Tips on minimizing withdrawal symptoms from Effexor (aka Venlafaxine)

I have been on Venlafaxine for 2o years
I now want to come off as it may have contributed to recent sleep disorder
I am in 150 mgs slow release
What dose is best Do I get a prescription for 75 mg first rather than alternate days?
Welcome anyone sharing their path with me

Hi, I’ve been on 300mgs daily of venlafaxine for the last 15+ years. Six months ago I started reducing my dosage very slowly. I had no problems until I was down to 37.5mgs BUT, I started on that dose by taking 75mgs on alternate days. I think this is what catapoulted me into severe withdrawals. I have just bought the book: ‘The Maudsley Deprescribing Guidelines for Anti-depressants etc.’. (The ‘Maudsley’ refers to a very large hospital in England, U.K. which specialises in psychiatry). In this book it states that taking this stuff every other day can bring on withdrawal symptoms. It’s all to do with the chemical levels zooming up and down on the alternate days, (I think). Anyone thinking about reducing their venlafaxine, and who doesn’t have a doctor who is very experienced in this, should have a copy of this book. It’s very readable and is packed with information. It’s not cheap, I paid £45.00, but it’s worth every penny. It looks as though I am going to end up back on my full dose of 300mgs again, to hopefully get rid of these appalling withdrawals. Having stabilised, I then intend to try again, even more slowly, and not taking doses every other day. I wish you luck! Proceed more slowly than you think you need to; be in close contact with your doctor; stop reducing your dose if you get withdrawals, until you’ve stabilised; buy the book before you start.
Regards,
Zainah-Elizabeth Lovell

Hi kratz5,

Great question :)! Thank you for asking. Sorry in advance for the botchy English, I'll try to make something coherent 😉

The past six years a lot of things have changed. All these changes made me realize that I'm in a very different place than where I was when I got prescribed the 300 mg at the time. I felt I'd no longer need as high a dosage anymore. Also the side-effects of anti-depressants are no fun.
I wanted to know how I'd feel at a lower dosage. I've consulted this with my doctor and she agreed with me tapering off it.
Below are the first things coming to mind when I think about the changes that helped me come to this decision.

1. Therapy and understanding my mind a lot better:
- I've learned and worked through a lot in therapy (although it took a while before finding the right type of therapy). Especially Schema Therapy and EMDR really helped. I've learned better ways to cope with my depression and anxiety as well as things to be mindful of in order to not exacerbate it.
- Two years ago I was diagnosed with ADHD-i(nattentive type). It explained sooo much and helped me understand myself much better.

2. Self-compassion and daring to be vulnerable:
- Allowing my emotions as well as practicing self-compassion (still a tricky one for me ;)!) have gotten better as well. Trying to be kinder to myself, instead of the usual anxiety driven perfectionism and judgments towards myself, played a major role in getting "better".
- Learning that it's okay to open up or to ask for help - and that you're not a burden for doing so! - made me feel less alone. At times it was like I didn't have to carry all the struggles by myself - like a bit of the weight I felt on my chest all the time was lifted.

3. Change in environment
- Among many things, my study, job, housing, relationships, are different from where I was six years ago. In a good way.

I don't intend to taper off fully right away. It would be nice if possible, but it is not my goal 🙂

Hope this answers your question!

-------------------------------------
Update in tapering schedule:
After consulting my doctor, right now I'm alternating 225 mg and 187,5 mg a day for two weeks. She told me this way I take an average of 206,25 mg daily.
After this, I'll go to 187,5 mg daily for two weeks. After that, alternating 187,5 mg and 150 mg for two weeks. Then 150 mg daily for two weeks.
This way, in theory, I'd taper 18,75 mg every two weeks because 37,5 mg every two weeks was definitely too fast!

Current side effects are dizziness, fatigue, headaches and major brain fog. Perhaps I'm still tapering too fast.

Thanks for the tip @njoys about the tapering strips! I'll look into them!

Hi there!

Right now I'm alternating between two different doses, suggested by my doctor. I'm alternating 225 mg and 187,5 mg for two weeks, because from 225 mg to 187,5 mg in one go was to fast for me (see post below).

I'm still unsure if this is not too fast, because I'm still experiencing quite some withdrawal symptoms, though they're less severe then before alternating.

Either way I'd suggest to taper off in the smallest steps possible to minimize withdrawal symptoms. I have 37,5 mg capsules (slow release), but maybe they're even lower dosages in capsules. I still have to look into that as well as the tapering strips.

Thank you for your reply and explaining your situation. Much more understandable now.
I will pray for you, and I wish you the best with all your life’s achievements and all those yet to come.
God bless you !

