hobbies, bio-feedback...) for dealing with stress.
Trying to find the most expedient method of withdrawal, with minimal symptoms (temporary masking is OK, so long as mask does not have withdrawal also). My husband is very supportive, loving, intelligent, rational… He and I both deserve better than what I have been able to give lately. I appreciate any suggestions you might have to help with my restoration mission. I will win. Its just discouraging to not know what is happening to my body, how long it will continue, what to do to get relief without using the same drug. It is very encouraging to know that I am not alone – others have been successful in the same quest, and that there is that proverbial light at the end of the tunnel.
Sorry for the long post. I guess there was much needing to be released. Onward and upward!
Posted by SLS on March 25, 2005, at 9:57:16
In reply to Re: About the Effexor XR Withdrawal, posted by gardenia girl on March 25, 2005, at 9:22:50
Hi GG.
I'm glad you posted.
> Sorry for the long post. I guess there was much needing to be released. Onward and upward!
As I have detailed in other posts, skipping days seems to be counterproductive with Effexor. If you feel you are headed in a positive direction despite skipping days, I guess it doesn't make sense to try anything different. Note that 3 days is the magic number for the onset of withdrawal syndrome. Your experience gives further evidence of this.
If it were me, I'd get the 25mg tablets to work with. Until then, you can use the 37.5 tablets effectively by dividing them into quarters. Try taking 1 quarter three times a day. See what happens. If you become stable at that dosage and can avoid the serious withdrawal effects that are keeping you from working, then the next step might be to take either 1 quarter of the 37.5 twice a day or 1 quarter of a 25mg tablet three times a day (preferable). I don't think you will be able to go further than one quarter of 25mg twice a day. Perhaps you will. That would be convenient. If twice a day is your limit to avoid constant withdrawal symptoms, then wait until you are stable and prepare for moving to complete discontinuation as your next step. Any residual withdrawal symptoms should be mild to moderate and will perhaps be amenable to palliative treatment with Benadryl.
I'd like to mention that those people who reported success using Claritin actually used the "Claritin D" preparation.
- Scott
Posted by gardenia girl on March 25, 2005, at 11:25:34
In reply to Re: About the Effexor XR Withdrawal » gardenia girl, posted by SLS on March 25, 2005, at 9:57:16
What I have read about skipping days being counterproductive does sound sensible to me. Unfortunately, that information has come to me after I have invested six months in this process. It appears that I have lost 30% of three months to "bad days", gaining nothing toward my goal. My FP did not offer any other help, except Welbutrin.
Are you saying that you think it is necessary to re-start E in the taper-off method before any significant improvement is realized?
Because I have already invested so much time, I am inclined to continue with the path I am on, elect not to put any more E into my body. I just cannot stand the thought that especially these last six days have not put me closer to complete discontinuance. What can I expect on days 8, 9, 10…? Have you collected any info on the various phases/timelines without returning the E the system? If, at day 15, my condition has not significantly improved and I decide to try the taper vs. skip method – can I break open the 37.5 capsules, divide the granules, and then take only a portion of them? Are all the granules equal, or are there some with more strength than others to facilitate the XR (timed release) property of the drug?
Posted by SLS on March 25, 2005, at 12:54:50
In reply to Re: About the Effexor XR Withdrawal » SLS, posted by gardenia girl on March 25, 2005, at 11:25:34
> Are you saying that you think it is necessary to re-start E in the taper-off method before any significant improvement is realized?
Have you already discontinued Effexor entirely? If not, what are you currently taking?
> Because I have already invested so much time, I am inclined to continue with the path I am on
That's why I made the remark that, "If you feel you are headed in a positive direction despite skipping days, I guess it doesn't make sense to try anything different."
> I just cannot stand the thought that especially these last six days have not put me closer to complete discontinuance.
Although only a theory of mine, I think the withdrawal syndrome gets worse and lasts longer the more time you allow it to persist.
> What can I expect on days 8, 9, 10…?
I guess we will both have to find out once you get there. Perhaps you will be lucky and not have to suffer beyond the two week mark.
> Have you collected any info on the various phases/timelines without returning the E the system?
No. However, there are many people here who describe a persistence of withdrawal effects well beyond two weeks. In fact, some people claim that they persist for months. This description seems to be particularly common with people who go off "cold turkey".
