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DH coming off Venlafaxine. Christ this is hard.(46 Posts)
I desperately need advice / support / real-life experiences of others who either have, or who know someone who, has successfully come off long-term anti-depressants and not needed to go back on them!!
DH has suffered from depression for his entire adult life (and probably most of his childhood too). I met him when he was 25; he is 40 now. I cannot remember exactly when he started taking anti-depressants but it was around the time of the birth of our DS, who is now 9.
During the time that we were together but before he was taking anti-ds, he had many, many depressive episodes, suicidal feelings, complete inability to get out of bed in the mornings sometimes, and became addicted to exercise in order to try to beat the low mood. He has had several episodes of counselling / CBT but is unwilling to fully take on board the discoveries he has made about himself ....
I cannot go into full details about how ill DH has been in the past, partly because I just can't bear to relive it and partly because it was so awful that I have blocked large chunks of it from my memory.
When DS was born, DH hit rock bottom and I literally dragged him to the GP and begged, in tears, for help. DH agreed to go on anti-ds. He was on citalopram for a couple of years, then moved onto venlafaxine which he has been on for years, with huge success. He has not had a major depressive episode the entire time he has been taking it. He has had the occasional period of stress / low mood, but has managed to deal with it and has done really well.
A few months ago he decided that he was going to come off the venlafaxine. He wanted to just stop, but I said that there was no way I would support him in this, and that he had to do it under the guidance of the GP (I had a nightmare coming off seroxat many years ago, before the DCs were born). So he went to the GP who advised him to reduce his dose by half, do this for 4 weeks, then reduce by half again, etc etc. So he has been doing this for the past few months and is now on 1/8 of the dose he started on - it's only about 6mg per day now. He is a teacher, so the summer holidays seemed the logical time to do this.
Every time he reduces the dose he is just AWFUL. Completely on edge, moody, tense, sleeping all the time, unmotivated, snappy, and generally horrible. It lasts a week each time, then it calms down as his body and brain adjust to the new dose, then we start again in three weeks' time with the same cycle.
He went down by half a dose a few days ago and I don't think I can cope. He is obviously struggling, and is not even able to make civil conversation about neutral topics. He cannot bear to be in the room with the DCs (9 and 6) which is a pretty important thing to bear in mind, as I work and he is supposed to be looking after them Tues-Fri during the holidays. He has been struggling so much that I've been booking babysitters as much as possible, and taking the kids to work with me when I can (I own a shop, so this is possible) in order to spare him - and them. His "thing" when he is depressed is to chant "I hate myself, I hate myself" over and over, and this cannot happen in front of the DCs.
But babysitters are not cheap, and this cannot continue for ever. I can literally see him turning back into the depressed shell of a man he was before he started taking the anti-ds, and it is heartbreaking. And so, so frustrating, as there is an easy solution: take the anti-ds!!
I guess my question is: is it reasonable of him to continue reducing the dose when we are ALL suffering as a result? Should I try to persuade him to go back to a slightly higher dose? - not as high as he was on at the start, but maybe go back up to somewhere between 12 & 25mg (he was on either 50 or 75mg to start with) as that seemed to be OK when he'd got over the first horrible week ...????
In case it doesn't come across in my post - I really, really feel for him. I have been in his shoes. I was lucky that my depression/anxiety wasn't caused by a permanent chemical imbalance and that a combination of meds and therapy "cured" it. But he has a wife and a family, and a job (and nobody there, and not a single on of our friends, knows anything about this). He has responsibilities, which he is incapable of fulfilling when he's like this. And term starts next week, and I am so worried that he will spend all his energies on appearing well at work, and will then be extra difficult at home (he has form for this).
We have no family support (mine are all dead; his are probably the cause of his depression - his parents sent him to boarding school in the town they lived in at the age of 6 and his father has serious, yet undiagnosed, MH issues, and his mother is a functioning alcoholic who enables his father). I have nobody to talk to in RL about this.
Oh, and thanks for reading. That was really loooooooong; guess I needed to get it all out!
