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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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58 y/o caucasian female, post menopausal.Stopping

Resolved Question:

58 y/o caucasian female, post menopausal.Stopping Venlafaxine after 10 YEARS! Had a major depressive episode in 1999 (divorce) and none since , but no MD would agree to take me off the med later. Have suffered hypercholesterolemia ( almost uncontrollable), had 2 CVAs, endarterectomy 3/11. Finally told my PCP I'm stopping the Effexor. Titrating down from 150 mf/day to 37.5mg/day. Very last dose of 37.5 mg was 4 days ago, but still having terrible brain "flashes", hot flashes then chills, sensitivity to sound, only relief is sleep, but can't stay asleep for more than a couple of hours. Please help me..I don't think I can function at work like this - am an accountant...
Thank you.
Suzanne P.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 5 years ago.
Hello. I believe I can be of help to you with this issue.

I agree with you; if your last episode of depression was 1999, it doesn't sound like you need antidepressant meds at this point. What I'm sharing is academic information because I cannot recommend a course of action or prescribe any such course as I'm not your doctor. But academically speaking, the symptoms you describe clearly indicate that this last dose of 37.5 was too low and would certainly suggest that a patient is needlessly experiencing too many withdrawal (what doctors like to call "discontinuation syndrome") symptoms. Again, academically speaking, the final phases of tapering from this medication almost always has to be done more slowly than initial tapering. This means cutting of pills into smaller pieces or example, and making the time interval between reductions a bit longer----this can take several months, actually, to do this with reasonable comfort. Incidentally, I'm going to assume you are fully finished with menopause now, for a few years (?) correct me if I'm wrong.

Now, if you really want to taper more slowly, you can get to your pharmacy and ask to buy some empty gelcaps. You can accurately divide any given dose into say, 10ths if you want by doing the following: half-way fill one gel cap as accurately as you can 10 times with cornstarch and each time, dump the contents into a small bowl. Next, take your dose of Effexor and crush to fine powder with a spoon; mix, mix, mix, mix into the corn starch thoroughly and then refill the 10 gelcaps with the mixture evenly---right at halfway point of the gelcap. Now you have 10 gelcaps containing exactly 1/10 of the dose of your Effexor. The point is that one can accurately taper from any dose of Effexor very slowly and gradually, over the course of additional weeks. I'm going to pause here and solicit your reaction to my response so far.
Customer: replied 5 years ago.
Thank you for the reply. I was in one of my naps at the time. I was hoping there was something I could do today, but it appears I'll have to go back to my MD to get a different regimen.
Expert:  Dr. Michael replied 5 years ago.
you can explain to your doctor that your symptoms suggest you are being tapered too quickly and then figure out on your own what would make sense using the methods mentioned above or ask him to get the pharmacy to fill a pre-specified prescription to do this more slowly.

Please let me know if I have overlooked any aspect of your original question. Please click on the green Accept button at the bottom of the screen. Thanks.
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