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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Bunny Goldberg on July 18, 2000, at 10:54:08
Thank goodness I found this site. All of you have been lifesavers. I have fibromyalgia and have been on practically
all of the meds around. I never had a problem with going off of them. They just stopped working for me and I
went to something else. Ten months ago a new rheumy put me on effexor. At first it was like a miracle. All my
pain was gone. A few months ago it stopped working and when I finally got an appointment he told me
to go off of it and start paxil. I went off effexor xr on a Friday and Sat. nite ended up in the er. Since then I have
had all the withdrawal symptoms you've all had and I am now down to 1/2 of a 37.5 capsule but I still feel
terrible. By the way I was only taking 75 mg of effexor xr all those months. I am glad to hear that I can take
Prozac to help me get off this drug. I have some 20mg capsules left over from my last rheumy. Can I just open the capsule
and get rid of half of the powder? Also how long do I take the prozac? Do I still take the small does of the effexor with the Prozac? I am so sick of checking with doctors -
tthey know nothing about these drugs or side effects. It's like give the patient drugs and they'll leave you alone.
Most of them just want their hours booked and the money rolling in. I know fibro is a frustrating disease and hard
to treat but for me personally I have yet to find a dr. that seems to know anything about fibro or the drugs they
prescribe. I am not taking the paxil and do not intend to. While I know that not everyone reacts the same to a drug I truly believe that this drug is dangerous. I
have been trying to get off of it for 2 months. I also take 10 m.g of Ambiem for sleep. To me that makes this drug dangerous. I would rather deal with the pain and other symptoms than go through this withdrawal. I believe I also have a handle on my depression. If any of you have fibro and
I can help in any way please don't hesitate to let me know. I will appreciate hearing from you about the prozac.
Thanks so much for your ears and shoulders! It really means alot to me.
Posted by Cam W. on July 18, 2000, at 22:08:04
In reply to help withdrawal, posted by Bunny Goldberg on July 18, 2000, at 10:54:08
Bunny - It is important that your doctor knows that you are taking the Prozac with the Effexor. He/She needs to watch you for signs of serotonin syndrome that some people get when mixing serotonergic drugs. Also, ask your doc about halving the powder in the capsule. This will give approximately a 10mg dose; it is hard to divide accurately, but will save money and decrease wasting of medication.
As to your conccerns on Paxil; it is a fairly safe drug and it is a little cleaner than other SSRIs in regards to metabolic activity. Most of the other antidepressants have active metabolites which prolong the drug's action (this is the reason some antidepressants need two to five weeks to wash out of the system. Paxil has no active metabolites and a half life of approximately 24 hours, so it really doesn't accumulate in the body. Where other SSRIs stop the production of certain liver enzymes, Paxil does this very rarely. Paxil also has anti-anxiety activity and works in panic disorder in many people.
Instead of the Prozac you could probably use the Paxil for the withdrawl from Effexor. The Paxil should work almost as well as the Prozac for stopping withdrawl syndrome. Again, ask your doctor about this as well. It is always good to go to your doctor with a couple different ideas, so it looks like he/she came up with the idea. It is always good to keep your doc happy; that way he will be more open to your ideas and more willing to help you (most of them, anyway).
Hope this helps - Cam
Posted by shellie on July 18, 2000, at 22:49:31
In reply to Re: help withdrawal, posted by Cam W. on July 18, 2000, at 22:08:04
> It is always good to go to your doctor with a couple different ideas, so it looks like he/she came up with the idea. It is always good to keep your doc happy; that way he will be more open to your ideas and more willing to help you (most of them, anyway).
>
Hey Cam. Thanks for making me laugh. I just printed off the above paragraph for my pdoc who I see tomorrow. She'll love it. Shellie
Posted by Bunny Goldberg on July 19, 2000, at 2:17:23
In reply to Re: help withdrawal, posted by Cam W. on July 18, 2000, at 22:08:04
> Bunny - It is important that your doctor knows that you are taking the Prozac with the Effexor. He/She needs to watch you for signs of serotonin syndrome that some people get when mixing serotonergic drugs. Also, ask your doc about halving the powder in the capsule. This will give approximately a 10mg dose; it is hard to divide accurately, but will save money and decrease wasting of medication.
