Thanks for the interesting updates Alex, and we're all wishing you improvement soon.
Hope it's helpful to paste here some info I put in another thread about withdrawals. It's not to replace anythign your specialst recommended but you might find it helpful to discuss with them in trying to understand their recommendtions ...
Experiences of this are massively individual - depends on metabolism (and presumably gene things they don't understand yet!), the drug, how long one's been on it, other health and meds etc etc. Some people sail off without many probs, but for many it's much much harder.
As CLKD says, because sometimes withdrawal symptoms are not dissimilar to originals, medics often miss and muddle them.
Her experience - of it taking a couple of months and stabilsing after 10 days each time - sounds exhausting and challenging but many do have much longer and tougher times ... I say this not to frighten you, as you may not, but because when my GP put me into withdrawal nightmare by advising very poorly on withdrawals from drugs onto which he should never have put me to start with, but he either didn't know about or didn't believe in hormones, I had to find this all out for myself, and really wished I'd known when I started. I was by then desperate to get off them, but realised the only way I'd have any chance of doing that sustainably was to do it really slowly and gradually - I'm NOT a patient person!!!
Anyway - here's the info from the other thread:
Specialist advice generally is that even the Royal College of Psychs revised guidelines are too fast - unfortunately psychiatrists are people who prescribe drugs.
For anyone trying to taper, I'd recommend looking at Critical Psychiatry / survingantidepressants.org / the work of Mark Horowitz / David Healy (sp Healey?) - lots around including on youtube.
Idea generally is to reduce by 10% not more than every month or so - your CNS needs time to catch up and stabilise. That means the reductions get very (VERY) small as you get to lower doses. So it's easier with liquid although there are other options - lots of info on survingantidepressants.org ... Alex venlaflaxine liquid is available, have you tried that for smaller decrements?
There's also a pharmacy that does 'tapering strips' - you need a doctor to order them - and has some very helpful info on the different meds and suggested decrements (including the graph thing I try badly to explain below).
www.taperingstrips.nl - search under 'antidepressives'.
What most GPs don't know or understand is that the 'effective mechanism' of all these drugs is on a graph like a hockey stick. So the difference between 0 and a teeny tiny amount or a teeny tiny amount and a tiny amount is massive (a vertical slope up) compared to say between (say) 112.5 to 75 of effexor (brand name for venlaflaxine, nicknamed by medics as side-effexor) - at those greater doses the 'effective mechanism' slope is almost horizontal. THe side effects may reduce as dose reduces, but it's at the lower levels (starting when you get 'down' to what medics often quote as the minimum therapeutic doses) that reductions often cause huge withdrawal issues ... so advice is to take them very slowly and gradually.
'Effective mechanism' is something to do with occupancy/binding or receptors, but way above my head!
Some people are fine doing halving and quicker etc but a lot of people have problems - hence even the RCS updated its guidelines and the Critical Psychiatry movement (all of whom, like Horowitz and Healey are psychiatrists).
The effective half-lifes can vary from hours to days - or even longer for some (and some have complicated functions that mean they get even further extended ... fluoxetine is one which is why sometimes people are bridged from shorter half-lives onto fluoxetine for the later reductions) .. and as always different people react/metabolise differently. Best practice isn't to shorten the hold just because something has a short half-life - but to give yourself proper chance to stabilise after each decrement; it's just that a longer half-life might give you a less bumpy ride / side-effects ... and for those with particularly long half-lives (eg fluoxetine) any effects might only emerge a lot later.
I'm not a doctor - simply sharing some general principles I learned the hard way. But they are very general principles and everyone is different. If I ever again was facing coming off ADs , I'd only consider doing so with some specialist input - and if a specialist wasn't familiar with Healy/Horowitz/Ashton-Manual/taperingstrips.nl, I'd find another specialist - I'd not expect them to agree with everything, but i'd want to know they were aware of the principles/discussions!
HTH and good luck to all
xx
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Topic: Severe Anxiety - is it wrong hrt meds or wrong anti depressants? (Read 46285 times)