What are the symptoms of Effexor discontinuation syndrome?

Question

Hi doctor,

I am a male. My height is 72 inches, and my weight is 182 pounds. I am seeing a psychiatrist for dysthymia, MDD (major depressive disorder), and attention-deficit hyperactivity disorder (ADHD). I have been on Effexor for three years and in the last year, on 300 milligrams. It has helped tremendously, but I do not want to be on medication forever. I feel like it is interfering with the potency of my ADHD medication.

Sometimes I even feel like Effexor is making it so much worse. I tried Ritalin. The effects were too unstable. Elvanse made me too tense. Now I have been on Dextroamphetamine Sulfate 30 milligrams a day for about one to two months, and it is better, but my executive dysfunction and attention are still all over the place. I have tried in the last week or two. I have tried to go up to 60 milligrams as a test. I felt too anxious, so I am back on 30 milligrams. Still dealing with moderate anxiety (I am assuming and hoping I will need a couple of days for it to stabilize).

I want to go off Effexor, but I am afraid of the discontinuation syndrome. I do not want to go through hell. Also, I do not want long-term or permanent side effects from it, and I want to avoid antidepressant-caused relapse for three to six months post-discontinuation. I am trying to find a protocol to present to my psychiatrist. I feel like he does not know his psychological pharmacology or take that into account. I do not know what I should do to discontinue Effexor and keep adjusting my ADHD meds (I will be starting CBT therapy soon).

I am tired of this. It is draining me, and I am losing faith in myself and in psychiatry as a whole. I was thinking of adding Guanfacine or Clonidine to my psychostimulant. Stabilize. Then maybe start going off Effexor slowly. But how to get off Effexor safely and effectively? Or maybe adding Strattera and stabilizing Strattera while lowering Dextroamphetamine sulfate from 30 milligrams to 15 milligrams (10 milligrams in the morning and five at noon). Once that is stable, I will start lowering Effexor. This is the only way I have to deal with the serotonin side of Effexor. But I am still quite afraid. I do not know. I am lost.

Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your situation. I want to ask if you are taking the above medications under a psychiatrist's observation or self-medication. You can taper off Effexor, but it takes time, as you are on a high dose, like 300 milligrams. You take 225 milligrams for six weeks, taper off to 150 milligrams for another six weeks, then taper off to 75 milligrams for another six weeks, then 37.5 milligrams. You have depression. Sometimes, because of depression, people have problems with concentration, which does not mean patients have ADHD (attention-deficit/hyperactivity disorder).

So kindly diagnose properly under your psychiatrist. If you want to take ADHD (attention-deficit or hyperactivity disorder) medication, please take it with proper precaution, as it is highly addictive and may have side effects if you do not take care. Do not take multiple psychostimulants. Select any one molecule, take the proper or optimal dose, wait for four weeks for that medication's full effect, and then add another one.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.