Saturday, March 28, 2015

Goodbye, Effexor: A Conscious Uncoupling

I was just looking back through my posts over the past few months to try to find the one where I told you the really awesome neurofeedback developments I've experienced, and I couldn't find it.

Well, duh: it's because I haven't written it yet.

Behold, true believers! I've got some pretty astonishing news!

You may recall how neurofeedback works, and what it showed me about my own brain, last May and June when I first began. I've linked those early posts here in this paragraph for you to go back and reread them if you like-- I recommend the refresher. I needed it myself, because WHOA, have things changed since then!

A couple of months ago, we did a little 5-point test, sort of a mini-Q, where several points on the brain are monitored at once to see how they compare to a general database of healthy brain function.

Just a little progress report, you know?

Okay, this was a limited test, but the circumstances were a repeat of the first time I took it, so the results can be compared to those, too. And the results were pretty profound: 

  • My ability to switch between states, which Dr. Q said before I seemed to really struggle with and which probably left me constantly feeling "foggy," (ah, if only she knew!)?   NORMAL!
  • Those markers for Chronic Fatigue Syndrome, Fibromyalgia, and/or a major sleep disorder?   GONE!
  • My general inefficiency and slowness of processing, caused by the old rerouting from the TBI and the hypervigilance and general misuse of resources?   MUCH IMPROVED! (not quite in the normal range yet, but much closer than before!)
  • Get this: My anxiety? My "At levels I've only seen in veterans recently returned from combat" anxiety?   GONE! (Not "Better." Not "Low Normal Range." Smack-dab in the center of "Just-Like-Everybody-Else NORMAL.")
  • And finally: my depression: Barely any movement at all.

First, a little celebration!

I'm sleeping better than I have in years. I virtually stopped taking lorazepam within 2 months after I began seeing Dr. Q, even though my PTSR was still in full effect. I am thinking more clearly, operating more effectively, and just generally feeling better in every way.

I don't think I can overstate the impact neurofeedback has had on my life. It feels like exactly the perfect component for me, and exactly the right time in my recovery. I really do feel like it is working to sort out and put in place all the pieces I've worked loose in my work with Dr. Oz.

Especially now, since the release

As I think you'll agree, if you've been reading along for any length of time, I was absolutely primed for this therapy, and it really is working accordingly. My ducks were in a motherfucking row, and boy, is it paying off! I can literally feel things falling into place sometimes.

It's amazing. Neurofeedback is amazing. 

And you know what else? Painstakingly setting up the dominoes so that you can finally watch them fall is pretty freaking amazing, too.



I think, if you'll peruse the list of test results above, that you'll notice that one of these things is not like the others.

Yup. The depression. Hasn't moved much at all.

I actually think this is because of my antidepressant. I think it has, in fact, been doing its job of keeping that part of my brain operating in a stable and consistent way.

The problem with that is that the rest of my brain has been stepping up its game in a dramatic, dynamic way.

I am now able to feel this discrepancy. I have been feeling over-medicated.

My antidepressant has been bringing me down.

So, last month, I began to ramp down from my 150mg of Effexor.

I began to notice an improvement almost immediately. Effexor has a very short half-life, which means you get almost instant feedback from it, which is a rare thing with antidepressants. This will become important in a moment, so remember this detail.

The extended-release version of the drug that I take comes in 75mg capsules. That's it. So any ramping down is going to involve big, jarring jumps or painstaking capsule-opening and bead-counting (because why should pharmaceutical companies make it easy for you to get off their meds? They don't want you to get off their meds!).

This wouldn't be a problem if ramping down were as easy as one's GP tells one it should be: "Just drop to 75mg for a week, starting tomorrow, and then stop after that. If you have any discomfort going from 75mg to nothing, try going to 75mg every other day for a week, and then stop. But you shouldn't have any problems."

I've found, though, that the laymen know best when it comes to these things. Discontinuation symptoms are wildly underreported (understandable, in a system designed to keep us on these meds, not get us off them). So when I ran into trouble with my ramp-down, I turned to the forums for help.

Oh. The trouble: I did have some discomfort going from 150mg to 75mg-- it took me about 2 weeks to stop feeling spacey and half-asleep-- so there was no way I was going cold turkey. 

I followed my doc's advice and went to 75mg every other day, there apparently being no smaller increment available to me (they say there's a 37.5mg capsule, but I've never seen one). 

The first two days I skipped, I definitely felt it-- "brain zaps," a little jittery and spacey, but otherwise fine. No emotional fallout whatsoever, nothing I couldn't manage. Then it evened out and I felt fine.

