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Posts (13)

Jul 22, 2018 · Chronic Pain, alternative Treatment in Chronic Pain

@colleenyoung — Thank you again for the post regarding kratom. I would just add that significant controversy persists regarding Dr. Gottlieb's statement, and the FDA advisory opinions pertaining to 'deadly' disks associated with kratom.

This isn't a comprehensive list, as there are numerous critiques on this issue, but here are four reputable reviews on this topic. The consensus from those on the other side is that it is unlikely that kratom has been responsible for any deaths at all. The general argument is that the cases cited involve multiple agents, and in some cases, suicide, and that none can be attributed to kratom directly. If one looks hard enough, a small handfull of cases with kratom as the single agent can be found, although many critiques for those exist as well.

First, here is a compilation of fatality cases from the FDA (02/2018) that readers may read to derive their own conclusions:

https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/CDERFOIAElectronicReadingRoom/UCM595575.pdf

Risk assessment from Pinney Associates (a Pharmaceutical Research Firm). [See page 52)

http://216.30.191.148/HL-AKA-Eight_Factor_and_Recommendations_by_PinneyAssoc.pdf

Letter from David Kroll, PhD, Academic Pharmacologist in Forbes Magazine:
https://www.forbes.com/sites/davidkroll/2018/02/09/fda-weaponizes-opioid-label-against-kratom-consumers/#38c4a4804536

Rebuttal from nine prominent academic scientists:

https://docs.wixstatic.com/ugd/9ba5da_345dd7a4f5d54c1088d86fc6299381cc.pdf

To be fair, here is an excellent piece that details deception on both sides of the issue:

https://thedrugclassroom.com/video/deception-on-both-sides-the-fda-vs-pro-kratom-advocates/

In short, I would assert that Dr. Gottleib's statement, and the FDA's position notwithstanding, the controversial issue of kratom safety is far from settled.

…for the record: I am not a Kratom advocate. I am an interested stakeholder actively observing this complicated issue as it develops.

May 1, 2018 · Chronic Pain, alternative Treatment in Chronic Pain

@colleenyoung – thank you for your interest in this topic, but your information is simply incorrect. To the best of my knowledge, the FDA has no power to regulate imports of anything. They have made a number of seizures of Kratom over the years, but not because the substance is illegal (it is not), but that certain purveyors have made false medical claims. That is a no-no, and within the FDA’s jurisdiction. The drug is not illegal, and has not been banned by the DEA (nor has it been scheduled as a Schedule I). It was in 2016, but only very temporarily. The DEA has since changed their position. Kratom is currently only a “Drug of Concern”.
See: https://www.dea.gov/druginfo/factsheets.shtml
And: https://www.dea.gov/pr/multimedia-library/publications/drug_of_abuse.pdf#page=84

May 1, 2018 · Tips on minimising withdrawal symptoms from Effexor (aka Venlafaxine) in Depression & Anxiety

@contentandwell – You ask a very important question. I can’t answer for everyone, but I can answer for me. I started therapy about a decade ago to help me cope with some situational issues that caused me some very severe depression. Venlafaxine had its place and I might even go so far as to say that it saved my life.

I am in a much different place in my life now, and no longer need the strict emotional stability that venlafaxine has provided. Now, I find that venlafaxine has actually provided *too much* emotional stability – to the point of stagnation, or emotional blunting. Sure, I don’t feel the low-lows that I once did, but more importantly at this time, I also don’t feel the high-highs either. These are part of what make life so precious.

I’m starting to get some of that back, and I’m realizing more and more each day what I’ve been missing.

I hope that makes sense …(?)

Apr 26, 2018 · Tips on minimising withdrawal symptoms from Effexor (aka Venlafaxine) in Depression & Anxiety

Hi @lisalucier, ohhhhhh! I figured out what I was trying to do – it is actually billy.com that generates the sexy https://mayocl.in/blahblah style links. I would delete this post, but unfortunately, my only option is to 'edit' it. So… I'll leave it at that. Thanks so much for your help.

