A new approach to tapering off Effexor XR
I've been on Effexor XR (venlafaxine HCI) twice in my life. It is a drug that is known to be "the med everyone wishes they never took" because withdrawal from it is horrific.
The first time I was on it, I was only seeing a GP, not a psychiatrist. As with birth control, so with antidepressants: GPs don't know much more than the basics, and all their recent information comes straight from pharma marketing reps. As he guided me through my first Effexor Withdrawal adventure, he took me from 75mg a day to zero in just three weeks. It was horrible. Night sweats, brain zaps, sudden weight gain, dizziness, the works.
This time I'm taking a different approach.
Resources
I've been reading up, as usual. Two key resources have been the Coming Off Psychiatric Medication website and the Harm Reduction Guide to Coming Off Psychiatric Drugs and Withdrawal, a 40 page guide from the Icarus Project.
I am also a member of a mailing list for women with mental health issues, and discussing this experience with them has been very helpful.
Dosage
For every medication, there's a bell curve of how people react to it. Some people react strongly to small doses, some people need a high dose to get an effect, and most people are somewhere in the middle. Recommended doses are based on people in the middle.
Effexor XR comes in units of 37.5 mg each. That is the smallest pill you can get. Each larger pill is a multiple of that, so you can get pills that contain 75 mg or 150 mg. Many people only stay on 37.5 mg for their first week, as they move up to the "clinically effective" doses. I have stayed at 37.5 mg and this has been effective. In fact, if I miss a dose, I begin to experience withdrawal symptoms within 6 hours of when I missed a pill. Moving up to 75 mg only increased bad side effects (e.g. inability to sleep) and did not provide any benefits.
The fact that I react so strongly to 37.5 mg is unusual, but my psychiatrist assures me that this just means that I'm on one end of the bell curve. So, given that I am at the lowest available dose and I react strongly to missing a dose, how to withdraw from it?
How not to get off
My GP the first time around had me take it every other day and then every 3 days and so on, and this is not an experience I want to repeat. It's bad enough when I miss a pill accidentally; I am not doing it on purpose.
This method seems to be standard practice (based on the experience of other people I know who have been on Effexor and gone off it on the advice of GPs) and it is a very stupid idea. Even Wikipedia will tell you that Effexor XR triggers 'discontinuation syndrome' (which is pharma-speak for withdrawal) and that this is due to its short half-life.
What the heck is a half-life and what does it have to do with this?
Every drug takes a different length of time to leave your system. Effexor leaves your system very quickly (five hours), which is why it is offered in an 'extended release' form. Prozac leaves your system very slowly (4 to 16 days). Since Effexor leaves your system so quickly, missing a dose has a bigger impact than it would for other drugs.
With that in mind, consider the effect of taking Effexor XR every other day or every 3 days. Purposely triggering a rollercoaster of dosage-levels in your system is a bad idea and is a recipe for withdrawal symptoms.
My new approach
One of the pieces of advice that I kept coming across in my research is that you should reduce your dose by 10% at a time. Since I am taking 37.5 mg, that would mean taking 3.75 mg less per day. But that dosage is not available to me. So I have to improvise:
Within each capsule, there are granules of the drug. The capsule snaps open pretty easily; you just have to squeeze the yellow part and twist it a bit, and it pops off. It also snaps shut when you reclose it due to a ridge on each of the halves, which is a nice little design element.
Each 37.5 mg capsule contains 150 granules. Yes, I counted them. 10 percent of 150 is 15, so for my first week, I removed 15 granules from 7 capsules, reclosed them, and took one a day. This week I'm taking capsules which have had 30 granules removed from each of them.
My psychiatrist is on board with this plan, and has cautioned me that I should not take the granules by themselves. He's not sure whether the "extended release" feature of Effexor XR is completely contained in the granules themselves or whether it has something to do with the capsule, so he's advised me to keep the two parts together just in case the capsule itself is important. It's also a bad idea to chew the granules, as this would probably immediately release the drug. It's also unclear how the throat and stomach would react to the granules without the capsule. With all of that in mind, I'm just opening the capsules, removing some granules, and reclosing it.
How it's going
So far, it's going fine. I don't have anything to report, and that in itself is a big deal. It's quite encouraging!
I suspect that as the doses get lower, I'll have to slow it down, perhaps removing only 10 more granules a week or something like that. I'm going to keep tabs on how I react each week, and if I have a bad reaction, I'll go back up to the previous level and then try coming down more slowly. If this 15-granules-per-week schedule keeps up, I'll be off by Christmas.