Not just fine. I felt better. Less was definitely more, where Effexor was concerned. The less I took, the better I felt. 

After a couple of weeks of that, I decided to go to 75mg every third day. 

The first time I skipped that second day, I was vigilant all morning, watching for symptoms. I felt fine, mentally, which was good. By noon, I felt a bit shaky, but still fine.

By 2pm, the zaps had started. By 3, I could barely keep my eyes open. was disoriented and confused. I was agitated. I kept falling asleep. And my body hurt, but in a way that's hard to describe. 

In a "there is something seriously, dangerously wrong" sort of way.

In a "my body is attempting to function without a vital element" sort of way.

In a "this must be what dying feels like" sort of way.

In a "this isn't something to push through; this is unsustainable" sort of way.

I lasted as long as I could. And then I took a pill. I have small children to care for. I can't mess around with my brain like that.

My husband, during this frightening little episode, had gotten online and found the forums and begun to research how the hell to get off this shit.

The people there: they've been around the block a few times. In their comment signatures, they list their medications and their ramp-down protocols. Some of them have taken 10 years to ramp down from extensive quantities of psychotropic medications.

It's not our world, this world of meds.

From the forums, I learned some basic rules of thumb:

1. Reduce your dose by 10% per month, as a general guideline.

2. Do not ramp down by skipping days between larger doses-- it's like playing ping-pong with your brain.

3. Open up capsules and count beads if you can't get them in smaller increments from the pharmacist, or get a scale and weigh your dosages yourself.

4. Let your own body's reactions be your guide. It will tell you if you can be more aggressive or need to be more conservative with your reductions.

Ah. Okay.

So, no more skipping. Cool. Especially with a drug like Effexor, with such a short half-life, this makes sense. So I went back to a daily dose, but since I'd already reduced below 75mg/day, I resumed at 50mg/day.

I did this by opening up some capsules and counting the teeny little beads inside. I ordered a big bag of empty gelatin capsules, grabbed some black cardstock out of my collection to make the little guys easier to see, got some tweezers, and went to work.

THIS, my friends, is a huge fucking pain in the ass. 

I thought it would be no big deal. I was wrong. They are full of static electricity, for one thing, so the stick together and jump all over the place. Plus, they are round and tiny and they roll everywhere. They are hard to contain. And I have a lot of pills to make.

It's just tedious.

So I got a scale.

Still tedious, but it takes a lot less time now.

I was on 50mg for nearly 2 weeks, giving myself time to recover from the "episode," as I think of it now. During this time, I made a little ramp-down calendar, in which I cut my dose by 10% every 3 weeks (feeling aggressive, me!), just to see how long it would take.

You wanna know? You wanna know how long it would take me to reduce from 50mg, if I were to reduce my dose by 10% every 3 weeks, starting from right now?


Yeah. Hell no.

Over the last week, my husband and I both noticed that I was feeling out of sorts: withdrawn, agitated, maybe a bit anxious. He thought I'd seemed that way since the "episode," in fact.

In neuro this past Tuesday, I was telling Dr. Q about it when it suddenly occurred to me what might be causing it: my antidepressant.

I'd been taking 75mg every other day before the episode, which equates to 37.5mg/day, and since the episode, I've been taking 50mg/day. I've actually increased my dose, when in the weeks before the episode I'd seen very clearly that the less I took of it, the better I felt.

So Tuesday night, I said "fuck it" to the 10% rule and to the "per month" rule, and I cut my dose to 40mg.


From this, I've learned a thing or two for myself:

1. My body can handle aggressive moves. It just needs a consistent dose.

2. The less I take, the better I feel = I need to get this stuff gone ASAP

3. I'm going to try cutting 40mg to 30mg next week (there has been no noticeable "adjustment" period here, so I think 2 weeks is fine. I'll extend it if I feel it. I'm letting my body be my guide, and my body is saying LET'S DO THIS!), because I think I can handle another aggressive cut. I won't know unless I try. And if it feels wrong, I can back off and bring it back up to 35mg. I know how to do this now.

So. I'm not going to jump the gun, because I know what that feels like, but I'm also not going to languish away forever if I can get this stuff out of my system more quickly. I want to get moving on this, because I want to give neurofeedback a chance to work its magic on my brain when it is NOT under the influence of antidepressants to see what kind of movement it's able to affect then.

I swear, I can already feel it having more of an impact as the dosage goes lower.

And guess what? At the end of all of this, I'm going to have a full Q again, so we can see the deep impact of this treatment, and I-- and you-- will be able to see the results of the work on my brain.


1 comment:

  1. I have gotten off Effexor before, and you are correct. It is no joke. Way to go on all your awesome progress!