Happy Monday! Let’s Talk Depression

Happy Monday! Let’s talk about depression.

A little back story, if you will. In 2008 when I was diagnosed with breast cancer, my oncologist prescribed Effexor XR to help alleviate the hot flashes I was having caused by chemotherapy. Effexor is an anti-depressant medication and often used off label to treat hot flashes. I took it for several years post treatment because I simply couldn’t wean off the drug. Effexor withdrawal causes incredibly debilitating side effects and I thought I was bound to be on it for life until I found a doctor who prescribed Prozac. You can read about that process of Prozac bridging here.

While I was taking Effexor for hot flashes, I was also prescribed Wellbutrin XL for a mild case of post cancer depression. You would think the Effexor would have helped with the depression too but it wasn’t. It was enough to manage the hot flashes but not enough to alleviate the depression. My GP suggested adding Wellbutrin XL. So, I took two anti-depressants for a good length of time.

When I was finally able to wean from Effexor, I felt ready to break up with Wellbutrin, too. I was just done being on all these meds that made me feel tethered. I was finally med free and felt normal and healthy and ready to move on.

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Fast forward to summer 2015. It had been nearly three years since taking any anti-depressant. I started to recognize changes in me that I knew weren’t normal. Mornings felt like Groundhog’s Day, my body felt like grinding gears, tasks looked like hurdles, social activities felt like obligations. I was bitchy, moody and mean. I was impatient with everything and everybody. I was completely self-loating, I didn’t care about my friendships, and my marriage was suffering. Everything that I had ever liked doing was no longer of any interest to me.

Yet, I pretended like there was nothing wrong.

To the faces at my daughter’s school, my friends, the people on Facebook, I would just put on a smile and act like everything was fine. I remember coming home and feeling exhausted because it would take so much effort to pretend like everything was OK. Existing in the world with a busy schedule and obligations and making small talk all the while just wanting to be left alone is really hard to bear.

I can’t pinpoint my breaking point. I knew things weren’t right when the one thing I really loved to do – make videos with Megan for Long Story Short – had started to lose its luster. It used to be a high that would sustain me for days but it was turning into an opportunity to self hate. We also went on a once-in-a-lifetime family vacation and it was all very blah to me. I found myself fixated on other families who were having fun while I was trying to figure out how to do the same.

I finally called my GP and a therapist.

The conversation with the GP started out as me telling her I didn’t feel good. I talked around the likelihood that I might be depressed. I suggested the lack of diet and exercise might being the culprit to my moodiness. I was embarrassed to ask about depression and afraid to jump into another anti-depressant after feeling like I didn’t need them anymore. I eventually agreed to trying out a new prescription.

Meeting with the therapist was much less anxiety ridden. I reached out to a therapist I had seen while undergoing treatment for cancer. I sat down and within 15 minutes had explained why I thought I was depressed. It was her professional opinion that I was indeed dealing with major depressive disorder and had agreed medication and therapy was my best course of action.

All the kinks haven’t been totally worked out yet. We’re still fine tuning the dosage of the new medication I’m taking. But, therapy has been wonderful. It’s been a soft place to land while I figure out the self-loathing and how to repair broken relationships. I feel lighter and interested in things and people again. Life doesn’t feel like a hurdle everyday anymore.

When I smile now, I’m not faking it.

I Did It: How to Stop Taking Effexor

I had taken Effexor XR for almost four years. At every appointment with my oncologist, I would mention that I didn’t feel it was necessary to continue the drug since I was originally prescribed the anti-depressant to help with hot flashes during chemotherapy. I had long been finished with chemo and the hot flashes had subsided but I couldn’t stop taking Effexor without dealing with the horrible withdrawal symptoms. My oncologist repeatedly recommended to wean to the lowest dosage available and then begin an every-other-day regimen until I finished the prescription.

But, it wasn’t working!

I felt dizzy, drunk-like, almost. I had blinding brain zaps. I felt nauseous, tired and sick. I could not function without taking that pill every day. I do remember considering to stop cold turkey but who knew how long the symptoms would last. It could be a weekend or it could be a month. I wasn’t willing to white knuckle my way through it.

I finally found some info online about why I was having such a hard time weaning from Effexor XR. I’m guessing since you’re reading this, you are also trying to find a way to get off the anti-depressant without the debilitating withdrawals. {Edited} Be sure to read the almost 200 comments on this post, you are not alone.

I took what I read online to my general practitioner and thankfully she was familiar with the Effexor-Prozac Bridge. If you don’t know what “the bridge” is, please take a few minutes to read this here:  Effexor-Prozac Bridge  In sum, it explains the chemistry of Effexor and Prozac.

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In less than TWO WEEKS I was able to stop taking Effexor!

After speaking with my doctor about the bridge, she prescribed a 30-day dosage of 10mg Prozac. She strongly advised that if I started to feel the Effexor withdrawal symptoms to open the Effexor capsule and take 3/4 of the granules.

On her advice, this is what I did to stop taking Effexor XR.

This information is not intended to replace any medical advice. This is my own, personal experience successfully weaning from the anti-depressant. 