> If, at day 15, my condition has not significantly improved and I decide to try the taper vs. skip method – can I break open the 37.5 capsules,
It is my experience that yes you can.
> divide the granules, and then take only a portion of them?
Yes.
> Are all the granules equal, or are there some with more strength than others to facilitate the XR (timed release) property of the drug?
Good thinking. I don't recall whether the granules are the same or different. However, I can't see what difference it makes since they are distributed randomly. I would recommend getting the 25mg tablets to work with.
I can appreciate your desire to not add any more Effexor into your system. If you are currently taking 37.5mg every three days, that averages out to 12.5mg per day. That obviously isn't enough. If it were me, I would get the 25mg tablets and divide them into quarters, each being 6.25mg. I would then "restart" daily dosing at 6.25mg three times a day = 18.75mg. When you are ready, go twice a day = 12.5mg. In the meantime, you can break open the 37.5mg capsules and divide the granules roughly into quarters and take 1 quarter three times a day. You don't have to be precise in your measurements. I believe more frequent dosing is important. It smooths out the peaks and troughs of Effexor blood levels.
You really wouldn't be adding very much Effexor back into your system; 12.5mg a day versus 18.75mg a day. You can decide how rapidly to taper from there. If you are in no rush, you can spend a week at each dosage. If you are in a rush, you can probably spend 3 days at each dosage. Once you get down to 6.25mg, you might no longer be able to stave off withdrawal symptoms. That's when you discontinue it entirely. Hopefully, your withdrawal will be mild by comparison to what you have already experienced and last no longer than a week or two. For me, it was a day or two, but I used a flexible-dosing strategy to taper.
Good luck.
:-)
- Scott
Posted by gardenia girl on March 25, 2005, at 16:16:49
In reply to Re: About the Effexor XR Withdrawal » gardenia girl, posted by SLS on March 25, 2005, at 12:54:50
>Have you already discontinued Effexor entirely? If not, what are you currently taking?
Last dose – seven days ago. None since last Friday.
>That's why I made the remark that, "If you feel you are headed in a positive direction..."Trick is, I don't know if it is headed in a positive direction. No personal withdrawal history beyond 5 days without E (until now). Every day is a wait and see kind of day. I thought others might have some recollection as to what happened to them as they survived each day.
>Although only a theory of mine, I think the withdrawal syndrome gets worse and lasts longer...Hmmm. Will have to think on that one. I wonder how much worse it can get.
>I guess we will both have to find out...That brings in the thought that I should be keeping a diary of sorts. The diary won't hasten the end of the symptoms nor will it lessen the severity for me, but it might provide comparison information for someone else.
>No. However, there are many people here who describe a persistence ...I think I finally get it! Skipping doses is not considered weaning oneself off at all. Only reducing the dosage amounts by stages alters the way the brain/body reacts to the removal of the chemicals, which are really only substitutes for what our own systems were not producing enough of to alievate anxiety in the first place. Yes?
>Good thinking. I don't recall whether the granules are the same or different. However, I can't see what difference...My thoughts were that by removing them from the delivery system and separating them into four groups there is no guarantee that one group won't contain all of the higher strength grains, another group all of the lower strength… But logically that scenario would be an absolute freak happening and the answer is easy. As you said - get the tablets. Then a grain is a grain.
>You really wouldn't be adding very much Effexor back into your system; 12.5mg a day versus 18.75mg a day.Help me out with the logic on this one. It seems to me it actually comes down to 12.5 mg per day vs. none. If one 37.5 timed release cap hits your system and is intended to produce results for a 24 hour period, with some residual into the next 24 hour period, then the next day another 37.5 hits – on a daily basis there should be an average of 37.5 + in your system. If you skip the next day you only have the residual in your system, not 18.75 mg. Yes? If you also skip the next day any remaining residual is used, skip the next day, residual is gone, hence the onset of the symptoms at three days w/o E. Every time your system reaches day 3 it is trying to use resources that are not there. Every three day cycle will be the same. By golly, I think I really am getting it!
If, however, your system was functioning without symptoms as long as there was some residual, then it becomes a matter of training your system to function with less and less per day, eventually finding the magic number, instead of jerking the rug out repeatedly as with the skipping doses method.
