Tapering Off Gabapentin

There are a very small but measurable number of people on Effexor (Venlafaxine ) who experience what's called "flipping." Instead of the depressive symptoms easing, they go the other direction. I know this from personal experience. In my case I become suicidally depressed, filled with rage, harbored violent fantasies (fortunately I didn't act on these, some people do), got extremely paranoid, developed sleeping and eating disorders, had become dishonest, and more. It went on for several years, and none of this was in character for me. I tried my best to conceal it because I had come to presume it was normal and honestly couldn't see a way out of it. The only thing my wife saw were the temper tantrums, which were beginning to threaten our marriage after 30 years. I never told her about the depression until I landed in the hospital after a near suicide attempt. That was the dishonesty at work. Even after discharge, presuming that I was adapted to the drug, I was kept on it with a mood stabilizer added. I leveled off a bit for a while, and the suicidal thoughts went away for a few months, but I was still in the worst place in my life. Flat and emotionless.

After a few months I turned suicidal again and quit the drug in a rage, figuring it wasn't doing me any good and I no longer cared if I got worse. I certainly wasn't expecting to begin getting better emotionally within days, but that's exactly what happened. I quit it all on a Sunday, and even though the withdrawal symptoms are brutal, my brain fog started clearing out by Friday. I could tell. (I do NOT recommend going cold turkey like I did; the symptoms went on for weeks - do it under medical supervision.). That's when I stumbled on a study on PubMed describing exactly what I had been through. I started reading it, and realized I checked off just about all of the boxes. Effexor was singled out as particularly problematic in these cases. If there had been even a chance of me going back on it, after reading the study, I determined to stay off of it and ride out the withdrawal no matter what. I've since found another article in the British Journal of Medicine about antidepressants in general that also noted these behavioral changes in a fraction of patients. This isn't Facebook medicine, this is documented and peer-reviewed. 99%+ of the time they are effective, but there are rare exceptions. I was one of them.

My psychiatrist was initially skeptical when I told her about the study (it's an outlier), and said to her, “I think this is what happened to me.” But at this point, months later, she's concluded that yes, I was one of those rare cases. The reversion to normalcy simply happened far too quickly for any other explanation.

I have since gone on Lamictal, an anti-convulsant for epileptics that has shown some off-label success treating depression, especially bipolar 2, which I'd been diagnosed with (I do believe the diagnosis is correct based on the whole of my life). The entire experience was too extreme, and coming out of it was too recent. I didn't feel comfortable with nothing. I've been free of depression now for six months after three years of daily suicidal thoughts. I'm no longer contemplating violence. I haven't lost my temper once, something that had become almost weekly. The paranoia has gone away (I live in a very low crime place, there was no real reason for it), and my sleeping and eating have gone back to normal. And as I said, these changes started happening within days of my quitting Venlafaxine, which, like you, I had been taking for years.

I’m sticking with the Lamictal for now, as I do not know what the balance between taking that and getting off the Venlafaxine is in all of this, but given the success, I don’t want to mess with the chemistry. I’m also in counseling, trying to work out and come to terms with all that occurred. I think this is important. I’m still recovering memories of that period, my mind had blanked them out.

I would advise asking your psychiatrist about this. Whether it's part of your problem or not I cannot say. But it's worth looking into. I cannot tell you in words how differently I feel from a year ago at this time, and it began when I abruptly quit Venlafaxine.

I’m not kidding. It’s like a miracle.

I'd like to invite @wedge58 to this discussion. @wedge58, you mentioned wanting to Connect with members who were weaning off of gabapentin. In this discussion, https://connect.mayoclinic.org/discussion/tapering-off-gabapentin/, members share how they have weaned off of this medication and their experiences may be helpful for you.

I started tapering off 1100mg Gab and over 6 weeks was able to reduce to 300mg. However when I tried to reduce from 300mg to 200 mg capsule, drop was way too much and not tolerable. My PCP gave me a rx for Gab oral liquid solution which allows for much small dose reductions. I have been able to cope with the withdrawal symptoms, but the paradoxical effect, (significant increases in pain, etc) that happens with each drop has been hell. Each time dose is lower, pain gets worse. I am down to 180mg, and have been dropping 5% each time. Interested in hearing from people in this or similar situations in terms of how frequently you are dropping dose to try and minimize the paradoxical effect. I was able to drop 10% every other day from 300mg - 200mg. Now trying to drop dose 5% daily. As I mentioned, currently at 180mg.

@annedenner
Good luck.
I just started tapering down Gabapentin which I've been taking for cervical and lumbar inflammation. I've been on the drug over ten years. The dose was 2,400mg per day which I'm trying to taper off 600mg at a time for a two week period. No significant withdrawal symptoms yet but just started a few days ago. I'm also tapering down Hydrocodone-Acetamin 10-325 for the same inflammation and on the same schedule. The dose was four pills a day and currently down to three.

@ripvan
Good luck on your taper but considering your dose, time on med and taper amount it seems quite fast to me. I hope you don't have withdrawals but as your dose decreases you may want to consider lowering your dose and lengthening your taper period.
Although more likely in people with a history of seizures, severe seizures are possible tapering to quickly, including status epilepticus which are dangerous seizures that don't resolve without medical intervention. I certainly wouldn't taper two drugs at once. Why the rush to stop them so quickly?
You should seek tapering advice from your physician.
Take care,
Jake

Thanks Jake, that's good advice. Frankly I'm tired of taking this pain medicine and I'm not sure whether it's helping me at all. I'll check in my pain management doctor to set up a taper schedule for the medications.

@edematta I’m on 300 mg 3 times a day. I have neuropathy in feet and lower legs plus new back pain Helps Back pain for 2 hrs. nerve pain doesn’t make better just different Asked for my neurologist guidance to go off and start something else or possibly nothing else. She just says go off and do another drug or just go off entirely. No guidance on any taper plan She very careless Put my on Tramodol That lasted 2 day I was a zombie and couldn’t breathe Stopped immediately Neurologist was actually irritated when I stopped😳