>
> As to your conccerns on Paxil; it is a fairly safe drug and it is a little cleaner than other SSRIs in regards to metabolic activity. Most of the other antidepressants have active metabolites which prolong the drug's action (this is the reason some antidepressants need two to five weeks to wash out of the system. Paxil has no active metabolites and a half life of approximately 24 hours, so it really doesn't accumulate in the body. Where other SSRIs stop the production of certain liver enzymes, Paxil does this very rarely. Paxil also has anti-anxiety activity and works in panic disorder in many people.
>
> Instead of the Prozac you could probably use the Paxil for the withdrawl from Effexor. The Paxil should work almost as well as the Prozac for stopping withdrawl syndrome. Again, ask your doctor about this as well. It is always good to go to your doctor with a couple different ideas, so it looks like he/she came up with the idea. It is always good to keep your doc happy; that way he will be more open to your ideas and more willing to help you (most of them, anyway).
>
> Hope this helps - CamCam, thanks for the info. I am just so disgusted with all the docs I've been too. I have not started the prozac and I'm actually hoping I can get off effexor without it. My main concern with Paxil is that because it is similar to effexor with the 24 hour out of the body time that I could have the same withdrawal problems. At least with prozac it takes about 3 weeks to fully leave your system so you don't have the same withdrawal problems. I will take your advice and call my rheumy tomorrow to at least try and get help with the withdrawl symptoms.
Posted by shar on July 19, 2000, at 18:41:35
In reply to Re: help withdrawal, posted by Bunny Goldberg on July 19, 2000, at 2:17:23
>>This will give approximately a 10mg dose; it is hard to divide accurately, but will save money and decrease wasting of medication.
**When I used prozac many years back my doc told me to start with 10 mg. also. He said take the 20 m.g. capsule apart and mix the powder with one cup of water. Stir well, very well.
Drink half the water in the a.m. (after stirring well). Stir water again in the p.m. and drink the rest of the water.
I have no idea if that is a good way to do it, but that's what the doc said.
Shar
Posted by Sunnely on July 19, 2000, at 20:00:37
In reply to help withdrawal, posted by Bunny Goldberg on July 18, 2000, at 10:54:08
Bunny,
Please, allow me.
The weight of evidence, although based primarily on clinical reports, suggests that Effexor is associated with withdrawal symptoms that may be similar to but more severe than those observed with other antidepressants. Patients may show withdrawal effects after only a few weeks exposure and upon dose reduction or single missed doses.
Withdrawal symptoms from Effexor may include anxiety, agitation, tremors, severe headaches, nausea, cramps, dizziness, lightheadedness, vertigo, numbness, depression, rapid heart beat, ringing in the ears (tinnitus), motor restlessness, "shock-like" sensations. Auditory hallucination was also reported in one case.
Although the extended release (XR) preparation of Effexor appears to produce fewer adverse effects (such as nausea) acutely, it does not appear to differ from the immediate-release (IR) preparation in likelihood of causing withdrawal reactions.
Some authorities recommend a very gradual tapering of Effexor, perhaps even as long as 6 weeks. Others have suggested the addition of Prozac for about 4 weeks to assist with Effexor withdrawal. Once Effexor has been gradually tapered down and discontinued with the least discomfort, Prozac can be then withdrawn with minimal or no withdrawal symptoms at all. Prozac has a much longer half-life than Effexor (and the other SSRIs). The gradual drop in the blood level of Prozac after abrupt discontinuation acts as a sort of protective mechanism from withdrawal symptoms. Withdrawal symptoms from Prozac are uncommon.