OK. Thinking out loud. The factors for making my decision are:I have already jerked the rug out. My system is looking for non-existent resources to relieve symptoms. I am well into the seventh day of the beating. If I don't put any resources into my system, the beatings will continue until my system figures out how to produce what it needs on its own. This now begs the question, what exactly is it looking for? What are possible ways to encourage production by my own system? Is there something I can do to hasten the end of the beatings without putting more of the drug into my system? How many more days of symptoms? Have I already been through the worst? Am I very close to the end and just don't know it? Lots of unknowns.
Or,
OK so I jerked the rug out. I can still put the drug back into my system but in much lighter doses and reduce it a little every day until I find my tolerance level. At some point I will still remove the drug entirely. How many days of symptoms will I have? What will be the severity? The same ways to encourage my own system to produce needed chemicals still apply. Will this method add to or subtract from the time investment of the other method? Still some unknowns.
Thanks for the forum to think out loud. Thanks for sharing your experiences and for the encouragement.
I have a decision to make and a diary to start. Good luck to all.
I will probably peek in periodically. I will definitely let you know what happens.
Posted by SLS on March 25, 2005, at 17:06:20
In reply to Re: About the Effexor XR Withdrawal » SLS, posted by gardenia girl on March 25, 2005, at 16:16:49
Hi GG #2.
I didn't realize you had completely stopped the Effexor. I thought you were still taking it 37.5mg every third day.
I hope this thing passes quickly for you. It is very reasonable to continue to follow your 0mg method. :-)
> I think I finally get it! Skipping doses is not considered weaning oneself off at all. Only reducing the dosage amounts by stages alters the way the brain/body reacts to the removal of the chemicals...
Skipping days with Effexor only makes things worse. This type of thing is called pulsing. Pulsing probably kindles the withdrawal syndrome that much more and increases the amount of time people suffer. It might even make the withdrawal symptoms more severe.
- Scott
Posted by winddancer on March 25, 2005, at 19:37:58
In reply to Re: About the Effexor XR Withdrawal, posted by SLS on March 25, 2005, at 19:03:36
Scott,
You seem to have a more indepth knowledge about this drug and the specifics about the way the medicine works, etc. What is your training/background??I am currently doing reasonably well with spreading out my doses of Effexor. I'm feeling very disorganized and a little anxious from that but I'm not sure if it's circumstantial or because of the withdrawal since it's been a long year - its almost difficult to remember what normal feels like. Since I live alone its difficult to get an outside opinion. The thing that frustrates me a lot is the feeling of cold hands/feet or numbness, what did you call it? parestasis? I took reg dose of benedryl - it doesn't seem to make me too sleepy during the day so I might use it more often in the day. I've taken 2 doses of the 1/4 cap of 75 SR Effexor today and hope I can stick to that.
Keep in touch.
winddancer
Posted by SLS on March 26, 2005, at 8:32:19
In reply to Re: About the Effexor XR Withdrawal » SLS, posted by winddancer on March 25, 2005, at 19:37:58
Hi WD.
> You seem to have a more indepth knowledge about this drug and the specifics about the way the medicine works, etc. What is your training/background??
I'm a college drop-out. :-(
I couldn't complete my junior year. My depression became so severe, that I could no longer read, learn, and remember well enough to pass my classes. I was a 4.0 before things turned so foul on me.
Like almost every other knowledgable person here - and the majority are - I was forced to learn things at that point when my doctors ran out of ideas.
> I am currently doing reasonably well with spreading out my doses of Effexor.
I'm disappointed to hear that you are not doing better than "reasonably".
> I'm feeling very disorganized and a little anxious from that but I'm not sure if it's circumstantial or because of the withdrawal since it's been a long year
Do you feel nervous or jittery? Do your hands shake? Are you sweating? Mental confusion? Dizzy? These things can be signs of withdrawal. If so, don't try pushing the dosage of Effexor down too fast.
I hope these things disappear so that you can begin to reduce further.
Yes, the numbness and tingling can be the parasthesia associated with withdrawal.