Day one – I replaced one 37.5 mg capsule of Effexor XR with one 10 mg capsule of Prozac.

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The first day I simply swapped pill for pill.  Whamo!  I started feeling those awful flu-like withdrawal symptoms and worried I wouldn’t be able to break free from my Effexor addiction.  And then I remember my doctor’s advice – TAKE THE EFFEXOR!  I broke open one Effexor capsule, poured out and counted the granules (there were about 35 in the pill).

You can see from the photo below, I put the granules in applesauce to swallow them.

Day two –  I took one 10 mg of Prozac and 26 Effexor XR granules.  I continued that ratio for another two days.

Days five and six – I took one 10 mg of Prozac and had reduced the number of Effexor granules by 1/2, taking about 15 or so.  I continued that particular ratio for another two or three days.

Days nine, 10, and 11 – I took 1 10 mg of Prozac and about 8 Effexor granules.

Day 12 – 1  10 mg of Prozac and NO Effexor!

FAQ:

How long did you stay on the Prozac?

I finished the 30 day prescription of Prozac and refilled for one additional month. I was worried weaning from Prozac would be difficult considering my experience with Effexor XR. I reduced my Prozac dosage to every other day, then every third day and simply stopped by the end of the second prescription.

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It took me roughly two weeks to stop taking Effexor.  Two weeks to stop taking a drug that I thought I’d never be able to move on from.  Two weeks!  Don’t accept that you have to take Effexor XR forever. Talk to your doctor about the Prozac bridge.


Have you ever taken Effexor XR?  Tell me about your experience!

PLEASE NOTE: This experience with Effexor XR and withdrawal regimen is totally my own at my doctor’s advice.  Please do not replace this information as professional medical advice.  Please talk to your doctor. If you are feeling suicidal, please contact the National Suicide Prevention Hotline at (800) 273-8255.

Effexor XR and Prozac | Bridging the Two Drugs

So you’re wondering what a Prozac bridge is, right? Well, if you take Effexor XR and have been trying to wean yourself from the drug but simply can’t get below 37.5mg, 75mg, or even more than maybe the Prozac bridge is the answer. Or not. You should DEFINITELY consult with your doctor before changing the dosage of any medication. This is NOT intended to replace your doctor’s advice. I’m sharing with you what my research has yielded and I will bring my findings to discuss with my own doctor when I see her next month.

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A few days ago I wrote about how I can’t stop taking Effexor XR. I’ve successfully gotten down to the lowest available time-released dosage of the medication. For a short time I was even able to get into an every-other-day regimen but currently I am taking it daily.

I’ve spent a good amount of time reading message boards and online forums from people with the same problem as mine. I came across a Q&A with Dr. James Phelps (I don’t know anything about this guy — he could be some random dude playing a doctor online — so consult with your doctor first!). He references Joseph Glenmullen’s book, Prozac Backlash and a chapter called “Held Hostage” where the author writes about the theory behind “Prozac bridging.” In the simplest terms: you replace Effexor XR with Prozac.

Now I know it sounds like you’re just replacing one med for another but there is science behind this idea and it has to do with the “half-lives” of the drug. All anti-depressants have “half-lives” and what that means is how quickly the drug leaves a person’s blood stream after you’ve taken your last dose. Effexor XR has an extremely short “half-life” which is the reason behind the horrible withdrawal symptoms. Phelps explains the details here. I also found EffexorWithdrawl.com to be a good source too in understanding “half-lives.”

So what’s Prozac have to do with it? Prozac is an extremely long “half-life.” It takes Prozac 7-9 days to leave the blood stream (as compared to Effexor XR at 15 hours). Withdrawal symptoms are considered unusual when taking Prozac. When you are able to get to the lowest dose possible on Effexor XR is when you are suppose to replace – or bridge – it with Prozac. It’s up to you and your doctor when you decide to wean from the Prozac but apparently it’s supposed to be head and tails easier to do than Effexor XR.


A couple of suggestions I received from this week’s earlier post on the subject that I thought were worth considering:

– My friend and nurse Kathleen suggested progressively lengthening the intervals. “It might be inconvenient (maybe having to set an alarm for the middle of the night), but you could make up a schedule for every 48, 50, 52 hrs, etc…? Or try taking one every 2.5 days (60 hr intervals)?” My note: I don’t know for sure if this would work considering those pesky short “half-lives.” I think lengthening the time between is just prolonging the withdrawal symptoms and then you are back at square one once you take it.

– Another friend suggested seeking help from naturopathic doctor. I’m seriously considering consulting with the specific doctor she recommended for this and possibly other issues I am experiencing (inflammation, fatigue, etc.).

– A family friend and pharmacist suggested taking the immediate release Effexor (I currently take the XR – “extended release”) which at its lowest strength is 25mg and it comes in tablet form that can be cut in half and quarters to decrease the dosage over time. The XR comes in capsule form which cannot be cut. Her thoughts on bridging Effexor and Prozac “would basically be adding a different drug that has the same mechanism of action” and “would not gain a great deal from that switch.”