Before you take that Prozac from your medicine cabinet, check the expiration date. I don't see any major problem with taking 20 mg/day but if you prefer to take a smaller dose, that will probably do, too. Actually, before Prozac was available in the lower dose (less than 20 mg capsule) and in liquid form, if lower than 20-mg dose is needed (e.g., the elderly), doctors were advising their patients to open the capsule and put half of the content in a glass of cranberry juice to make it more palatable. This preparation eventually became known as "Cranzac."
I will avoid the use of short half-lives SSRIs such as Paxil, Zoloft, Celexa, Luvox. They are about similar to Effexor in causing withdrawal symptoms. Their short half-lives (much, much shorter than Prozac) lead to drastic drop in blood level if the dose is reduced or stopped,. This, in turn leads to withdrawal symptoms.
Source: Venlafaxine withdrawal. In: Biological Therapies in Psychiatry Newsletter by AJ Gelenberg MD (editor), January 1999.
Posted by Greg on July 19, 2000, at 21:56:49
In reply to Re: help withdrawal, posted by Bunny Goldberg on July 19, 2000, at 2:17:23
Bunny,
Just to be completely safe, wouldn't it be best to just have your doc prescribe 10mg Prozac? I don't know what your circumstances are, so forgive me if I come off sounding a little ignorant. It sounds like you are concerned about taking to much and the 10mg pills would certainly be the safest way.
Greg
Posted by Cam W. on July 19, 2000, at 23:29:04
In reply to Re: help withdrawal, posted by Sunnely on July 19, 2000, at 20:00:37
Sunnely - Don't give up on Effexor (or any of the other short half-life drug) just for fear of withdrawl symptoms, perhaps due to non-compliance or other situations out of your control. Education about how the drug works and why it should not be stopped suddenly would be a better approach. You also have to choose those who are able to follow your instuctions for these drugs. This is really no different than education for the proper use of MAOIs. By saying that you would not use a certain drug, you a depriving yourself of a treatment modality, thus shrinking your arsenal.
I have seen a very low dose of Effexor XR 37.5mg virtually stop panic attacks and I have seen low doses work in GAD where other drugs have not worked. At higher doses Effexor transforms from an SSRI to an SNRI, changing (or augmenting) it's antidepressant effects. High dose Effexor has worked in resolving depressive symptoms that SSRIs could not.
Also, 30-40mg of Paxil works wonders in many cases of panic disorder. So, please don't rule out any drugs that are available, even if it (gasp!) has to be for off-label use.
Oh, and for some reason many people who stop Effexor cold turkey have no withdrawl synptoms, which baffles me. It may have something to do with individual neurochemical mixtures within the brain.
Just some thoughts - Cam
Posted by Sunnely on July 20, 2000, at 0:14:25
In reply to Re: help withdrawal » Sunnely, posted by Cam W. on July 19, 2000, at 23:29:04
Cam,
I wholeheartedly agree with what you said. I was only addressing the issue of how to deal with SRI withdrawal symptoms with less difficulty. I did not mean to insinuate that the short half-life SRIs are not effective for conditions for which they are clinically indicated.
If I am not mistaken, the way I understand Bunny's question is, she wants to stop Effexor. She wants to add Prozac to ease the possible withdrawal symptoms while she tapers down and eventually stop Effexor. I assume she also eventually would like to stop Prozac once she's off Effexor. (Based on her statement that she believes she has a handle on her depression.) Based on this, I still say Prozac, with its long half-life, is the best add-on to a shorter half-life SRI being withdrawn. Once one has tapered down and completely discontinued Effexor, he/she probably could even abruptly discontinued Prozac without fear of bothersome withdrawal symptoms (well, almost always). I don't believe you can do that with any of the shorter half-life SRIs. Just my own 2 cents.
Thanks for your additional comments.
Posted by Bunny Goldberg on July 20, 2000, at 1:20:02
In reply to Re: help withdrawal, posted by Sunnely on July 20, 2000, at 0:14:25
> Cam,
>
> I wholeheartedly agree with what you said. I was only addressing the issue of how to deal with SRI withdrawal symptoms with less difficulty. I did not mean to insinuate that the short half-life SRIs are not effective for conditions for which they are clinically indicated.