Do you notice a lessening of these symptoms immediately after taking a dose of Effexor (30-60 minutes)? If so, it would be advisable to remain at the 37.5 for a bit longer. Get those 25mg tablets! 12.5 x 3 times a day = 37.5mg! Hopefully, you will reach a point of being symptom-free. I know it is difficult to differentiate how much anxiety is biological and how much is situational right now, but you shouldn't have shaking hands and paresthesias if they weren't present before attempting to reduce the Effexor. Once you get the 25mg tablets and cut them into quarters, you'll be able to more easily move downward. It might be the right move to next go to 5 quarters (31.25mg) divided into 3-4 doses during the day (breakfast, lunch, dinner, and 2 at bedtime).
In what ways do you feel Benadryl helps you?
I really don't like the idea that you are experiencing withdrawal at all.
If you are in doubt, you might consider taking the whole 37.5mg in the morning and see if the withdrawal symptoms disappear. If they do, then you have your answer. Of course, you will need to take some amount in the evening to prevent a more intense withdrawal from appearing the next day. It will then be up to you as to whether or not to continue at 37.5mg. If you had the 25mg tablets to work with, you could temporarily move up to 43.75mg and be comfortable. I realize how unlikely you are to do this, but it is what I would do if I had to function and found it difficult to do so. Then again, you might see withdrawal symptoms disappear within a couple of days if you continue 37.5mg. I really don't know.
Let's see how much more we can confuse WindDancer!
Do what your instincts tell you to do. Remember, you have the luxury of time if you do not have discontinue Effexor by a certain date. Use time to your advantage.
I am very much interested to see you get through this unscathed. I am a bit of an optimist. You shouldn't have to suffer. Please remain optimistic that your experience with Effexor discontinuation will be relatively painless. I wish I could guarantee this for you, but we both know that I can't. Try to be patient.
Have a nice day. See you soon.
:-)
- Scott
Posted by Detroit on March 26, 2005, at 9:50:08
In reply to Re: About the Effexor XR Withdrawal » winddancer, posted by SLS on March 26, 2005, at 8:32:19
This discussion thread has been a godsend to me so far.
I have been tapering down E-XR from 150mg over the past year, and stopped cold-turkey from 37.5mg this week (Tuesday pm was last dose).
Yesterday (Friday - aka day 3) was hell on earth! My wife and I did some searching and found your site and this thread.
At dinnertime last night I broke open a 37.5 capsule and took roughly 1/3 of the granules. The ear ringing stopped in about 2 hours and I slept last night! No weird sensations (not pain, not tingling - someone posted about an almost electrical sensation which seems to describe it somewhat) in my feet and legs to keep me awake. Woke up today to no dizziness when I move my eyes, nor any brain flashes(?), although I feel them starting slowly...
Going to try the suggestion to take a small amount from a capsule as symptoms appear - not on a set schedule - and see how it goes. I will talk to my doc on Monday about the tablets.
Thanks to all who have shared here (both good and bad experiences) it has been helpful to me so far. I'll keep you posted on how my process goes.
-Detroit
Posted by SLS on March 26, 2005, at 10:04:20
In reply to Re: About the Effexor XR Withdrawal, posted by Detroit on March 26, 2005, at 9:50:08
Hi there!
> Going to try the suggestion to take a small amount from a capsule as symptoms appear - not on a set schedule - and see how it goes. I will talk to my doc on Monday about the tablets.
:-) <smile>
I sincerely hope the flexible-dose strategy pays off for you. You did the right thing by restarting the drug.
I look forward to watching your progress!
Sincerely,
Scott
Posted by gardenia girl on March 26, 2005, at 10:21:28
In reply to Re: About the Effexor XR Withdrawal, posted by Detroit on March 26, 2005, at 9:50:08
At first I thought I was having a stroke, then as it progressed and I realized it must be related to withdrawal of Effexor I started searching inet. I found a site http://depression.about.com/cs/venlafaxine/a/brainshivers.htm that has about the best descriptions I have found so far as to what is going on inside my head. Trying to describe it to those who love you and want to help is not easy. If I were on the outside looking in it would be difficult to take anyone seriously that was making these claims. Fortunately I have a very supportive and intelligent spouse. But one of the best affirmations of my sanity has been these web sites and those of us brave enough to verbalize our personal hell. My gratitude to all of you. Wouldn't it be wonderful to see postings from everyone WHEN we get through this. I am about to leave the house and TRY to take a ride up into the mountains, mostly for distraction. Later.