I just want to reiterate that I love him and want to support him in a way that suits him, me and the DCs!
I have experience - will do the detail as a later post. fuck I feel for you.
I think the key thing is why he is stopping Venlafaxine. Did he hate the particular side-effects of being on Venlafaxine, or is it that he feels he is better and doesn't want to be on any meds at all (who does)?
There are things IMO it is always OK to say- and one of them is 'you seem very low and angry at the moment'. 'I'm worried about whether you are up to having the kids around at the moment' would be another.
Ask him to see the GP again (preferably with you) as you are worried, rather than getting into the detail of dosages, which he could legitimately say is the med profs area. Is there a crisis team locally? Does he have a CPN?
DH is now on amitriptyline, having suddenly hit a wall and come off citalopram and then Venlafaxine (Mirtazapine lasted a week, it was the worst of the lot for him). He's been well for 3 months, which is the longest period we've had
for ever well, actually, for ever.
Thank you so much for replying Joan, and I'm so sorry you've been going through something similar.
DH's reasons for coming off Vanlafaxine: he just didn't want to be on any meds. He has no side effects at all whilst taking them!! Hence my flippant "take the anti-Ds!" in my OP as, in his case, they have done him nothing but good.
He sadly feels that there is a huge stigma attached to mental health issues. Nobody at work knows, nor do his family (probably a good thing, they are a toxic nightmare), nor do any of our friends, I am the only person who knows apart from the GP.
It worries me that not even his line manager or HR dept know - what if something happened to him and they needed to know that he was taking medication? He lies about it on official forms etc.
I don't know what a CPN is so no, he doesn't have one. He is embarrassed and feels a failure for having depression, and does not like talking about it. He has had counselling but - and this is where I lose a lot of sympathy - he just doesn't try to make it work. e.g. wrt to his issues with his parents and brother: he doesn't want to accept that they are selfish people and he'd be better off not contacting them. Instead, he keeps on and on about how he wants them to change. He will not try to change his way of thinking though ....
God it's frustrating!
I am sorry I have no advice but just wanted to say how lucky your dh is to have such a loving and supportive wife.
cpn = community psychiatric nurse. Can be wonderful.
Does he see a psychiatrist, or is he only under GP care? Sounds like the latter. That's OK provided he continues to see the GP...
He really had NO sideeffects with venlafaxine? Unusual. DH had weight gain (true for all ADs he has had), retarded ejaculation (miserable for us both tbh) and what he describes as a feeling of being 'contained'. Again I think many ADs cause a similar feeling, but DH found it especially unpleasant on that one. Amitriptyline has not only improved his mood but has also reduced his lower back pain which was doing in his sleep, and then sleep disturbance was increasing his psychosis (he's also on an antipsychotic.) I'm saying all this because it is possible that he may find another AD better. But not if he's having no sideeffects...
Bear in mind that YOU deserve support. Google Rethink, and give them a ring (and if you're reluctant to do it, well, guess what, that's what he's feeling). Trying to be his wife without telling anyone what's going on and getting support is horrendous, although i do sympathise with him to some extent, you really can't tell how people will react, some are brilliant, some really aren't. I would get some counselling yourself if you can.
Re the family, tbh if he could let go of his (childhood?) need for them to be what he needs, he wouldn't be so depressed. What I sometimes say is 'well, that's how they are' and perhaps also sometimes say something predicting how they will react before we tell them something.
No, he had no side effects on the meds at all. The only thing that happened was that his depression went away! (And, when he got ill with a cold, he would get an elevated temperature and be more incapacitated than you'd expect with a cold virus - man flu huh?!).
I'll try Rethink, thank you. I have no problem with asking for help or getting counselling; I just cannot talk to anyone who knows DH in RL as he does not want me to. (Yet when I was suffering from anxiety and depression he was quite happy to tell his colleagues and some of our friends ).