Apr 25, 2018 · Tips on minimising withdrawal symptoms from Effexor (aka Venlafaxine) in Depression & Anxiety

@fussellp – Hello! I am day 3 post-venlafaxine (but who is counting, right!!? 🙂

Thanks so much for sharing and I am so sorry that you are going through this. I am not only an ex-venlafaxine-user, but also a prescriber. Mea culpa for prescribing venlafaxine for hot flashes, too. The literature (scientific studies) are very positive about using venlafaxine for this purpose, and I remember feeling excited for having found an alternative to hormone therapy for hot flashes and perimenopausal symptoms. It is true, as you have noted that venlafaxine does work in this regard, HOWEVER, and this is a really big HOWEVER, venlafaxine therapy does have its consequences that I personally know about all too well. In the future, I will rarely prescribe it for this purpose anymore, and now only after very carefully screening the patient and after thoroughly educating them on the consequences. I am uniquely qualified to provide this education now…

With respect to easing the symptoms of withdrawal, I posted some proposed pharamacotherapeutic options you may wish to discuss with your prescriber – that post is currently on page 39 [someone please tell me how to make those cool short Mayo links…] (https://connect.mayoclinic.org/comment-redirect/100402) The options I mention come with their own consequences, so be very careful. For non-pharmaceutical relief, I encourage you to talk sincerely with loved ones about what you are going through, and try to stay very busy with positive activities. e.g. I am currently distracting myself by building and caring for a garden, The best thing for this, I think is simply time. Every day is another day closer to your goal.

Hang in there, and thanks again so much for sharing!

Apr 24, 2018 · Tips on minimising withdrawal symptoms from Effexor (aka Venlafaxine) in Depression & Anxiety

@gailb You seem to be in favor of limiting your intake of pharmaceuticals, although you have decided to continue citalopram forever. Given your objectives, I would encourage you to investigate the chemistry of citalopram. I won't geek out too much on the chemistry here, but in short, I will say that citalopram is 50% (S)-(+)-citalopram, aka escitalopram, aka lexapro, and 50% (R)-(−)-citalopram, which (in my humble opinion) does little more than give your liver more work to do. In other words, you could potentially take your current dose of citalopram, cut it in half and replace that with escitalopram (aka lexapro) and receive the same pharmacotherapeutic benefit. Actually (in my opinion), you could potentially go even lower than 50% because (R)-(-)-citalopram has actually been found to counteract the effects of (S)-(+)-citalopram.

See e.g.:

https://www.researchgate.net/publication/8546695_Escitalopram_versus_citalopram_The_surprising_role_of_the_R-enantiomer

See also:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204633/

Talk to your doctor and/or pharmacist for more information if this interests you.

Cheers!

Apr 23, 2018 · Tips on minimising withdrawal symptoms from Effexor (aka Venlafaxine) in Depression & Anxiety

Hello all. Much ❤️, and may you have a smooth journey tapering off of venlafaxine

I wanted to post an update, and perhaps a conclusion on my journey, and in the process, gently argue that for some, it may be better to taper rapidly vs. slowly.

My journey began in roughly 2008 when I started taking the drug. I am in a much different place in my life now, and it is time to return to the real me. My taper began March 2, 2018 (to the best of my backward calculating skills because I didn't keep track in the beginning), and ended April 22, 2018 (almost exactly 50 days). I started at a dose of 375mg/day.

My titration 'plan' so to speak, because I didn't really put much thought into it was to decrease my daily dose by 37.5mg every week until I hit zero. For the first 4-5 weeks, it was moderately unpleasant, but very tolerable. My anxiety bumped up a couple of notches, and my head buzzed a little bit, but that was about it. …and THEN at 187.5mg, like a ton of bricks, the symptoms hit me HARD. I talked about that on page 38: https://connect.mayoclinic.org/discussion/tips-on-minimising-withdrawal-symptoms-from-effexor-aka-venlafaxine/?pg=38#comment-100076 Essentially, I spent an entire weekend curled up in a fetal position grunting and moaning in pain. It was absolutely excruciatingly toxic. At that time, I made a difficult, but very important decision – I was looking at another 4-5 weeks of tapering with my current "plan", so I decided instead to accelerate the process with a new "10 day plan". I fully expected my symptoms to get worse, but much to my surprise, they actually did not. I took my last dose yesterday, and I honestly feel much better today than I did at 187.5mg. I still anticipate a good 4-6 weeks of symptoms to some degree as I return to me. Already, I can feel higher highs, and lower lows than I did with therapy, but I am looking forward to the good and the bad as I return to 'normal'.

So… That is my $.02 on rapid titration vs slow. If you want to get off this drug, you are going to have symptoms regardless of how slowly you taper. Your mileage may vary, but for me, a fast-ish (50 day) titration worked out pretty well, all things considered. Everyone's situation is different, but for those of you out there considering a fast-ish taper, I am here to say that it can be done, and in truth, it really isn't all that bad.

I wish everyone the best of luck and good health on your journey. Peace and love to you all….

~efexnot

Apr 23, 2018 · Tips on minimising withdrawal symptoms from Effexor (aka Venlafaxine) in Depression & Anxiety

Not too fast at all – just right. Congratulations! I'm going to make a new post re: tapering fast vs. slow. I think fast-ish is much better for a lot of reasons. Good for you!!!