Posted by winddancer on March 26, 2005, at 17:54:48
In reply to Re: About the Effexor XR Withdrawal, posted by gardenia girl on March 26, 2005, at 10:21:28
Thanks for posting this link. I thought that it was well presented and then it had suggestions advertised for alternative solutions for dealing with depression and anxiety. I have emailed the site to my dr. I just hope she will look into it. It surprises me often that the dr. that specializes in prescribing drugs for depression and anxiety can be so uninformed about any other alternate methods of dealing with the symptoms. Its as if they have been brainwashed by the drug companies to not be interested in the patient getting well if it cannot be connected to prescribing meds. It would be nice to feel that the drs who are bright and have many years of training, would be primarily interested in healing the patient in any way possible, regardless of whether it meant purchasing a drug. Oh well, dream on.
winddancer
Posted by gardenia girl on March 26, 2005, at 22:32:52
In reply to Re: About the Effexor XR Withdrawal » gardenia girl, posted by winddancer on March 26, 2005, at 17:54:48
FYI
I stumbled across the following this afternoon.
Supplemental to Scott's tapering method.http://www.rxlist.com/rxboard/effexor.pl?noframes;read=5422
Count the Granules
Posted By: Help_Harry
Date: Friday, 25 February 2005, at 4:16 p.m.
Hello all,
After the response to my last post from Janet about observations, I thought I would take this one step further and count granules of both a 75mg capsule and a 37.5mg capsule. Remember this is for the XR version of effexor. Janet's count was 160 from a 37.5mg capsule. For some reason I have found a different count for the 37.5mg capsules. But the weight proportions between the 75mg and the 37.5mg capsule sizes seem to be correct. Each type of capsule has small, medium and large size granules. I did my best to separate them. I used a cross section of two of each size capsule and found similar enough between them to come to the conclusions below.
Here are my discoveries:
75mg capsule
Large - 22
Med - 101
Small - 67
total - 190
37.5mg capsule
Large - 16
Medium - 48
Small - 32
Total - 96
The 37.5 has a nice ratio of 1:3 between the small, medium and large. If you removed one large, two small and three mediums each day that would be an equal reduction but in my opinion probably too fast of a weening schedule. The 75mg doesn't have as nice of a balance. You would have to eliminate one large, 4.5 mediums, and 3.5 smalls each time, probably also too fast of a weening. I am thinking about a month schedule for each capsule size. One month to go from 75mg to 37.5mg and then one more month for 37.5mg to 0mg. My brain is fried from all the counting so I will throw this out there for debate and suggestions. My thought is you can never have enough planning for something like this.
Best
Harry
Posted by gardenia girl on March 26, 2005, at 22:49:30
In reply to Re: About the Effexor XR Withdrawal » gardenia girl, posted by winddancer on March 26, 2005, at 17:54:48
Have been researching links all evening. I wish I had done as much investigating before I started taking E-XR. Spilled milk. But on the other hand, this kind of info was probably not yet "out there". Some of the links below are from medical journals, some from media, one from FDA, other message boards, law firm... Some of it is easy reading, some long and tedious, but all of it validates our struggles, our frustrations, our hope, and most importantly that our quest is attainable. Not easy by any stretch of the imagination. I guess we will truly see what we are made of.
http://www.rxlist.com/rxboard/effexor.pl?noframes;read=5447
http://www.pharmcast.com/WarningLetters/Yr2004/Mar2004/Wyeth0304.htm
http://www.join-the-fun.com/effexor-withdrawal.html
http://www.effexor-xr-side-effects-withdrawal.com/case-report-of-withdrawal-symptoms.html
http://www.washingtonian.com/health/hardtoswallow6.html#6
http://www.socialaudit.org.uk/4200DTAY.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=9588310&dopt=Abstract
Posted by SLS on March 27, 2005, at 6:53:10
In reply to Re: About the Effexor XR Withdrawal, posted by gardenia girl on March 26, 2005, at 22:49:30
Nierenberg and his group at Harvard are an outstanding group of people whom are not afraid to attack a problem.