If only it were as easy as just letting go of what he needs his family to be...!!!!!! Years of (expensive, private AND NHS) therapy have not achieved this. This, more than anything else, is what frustrates me. His family are awful.. He acts like a puppy, constantly going back for another kicking. I think it has become an addition in a way. I think he is frightened of not feeling this need for them any more, so he keeps on deliberately torturing himself. Sometimes I feel like telling him that he has to choose between his parents & brother, or me - but then I think, what right do I have to do this? (*PearlyWhites*: I'm not as supportive as you think!).
God he is such a lovely bloke, it's heartbreaking.
Honestly, if he could let go of his family I really do believe that he would feel so much better, and I have posted about this before and have been told that he is behaving selfishly for constantly begging for scraps of affection from his parents and brother .....
.... Behaving selfishly by constantly begging for scraps of attention from his parents and brother, instead of trying to deal with the situation, accept it and move on
Does he feel that he's depressed at the moment (or is it one of those things that's just impossible to ask)...
I feel like it's too simple to say he's selfish for contacting his family -I think you describing it as an addiction is much closer. I think, actually, you could say that you are not prepared to be in a relationship with him if he is in touch with them, and/or not on an effective dose of Venlafaxine. But that would be an enormous thing to say and you'd have to be prepared to back it up. There are times when I haven't left dh only because there's no way I would be prepared for ds to visit him solo in the state he's in (much happier at the moment, though).
It's shit, isn't it. Wish I had some good ideas. Particularly frustrating that he walks away from or blocks so many routes of help. I sometimes think that when dh is depressed, he despises the person that he is when he's not depressed, and therefore resists treatment.
I've done it in the last 6 months. Came down from 8 yrs of 375 mg. did 4 week reductions down to 37.5 then started cross tapering with 50mg sertraline. Halved then quarter the 37mg tabs and increased sertraline to 100mg. Really felt v few effects at all. I know this sounds like replacing be drug with another but sertraline much easier to wean off than venlafaxine.
That drug has a really short half life. With many antidepressants you might realise you missed a dose the next day. With that you feel it in less than 8 hours - sickness, dizziness, the room spinning. Ideally you should step down in a maximum of 35g intervals.
I wish I had an idea how to help you.
All I can say is that he has to let go of his parents. Mentally. This need to still seek their approval and get a kick in the teeth is keeping him depressed. They will Never change.
Believe me, it is a hard process to let go, but it can be done. I was 38 when I managed that, and I still talk to my mum, but nothing she says will ever get me down again.
Get him professional help. There are people who have to be on meds for life.
"I sometimes think that when dh is depressed, he despises the person that he is when he's not depressed, and therefore resists treatment."
YES. This, exactly.
DH was told constantly by his father, from a very young age, "You're a <insert surname here>, this means you can never be happy."
When DH had been on the Venlafaxine for a few months and everything had stabilised, I remember having a conversation in which we agreed -at least, I thought we'd agreed - that he would always stay on an effective dose of anti-depressants. (He was in his thirties by then, so had been suffering from acknowledged depression for his entire adult life and probably longer, and had proved time and again that he needed those chemicals in order to live an untormented life). Obviously he either doesn't remember that conversation, or the imagined stigma of being o medication has become too much for him.
I'm actually really, really pissed off with him right now, because there is absolutely no acknowledgment that this affects anyone other than him.. I am very tempted to issue an ultimatum but I don't want to split our family up (he's a brilliant dad - when he's on an appropriate dose of Venlafaxine! - very hands-on and just fantastic really); I also don't really think I have the right to make him choose between his family and me, or to insist that he takes medication if he really doesn't want to .... I don't know how much I, as his wife, should step in and take control ....
I am actually starting to wonder if we are going to survive as a couple long-term, because one thing is for sure: I cannot bear him when he is depressed, and I'm buggered if I'm going to subject my children to his depression.
Bugger bugger bugger. I am going to ring the GP tomorrow, make an appointment (it will take a couple of weeks to get one) and insist that DH and I go together. Then hopefully we can discuss medication, dosages, alternatives etc in a positive way. Our GP is fantastic and I think DH trusts her (I know I do).
