09 March 2014

How to quit Effexor without horror side effects

Many of you won't understand why anyone would need to write about quitting a prescription medication. "Hell ... just quit taking it!" or, from most doctors, "We will taper back your dosage over a couple of weeks/months."

Well, there is a class of medications -- and one drug in particular -- for which being able to just quit or to reduce dosage via commercially available pill or capsule sizes WILL lead one directly to hell on Earth.

Generically, the medication is called venlafaxine, or, in the USA, it is most commonly called Effexor. The type most commonly prescribed is the "XR" (slow release) version. That is what I was taking, as one 75 milligram dose capsule per day. Very common dose.

So, what's the big deal about quitting this drug?

Where to begin? Many people have only a few of the following withdrawal symptoms. Some will have them all. Everybody on the "how the hell do I quit this" forums seems to be a little different. All I can relate is what I personally experienced (which is actually pretty typical, from what I see out on those forums.)

The first thing that hits when you miss a single pill is usually a mild "head zap". That is a sensation of an electrical shock zorching through your brain. This occurs upon standing, changing head orientation or maybe even just a sudden shift of your eyes. These would start for me about 8 hours after missing my morning dose. They get worse as time goes on, eventually beginning to include a sensation of sound. Maybe it was "all in my head" but I would begin to hear the sound of an electrical arc to go along with the head zap.

Next up would be a laundry list of symptoms but the most prominent for me would be my jaw and teeth hurting. This isn't toothache or punch in the jaw hurting. This is a dull, deep, profound ache in all of my teeth and the jawbone. My head would just plain hurt. Then there's general dizziness, frequently an overall gastro-intestinal discomfiture and later, other body aches.  All of the preceding is constant.  No breaks.  No relief. Eventually I would have tremors, terrible nightmares, nausea and true vertigo (way beyond "dizziness".) This could go on for many many weeks.

And, then there's the blackness.

Blackness (depression) is what Effexor is all about. I had some causes for depression 30 years ago and that's what got me started on this horrible drug. Yes-sir-ee, you can be in a real dark place and take any of a number of drugs in this SNRI family and suddenly feel bright and happy. Happy pills. The problem upon quitting is that (as in my case) even if there is no longer any reason for depression your body has spent years pumped up on "happy dope" and all of a sudden, the dope is jerked away. Your nervous system and brain go into the tank.

Lastly comes the very worst part for men. {Imma' smack you man if you ever bring this up -- I swear} No matter what method you use, your emotional toughness (manliness?) is going into the shitter for months. Yes, months. You're going to weep like a little girl when watching chick flicks. If somebody posts the tiniest little "Awww, isn't that sweet" crap on Facebook, you're going to "get a little something" in your eye. Sucks. Seems like it's never going to end. Sniff.

Here's where I state I AM NOT A DOCTOR AND YOU SHOULDN'T QUIT TAKING THIS MEDICATION IF YOUR HEALTH CARE PROFESSIONAL SAYS THAT YOU SHOULDN'T STOP. Whew. Sorry for the shouting but some people need drug-help to keep them from going to pieces. Once I was one of them but I knew that I could pull this off with my wonderful marvelous fabulous wife, new lifestyle, and retirement from the corporate rat race.

For most patients, even when the professionals decide that it would be O.K. for a patient to get off of Effexor, the drug companies and doctors do NOT get it because they aren't really taking this crap. Invariably they will state that the withdrawal "can go on for a week or more." Bull-dog-cat-horse shit. Without some chemical (alternate drug) remediation or very long term taper down (which I'm getting around to telling you about) the withdrawal crap will go on for weeks and weeks. And weeks.

BUT THERE IS A WAY! So, pay attention because I've done it and it works flawlessly.

[This is where all of the snake oil salesmen will try to sell you their special vitamins and special hoobis-goobis pills, derived from secret plant extracts known only to the Pordiscapi Indians of the Upper Amazon. Sorry. I got nothing to sell. Now if you want to send me money for the hell of it, I'm sure Doña Patricia would be most appreciative, but I got no magic for ya.]

Here's the method: You take 30 Effexor XR capsules and scrape 10% (by weight of active ingredient) of the little tiny beads of the actual medication out of each one and then put the capsules back together. Then you take that 90% dose for a month, like you always do. Next month you scrape out 20% of the beads, etc., cutting the dosage each month, until the dosage is so small that you've fooled your carcass into not missing the dope at all.

Yes, it is looking like this will take a long time, require some special tools and a lot of effort. Right. Wanna trade that for zero head zaps and no falling down when you get up out of a chair? I thought so.

Here's the full procedure and everything you need:

First, you'll need a good milligram scale and you'll need to know how to use it. In the old days, these were several thousand dollars, they sat inside a walnut and glass enclosure and you needed many days of training to learn how to accurately run the damn things. No more. For $25, Amazon, or your favorite Chinese electronics dealer sells "good enough" battery-powered milligram scales. I selected their "American Weigh Scales GEMINI-20 Portable MilliGram Scale".

AWS Gemini-20 Scale

NOTE: Milligram scales are incredibly delicate and sensitive. Do not put anything heavier than the calibration weights into or onto your scale. Don't bump or bash the scale pan while weighing. Make sure the scale pan is centered on its receiver disc on the top of the scale. Do all of your weighing on a stable, level table, in a still-air room (no breeze -- no fans), with a stable temperature. Treat your scale like it is delicate because it is.

Next, you'll need a very tiny spoon or scraper. I have jewelry manufacturing experience so I forged a little bitty spoon but they're sold commercially. Several types are shown on the same Amazon page as the scale if you scroll down a bit. Something like this: Transfer Scoop. Or, I guess a bent toothpick would work.

