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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by grrrly on July 8, 2005, at 7:08:58
I have been tapering off Effexor for a week now using a regime given to me by my doctor. I had concerns that it would be too fast a reduction, as I have experienced severe discontinuation symptoms in the past from accidentally missing a dose, but the doctor assured me I would hardly notice.
I was on 150mg Effexor XR per day, and the doctor immediately cut that to 37.5mg Effexor morning and night. Found I couldn't walk properly, was shaky, dizzy and felt generally unwell but no unpleasant electrical sensations or depressive symptoms. Also had to call in sick to work as I was definitely not functioning well.
After 3 days this was cut to 37.5mg in the morning only, which severely increased the severity of my discontinuation symptoms, I would fall over when trying to stand up, become teary-eyed, irritable and angry for no reason. Still not able to go to work.
Yesterday the regime called for me to skip a dose, which I did not cope with well at all. I started experiencing the distressing electrical sensations in my head, I couldn't stop crying and I vomited several times.
So back to the doctor this morning, who takes one look at me and sends me to the local hospital. I spent 5 hours there with them doing all sorts of tests to see what is wrong with me, finding nothing medically wrong of course. The doctor there insists that my symptoms cannot be due to Effexor withdrawal, as it will only cause mild flu-like symptoms!!! He was insistent that the tapering regime my doctor put me on is appropriate. He then started to imply that perhaps what I am experiencing is all in my head, and questioned me about possible stresses in my life that might be making me feel like this, and suggested that I contact the community mental health team for psychiatric assistance if I continue to experience problems. With regard to the Effexor withdrawal, his only suggestion was that I go back to taking the 150mg per day and see if I feel better! As I need to get off Effexor due to the side effects, this is hardly the advice I was seeking.
So I am left still sick and unable to go to work, with no appropriate tapering routine (still taking 37.5mg once per day) and the feeling that the medical professionals I am seeing have no idea of how severe Effexor discontinuation can be. I live in regional Australia so can understand that the doctors here may not have a lot of experience in dealing with SSRI withdrawal. I cannot get back to see my own doctor for several days, and would really appreciate any tips for coping in the meantime, and also any advice people have for communicating with my doctor when I do go back to him?
Posted by SLS on July 8, 2005, at 9:45:10
In reply to Effexor taper frustrations, posted by grrrly on July 8, 2005, at 7:08:58
> I have been tapering off Effexor for a week now using a regime given to me by my doctor.
How much Effexor do you have left to work with?
- Scott
Posted by apenname on July 8, 2005, at 15:01:32
In reply to Re: Effexor taper frustrations, posted by SLS on July 8, 2005, at 9:45:10
Advice for talking to the doctor: Research!
Find if your doctor can get hold of the prescription pamphlet that comes with Effexor XR and tell your doc to Read It! I know you can download it off the effexor website, but you have to agree to something that says you are in the U.S. (Apparently this is some sort of regulation thing where other countries have more or less rules on what Wyeth is supposed to share.)
Their web site lists what can happen with "too sudden discontinuation":
http://www.effexorxr.com/faqs.asp#10The U.S. version of the pamphlet very clearly lists all the symptoms you've been having (under "precautions") and says:
"Discontinuing Effexor XR
Symptoms associated with discontinuation of Effexor XR, other SNRIs, and SSRIs, have been
reported (see PRECAUTIONS). Patients should be monitored for these symptoms when
discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is
recommended whenever possible. If intolerable symptoms occur following a decrease in the dose
or upon discontinuation of treatment, then resuming the previously prescribed dose may be
considered. Subsequently, the physician may continue decreasing the dose but at a more gradual
rate. In clinical trials with Effexor XR, tapering was achieved by reducing the daily dose by
75 mg at 1 week intervals. Individualization of tapering may be necessary. " --> That's the key sentence here, Individualization of tapering.Another resource which I found fascinating was the "tips" section here on Psycho-Babble. (Effexor discontinuation: http://www.dr-bob.org/tips/split/Antidepressant-discontinua.html ). From what I could tell all of these were reports from psychiatrists, so it's the sort of thing a doctor can take seriously: colleagues reporting it rather than "it's all in the patient's head" reporting which they might otherwise say. I would not be surprised if there were medical journal articles as well.
As for surviving it, it's tough, I thought I just had a bad sinus infection myself, but realized that it was affecting my mind, as opposed to just pain and dizziness, and taking a dose of the medication made it all vanish. SLS asks about how much medicine you have, because you can do a slower tapering method. You might be able to get some "hold-over", a few extra doses of Effexor from your local pharmacy or community mental health team. Effexor XR withdrawal may have mild flu-like symptoms in the majority of cases, but not all of them!
Do not discount reducing stressors in your life, if possible. My own personal experience of the withdrawal, I found that increasing exercise, healthy eating, getting enough sleep, relaxing, and any other way I could "take care of myself" sort of cut the edge of the symptoms. Others here have had good results with additional vitamins to help with withdrawal.
Good luck!
Posted by rabble_rouser on July 10, 2005, at 4:42:32
In reply to Effexor taper frustrations, posted by grrrly on July 8, 2005, at 7:08:58
Hi Grrrly,
sorry to hear you are going through the mill at the moment. I have had similar troubles with doctors in the past in England - in the UK our doctors are not quite so flexible in their approach.
As SLS and penname will tell you, what youre experiencing is very typical of effexor withdrawal. The first time I went through it, I experienced extreme dizziness, aggression (nearly knocked my best friend out), 'electric shocks', brain wobbles, headaches (but yet no flu symptoms - odd) etc etc. That was in 2003 and my doctor claimed to know nothing about it then. Its tough to argue with them when you're feeling that way.
Compared to what I have read about, it sounds as though your discontinuation regime is different to that which many others have used. Most people have had success with little steps down, say 15-20mg drops.
I have recently been on it a second time, and whilst my doctor now acknowledges the discontinuation syndrome, he 'recommended against breaking doses apart'and told me to go 1 week - 75mg every day, then one week 75mg every other day, then 3 days etc. I knew this would be harder work (In '03 when I was on 150mg, I missed a dose one day. Wibble. Zap. Grrrr. Not fun), so rightly or wrongly I went out and bought some clear gelcaps (little empty tablet packs like the effexor comes in) and split the doses this time.
I chose to then adjust according to how I was feeling. I was personally lucky because I discovered a range of vitamins and minerals (amino acids) which totally smoothed the withdrawal and side effects for me whilst on Effexor. For this reason I came off quickly, but the beauty of the gelcaps is that you can carry around a little 'emergency dose' in case you start to lose it.
This is what has worked for me (thankfully!) There are many other approaches all over this board - I hope you find something that helps!
rabble
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