Tips on minimising withdrawal symptoms from Effexor (aka Venlafaxine)

Posted by richyrich @richyrich, Nov 2, 2016

I have been taking Effexor/Venlafaxine for years and tried to get off it a few times but each time I try to give up the chemical withdrawal symptoms are a horror story and I give up giving up. Anyone got any tips or tried and tested strategies? Thank you

@youngsally

I am going through a tapering right now…my therapist was really concerned that it would be difficult – but so far – not too bad…especially considering how damn awful it was getting on the drug. But I feel for you. It seems Effexor has a reputation for being really difficult to taper off for a lot of people.

Was on Effexor XR 150mg c. 15 years….It probably stopped doing much for me 5 years ago. Previously had been on prozac (did nothing), serazone (ditto), Paxil (helped but made me FAT)….and then Effexor. . I am on week three of a four week titration (Week 1: 37.5mg TID, Week2: 37.5mg BID, Week3 37.5mg once a day) and should be off by next week. I've had limited problems specific to the withdrawal- one day during week 2 of mild facial numbness, and today I am on day 4 of week 3 and have had my first real "crazy dream" night and I slept through my alarm twice….also some facial numbness today. I am scheduled to titrate off completely by Monday – but will probably stay at 37.5mg until I see the psychiatrist late next week or the symptoms moderate over the next couple of days.

Maybe you should seek some guidance on a tapering schedule…although I think mine is pretty standard. I've been fortunate so far – but won't know until I've been off for a couple of weeks.

PS – I also have a lot of difficulty getting to sleep (but I had that prior to taking any antidepressants).

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Thank you for your response and advice. I have an appointment with my oncologist Wednesday, so I am going to have a lot of questions for him. My biggest question would be why he put me on this Effexor right after my surgery before I was showing ANY signs of depression or mood swings.

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@texasduchess

I mentioned that I did some research to see what steps I could take to minimize the Effexor "discontinuation" symptoms I started experiencing six weeks after taking my last dose after tapering slowly; here's a bit of what I learned.–

78% of people stopping Effexor (venlafaxine) have withdrawal reactions. (In this situation, I would have been happy to be in the 22%!)

While anti-depressants aren’t addictive in the sense that cocaine and other street drugs are, they do cause dependence, meaning the brain has to substantially reorganize when you stop taking them.–Therese Borchard, Everyday Health Columnist

Withdrawal symptoms are more likely with antidepressants that stay in the body for a short period of time, especially medications that affect both serotonin and norepinephrine such as Cymbalta (duloxetine) and Effexor (venlafaxine).–Nootriment.com

Certain supplements are well-known to buffer the effects of withdrawal. The right supplements can make a huge difference in expediting your recovery. Think of supplements as a way for your body to repair itself and minimize withdrawal symptoms. They help make the transitory process from being medicated to being medication-free a little bit easier.

NOTE: These supplements are helping me, but might not be helpful to you. I went through quite a bit of trial and error; I have a whole shoebox full of supplements I tried and either didn't find helpful, or found something better, or chickened out of trying (kratom). The friendly folks at Vitam*n Sh*ppe now know me by name instead of just recognizing my face.

ALSO NOTE: I am not a doctor–I'm not in the medical field in any way other than as a patient. It's always recommended to consult with your doctor before taking anything and to consider what you are already taking. You can learn about some supplement interactions here–https://bottomlineinc.com/health/supplements/new-dangers-supplement-users.

Fish Oil–During withdrawal from an anti-depressant, one of the quickest ways to help the brain heal is to supplement high-quality omega-3s (there are significantly more omega-3s per serving in fish oil than in krill oil). For some people, omega-3s may significantly improve symptoms of anxiety. Many people have documented significant reductions in the frequency and number of “brain zaps” they experience during withdrawal as a result of supplementation. Many people become highly irritable during withdrawal from anti-depressants. While omega-3s will likely not cure the irritability, they may help improve it. The improvement is likely a result of changes in brain activity and neurotransmission.

