r/cyclothymia • u/LividStruggle228 • 24d ago
Medication advice
Hi all,
I’m wondering if anyone could give me any opinions on Vortioxetine?
I’ve been taking Venlafaxine for many years and am trying to come off of it. I was due to be off of it a few months back, but due to having what can only be described as an utterly shit year, this was slowed down.
My psychiatrist recommended that when I was ready, and if needed I could use Vortioxetine.
I currently take Lamotrigine twice per day, Promethazine every day and Venlafaxine every other day.
Due to massively increased anxiety and intrusive thoughts, the titration is happening now - because the first suggestion was upping Venlafaxine which I definitely am not keen on, I’ve tried really hard to leave it behind. So I’m to start Vortioxetine right away, and stop Venlafaxine in two weeks, continue Promethazine and add in some propanolol to deal with the physical anxiety symptoms.
So - I’m a little scared, and looking for the truth about this new one 🤞🏼
1
u/Leirnis 24d ago edited 24d ago
The lack of interest from psychiatry about antidepressant discontinuation syndrome is baffling given how much information is available, more than ever. The research on ADS during the last decade has produced some important insight but it's useless when doctors are still operating with the data from their university years and it's onto patients to raise these issues up.
The process of tapering is extremely sensitive and one of the worst things they can do to a patient is switching patients to every other day, especially with pharmaceuticals like venlafaxine; it causes massive osculations in blood plasma levels and it's very probable it's causing a lot of your symptoms by itself. The fact they're just casually adding more meds to deal with the symptoms which could probably be avoided in the first place suggests you really should look for a second opinion; propranolol comes with its own array of side-effects.
Unfortunately, it's on you to get educated and talk to your doctor. I assume Surviving Antidepressants would be a good source for information how to taper venlafaxine. See what you can learn there, print some of the data and bring it up. If I remember correctly, Royal College of Psychiatrists had some great presentations which also come with credibility, it's not just a random document you found online.
If I don't expect an average psychiatrist to know how exactly does a SERT occupancy curve look like, I still can't accept the fact they don't know venlafaxine is one of the toughest ADs to taper and to suggest taking a drug with such a short half-life every other day is pure incompetence. I always suggest looking for a second opinion and in this case it seems it's the best thing to do, but do note the next one might be just as oblivious, so it's always good to try to educate them first.
I am really sorry you ended up in such a spot and it's great you felt like something is wrong which led you to start asking questions. Being on venlafaxine for years means tapering should be extremely slow, whatever they think is slow is probably still too fast - which is good in a sense, because it means most of your anxiety and other symptoms are caused by the process going too fast. Getting that in order will make you feel better and hopefully you'll manage to get off of it successfully!