I'm also saving the granules I remove, as you can see in the first photo, and eventually I'll have to explain to a very confused pharmacist what I'm bringing them and asking them to dispose of safely. Psychiatric drugs don't belong in landfills or the water system; they require more careful disposal methods.
Comments
coming off exffexor xr
I have to say thank you very much for this post. I have been doing the 37.5 taper every three weeks and still get bad withdrawl systems. So this makes sense to me and this is my new taper method fromt this point on. It is easy for a doctor to say it takes time and it will pass, however they don't have to miss time off work each week with work piling up and other people in the office not liking you because of it. And besides who wants to explain to people they are a druggie on this stuff. I have had vomiting, vilotent diarrhea, migraine headaches, cramping to the extreme, body cramps, and an off balance feeling like when I had an inner ear infection. Even extreme sweeting and high blood pressure with nose bleeds. It is truley the drug from hell.
Thank you
Hi Little Monkey,
I have been on Effexor XR 75 mg for approx. 5 years now and have tried to "wean" off several times without success and all of the withdrawal symptoms. Its horrible. I was also prescribed this med. by my GP to manage my GAD. I started with the 37.5 mg and increased it to 75 mg per my GP's instructions and have been on this dose ever since. The drug worked ok for me and several of the GAD symptoms went away, but every time I would try to wean off the med, I immediately felt the withdrawal effects. I did this 2 or 3 times during the last 5 years and always had to go back to it. Eventually, I noticed that I always felt sleepy and fatigued, lightheaded and felt "monotone" most of the time (all symptoms I experienced before I started on Effexor) and the latest symptom was sweating more than usual and having body odor!!! Not even the clinical strength deodorants work on me!!! I live in Miami and the heat has just been killing me with this problem. I hate it. In addition to all of the above, my blood pressure increased slightly, putting me in the "hypertensive" category. I should say that I've gained over 50 lbs. in 4-5 years, but don't believe it is a result from taking Effexor, although, I do think it contributed to my sweating, BO issue and related blood pressure problem. I realize now, that the Effexor was causing all of this in me, after believing for so long that it was my anxiety acting up because the effects were so similar...I started seeing a Psychiatrist about 6 months ago (yes, it took me this long to go see one) who recommended an increase to 150 mg. since the side effects I described were tolerable (I use the word loosely). SO, I've been on 150 mg for the last 3 months (approx.) without much improvement. On our last session, I told him about the blood pressure and the sweating and he suggested switching me to Citalopram, which I was all for, but this meant weaning off the Effexor while introducing the Citalopram in my system which terrified me, but I began the process. My Pschyc. suggested the every other day and then every 3 days and so on method which I tried, but stopped after the 3rd day. I felt terrible. So, because I knew how this process affected me, I began to research ways to taper off without experiencing such severe withdrawal symptoms and found your post. I have been trying it your way and I think its working!!!!! I am ignoring my psychs' intructions and tapering off your way...I'm tired of feeling so bad all the time from a substance that is supposed to be helping me....One note on the Citalopram, I am taking 10 mgs and on the 2 days I didn't take Effexor, the BO issue stopped...I am willing to take it just on that single merit. I have hope it will be better for me than Effexor which I will never take again. I am on the 75 mg phase now and like you, I hope to be Effexor free by Xmas!!!
Thank you for writing such a detailed and POSITIVE piece on this topic. You have given me new hope...
thank you for posting, i'm
thank you for posting, i'm currently tapering off of effexor and am at 37.5 mg daily, my gp's advice was to take every other day after this until taking none per day. i really like your suggestion and think i will take your advice since i am currently on the generic venlafaxine. i didn't think that i would be able to make it back to 37.5 mg but i am now having fewer side effects than before although my sleeping pattern is still off and i dont feel nearly as drowsy as i did before. however, i am also 10 lbs heavier and its frustrating. i'm telling myself not to focus on the weight gain but to focus on getting off of this horrible medication! thank you again, i feel like i am not the only one who is experiencing all of these horrible symptoms and side effects!
Using extra granules?
So my GP told me to take one every other day, like most of yours and I just can't believe that she thought this was a good idea. I asked her "won't this be like yo-yo'ing dosages in my brain?" and she emphatically said: no. I've had the withdrawal symptoms enough in the past when I've missed a dosage, I'm not going to purposefully put myself through that!