L-tryptophan–Your serotonin levels are likely abnormal upon [anti-depressant] discontinuation. The drug rewires your brain to become dependent on it to create sufficient serotonin. When you discontinue the drug, the brain is still expecting to receive the serotonin boost that it got from your anti-depressant. It takes the brain a little while to figure out that it’s no longer getting any serotonin from the medication. Things can then get chaotic as the brain attempts to reset its normal functioning. L-tryptophan is an essential amino acid that is an indirect precursor to serotonin. Tryptophan is metabolized in the liver into 5-HTP, which then travels to the brain and is converted into serotonin. By taking L-tryptophan (or 5-HTP), you’ll be increasing the level of serotonin within the brain. This helps reduce anxiety, can improve mood and decrease all withdrawal symptoms related to low serotonin. Some people find that for targeting insomnia, L-tryptophan is the more potent option. If you are taking 5-HTP, or L-tryptophan daily (dosage 6-12 g split into 3-4 doses per day), you may want to keep at it for a few months. Once you’ve taken it for a few months, you should then attempt to reduce the doses and taper yourself off. These supplements help increase serotonin levels, but you don’t need to rely on them long-term.

B Vitamins–Vitamin B3 aids in the conversion of tryptophan and B6 helps the body make the hormones serotonin (which regulates mood) and norepinephrine (which helps your body cope with stress). Long-term high doses with supplements (not from food) can lead to liver toxicity and nerve effects.

GABA–Should calm you down, reduce anxiety, curb insomnia, and decrease agitation. This chemical occurs naturally in your brain and produces feelings of calm, lessens the neurological signs of nervousness and stress, increases focus and aids in falling and staying asleep. GABA is one of the most important brain neurotransmitters for mood regulation and boosting alpha brain waves. Some believe that oral GABA works by stimulating GABA receptors in the stomach which are capable of communicating with neurons in the brain. Much of the GABA found in the body is produced in the gut.–Excerpted from Mental Health Daily Taking GABA with other supplements such as l-arginine may help it cross the blood-brain barrier.

Ashwagandha–Can reduce the stress hormone cortisol by 25%. It is very helpful at calming anxiety of all kinds. Ashwagandha is safe to be consumed for 6-8 weeks; following this, abstain for a month before resuming consumption to avoid dependence. High doses could worsen acidity, ulcers, skin rashes and anxiety. (People using diabetes, blood pressure, thyroid, anti-anxiety, or immuno-suppressant medications; sedatives; or alcohol should consult their doctor first before using ashwagandha.)

Lemon balm–Purported to possess sedative, or tranquilizing effects. Lemon Balm essential oil can interact with GABA receptors in the brain and also increase alpha waves (which indicates relaxed states) similarly to GABA. The Natural Medicines database has rated Lemon Balm as Possibly Effective for improving symptoms of anxiety.–Nootriment.com

Kava–Increases the number of attachment sites for GABA in the brain. By creating more attachment sites, the effects of GABA might be more profound, which results in a mild sedated state. This herb might have detrimental effects on the liver if consumed in excess.–Livestrong.com

Rhodiola rosea extract–Modulates the enzyme monoamine oxidase which metabolizes serotonin. When it is inhibited, serotonin synthesis increases. Dosage: 200-1,000 mg per day, taken 1-3 times per day.–Nootriment.com

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L-arginine and Vitamin C can help the l-tryptophan work.

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@texasduchess

You can learn about some supplement interactions here—https://bottomlineinc.com/health/supplements/new-dangers-supplement-users

My discontinuation symptoms began at the end of the first week of June (about six weeks after my last tapered dose of Effexor). I tried Thean*ne Serene, Anxi*-T, Natur*al Calm and 5-HTP for the anxiety and took melatonin, valerian and Ben*dryl to sleep. On 6/19, in desperation about the akasthisia, I sent my husband to Vitam*n Sh*ppe at 8:30 pm to get L-tryptophan before they closed at 9. Taking one 500 mg L-tryptophan as soon as he got back immediately relieved the akathisia (agitation/anxiety/restlessness) I was feeling.

Note: I am not a doctor and you should consult your doctor before taking any supplements.

