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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Laurie S on May 7, 2004, at 9:53:09
Hello all. This is my first post to this site and not only am I gratefully thankful I survived the event I will explain, I'm equally as glad I found this support site.
For the past year or so, I have been tapering SLOWLY off Effexor XR (under super high surveillance of my wonderful psychiatrist), which I have been taking daily for the past 5 years. The highest dosage has been 150 mg, 3X/day. I no longer need the meds, for I have found that I can control my anxiety and bought with depression with talk therapy that took a long time to master, and which woks well for me). On 4/1/04 I reached the lowest dosage of Effexor XR, I have been on (75mg). Every 3rd day since 4/1, I dropped another 5 granules. Around 4/20 I started to really feel the effects of the withdrawal - nausea, migraines, unbelievable ear ringing noises, chills, etc. On 4/30, I woke up like every other morning, took a shower and decided that I couldn't take the withdrawal anymore, slit my left wrist with a razor blade, vertically, completely severing one of the 2 main arteries providing blood flow. I remember freaking out and crawling to the phone and calling 911 after I realized what I’d done. I passed out from high volume blood loss (90% of my blood was gone by the time I was admitted to trauma). This is all I remember. My parents have filled me in on the details, which due to their frightening nature, and which is unnecessary to this post, I will not write.
The action I took is completely out of my personality--life has been going well, no big problems, just bad withdrawal symptoms which I'm been able to semi-able to control will meds. Has anyone heard of such a withdrawal reaction to Effexor or similar SSRI?
Thank goodness my hometown has one of the top 3 medical centers in the country, otherwise I would never of survived my injury. I was in the trauma dept. for 16 hours while vascular surgeries clamped my artery and stabilized my extremely unstable blood pressure, and nearing undetectable pulse. I coded twice, and was given 13 units of blood over the course of the day and during surgery. I spent the next 16 hours in ICU observation.
I spent the past 4 days in a psychiatric clinic here being mentally stabilized while experiencing flashbacks of the incident, nightmare, extreme anxiety, sleepwalking and a general sense of being completely freaked out. I'm back on Effexor, 450mg/day, by the way. Besides my blood work being completely out of whack- (CBC panel is dreadful, - which is being addressed and monitored daily - pain and swelling in my wrist is hard to bear without medication and the cast I’ll have on for the next 2 weeks isn’t exactly pleasant, I’m doing OK. No suicidal thoughts---this incident was the first ever.
This is an extreme case I know, but any insight would be appreciated. BTW, I am a 29 yr old, female grad student if that makes any difference. Thanks!
Posted by finelinebob on May 7, 2004, at 11:33:14
In reply to Effexor, Suicide Tapering Off Meds, posted by Laurie S on May 7, 2004, at 9:53:09
Laurie, after working on my PhD, a number of my best friends in the same program agreed that all grad students NEED to be medicated ... ;^)
I'm just throwing this out as a possibility ... maybe someone else out there has a better experience or more experience and can add to it or poopoo it:
I had a pretty horrific experience coming off Paxil. Not as bad as yours, but the hallucinations were enough for me. My pdoc was going to switch me to Wellbutrin at the time and he wanted my system to flush the Paxil out first, but after a few days of withdrawal he started me on a low dose. The withdrawal symptoms disappeared.
Now, what Wellbutrin did to me at my full dosage is another horror story, but for that short time when I was tapering off Paxil with a low dose of Wellbutrin, I was actually quite sane.
I know that as Zyban, Wellbutrin is used to deal with nicotine withdrawal. Methadone for Heroin withdrawal (more problems there as well). But maybe there is something to it.
Does anyone else have any experience taking a low dose of a different med to help with withdrawal? Maybe its something you can bring up with your pdoc as another approach, Laurie. I know -- when you're trying to get off one med, starting up another may seem like the dumbest idea around ... but if its something you can use to help ease you off, it may be worth it. Not all meds are going to give you fits coming off them -- I took just about every SSRI, and Paxil was the only one to do it to me.
Here's another idea -- again, maybe someone else has more experience with it: acupuncture. I got hit hard by PTSD after 9/11, and if it wasn't for acupuncture I don't think I would have been able to leave my apartment. Some insurance plans actually pay for acupuncture treatments in smoking cessation and in treating chemical dependencies, and my MD used it for that quite frequently (yes, my regular, western-trained MD was also my Chinese-trained acupuncturist).