So the bad news is that I've only got 13 pills to work with right now, but the good news is that I'm going to try your methods, however I don't have the luxury of tapering off as gracefully as yourself. I'm separating them into two different bags: one with 1/2 removed and one with 3/4 removed and I hope this will be good enough. One thing i wonder is if it's possible to buy empty capsules and fill them up with my extra granules? Is there anything special about the Effexor capsules themselves?
There's nothing special about
There's nothing special about the capsules, so far as I know. Definitely not for the generics. You can put the granules in yogurt or juice, just make sure NOT TO CHEW THE GRANULES. Swallow them whole. In my follow up posts, you'll notice that I found that each capsule had different numbers of granules, so you may want to actually count how many you're putting in the capsules, rather than how many you're taking out. Good luck! And don't be too hard on your GP, this stuff changes all the time as new drugs come out and the pharma companies don't go out of their way to educate doctors on how to lessen terrible withdrawal symptoms.Coming off Effexor
Thank you so much for the suggestions. As I am writing this I started my third attempt to come off of this horrible drug. I hope it work a few granules at a time. It is sad we have to go through this. It was never told to me this is a dependent drug. I would have never started. Thank you again I hope it works.
re:using extra granules
Thanks again for your replies. I consulted a friend of mine who is doing her nursing practicum and she told me that the capsules have to do with the extended-release effects. In any case, i got some more pills out of my GP, and of course she didn't like that I was "randomly" removing granules...which of course I understand. She instead wants me to bridge with my former med, Cipralex, however I had a lot of side effects when I first went on Cipralex...I've once again decided to go against my doctors wishes. I'm going to try tapering with 10 granules, then 5, then 3. I haven't taken any yesterday or today yet...trying to stretch my limits and see how far I can go. I was too afraid to do it the first time. It's so hard to go through the shocks and zaps and the discomfort of it all when your cure from these feelings is just a hand-reach away....
Thank you for responding and just putting this information up in general. It has been invaluable to me. I will continue to update about how things are going with me.
Coming off
Wow, I'm glad I found this so soon! I started coming off last September. I was OK til going from the 70 ish to 37.5- had 3 weeks of withdrawal. Yesterday I started what the doc suggested- skip a day, take it for 2 (which really make sense to me). Within 2 hours of the missed dose I felt like crap- the buzzing electric feeling I've been describing to people that no one understands! I'm normal! This is the first time I've heard of someone else feeling like that. Today I took a pill. Tomorrow I will start cutting out some granules. I'm supposed to be training for an Ironman right now- and I feel dizzy walking. Not sure it would be safe to be out on the roads! Thank you so much for making this site.
Cindy
I just wanted to add that if
I just wanted to add that if using this method you should count the granules each time. Mine have varied from 104 to 150. Pharamcist says it is measured by weight, so you need to take, for example, %10 of the pieces each time. (try to take average size pieces as well) 150- I subracted 15; 130, I subracted 13 etc. I'm on day 6 and besides some headaches, it's going very well.
Cindy
Yes, Cindy, I found that as
Yes, Cindy, I found that as well. It surprised me how much they varied! Good luck with tapering off. I'm glad to hear it's going well so far!
it surprised me how nasty the
it surprised me how nasty the stopping effects others discribed.
Cause I was on effexor xr 75 for 4 years but recently I had been feeling mentaly and physicaly distant so my psy. change the dosages to 35.7 for 1 week and half and then 0 at 20 days.
Now it's been 2 months I didn't go through any withdrawl sindroms, but I'm glad to say I feel like myself again even my anger problems came back, I'd rather live with my anger managing it myself then return to being a sheep...
2 weeks after my dosage was 0, I did break a bone in my hand cause of my rage but I was not out of control, I had time to tink about the consenqueses of punching something and I knew I couldn't repress it so I gut punch my room door (ps it's a solid fire proof door) so I broke something, but I more happy that in real time I made my mind was less then a sec, but in my mind it felt like I tough about it for over 2 min.
For my experience it was a double possitif with just one negatif. Now the only med's I'm left on are Lithium.
thank you for letting me share with you all.