I am taking 4-5 times per day (usually 4 to 5 hours apart, depending on how late I stay up):
• 3 1,000 mg fish oil capsules (EPA 650 mg)
• 1 500 mg L*dtke brand l-tryptophan (This made such a difference to the agitation I was feeling!)
• 2 500 mg Solg*r brand GABA
• 1 500 mg l-arginine
• 1 470 mg ashwagandha root extract capsule
• 5 100 mg B6 tablets (now reduced to 2 qty)

Occasionally I take:
• Dram*mine (for vertigo)
• Ben*dryl (sleep aid) as needed (I don't need it very often now)
• My oncologist who prescribed the Effexor many years ago prescribed 15 5 mg diazepam to take as needed when the akathisia/anxiety gets too bad. Since filling that prescription on 6/20 and figuring out what supplements help me, I’ve only used 5.5 tablets (taking 1/2 tablet now and then).
• Lemon balm Purported to possess sedative, or tranquilizing effects.
• Kava Increases the number of attachment sites for GABA in the brain. By creating more attachment sites, the effects of GABA might be more profound, which results in a mild sedated state. (Good for the fluttery feeling I sometimes get in my chest and anxiety.)
• Rhodiola rosea extract—Modulates the enzyme monoamine oxidase which metabolizes serotonin. When it is inhibited, serotonin synthesis increases.

I was on Effexor for 18 years, so I don't expect to return to normal for a while yet. I will keep up this regimen for another 45 days and then try tapering to 3-4 times per day, 1-2 times per day, etc.

P.S. I have noticed that I must be careful what shows I watch (nothing too violent, too stimulating, too many camera angles) and I can't get too hot (it's August in Texas!), or I start feeling anxious/agitated. So, I am trying to maintain an even keel and not do anything out of the ordinary for now (so not taking up skydiving).

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I have added 1 1,000mg Vitamin C capsule to the list above to help the l-tryptophan.

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@snooterbell

Thank you for your response and advice. I have an appointment with my oncologist Wednesday, so I am going to have a lot of questions for him. My biggest question would be why he put me on this Effexor right after my surgery before I was showing ANY signs of depression or mood swings.

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A friend has been in remission from a breast cancer (sorry don't know more about it other than it is hormone sensitive but was cared for with surgery and chemo) – her oncologist switched her from tamoxifen to an aromatase inhibitor after five years (when she would be at menopause) — and her moods have been awful. As I understand it – the AI's can really affect one's mood and so antidepressants are often prescribed- and, alas, my friend doesn't believe in antidepressants…or medicine in general – so we all suffer with her horrid moods. But I'm not a doctor or even remotely knowledgeable on oncology – so take this anecdote for what it is. But you are doing the right thing by asking your oncologist why it was prescribed – although it takes time to titrate up and to see if an SNRI is even the right choice for you. When in doubt – ask questions….and if you have side effects on something that you find intolerable – speak up…

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@joecub

I'm in the process of reduction dosage of Effexor under the care of my Psychiatrist. I was on 225mg and have been reducing by 37.5mg each week. Now at 112.5mg and feeling the skin affects and powerful dreams that are borderline nightmares.
Anyone else who has these dreams?

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They just started for me — but I've had them before when I missed a couple of doses. For me the dreams are kinda fun – and certainly crazy. I'm down to 37.5mg from 150 in 3 weeks….so I went almost 3 whole weeks before the dreams hit.

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@youngsally

A friend has been in remission from a breast cancer (sorry don't know more about it other than it is hormone sensitive but was cared for with surgery and chemo) – her oncologist switched her from tamoxifen to an aromatase inhibitor after five years (when she would be at menopause) — and her moods have been awful. As I understand it – the AI's can really affect one's mood and so antidepressants are often prescribed- and, alas, my friend doesn't believe in antidepressants…or medicine in general – so we all suffer with her horrid moods. But I'm not a doctor or even remotely knowledgeable on oncology – so take this anecdote for what it is. But you are doing the right thing by asking your oncologist why it was prescribed – although it takes time to titrate up and to see if an SNRI is even the right choice for you. When in doubt – ask questions….and if you have side effects on something that you find intolerable – speak up…

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Thanks for your reply. I did notice myself starting to get irritable. I don’t want my family to suffer because I don’t want to take an antidepressant. I did get my refill and I will still ask my doctor Wednesday about it. I suppose they are working. I just haven’t noticed it until now. And maybe he just wanted to get a jump on it before depression set in. I’m not a doctor either. Lol!

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@texasduchess

@edziner
Thank you for letting me know that CBD oil is working for you and your friend. At the start of my symptoms back in June, I visited a couple of local head shops and bought a 500 mg bottle of Green Garden Gold Hemp Oil Supplement (Med Pac MCT Coconut Oil with naturally occurring CBD; hemp extract 16 mg). (Anyone know if this particular brand is any good?) Brightwings AKA Cute Susie was using CBD oil very successfully. Only tried it once as supplements, particularly L-tryptophan, were working for me.