There's an answer out there for you. Have faith that you'll find it.
flb
Posted by Emme on May 7, 2004, at 11:49:49
In reply to Re: Effexor, Suicide Tapering Off Meds » Laurie S, posted by finelinebob on May 7, 2004, at 11:33:14
Hi. First, side note to Laurie - I'm sorry about your nightmare experience and I hope you make as fast a recovery as possible.
> after working on my PhD, a number of my best friends in the same program agreed that all grad students NEED to be medicated ... ;^)
I often joked that grad school is a form of brain damage. :)
> Now, what Wellbutrin did to me at my full dosage is another horror story, but for that short time when I was tapering off Paxil with a low dose of Wellbutrin, I was actually quite sane.
Maybe the combo of low dose Paxil and low dose Wellbutrin was a workable mix for you. Did you and your pdoc consider staying with that since you started to feel okay at that point?
Emme
Posted by finelinebob on May 7, 2004, at 12:17:04
In reply to Re: Effexor, Suicide Tapering Off Meds » finelinebob, posted by Emme on May 7, 2004, at 11:49:49
Emme, the "funny" thing was that Paxil on its own and Wellbutrin on its own both had me so screwed up it was 6 months or so before I had regained enough mental stability to realize how stable I had been in that short space of time between. Paxil had me seeing skyscrappers bending over the top of my head, ready to collapse; Wellbutrin made me psychotic. I really don't want to chance either of those episodes again to see if the combo would work over a longer period of time, knowhutimean? ;^)
Hmmm ... maybe severe agorophobia and homicidal rage can neurochemically cancel each other out -- like adding a base to an acid? NAH! =^P
Turns out I respond to TCAs, not SSRIs. It just took too long to get there ... but I'm there!
Posted by Emme on May 7, 2004, at 12:34:52
In reply to Re: Mixing Meds » Emme, posted by finelinebob on May 7, 2004, at 12:17:04
> Paxil had me seeing skyscrappers bending over the top of my head, ready to collapse;
Well, that's not very good. You must've been pretty frightened.
> Wellbutrin made me psychotic.
That's not good either. How high were your doses of these things?
> I really don't want to chance either of those episodes again to see if the combo would work over a longer period of time, knowhutimean? ;^)
Yeah, I sure wouldn't want to go there either!
> Turns out I respond to TCAs, not SSRIs. It just took too long to get there ... but I'm there!That's good. Best wishes staying there.
Posted by harryp on May 7, 2004, at 13:43:16
In reply to Effexor, Suicide Tapering Off Meds, posted by Laurie S on May 7, 2004, at 9:53:09
Laurie,
What a horrible experience! Thank you very much for sharing it. I am so glad that you are all right.
I was curious if you were using Prozac to relieve the Effexor withdrawal symptoms?
I had a bad reaction to Remeron that your story somewhat reminded me of. The first dose basically turned me into a zombie. I quit taking it, and the next day I wound up spending in a twisted position in my apartment, completely unable to move. I experienced this horrible physical/mental anguish that reminded me of things I had read about heroin withdrawal. I remember being strongly suicdal--not because of depression--but to escape this unbearable sensation. I have a lot of woodworking tools, and I couldn't stop thinking of a fantasy of sawing off my forearm with the mitre saw so I would bleed to death! Thank God I felt better the next day.
I am disturbed because your experience reminds me of some of the "SSRI" suicides I have read about--in which someone not previously suicidal or impulsive suddenly "decides" to kill themselves. You may have read that this effect has been observed in studies of adolescents on SSRI's, and in that poor girl who hanged herself during the E. Lilly (?) drug trial.
If you decide to go off Effexor again (and I think you should eventually--that drug should have a black box warning at least) be careful to have close supervision and Prozac to manage the withdrawal.
I would use TCA's, Welbutrin, or MAOI's in the future. The SSRI's (which is Effexor's main effect as well) drugs are just too risky psychologically, in my opinion.
God bless you, and once again I am so happy you survived. This shouldn't have ever happened to you.
Posted by harryp on May 7, 2004, at 17:52:21
In reply to Effexor, Suicide Tapering Off Meds, posted by Laurie S on May 7, 2004, at 9:53:09
I just wanted to add that Prozac seems less likely to cause wacky psychological symptoms than some of the newer drugs, although I would avoid SSRI's (especially Paxil) based on your response.