The last piece of mandatory hardware isn't really mandatory if you still remember how to do multiplication and percentages. But, hey, a nice electronic calculator always speeds things up and I used one.

Getting into the actual procedure, I found that a little glass pill vial, a very small funnel (I made one out of a disc of parchment and scotch tape,) and a little dish to hold the finished capsules all are helpful.

First, you need to find out the total weight of your capsule contents. For a 75mg Effexor XR it is NOT 75mg. There's a lot of filler/binder/something mixed in with the actual drug. So turn on your scale, calibrate it using the provided test weights and tweezers, then carefully slightly deform the capsule walls with your finger tips while rotating the cap-end of the capsule. The cap will come away. Set it aside.

You will see that the capsule is far from full. Carefully begin tipping the open capsule over the tiny scale pan and as you tip, bring the open end as close to the scale pan as your fingers will allow. Then, using your tiny spoon, start transferring medication beads from the capsule into your scale pan. Eventually you will be able to tip the capsule over so far that all of the remaining beads will fall out into the pan. Write down that reading of milligrams.

For reference, my name-brand Effexor XR 75's came in at 253mg total bead weight. [But, a generic brand of 75's came in at only 195mg, so if you change brands in mid-stream, remember to verify the new net bead weight.]

Now the math.

How many milligrams of filler/binder/drug equals an actual milligram of active ingredient (the Effexor)?

Using your net bead weight, divide that by the published number of mg's of active Effexor and that gives you the number of milligrams of beads that you'll have to pull out of a capsule to remove 1 milligram of Effexor.

Using my numbers as an example, the net weight of beads was 253 milligrams. Divide that by 75 milligrams and you get 3.37333333, which needs to be rounded to something the scale can work with, which is 3.4 -- therefore, to remove 1 milligram of Effexor from these particular capsules, you have to pull out 3.4 milligrams of beads. [That is VERY few beads!]

Now it gets a little more complicated to follow because we want to lower the 75 milligrams by 10%. While this seems like it would be 7.5 milligrams we have to take into account all of the filler so what we really need to remove is 7.5 times 3.4, or 25.5 milligrams (which we have to round up to 26 due to some dumb significant digits lab rule that I forget the name of.) On your scale readout, 26 milligrams will be 0.026

Notice that there is a button on your scale that says "TARE". Because slight vibrations, air currents, passing faeries, etc., can make your scale reading go all over the place, you may have to push that button before each weighing to get the display, with the little scale pan in place, to read 0.000 Just don't push that button in the midst of doing a weighing and once it is pushed, don't dilly-dally. Start spooning beads immediately.

Take your 30 capsules and one at a time, open one, spoon/scrape out the calculated number of milligrams (26 in the case of my example) into the scale's pan then put the top back on the capsule. Dump the "waste" into your tiny funnel and into the little container where you want to keep the excess Effexor (see at the end). At the end of the month, you will have taught your body to live with only 90% of your previous dosage.

[Point of lab procedure: Don't touch any "business" part of your scale or its components with your fingers. Use the tweezers that come with the scale. Getting finger oil and dirt all over the pan, weights or platen will eventually lead to problems. Fingers only go on the front buttons and the plastic body/cover.]

Next month, to do the math, we want to "throw away" 20% of the 75mg dosage; so, 0.2 x 75 = 15 and then 15 x 3.4 = 51. So, the second month you want to scrape out 51 mg, or on the scale readout, 0.051 [Remember, these numbers are ONLY examples, based on the net weight of my particular capsules.]

Because I was very nervous after having a terrible experience trying to quit this drug in the 1990's I backed off at the 3rd through 6th month and only dropped 5% per month -- meaning I was only dumping 25%, 30%, 35%, etc. After 6 months, since I was experiencing no side effects whatsoever, I then went back to 10% per month. Nothing bad happened.

Once I got to the month where I threw away 75% of the drug, I finished out that tiny dosage and quit cold turkey. Once I was totally off the drug, the only side effect that I possibly experienced was a very slight dizziness a couple of times per day, about every 2nd or 3rd day, for about 2 weeks. Then, even that was gone!

Full disclosure: Two times in all of the months I was getting off Effexor, I had a single moment of dizziness. However, both times, it could have been due to a common alcohol hangover because both times, I had been a bad boy the night before. As best I can remember my personality from 30+ years ago (before Effexor) I think that I've reverted to a little harsher/edgier character, much like I think I was pre-drug. Good thing I'm in the Land of Pura Vida with a good strong gal by my side. Finally, I'm several months "off" now and yet I'm still way more susceptible to feeling emotion due to sappy stories, etc. This is very hard on a nasty, vicious old pirate -- arghhh!

Endnote: If you are fortunate enough to live in a low humidity climate or have been storing your "waste" Effexor beads in a sealed container with a desiccant cartridge AND if you are paying for your Effexor (no insurance) AND if you're lucky enough to live where you can get empty gel caps, then in the last months of this odyssey, when the dosage contents are very low percentages, you could start filling empty caps with your saved "waste." Just a thought.

UPDATE:  In late 2015, I had a medical episode that landed me in the hospital.  Recalling my paragraph above regarding being overly emotional after getting off of Effexor, once in the hospital and under treatment, I had time to "stew" about my situation.  It resulted in a dive into super-dark depression -- so dark that they brought in the hospital's staff shrink.  He interviewed me and heard the long story above.  He stated that there were new drugs in the same family as Effexor which didn't have all of the terrible side effects.  He started me on Escitalopram (brand name in U.S. = Lexapro) and the dark went away.

No side effects at all that I can detect, now after over a year on this stuff.  The BEST part is that I got my Man Card back.  No more weeping at chick flicks or Facebook posts about lost puppies.  Damn the torpedoes men ... full speed ahead!

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