Reinstatement not working?

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Hello everyone, 

I've been on effexor for the past 3.5 years. My highest dose was 150 mg. I was feeling fairly well throughout most of this time and decided to give getting off the med a shot. I started reducing in September and took my final pill (half of 37.5mg) on the last day of December. I began to be plagued with all the typical physical withdrawal symptoms (nausea, headaches, brain zaps, vertigo, etc.). The week after that (second week of January) the physical symptoms subsided quite a bit but the depression and anxiety came very, very strongly! I started also having quite strong panic attacks and had a hard time functioning (eating, sleeping, going to work). It was hell on earth. 

I decided that perhaps this was not the right time for me to be coming off the meds and decided to reinstate. I started with 37.5mg,but the awful mood continued. I then did two weeks on 75mg, and then the month on 150mg but I still could not stop the crying, the lack of appetite, and depressed/anxious mood. I went to my GP and she advised that we go up to 225mg. I have been on the last dose for about 3 weeks now but still no change in mood (except that I at times have moments where I feel very numb or just strong feelings of dysthymia). 

I wanted to ask if any of you have any suggestions on what to do next?

Should I try another med? Should I keep on waiting? Is it normal for it to take this long to get back to my normal self after withdrawing and reinstating?

Thank you all. 

 

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  • Posted

    Hi Natalie,

    So sorry you are dealing with this. I've been there. My thought is that you withdrew too fast. I know four months seems like a long time, but you probably need more like a year or more. When I've withdrawn too fast in the past, I've experienced the same as you...first bad physical symptoms and then the bad psychiatric ones...even months later. It's not returning depression...it's withdrawal for sure.  

    I've heard that reinstating after you've been off the drug awhile can be hard and make things worse. If anything you have to do it slowly and you'll probably feel worse before better. I would think, just like tapering, you should wait at least 6-8 weeks to judge how you're feeling on a dose. Sometimes even longer. 

    These are just my thoughts, but I would think you could try to go back to 75 mg and wait a couple of months to see how things balance out. The changes in your brain are not immediate and need time to stabilize. Maybe in the meantime you could get something else to help with anxiety? Also, I know it's not easy when you feel bad, but exercising (every day if possible) REALLY helps. And taking fish oil, vitamins, etc.

    Again, so sorry. I ended up in the hospital for a night because of withdrawing. I've been scared to wean again in the past 5 years and I just started on a tapering program that reduces 10% of the latest dose. It will probably take me 1.5 years, if I'm successful. I have read many forums and it seems this is the best option and safest option.

     

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    • Posted

      Coco, glad you found out about the 10% protocol!  I've generally been doing that off Effexor and Mirtazapine for 2 y 9 mo, doing each on average 5% per month.  It's a real pain to accept that it will take that so long to come off, but like you, I had a bad withdrawal crash from coming off of Effexor too quickly.  So, I am resigned to the slow method to be successful.  I am at 6 mg Effexor and 3 mg mirtazapine now and have not experienced bad withdrawal along the way.  Low motivation is a problem, low energy, but not the devastating depression and anxiety and insomnia!

       

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    • Posted

      Wow! You've come a long way. Good for you. I am just beginning and it seems like forever. Do you think the low energy and low motivation is a withdrawal effect? Did you have that before? I'm feeling that just by reducing 5% 2 weeks ago.

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  • Posted

    Natalie, I agree with Coco that you may have overshot the amount you needed to alleviate the worst symptoms.  It takes a minimum of 4 days for the body to register a dosage change, and one should wait 3-4 weeks to allow the system to adapt to a change.  With reinstatement, it can go paradoxical which is why it is recommended to reinstate at a very low dose, maybe even less than the last dose you were on before jumping off, just in case you feel WORSE due to becoming sensitized by the drug.

    When we come off too quickly, we are exceeding the nervous system's speed at which it can adapt to less drug, especially if we cut too precipitously or too often. BUT, some adaptation did occur, and so when reinstating, you don't want to take more than your system had adapted or you will have start up side effects! Also, did you know that too high serotonin can cause depression and anxiety?  

    Are you taking any supplements?  Taking anything that could ramp up serotonin in some way on top of the drugs can cause too high serotonin and worsening symptoms.

    Rather than go higher and higher, I agree with Coco, back off and hang tight.  Your brain took a big bounce with coming off too fast and then zooming back up way high.  You will have to accept some discomfort while your brain settles down.  Be gentle with yourself.

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