Over the past few weeks I have been tapering off of Efexor-XR—an antidepressant—on the advice of my doctor. A number of people on Twitter have suggested that I write an account of the experience, perhaps to help others who discontinue the drug.
First, a little background. I have Major Depression. I was first diagnosed in 2001, although a later psychiatric assessment suggests I have had Depression since the mid 1990’s (my early teens). Throughout my Depression I have felt frustrated that my doctors have only ever treated me with medication, that they simply “threw drugs at the problem” to get me out of their office. Mid-2007 I began searching for a doctor that would take my Depression seriously.
It took me about four doctors to find one that was willing to refer me to a psychiatrist for a Mental Health Assessment. I was also put on a Health Plan and given a referral for Cognitive-Behavioural Therapy. Unfortunately, one of those doctors outright blamed me for a sexual assault I’d experienced, and as a result I had a breakdown and was placed on Efexor-XR. So much for not throwing drugs at the problem.
Two years later, and the Efexor no longer works. The decision was made to discontinue the drug, tapering off by 37.5mg a week (down from 225mg), beginning 9 August 2009.
Efexor has a very short half-life, so missing a single dose is enough to cause discontinuation effects. I’d accidentally missed a few doses before, and knew to expect the brain-zaps, fatigue, and headaches, so I asked the doctor how I could deal with the discontinuation. Sadly, my doctor pretty much shrugged off these concerns and said that I would be perfectly fine as long as I came off the Efexor slowly enough.
I was not—and am not—”perfectly fine”.
The third day of discontinuation was my first and only day of work. Despite how awful I felt, I told myself that I wasn’t contagious and that I just needed to be brave and I could keep on working. I told myself I could handle the vomiting and the diarrhoea; I’d just need more sudden unexpected breaks. I told myself if I stayed really still (and didn’t move my eyes sideways) that I wouldn’t get the brain-zaps: just keep my eyes front and work. I even told myself that paracetamol would handle the headaches. And that was all fine and dandy except that I couldn’t actually work. I hadn’t counted on the mental confusion, concentration problems, and general fog. Turns out you can’t be a web developer if you are too confused to code.
I went home halfway through the day after squinting at TextMate all morning in failed attempt to comprehend my own job. I couldn’t make any sense of what I was doing from one moment to the next, so I went home and I slept. It’s one of very few times I’ve felt I’ve actually “lost my mind”.
I slept nearly the whole week. Over the course of the week I noticed improvement towards the end, but then I had to reduce dose again and so it began all over again.
For the first few weeks I was able to do very little besides sleep. Even gentle walking caused big problems with brain-zaps and vertigo, so I barely left the house. And then at a certain point the discontinuation effects shifted, and started having major psychological effects as low Seratonin levels and cabin fever kicked in.
From here it gets difficult to give an articulate account of the effects. The first major change is that I stopped being able to sleep, stretching out to a randomised 30 hour + wake cycle. And of course, with the sleep deprivation, low seratonin, and cabin fever, my moods (and behaviour) are going haywire. One minute I’m giggly, the next I’m having frightening thoughts of self-harm. I am also aware that my behaviour is upsetting people I know online (I’ve been reproached a couple of times over Twitter) and I’m struggling to simply be myself instead of alternating between whiny and asinine.
So, what’s the final word? I don’t think I really have one. It would be seem easy to say “never use Efexor, it’s horrible!”, but I have to admit that when it worked, it worked well for me. This entry is simply to give an account of what it’s like to discontinue it. If you have to take Efexor, make sure you know what you’re getting yourself into, and make sure you have doctors, psychologists, and psychiatrists that are supportive and available. Find someone open-minded who will support you with your side effects and make sure you have good friends to help you through.
I don’t know where I’m going from here. The doctor has suggested Cymbalta as the next drug. I’m afraid it will be like Efexor all over again, so the doctor’s giving me a couple more weeks to “settle down”. I’ve asked for a referral to a psychiatrist.
Also, I think this might be the most difficult blog entry I’ve ever written.