I also wanted to mention that your doctors may (with perfectly good intentions) attribute your near-suicide to depression and use it as "proof" that you shouldn't have been going off the Effexor.
In my opinion, you were nearly the victim of a psychological effect that has been observed (especially during withdrawal) in many people on the post-Prozac SSRI-style drugs. In short, I think you nearly died because of a drug effect--not because of any mood disorder.
Depression after your experience would be very normal! I think you should stay on some AD for a while, continue therapy, and be very cautious when tapering off meds.
That said, I would try to axe the Effexor eventually (with great caution, supervision, and Prozac, of course!). I'm glad that many people have responded well to Effexor, but if I were a psychiatrist, it would be the last drug I would try, after multiple TCA's, and both MAOI's w/lithium augmentation had failed!
Posted by ku4ns on May 7, 2004, at 19:52:47
In reply to Effexor, Suicide Tapering Off Meds, posted by Laurie S on May 7, 2004, at 9:53:09
When I first started effexor I was working toward my graduate degree and the drug worked well for me. I did, however, have a very difficult time stopping effexor. My physician switched me to prozac with a week of overlap (with effexor) and I have been off of effexor for 1.5 months with no withdrawal symptoms. I am currently taking the prozac and feel like my old self. John
Posted by Sad Panda on May 7, 2004, at 20:37:55
In reply to Effexor, Suicide Tapering Off Meds, posted by Laurie S on May 7, 2004, at 9:53:09
(nm) = No Message :)
Posted by Sad Panda on May 7, 2004, at 20:39:05
In reply to Re: Mixing Meds » Emme, posted by finelinebob on May 7, 2004, at 12:17:04
> Turns out I respond to TCAs, not SSRIs. It just took too long to get there ... but I'm there!
>Which TCA did you end up on?
Cheers,
Panda.
Posted by Sad Panda on May 7, 2004, at 20:43:45
In reply to Re: Effexor, Suicide Tapering Off Meds, posted by harryp on May 7, 2004, at 13:43:16
> Laurie,
>
> What a horrible experience! Thank you very much for sharing it. I am so glad that you are all right.
>
> I was curious if you were using Prozac to relieve the Effexor withdrawal symptoms?
>
> I had a bad reaction to Remeron that your story somewhat reminded me of. The first dose basically turned me into a zombie. I quit taking it, and the next day I wound up spending in a twisted position in my apartment, completely unable to move. I experienced this horrible physical/mental anguish that reminded me of things I had read about heroin withdrawal. I remember being strongly suicdal--not because of depression--but to escape this unbearable sensation. I have a lot of woodworking tools, and I couldn't stop thinking of a fantasy of sawing off my forearm with the mitre saw so I would bleed to death! Thank God I felt better the next day.
>
> I am disturbed because your experience reminds me of some of the "SSRI" suicides I have read about--in which someone not previously suicidal or impulsive suddenly "decides" to kill themselves. You may have read that this effect has been observed in studies of adolescents on SSRI's, and in that poor girl who hanged herself during the E. Lilly (?) drug trial.
>
> If you decide to go off Effexor again (and I think you should eventually--that drug should have a black box warning at least) be careful to have close supervision and Prozac to manage the withdrawal.
>
> I would use TCA's, Welbutrin, or MAOI's in the future. The SSRI's (which is Effexor's main effect as well) drugs are just too risky psychologically, in my opinion.
>
> God bless you, and once again I am so happy you survived. This shouldn't have ever happened to you.
>
>What is sadly ironic is that SSRI's got their foot in the door because they are a lot safer in overdose than the TCA's, only thing is you are more likely to have a paordoxial suicdal or homicidal reaction SSRI's.
Cheers,
Panda.
Posted by finelinebob on May 7, 2004, at 22:37:19
In reply to Re: Mixing Meds » finelinebob, posted by Sad Panda on May 7, 2004, at 20:39:05
> > Turns out I respond to TCAs, not SSRIs. It just took too long to get there ... but I'm there!
>
> Which TCA did you end up on?Nortriptyline. Tried desiprimine, but had an immediate drop in efficacy, so I switched back. Been on it for about six years now, no side effects =^). While I was living in NYC, my pdoc there had me augmenting with Ritalin, which worked pretty well, and managing my anxiety with clonazepam.
flb
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