Sick as a Dog
I tried a much faster than optimal taper and am currently feeling severe withdrawal symptoms.
wow this is great
Hi, I am so happy that I found this webpage! I have been on effexor 75mg for years and have beent rying to quit smoking for years as well. I have done talking therapy, lazers thereapy, hypnosis, patches, pills, fake smokes, you name it I have tried it, even cold turkey. I tried wellabutrin a few years ago because a natural side effect of it is that most people quit smoking. It worked for me, I suffered through effexor withdrawl for a few weeks went on wellabutrin, quit smoking for three weeks then went back on the effexor because I couln't handle the nausea, noises and constant tireness. Started smoking again. I talked to my Dr. a few weeks ago he said to try it again, go on 1/2 dose effexor for 5 days then cut off and take wellabutrin, well it has been over two weeks of nausea, headaches, noises, sleep, and general hell for me and my family. I am not going back on the damned effexor, nor have I quit smoking yet, my question is can I just stop the wellabutrin when I have quit smoking? my doctor wants me to stop the wellabutrin then do 5 days of 1/2 effexor and then full 75 effexor, I am not going back on the effexor, ever.
So does anyone have any ideas about how much longer I will be sick from the effexor withdrawl? I have just started looking this up today on the internet so haven't found any answers yet.
Once again, thanks for sharing your stories, I thought I was crazy or something, my family thinks I am playing it up and it has been really hard to be so sick for weeks.
thank you
Thank you so much for this site. I just found it after being on effexor for 12 years. I've gotten down to 35.7 and for the past month have been taking it every 36 hours. After just passing a bad night of electric shocks and sweats, I felt like a heroin addict grateful to get my dose this morning. I've been functioning ok on the 36 hour dose despite feeling bad at 24 hours (roughly) but I will try your method starting tomorrow. I'm committed to getting off the medicine entirely this year. Thank you so so much. Allison
Just starting
Wow this is my 4th day on effexor xr and I thought it was hard to adjust to it, I can't believe all the horrible stories from people trying to get off it. It was given to my by my gp for anxiety and panic attacks and im wondering now is it really worth it?Add comment
Effexor withdrawal
I used basically the same approach you described above. I took effexor xr for 5+ years and wanted to stop for at least 3 but couldn't because of the uncomfortable "discontinuation" effects. My doctor had me reduce from 75 mg to 37.5 mg, then I was supposed to take 37.5 mg every other day.... couldn't do it. I had to take it every 36 hours for a while, then down to every other. The next step per my doctor was to "just stop". OK, tried that, very bad. I couldn't tolerate it and had to start taking it again. I researched on line and came across the tapering off by removing granules from the capsule method. A Social Worker with whom I was visiting with (not being "worked on" by) mentioned that her son had to reduce "granule by granule" in order to get off his antidepressant. I was taking the brand name with 150 granules per capsule, and I made a plan to remove 3 granules, take that dosage for 3 days, then remove 6 granules for each of the next 3 days, and so on. Only problem--I couldn't keep track of where I was in the reduction scheme or I'd forget to remove granules and take a full 37.5 mg.... I stayed on the 37.5 mg daily for a while, then a generic form appeared when I got my refill, and the 37.5 mg generic capsule contained 40 granules instead of 150! I formed a plan again, reducing my dosage by one granule more every 3 days. Sometimes I got brave and only went 2 days. I tapered all the way down until (foolish as it seemed) I was taking only 1 granule in the capsule, then finally stopped. The next day was harder than I had anticipated. I rummaged around in purse and pockets and anywhere I may have stashed an extra capsule, feeling like a street druggie. Couldn't find any. I toughed it out (because I had no medication, I was going to be danged if I spent any more money on this stuff unless I really couldn't stand the withdrawal, and besides, my prescription was through mail order). I made it through, and each day since (it's been 3 weeks) has been just a hair easier. My symptoms have mostly been the electric currents, not shocks really, not zaps, more a flow of current, at various times and durations during the day. There is some disconnection from myself at these times, hard to describe, kind of like not being lined up with myself or slightly next to myself, but the duration and frequency has become shorter and shorter. I find myself tangling up words. I am having some trouble sleeping, but not too intolerable. Knowing that the symptoms I am experience are due to withdrawal makes it possible for me to push through them, but only after the very very slow granule by granule tapering. I pity anyone who can't afford their refill or stops taking the drug according to instructions like those given me by my prescribing physician, who doesn't know what to expect. I think I may get to the point where I don't have the withdrawal effects any more. Right now it's just something that's with me, like the scar from a major surgery I had that I continued to feel months later, not debilitating but enough to be a reminder of what I had been through. Time will tell.