I’m not exactly sure what avenue I’m going to pursue yet. I’ve really considered the white knuckle approach but I’m so worried that the side effects would last longer than three days. I’ve read some people feel sick up to a month. I really don’t want that. I’m definitely going to discuss the options with my general practitioner (as opposed to my oncologist who said I should just keep taking it). I’ll keep you posted.

This information is not to replace any advice your personal doctor has given you.  I do not make any claim that Prozac bridging works.  This is simply the research I have found.  Go talk to your doctor!

This post contains an Amazon affiliate link.

How to Quit Effexor | Anti-depressants

A little back story to how I got hooked on Effexor XR. I started getting crazy hot flashes after I started chemotherapy treatment back in 2008. In addition to chemo, I was also receiving monthly injections of a drug called Zoladex in an effort to preserve my ovaries. My body was in chemotherapy-induced medical menopause. Hot flashes come with the territory so my oncologist prescribed Effexor XR to combat my wacky body temperature. Effexor XR is an anti-depressant but has been proven to reduce hot flashes by about 50% in women with breast cancer according to a study done by Dr. Charles Loprinzi at the Mayo Clinic (breast cancer.org). I was willing to try anything that would ease the hot flashes I was having so I ran down to the local Walgreens and filled that sucker. I’ve been trying now for at least a year-and-a-half to kick Effexor XR and it’s nearly impossible.

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The highest dosage of Effexor XR I’ve taken was 75mg. At this dosage I felt numb. I was completely void of emotion. I didn’t cry. I didn’t laugh out loud. I was pretty much a zombie. But I didn’t have any hot flashes either. When I complained about how I felt my doctor lowered the dosage to 37.5mg – the lowest dosage available. Coming off of the 75mg to the 37.5mg wasn’t that hard. I was advised to continue the 37.5mg for two weeks and then take it every other day. The days I didn’t take Effexor I would feel awful. Dizzy, nauseous, and blurry vision. It’s like the flu on steroids and hangover all mixed in together. So, for months and months I stayed at the 37.5mg daily. Eventually, I was able to get to an every other day regimen but nothing else beyond that. I’m stuck.

I brought it up to my doctor again at my last visit. Her response was less than what I expected. She suggested I just stay on the Effexor if it’s so hard to stop taking it. What? Continue taking a pharmaceutical drug that I do not need just because she doesn’t have a discontinue solution. Ridiculous. Thank goodness there’s Google.

By the way, I still occasionally have hot flashes but I know what triggers them for me (coffee, wine, and sugar). Additionally, research is showing that a higher total dose of 75mg daily is needed to get significant relief from hot flashes. So there is absolutely no point in taking the 37.5mg of Effexor.

I’m not alone.

Back to Google. Forums and message boards are flooded with people asking advice on how to effectively wean from Effexor. I found that many of us are stuck at 37.5mg. The side effects from discontinuing this drug are horrible. I’m lucky because some people have extreme withdrawal symptoms – brain zaps, shakes, and chattering teeth.

But, I think I’ve found two options on how to finally get off of Effexor. I can either white knuckle it – hunker down in bed for at least three days and deal with what’s thrown at me. Or I can pursue the Prozac bridge.

What’s the Prozac bridge? I’ll explain later this week!

I’d love to hear if you’ve taken Effexor XR and successfully discontinued the drug. Tell me what worked and what didn’t work.


Updated: I finally quit Effexor.  Read here how I quit Effexor without the withdrawals!

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Army of Women | Hot Flash Study

Army of Women need women ages 40 to 62 who have not had breast cancer and have bothersome hot flashes or night sweats to take part in a research study. The study is testing two medicines that may help women who have menopause-related hot flashes. Researchers in Boston, Seattle, and Philadelphia are running this study. It is one of three clinical trials currently being conducted as part of the Menopausal Strategies – Finding Lasting Answers for Symptoms and Health (MsFLASH) study, sponsored by the National Institutes of Health.

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Know someone who lives in Boston, Seattle, or Philadelphia who might be interested? PASS IT ON! Forwarding our information to friends and family members is just as important as joining the study.

Who can participate?
You can join if you match ALL of these MAIN categories:
• You are a woman between ages 40 and 62

• You are peri- or postmenopausal

• You have bothersome hot flashes/night sweats

• You have NOT been diagnosed with endometrial, ovarian, or breast cancer

• You are NOT currently pregnant, breastfeeding, or planning to become pregnant

• You read, write, and speak English

• You live near or are willing to travel (at your own expense) to Boston, Seattle, or Philadelphia for 3 or more study visits.

After you RSVP, the research team will ask you additional questions to be sure that this study is a good fit for you.

Sign up to join the Army of Women today!

I was not compensated by Army of Women to share this study with the readers of Wendy Will Blog. Additionally, I think it’s important to share that I currently – and have since starting chemotherapy in 2008 – take a low dose of venlafaxine (brand name Effexor XR) to help manage hot flashes. I’ve tried several times to wean from venlafaxine and have been unsuccessful. This drug is very difficult to stop taking. I strongly urge anyone considering this study to consult with your doctor first.