- Scott
Posted by MommyFruitcake on March 27, 2005, at 17:49:58
In reply to Re: About the Effexor XR Withdrawal, posted by miracles on March 27, 2005, at 14:06:25
I have been taking effexor for a couple of years, and it has been the most successful drug to combat depression for me. I was suffering from post-partum depression, and my daughter is about to turn five. I went on a 4 day camping trip this weekend, and forgot my meds. I am experiencing withdrawls, very similar to the effects I felt when I first started taking this drug. I have been contemplating going off of the drug and seeing how it goes. I was thinking that since I haven't had a dose since wed night, this may be a good time to try it. My question is, does anyone know how long the withdrawl effect should last? If it's only a week, then I'm half way there, but it'd it is more like a month, i'm not sure if it's worth it. Anyone have advice?
Thanks
Kathryn
Posted by Detroit on March 27, 2005, at 23:56:56
In reply to Re: About the Effexor XR Withdrawal, posted by Detroit on March 26, 2005, at 9:50:08
Update on my progress.
Flexible dosing is going well.Overall, I feel better than I have in more than two years!!! So much of what I've felt in the past few years I now believe to be "minor" withdrawals from the Effexor XR brought on by the 24 hrs between doses.
Like others here, I have very mixed feelings about this medicine now. It definitely helped me more than some other meds I tried (Imipramine, Prozac, Wellbutrin), but is clearly not without its own problems - the biggest being withdrawal related to its incredibly short half life - even in the XR version.
I sure wish my doctors and I were all 1)better informed, and 2)had more discussion prior to taking this med. I may still have done it, but wouldn't have been so surprised by what has happened to me during the withdrawal.
Again, thanks to everyone who has shared their experiences here!!! You have helped at least one person - ME!
Specific History:
150mg dosage for several (5?) years.
Down to 112.5mg 12 months ago.
Down to 75mg 5 months ago.
Down to 37.5mg 6 weeks ago.
Took last 37.5mg dose Tuesday night.Very little sleep Wed or Thursday night.
Increasing brain zaps, dizziness, and electrified feeling in feet and legs.
Friday was the complete hell-on-earth that others have described also.
My wife (a former pharmacist) was sure what was happening to me was related to Effexor withdrawal.
She started searching the web for helpful info Friday afternoon.
We read about alternative tapering down plans on this site and others. Decided to try.Friday 7pm took ~1/3 granules from 37.5mg capsule (I did not do the big/medium/little granule counting or measuring that others have described - just grabbed some).
Sat noon (15 hrs later) took ~1/3 granules.
Sat midnight (12 hrs later) took ~1/3 granules.
Sun 1am (~25 hrs later, in just a few minutes) I will take about 1/4 of the granules.
No significant withdrawal effects since about 8pm on Friday (although I am have some insomnia).I only take some when I feel the symptoms coming on, and it is working so far.
I will talk to my Doc Monday about the tablets to enable more precise dosing without attempting to count those little granules...
Posted by SLS on March 28, 2005, at 6:53:39
In reply to Re: About the Effexor XR Withdrawal, posted by Detroit on March 27, 2005, at 23:56:56
Hi Detroit.
I think you are the second person here to use a flexible dosing strategy to discontinue Effexor. The most difficult period for most people seems to be making it past 37.5 - 75.0mg. Flexible dosing becomes more and more necessary the closer one comes to 0.0mg.
I used a flexible strategy beginning at the higher dosages. I was able to discontinue 300mg of Effexor twice in 10 days without suffering a single withdrawal episode. Upon complete discontinuation, the withdrawal symptoms were mild and lasted for about a day or two. I'll be very curious to see what your experience is.
I think it makes sense to wait for the withdrawal syndrome to appear before taking the next dose, albeit not allowing it to last for more than a 1/2 hour. It guarantees that you are decreasing the dosage as quickly as the body and mind can handle comfortably. You are thereby optimizing your rate of taper. My schedule was to take as much Effexor as would allow me to remain symptom free for 6-8 hours. The first time, I used the tablets and simply bit off very small amounts towards the end of the taper. Precision is not really necessary. The second time, I used the granules contained in the 150mg capsules. Perhaps you will find a schedule or dosing method that works better for you.