Thank you so much for reading this xx
OP, make an emergency appointment, you have to see the GP asap, especially with the new term looming. Good luck!
X-posted, hi everyone,
OK, will ask the GP about sertraline, Prozac etc as a replacement, thank you.
Thanks for the advice re reducing dosage. He iscoming off the Venlafaxine gradually, in a disciplined, medically approved way. Initially he went down from 50mg to 25mg for 4 weeks, then down to 12.5mg for 4 weeks, now he's on 6.25mg. But each reduction is causing him to feel more and more depressed (or "stressed" is what he's calling it).
Yes, he does need to be on meds for life. But only he can decide that. I have known him for 16 years now, and believe me, it is not as simple as "getting him professional help." I have!! Many times!! We have spent a fucking fortune on counselling for him, but he doesn't want to change.
Sorry, I realise I'm sounding negative, but I think the only thing I can do now is drag him back to the GP and cry on her shoulder while DH listens! And then leave him if he refuses to go back on an adequate dose of meds.
I could just kill him for putting us through this hell again, actually
Sorry, I didn't mean it like that, the professional help bit. I know you have and are coping with this for a long time.
Yes, please go to the GP and tell her how you feel. Maybe it does reach him if you cry on her shoulder. You should not have to carry all the weight on your own. That's what I meant.
I know that when a psychiatrist told dh what he had put me through in stopping meds and going missing, he got it, in a way he never had before. Great plan to see the GP; re-read this thread beforehand, if you need to, and DO NOT HOLD BACK. Don't allow the stiff upper lip a look-in. Cry. Show him, and the GP, what this is doing to you.
Oh, and do it initially on the phone to the receptionist. You need an appointment sooner than 2 weeks, IMO you need one before term starts.
That's a very low dose he was on. It's a shame he's so insistent that he wants to come off them. Does he feel embarrassed about being on them?
My DH's parents are so deeply anti any medication they never even have paracetamol in the house. They still regard it as a weakness for people to take medication. Except for FIL's statins and warfarin. That's different apparently . DH ignores them but does feel some discomfort at being dependent on taking tablets as a result.
I am currently coming off Bupropion, mainly because it is not licensed to treat depression in the UK.
I have a prescription for mitrazipine, which I am meant to be switching to. So far I have not, as apart from the swaying/dizzy feeling I get from time to time, I am doing fine.
If I did start getting depressive symptoms, I would get the prescription filled like a shot.
Your husband is being totally unreasonable and needs a swift kick up the bottom.
As for stigma surrounding taking them, whatever. Everyone knows someone, who is on anti-depresssnts nowadays. Suffering depression is not something to be ashamed of.
As for the contact with family, I would be offering him a them or me ultimatum.
None of what you want is detrimental to his well being and therefore it is perfectly reasonable for you to broach these topics and their impact on you, with him.
I too have experience of this. On Both sides
I have come to the conclusion that for me, supporting someone with depression is so fucking hard. Worse even than the hell that is suffering depression.
My deal breaker is, given how much a depressed person drags everyone else down ( I know, I did it myself) I will only support a close family member if they are actively doing everything they can to minimise that depression.
Coming off zero side effects meds for no reason than to try and pretend to themselves they are well would mean a stern tough- love talk time. Something along the lines of if you persist in pretending you don't need treatment then you do it alone, away from the family. It isn't blackmail. It is a simple statement of what you can cope with without risking your own mental health.
I took myself off setraline because the side effect were fucking awful, but jumped straight into 6 months of intensive counselling.
And interestingly I was v open about being on meds. I told my boss, and most colleagues. Partly due to the alarming side effects. A surprising number came to me and admitted later that they were on ad's and admired my courage in 'coming out' as it were.
Sorry that was long. I'm projecting, but I get cross when people selfishly expect someone else to pick up all the pieces.
Talk to Rethink before you go. Do come back to update if you can. Thoughts are with you.
Thanks all. You are all talking a lot of sense!
I'm ringing Rethink tomorrow from work.