>
> If I am not mistaken, the way I understand Bunny's question is, she wants to stop Effexor. She wants to add Prozac to ease the possible withdrawal symptoms while she tapers down and eventually stop Effexor. I assume she also eventually would like to stop Prozac once she's off Effexor. (Based on her statement that she believes she has a handle on her depression.) Based on this, I still say Prozac, with its long half-life, is the best add-on to a shorter half-life SRI being withdrawn. Once one has tapered down and completely discontinued Effexor, he/she probably could even abruptly discontinued Prozac without fear of bothersome withdrawal symptoms (well, almost always). I don't believe you can do that with any of the shorter half-life SRIs. Just my own 2 cents.
>
> Thanks for your additional comments.Boy you people are really knowledgeable about this stuff. I wish my docs knew as much. Anyway, Sunnely is correct - I want to get off all the anti-depressants and anti-anxiety pills and see how I feel. I was taking the antidep. for both depression and for the pain I have from fibro. No one seems to know why but anti-dep. and anti-anx. meds help with fibro pain. Now that I don't feel depressed I would rather live with the pain than feel so detached from life. These pills rob me of my emotion. I definitely don't feel normal emotions on anything I've been on. I'm going to try nutrition and exercise (I eat all the wrong foods and am a real couch potato). The only med I can't live without at this time is Ambiem. I would never sleep if I didn't take it. As far as withdrawal, effexor xr is the only med I've been on that caused such horrible withdrawal problems. Prozac and everything else was a breeze compared to effexor. I also think if I had been told about the withdrawl symptoms at least I could have made the choice of whether to take it or not. Again, I thank all of you for your imput. I'm going to print out your replies to show to my doc.
Posted by Bunny Goldberg on July 20, 2000, at 1:24:42
In reply to Re: help withdrawal, posted by Greg on July 19, 2000, at 21:56:49
> Bunny,
>
> Just to be completely safe, wouldn't it be best to just have your doc prescribe 10mg Prozac? I don't know what your circumstances are, so forgive me if I come off sounding a little ignorant. It sounds like you are concerned about taking to much and the 10mg pills would certainly be the safest way.
>
> GregGreg, of course you are not sounding ignorant. I appreciate the concern. I just didn't ask my rheumy because he is the one who didn't know the first thing about effexor and possible withdrawal problems. I also have a bottle of almost thirty 20 mg of prozac that doesn't expire until 11/00 - so - I figured I would use them and save on my $20 co-pay. I am seeing my family doctor tomorrow about all this. Bunny.
Posted by lolo on October 14, 2003, at 17:35:14
In reply to Re: help withdrawal, posted by Bunny Goldberg on July 20, 2000, at 1:24:42
thanks for all the information you have given reference the proxac. I mentioned this to my doc who said that he wasn't happy with prescribing it for me on withdrawal for effexor. But now I have printed it out and will take it to him tommorrow and hopefully he will now listen, as I am having a really hard time coming of effexor. Feel more depressed now than before I went on them. Thanks. If anyone has any other advice on making this easier i would welcome it gratefully.
Posted by MOTHERNEEDHELP on November 9, 2003, at 23:14:39
In reply to help withdrawal, posted by Bunny Goldberg on July 18, 2000, at 10:54:08
I don't know if i'm doing this right but I have to give it a shot.My husband got hooked on hydracoden(dont even know if this is spelled right)But, i'm sure you know what I mean.I know that he wants off of this b/c he has tried so many times.However, when he stops taking the pills he can't sleep he is up all night w/ his legs jumping around. The doctor put him on this for his back and everytime he would go back to the doctor and tell them he needed more they would give him a bigger qty. and then up the strenth of the pill. Well, now he can't be without them and wishes that he never took one he says that when he dont take them he hurts worse then he ever did before.
This is the end of the thread.
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