So I gave up on my psychiatrist because she’s been pretty adamant about me making timely follow-up appointments. Unfortunately, part of my problem is that my executive function is seriously fucked. I’m just not very good at making plans. Seriously. It must be at least a minor miracle that I’ve made it this far without ending up dead.

I don’t know whether to blame this on depression, or whether I really do have some type of brain injury.

The problem with not having a psychiatrist is that I can’t get my psychotropic medications. This, too, would be OK if venlafaxine didn’t have such awful withdrawal symptoms.

• neurological/psychiatric symptoms
  1. vertigo
  2. “brain zaps”
  3. akathisia
  4. excessive day-time sleepiness
  5. insomnia
  6. diaphoresis
• ENT symptoms
  1. facial discomfort/sinus pain
  2. constantly runny nose
• GI symptoms
  1. nausea
  2. bloating
  3. frequent bowel movements

Most of these can be dealt with perseverance. But the akathisia and the constant feeling of wanting to throw-up all the time made me want to throw myself off of a tall building. Add to this the brain-zaps, and it’s a wonder that more people don’t kill themselves while trying to get off this stinking drug.

The last time I decided to flush it out of my system was a couple of years ago. This was, in retrospect, probably a really bad idea. The work I was doing was kind of high-stress to a degree, and while I managed to cope, I could’ve worked on timing it a little better. I managed to do OK off of the meds for a couple of months. That’s when I realized I needed serious help.

But what I found that sort of worked were all the anti-cholinergic (really, anti-muscarinic) drugs that you can get over-the-counter. Things like diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton). Meclizine (Antivert) was useful, too. At the very least, all these drugs helped with the constant nausea and dizziness.

The problem was that these drugs also make you excessively somnolent. I mean, I really shouldn’t’ve been driving while taking this toxic cocktail of over-the-counter meds, much less working.

I’m thinking it all abated after a week of intense suffering.

This time, I just couldn’t take the brain zaps. For those who aren’t familiar, what this is is a sensation of some kind of force discharging through your cranium. It’s really hard to describe, actually. But I think some of it is the fact that your facial muscles contract suddenly and forcefully. Even the tensor tympani seems to contract, and this may account for most of the nausea and dizziness, now that I think of it. The zaps tend to occur when you’re moving your head. It’s like the worst case of motion-sickness you’ve ever encountered. I mean, I could do fine if I held my head rigidly, with neck flexed. But any slight deviation, and the zap would happen. It’s actually quite a miserable way to live. Maybe not the most miserable, but it’s pretty bad.

The idea is that this happens the most with venlafaxine because it’s such a short acting drug. Without the XR formulation, you’d have to take it three-times a day to maintain a steady state, for one thing. And even with the XR formulation, I’d get withdrawal symptoms if I went more than 24 hours out without taking my next dose. This makes taking overnight call slightly painful if you fail to plan ahead, like I tend to.

So I have some sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro) lying around from long-ago attempts at finding the right drug for me. It’s only a handful of pills, so I’ve had to use them exceedingly sparingly.

I’m coming down from venlafaxine XR 300 mg daily. The maximum dose recommended in the monogram is actually only 225 mg, but I’ve seen psychiatrists use this dose once in a while, particularly for resistant cases. If I had a way of partitioning the capsules, it might’ve been feasible to do an extended taper, but all I’ve got are 150 mg pills, and going from 150 to zero is god-awful. At first, I tried to subsist on my toxic cocktail of OTC anti-cholinergics, but that left me way too somnolent and I was basically in bed all day. So I tried the sertraline. It’s only 25 mg, so it barely has any effect on the withdrawal symptoms, and it, too, has a short half-life. When I realized this, I went with the fluoxetine.

The great thing about Prozac is that it stays forever in your system. It would probably be feasible to do every-other-day dosing once you’re on a maintenance regimen. Even at the base dose of 20 mg, it has managed to abolish most of the symptoms for the past 48 hours.

Except for the brain zaps. Damn them.

Lexapro has a much shorter half-life than Prozac, but it’s still longer than either Zoloft or Effexor, so I took 10 mg of that after the brain zaps started making me crazy. The dose I took yesterday is probably still sitting in my system, though. I had to take another dose of Prozac this morning. I’m trying to get to fluoxetine 20 mg every other day, with escitalopram or maybe even sertraline for breakthrough. I’m trying not to touch the venlafaxine ever again, but I may have to resort to opening up the XR capsules, crushing the spherules inside, and finding some gelatin caps to make my own 37.5 mg doses.

I think it’s been a week since I took any Effexor, though. Going cold-turkey, I think it took a total of two weeks to finally be rid of the withdrawal symptoms. With this taper I’m doing, it might take way longer than that. I’m hoping I have enough pills to survive before I start thinking about throwing myself off of a tall building again.

The interesting thing I learned about this escapade is that the antihistamines were actually attempts at making more selective anti-depressants. This was back in the day when all they had were the nasty tricyclic antidepressants (TCAs), which include amitriptyline (Elavil), nortriptyline (Pamelor), imipramine (Tofranil), and desipramine (Norpramin). So they came up with diphenhydramine and chlorpheniramine. Basically, Chlortrimeton and Benadryl are the scaffolding for all the SSRIs. The first SSRI was zimelidine, based on chlorpheniramine, which unfortunately caused Guillame-Barré syndrome and drug rash with eosinophilia and systemic symptoms (DRESS). The second SSRI, as I’m sure we all know, is fluoxetine, based on diphenhydramine. And the rest is history.

What would be neat is if I could find the affinity constants for diphenhydramine and chlorpheniramine for the serotonin receptors, but I’m sure all that stuff has been shredded by the drug companies who are more interested in you buying the latest and greatest drugs on the market. I’m also certain that the doses they’re recommending for allergy symptoms aren’t anywhere near the effective doses for serotonin reuptake inhibition. I also now understand why all the junkies want their Benadryl IV.