Thanks
37.5 is the lowest slow release
However it is possible to get the drug in liquid form with a special prescription
Another member of the group suggested a book by The Maudsley Hospital and I will attach the regime recommended by them
Best wishes

Maudsley® Deprescribing Guidelines
reductions made every 2-4 weeks.
Step
RO (%)
Dose (mg)
88.4
300
Use tablets/capsules
150
Use tablets/capsules
86.7
112.5
Use tablets/capsules
CHAPTER 2
2
3
4
85.7
83.6
75
Use tablets/capsules
Switch to venlafaxine 7,5mg/mL solution*
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
81.5
55
3.67mL (twice daily)
25
26
27
28
29
30
79.8
45
3.00mL (twice daily)
77.6
37.5
2.50mL (twice daily)**
75.7
30.4
2.03mL (twice daily)
73.7
26
1.73mL (twice daily)
71.7
22.6
1.51mL (twice daily)
69.7
19.8
1.32mL (twice daily)
67.7
17.5
1.17mL (twice daily)
65.7
15.6
1.04mL (twice daily)
63.7
14
0.93mL (twice daily)
61.7
12.6
0.84mL (twice daily)
59.7
11.4
0.76mL (twice daily)
57.7
10.4
55.7
0.69mL (twice daily)
9.4
53.8
0.63mL (twice daily)
8.6
51.8
7.8
0.57mL (twice daily)
49.8
7.2
0.52mL (twice daily)
31
32
33
34
35
36
37
38
39
40
41
42
43
44
47.8
6.6
0.48mL (twice daily)
45.8
6
0.44mL (twice daily)
43.8
5,5
0.40mL (twice daily)
0.37mL (twice daily)
See further steps in the right-hand column
45
46
47
RO = receptor occupancy
41.7
5
Volume
39.8
4.6
37.8
4.2
0.33 mL (twice daily)
35.7
0.31 mL (twice daly)
3.8
33.9
0.28mL (twice daily)
3.5
0.25mL (twice daily)
32.0
3.2
0.23mL (twice daily)
Switch to venlafaxine 0.75mg/mL dilution*
0.21 mL (twice daily)
30.0
2.9
27.9
2.6
1.93 mL (twice daily)
25.6
2.3
1.73 mL (twice daily)
23.5
2.05
1.53mL (twice daily)
21.3
1.8
1.37 mL (twice daily)
19.5
1.6
1.2mL (twice daily)
17.5
1.4
1.07 mL (twice daily)
16.0
1.25
0.93 mL (twice dally)
14.4
1.1
0.83 mL (twice daily)
12.7
0.95
0.73 mL (twice daily)
10.9
0.8
0.63 mL (twice daily)
9.1
0.53mL (twice daily)
0.65
7.1
0.43mL (twice daily)
0.5
5.1
0.33mL (twice daily)
0.35
0.23mL (twice daily)
Switch to venlafaxine 0.075mg/mL dilution*
3.0
1.5
0.2
0.1
0
0
1.33mL (twice daily)
0.67mL (twice daily)
0
out beads or making a suspension are outlined above.
our are on on al, the of label options for making up smal doses including masans

The YouTube video available through this link is informative and explains why alternating doses is not ideal: https://iipdw.org
It is entitled, "Antidepressant Withdrawal Syndrome & its Management," presented by Stevie Lewis & Dr Mark Horowitz, on behalf of the International Institute for Psychiatric Drug Withdrawal (IIPDW).

I didnt know I was on an extremely high dosage which was 400mg per day until my psychiatrist retired and I had to get a new one. The scary thing is that I was at 500mg before that for awhile. I've been taking this medicine for about 10 years. My new psychiatrist told me that 400mg was an extremely too high of dosage and it could hurt my heart. He tapered me down to 225mg within in a month. He had me take 20mg of xanxax with it to help with the withdrawal symptoms. Everything seemed fine and I was doing really well at first. But then when I got down to 225mg, he had me stop taking the xanax. I started struggling with feeling depressed and having anxiety. My head hurt all the time and I had no patience. I couldn't sleep and I felt like I needed to move my legs all the time while laying down. Then I received some bad news that turned my world upside down and I couldn't stop crying and could barely get out of bed. I didn't go to work and I stopped taking care of myself. I will admitt, it was the scariest and hardest time of my life. I became so lost in the pain and feeling like I would never be happy again. I was seeing a therapist during this time. I had to continue to advocate for myself, even when I felt like giving up. I told my psychiatrist and he switched me to the extended release venlafaxine ,which did nothing. I had been on the extended release before and it didnt work. I had to continue to to keep on him and telling him this isn't working, even when I felt like there was no hope. He said I could start taking the Xanax again and weeks went by and I was still not getting better. I was exhausted and tired of fighting for help. I finally got them him to do something different and he put me on 40 MG of xanxax. This seemed to work and I started to feel like my oldself again. But I have to say, during the times I was on my period, it felt like I was on no medicine at all. I tried to tell my psychiatrist and he acted like it was no big deal. Each time I was on my period, the depression was 100 times worse. I'm looking for a new psychiatrist, because I believe mine was very careless and doesn't know the power of this medication or the seriousness of the side effects. I've also have had memory problems while on this medication, I can see in my head what I want to say, but I can't think of the word. I forget things very easily and also have severe constipation which I have to take other medication for. Both of these symptoms were dismissed as being unrelated to the medication. But I didnt have them, before I was on the medication and I've recently read about others who have them too. I really am hoping to find a psychiatrist who knows more about this drug, I know it can be hard to advocate for yourself, but keep trying!

You are right about the symptoms you’ve experienced; they are all related to the venlafaxine. I have all the same ones with the exception of the needing to move my legs when laying down. Which country are you in? That will probably affect how you find a new psychiatrist. I’ve been trying to reduce my venlafaxine, but at the moment am back on my original dose of 300mgs daily because of withdrawals. Should you ever want to do this, there is a book called: ‘The Maudsley Deprescribing Guidelines for Anti-Depressants etc.’. I paid £45.00 for my copy and it’s worth every penny, and should keep you safe. Good luck with everything!