Although I haven't set out to determine a biological mechanism yet, intuitively, I think it might be desirable to allow the system to reach the threshold of withdrawal syndrome purposely. It might help to provoke the system into making the adjustments necessary to allow for the complete discontinuation of the drug by providing it with a periodic gentle nudge. Pharmacologically speaking, this might act as a stimulant for the neurons and neural pathways to re-regulate themselves toward their original genetically defined state. This is a just an idea of mine that may or may not reflect what is really going on, but I think altering gene expression is essential. It is ironic that it might be the allowance of an unmitigated withdrawal state to continue that sets up for a protracted withdrawal syndrome long after the drug is discontinued. I believe this phenomenon represents the consequences of kindling.
> Overall, I feel better than I have in more than two years!!! So much of what I've felt in the past few years I now believe to be "minor" withdrawals from the Effexor XR brought on by the 24 hrs between doses.
That is an excellent observation and deduction. I never gave it much thought regarding Effexor. You might be absolutely right. What an important insight this! I used to experience the same thing using Halcion or Ativan for sleep, so I am quite sure it is possible.
I make a habit of dividing my doses of most medications, despite the once-a-day prescribing habits of most doctors. I always divided my Effexor dosage by taking it twice a day. Even with drugs that have a 24 hour half-life, I like to do this. I feel it is desirable in most cases to provide as steady a blood level as is possible. Consequently, I can't speak from experience the results of a once-a-day dosing schedule for Effexor. However, it does seem reasonable that it would set up for a chronic withdrawal state.
> Like others here, I have very mixed feelings about this medicine now. It definitely helped me more than some other meds I tried (Imipramine, Prozac, Wellbutrin), but is clearly not without its own problems
Of course, this is true of so many drugs.
The other potent serotonergic drugs are capable of producing discontinuation syndromes despite their longer half-lives. Effexor is the most notorious, but is not without company.
> the biggest being withdrawal related to its incredibly short half life - even in the XR version.
This is why I am so interested in investigating methods of discontinuation that work and no longer makes the fear of withdrawal be the reason people are disuaded from using particularly effective treatment.
Best wishes for your health and happiness.
- Scott
Posted by SLS on March 28, 2005, at 7:21:03
In reply to Re: About the Effexor XR Withdrawal » miracles, posted by MommyFruitcake on March 27, 2005, at 17:49:58
Hi.
> I have been taking effexor for a couple of years, and it has been the most successful drug to combat depression for me. I was suffering from post-partum depression, and my daughter is about to turn five. I went on a 4 day camping trip this weekend, and forgot my meds. I am experiencing withdrawls, very similar to the effects I felt when I first started taking this drug. I have been contemplating going off of the drug and seeing how it goes. I was thinking that since I haven't had a dose since wed night, this may be a good time to try it. My question is, does anyone know how long the withdrawl effect should last? If it's only a week, then I'm half way there, but it'd it is more like a month, i'm not sure if it's worth it. Anyone have advice?
Since "Miracles" is temporarily indisposed, I would like to make a few comments.
I believe that it is essential that you not discontinue Effexor abruptly ("cold turkey") unless you want to suffer unnecesarily. Withdrawal symptoms almost invariably begin 3 days after discontinuation or an abrupt reduction of dosage. It is also advisable that you not taper so fast that you must suffer withdrawal symptoms chronically along the way. In other words, I think you will be better off to restart the drug and decide whether you would like to discontinue it or not. If you would like to discontinue it, you should do so in such a way as minimizes your discomfort and prevents the persistence of withdrawal syndrome once you do discontinue it. You will find some "tricks" here on the Withdrawal page. You might want to give them a try. I have had great success using a flexible-dosing strategy that I have described in my posts here. In the meantime, it might be most prudent to restart Effexor and talk to your doctor about the desirability of discontinuing it.
There are some people who manage quite well discontinuing Effexor abruptly. You might be one of these people. I am not yet aware of a way to predict what will be one's experience with its abrupt discontinuation. I guess you can give it another a week just to see. I don't want to straddle the issue, but, rather, make you aware that everyone is different in the way they react to the addition and subtraction of medication.
I am not a doctor, by the way. Neither are most of the other people here. Please take this into account when considering any advice or suggestions being given by me or anyone else.
Good luck.