Spoke to DH briefly earlier re switching over to something like Prozac or sertraline for a bit, and going back to the GP.... He made it very plain that he sees this as HIS decision, and his alone, and then refused to discuss it further.
I am tempted to tell him that he can't live with us until he's sorted himself out, frankly. I can't even bear to be in the same room as him at the moment. How the hell did it come to this?
I would say focus less on 'this is what meds you, dh could try' and 'this is where you, dh can live' and more on what you, MrsMc, are feeling/able to bear.
We are trapped in a vicious circle though, so I CAN'T talk to him frankly about what my limits are - because he isn't well enough at the moment to deal with it properly. He has taken that option away from me, by selfishly stopping his meds. I am so, so angry.
Ooh x-post with Joan there, quite freakily reading my mind Joan!
Also make a GP appt for yourself.
No brilliant advice Mrs but just wanted to sat I completely understand where you are coming from. Dh is long depressed (and a teacher with a nightmare family and reluctance to deal with stuff by trying to change his mindset!) and every so often he decides he wants to ditch the meds and everything goes tits up. We're also in the situation where he refuses to tell anyone that he is suffering so I don't have anyone to vent to.
I know it sounds selfish to insist that a partner takes meds but when the impact of them not doing so is complete devastation then something has to give. I love dh to bits but I am no longer willing to expose my dcs to his mood swings and emotional 'coldness' when he is in the grips of unmedicated depression. I know that he withdraws in order to deal with his feelings but I how the hell do you explain that to two kids who are getting their heads bitten off for making the slightest bit of noise in their own house?
I bloody hate depression and would give anything for dh not to have it . Off to check out Rethink.
Sorry to hijack but just want you to know that you're not the only one in this situation.
I have nothing useful to add about whether your DH should or shouldn't try to come off of Venlafaxine (although I can't see me ever coming off of medication, every time I try I just sink.)
But, I tried Venlafaxine a good few years ago. It did nothing for me at all, so after a few months I weaned off it. Good god, that was a nightmare. Over the years I've tried many anti-depressants, most haven't done a thing (the only thing that's helped me so far is 200mg amitriptyline), but I've never had such problems coming off of a med. Cutting the Venlafaxine dose made me feel indescribably awful, & bear in mind it didn't have any effect on my mood in the first place. I ended up breaking the capsules apart & counting the grains inside, every day I would take one grain less. It was the only way I could wean off of them.
Sorry I can't be much use on the should/shouldn't side of things though, I hope it all works out.
Hi OP sorry you're suffering with this. I read with interest because I'm coming off venlafaxine too. You mentioned that he was taking about a week to 'settle' after each dose decrease. Is this not working this time? Or do you mean he is still not well after he settles? Does he think that he is depressed/miserable or does he think that he's fine?
Just wanted to update: DH's mood has settled and we are now able to talk productively about what the next steps should be .... He desperately wants to be off all medication, but understands that this may not be achievable in the timescale he wants (or ever). He is willing to talk to the GP about switching to sertraline/Prozac/anything else that might have an easier withdrawal, and he also accepts that he may need to stay on a low dose of Venlafaxine long-term....
I am very scared about the next reduction in meds, in 3 weeks' time, but we will cross that bridge when we come to it....
Thank you all so much for posting and for sharing your experiences. X
AlteredState - hello! How are you getting on with reducing your dose?
MrsMc im so pleased. hope things continue more stable.
Venlafaxine/Effexor is known to be one of the hardest psych meds to go through withdrawal from - some people even suffer piercing brain "shivers" and choose to remain on it for life rather than go through withdrawal.
Ironically I managed to come off this in around 8 weeks by tapering the dose and had a shocking withdrawal from citalopram instead.
That's good he's settled down MrsMc. Bit confusing that he wants off meds when he seems to benefit and without side effects when on them. As know one else knows apart from you, him and his gp couldn't he pretend he didn't take them .