It's just this Friday, Saturday and today that I am resorting to the Valium more than I want to–I have such a small supply and don't want to use it up if a worse episode occurs later and I have nothing. Not sure what's different about this weekend and why the akathisia/anxiety is so bad. I've pulled the Hemp Oil out and put two drops under my tongue (I believe Cute Susie said less was better and start slow although the bottle instructions say to use 1 to 2 droppers full twice daily).

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Well, it's been a cr*ppy week, or so. My akathisia got the better of me this past weekend. For a few days before, I tapered way back on the supplements especially the l-tryptophan as I was using more Valium (see my 8/19/18 post) and thought maybe I had too much serotonin building up and that was ratcheting up the anxiety. Then last Friday's two-hour staff meeting and hour+ meeting after lunch was too much; despite taking 1/2 a Valium and several doses of l-tryptophan, GABA and B6 throughout the afternoon, by the time I got home, I was having a lot of akathisia. I was able to calm down late evening and rest Saturday. Sunday I began an acute episode of akathisia. Around 4 pm, I felt I had better go to Care Now as I was not getting relief from the maximum Valium dosage. Fortunately, the doctor I saw is familiar with Effexor withdrawal. She wrote a prescription for a l-methylfolate supplement as well as a three-day stay at home taking a whole Valium twice a day and resting. Her thinking was that I needed to use a significant amount of Valium to stabilize and then back off. I am also back to taking all my supplements four times a day. All of this seems a pretty serious consequence for taking 25mg of Effexor for hot flashes despite slow tapering and being off the drug for MORE THAN FOUR MONTHS!

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Saw this info about an Effexor tapering kit (New Schientist 7/7/17); I have no affiliation with this group, nor have I tried the kit. May only be of use to those in the Netherlands–
https://www.newscientist.com/article/2140106-people-are-hacking-antidepressant-doses-to-avoid-withdrawal/
https://www.cinderella-tx.org/en/
http://www.taperingstrip.org/
To help people taper their dose more easily, a Dutch medical charity, called Cinderella Therapeutics,together with Maastricht University creates personalised "tapering kits”, with precisely weighed out tablets in labelled packets that gradually reduce over several months. The website recommends people do this under medical supervision and must first receive a doctor’s prescription.

The charity has been sending out such kits since 2014, distributing around 2,000 tapering kits for 24 different medications so far. Most of these were for people in the Netherlands, but a few kits have been sent to other countries, including the UK. The website is in Dutch, but an English-language version is being launched next week. [Is now launched.]

Pharmacist Paul Harder, who makes the tapering kits for Cinderella Therapeutics, says an unpublished survey by the charity found that about 80 per cent of users manage to completely stop taking their medicine. Another 10 per cent reduce it, but the rest return to their original dose. The average time people using the service taper for is two months, he says, but some people take up to seven months.

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Wow. What a great idea! Thanks for posting this.

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"Sometimes, even if you are slow and deliberate when weaning yourself off an antidepressant, you still may experience symptoms of discontinuation syndrome. One possible way to get relief is to take a single 20 milligram (mg) dose of Prozac [sometimes another]. Your symptoms will likely go away within a few hours. And because of Prozac’s long half-life, you won’t have withdrawal symptoms after taking that one capsule."–Antidepressants and Discontinuation Syndrome: Tips for Relief from Withdrawal Symptoms by Nancy Schimelpfening; https://www.verywellmind.com/tips-to-reduce-antidepressant-withdrawal-symptoms-1066835

Has anyone tried this? If so, did it work? Do you know if it would work on someone who's been off Effexor four months and still experiencing discontinuation symptoms?

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Sounds excellent – let me know how your discussion goes. My friend won't even bring up the fact that her AI is making her irritable to her oncologist and ask if there might be a different AI she could try (in her mind there is nothing wrong – it's everyone else that is the problem – according to her husband)

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@haleysmom

I switch off and on between benedryl and just a pm sleep aid so my body doesn't get too used to it. The tingling has to be horrible!! I get that and itching with certain pain meds.

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Check the back of the package but Benadryl and a PM pain med usually contain the same ingredient diphenhydramine -it's just that the pain med also has ibuprofen or some other NSAID as well. In other words – both will probably help address the itching and any sleeping issues – the pain med will help if you have – you guessed it – aches and pains or fever.

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