- Scott
Posted by SLS on March 28, 2005, at 7:23:06
In reply to Re: About the Effexor XR Withdrawal » miracles, posted by MommyFruitcake on March 27, 2005, at 17:49:58
Posted by MommyFruitcake on March 28, 2005, at 10:09:21
In reply to Re: About the Effexor XR Withdrawal, posted by SLS on March 28, 2005, at 7:21:03
Thank you for your help. I have only been taking 75mg for the past two years, so there isn't much to taper off of. I was really hoping that since I've been off of the drug since last Wed, I would have been past the withdrawls by now. I woke up this morning, unfortunately still dizzy and light-headed. I am hoping this will subside soon. I think I am going to give it a couple more days. My biggest hang up is that I am scheduled to take my black belt test on April 16th, and I need to be over this to do that.
Thanks for the knowledge. I do appreciate it
Kathryn
Posted by Hawklady on March 30, 2005, at 19:30:32
In reply to About the Effexor XR Withdrawal, posted by MoparFan91 on March 10, 2005, at 4:00:00
Hi,
I have just joined this forum. I am in the UK and started effexor XL 150 mg in Aug 2002, in Aug 2004 I tried to come off it too quickly, the side effects were horrible ,worst I have ever experienced even when I "stupidly" experimented with recreational illeagal drugs in the 90's.
I am down to 1/4 of a 37.5 mg tablet a day, I take 1/2 am and 1/2 pm. I am still getting some pretty minging side effects and have been reading here that I could use different tablets the, the capsules and count the beads amd also that there are other medication I could take to alieveate the symptoms which are:- aching all over, head ache, head twitch/jolts/pains, racing heart beat, palpatations (doc given me beta blockers for these) sleeplessness, twitchy/restelss legs in bed, numbness everywhere particular hands, feet, head, nether regions UNFORTUNATLY!! low libido never had a problem prior, quite the opposite, weight gain. I am on such a low dose its a shame to have to back track, any advice would be appreicated.
Good luck everyone - yours un-comfortably numb.
PS Sorry for my rubbush spelling, its 2.29 am here in the UK and visiting these forums helps with the insommnia
Posted by gardenia girl on March 30, 2005, at 20:08:01
In reply to Re: About the Effexor XR Withdrawal » gardenia girl, posted by SLS on March 25, 2005, at 17:06:20
Update on Gardenia Girl
Saturday - tried splitting capsules, sorting beads by size, separating into 4 equal portions. Took 1/4 around 10:00 am with 1 Benadryl. Symptoms were tolerable but not what I wanted. By 5:30 was very sick, took 1/4 more and within an hour was tolerable again. Slept, but not restfully.
Sunday - 1/4 in the morning with 1 Benadryl. Nothing needed for remainder of the day. Slept OK.
Monday - Hands and feet looked like they belonged to a freakin' elephant. Swelling was so bad I could not make a fist without pain. Took 1/3 in the morning w/1 Benadryl. Went to the doctor. Took all the info gathered from interenet. Doc said OK to try cutting 25 mg tablets, but wanted me to use Valium 2mg for queesy, dizzy symptoms. Doc thinks I have Thyroid problems (big lumps in my neck). Did blood tests. Will know by Friday. Gave me diuretic for fluid. Took 1/4 of 25 mg Effexor tablet and 1 Valium and 1 diuretic around 5:00 pm. Slept very good.
Tuesday - 1/4 tablet, 1 Valium, 1 diuretic about 7:30 am. By the time I got to work I was sick and throwing up. All the symptoms (and a few I had not yet experienced - feet / hands tingling) returned with a vengence. Threw up all day long. Have no idea how I got home without ending up in a ditch. Curled up in the hammock outside and slept until about midnight. Restless sleep remainder of night.
Wednesday - Time to rethink. Start over and change one thing at a time! Went back to 1/4 of capsule beads and Benadryl at 7:30 am. No Valium. No diuretic (lost 6 pounds in fluid from Monday mid-day until Wed morning). Today was OK. A little dizzy. Able to eat today without hurling. No Star Wars Light Sabers going off in my head. That's a good thing. No other meds today. It's about 9:00 pm here and I am going to try to go to sleep.
Good luck to everyone on this journey.
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