My reduction is going ok thanks but am doing it oh so slowly - 10 months to go from 225mg/day to 75mg/37.5mg daily on alternate days . But I was suffering with side effects (exhaustion and extreme mood swings at high dose, rather than long periods of low mood, and awful pins & needles in hands/feet though also have a carpal tunnel syndrome diagnosis so wasn't until I dropped below 150mg that I discovered most of the tingling was venlafaxine side effects .
Anyway good luck with the rest of his taper/switch.
MrsMc I didn't know venlafaxine came in smaller doses than 37.5mg. You couldn't tell me what brand he takes as I was dreading the 37.5mg to zero drop but if there's one out there perhaps I can highlight it to my gp. (Please don't tell me he's off the counting-the-tiny-pills-out-the-effexor- capsule variety of patient !!)
i think my dh had to cut pills in half at one stage
Ah thanks joan i honestly didn't think of that . Did he have a pill cutter? Cutting my sertraline from years ago wouldn't have been a problem but my venlafaxine now is round and without a 'score' mark to help divide it.
Venlafaxine is 'like crack' according to one American psychiatrist. By far the worst withdrawal syndrome from any of the modern antidepressants in my experience - only paroxetine comes close.
The GP may be right when he suggests changing to another medication to stabilise the symptoms and then withdrawing from that - it is a well known and test method for getting off certain medications. Something like Citalopram or Fluoxetine (prozac) would be ideal as they quite mild and have a really long half-life which means the withdrawal is much less evil.
If he is on the immediate release venlafaxine then another option would be to change to the extended release version. This is because the 'XL' version is a capsule containing tiny balls of the medication and you can open up the capsule and remove just one or two balls which would allow him to reduce the dose extremely slowly over a long period of time.
Oh and don't confuse the withdrawal effects (anxiety, agitation, mood swings, sweating, stomach upset, brain zaps, sleeping problems, tearfullness, etc.) with return of the depression..... most likely it is the withdrawal effects which can last a long time in my experience.
Yes I think you are spot on LongTimeLurking - I have been confusing the withdrawal symptoms with the depression.
AlteredState: DH is cutting the pills in half, yes.
Dreading the next stage - where he goes on to half a pill every other day .... I just don't see how he will ever feel well if he's missing the meds every other day. Need to switch to Prozac before we get to that point.
AlteredState: he's cutting the tablets in half with a very sharp knife.
I really like the sound of the long release capsules! Excellent idea, will ask DH if the GP can prescribe those ...
Thanks MrsMc. Sharp knife it is then . I was worried about altering the slow release mechanism (for want of a better expression) of cutting a tablet that is presumably designed with bulking agents and coated etc to gradually release the active drug ingredient. I will have to practise pill cutting on some spare 225mg tablets .
Fingers crossed for next stage. If dh is patient, capsules could be the way to go.
Yes, indeed - how are you feeling at the moment AlteredState? DH has booked an appointment with the GP to discuss whether to switch to the capsules (and to ask if he can an get Venlafaxine in liquid format to use with a syringe - much easier to measure and reduce the dose gradually. I did this when I came off seroxat/paroxetine although I still ended up needing to switch to Prozac for the last month).
I'm afraid I did get tough with him and tell him, kindly but firmly, that he needed to do something to ameliorate the withdrawal symptoms - i.e. investigate slow release capsules or switch to another antidepressant in the short term - because if he didn't, he would be doing the withdrawal whilst living elsewhere. He honestly had not realised how tough it has been for the DCs and me; he just kept saying "I can do it" to which I replied, "yes, YOU can do it but WE can't and this is NOT just about YOU!" He was really shocked. He had chosen to bury his head in the sand and not read up on the withdrawal process because it was too scary..... which I understand, up to a point.
Sadly his overall mood is definitely noticeably lower and he is getting stressed and blowing up over the smallest thing. I still think he needs to stay on the meds. He has been on citalopram before, so that might be the way to go.
wow venlafaxine in liquid format - that'd be handy. Has your dh had his gp appt yet? I'm doing ok. Will probably see gp this week as they've taken my prescription off repeat and am almost out. I don't think I want to drop to nothing (although last gp I saw didn't seem to think it'd be a problem - don't think I want to risk it!)
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