Im sorry you have to go through that, again. The first time I decided to come off cymbalta, I decreased my dose way too quickly. I wish doctors had informed me about the side effects and how difficult it is to come off some of these medications, namely, cymbalta, effexor and paxil. From what ive read, those are the three most difficult ones to come off of (atleast from the antidepressant family).
Your observation that its most difficult when youre at the last 20 - 15 mg lines up with the literature ive read. As i understnad things, it has to do with receptor occupancy. Decreasing medications is the inverse of increasing your dose. The higher your dose gets, the less impact the medication has (theoretically, or pharmacologically speaking). And the lower your dose gets, the more impact it has on your brain. As you start a medication, the starting doses and the next dose increase technically have the biggest impact on your brain. You go from nothing, to like up to 70% increase in receptor occupancy (+/- but its something to that effect). I read an analogy explaining this which used a towel, I think it was a towel. Anyway, If you take a completely dry towel and quickly dunk it into a lake, it is going to get pretty wet. Actually, it will get soaked instantly. It goes from 0 to 100%. But if you are handed a towel that is already dripping wet, and you dunk it into the lake again, it isn't going to absorb much more water...Albeit it will still absorb a tiny bit of additional moisture.
Starting a medication and going from nothing to something has a massive, significant impact on your brain; the exact same way dipping a dry towel into a lake does. Your brain's receptors go from completely open to heavily saturated right away.
The same logic applies to changing your dose. The higher your medication dose gets, the more saturated those receptors (serotonin and norepinephrine) become, and the less impact a small change will have. Because of this, reducing your dose from the very top has a very minor effect (atleast, thats what the textbooks say... i might be living proof to show that is not entirely true). Anywah, If you are taking a high dose of effexor, like 300 mg, your towel is already completely submerged at the bottom of the lake. Pulling it up just a few inches, like, decreasing your dose from 300 mg down to 262.5 mg. It shouldn’t be much of a change. At least, it shouldn't be overly disruptive from a theoretical or pharmacological standpoint, because the towel stays completely soaked. Buy once you get down to the lowest doses, the rules completely change. When you are down to a tiny dose, your towel is no longer deep underwater; it is hovering right at the surface of the lake. At this point, even a tiny reduction is the equivalent of ripping the towel out of the water and into the dry air. Because the receptors are no longer saturated, going from a small dose to zero causes a massive, sudden drop in occupancy. What felt like a smooth, unnoticeable transition at 300 mg suddenly becomes a harsh, abrupt shock to the brain's chemistry. You didnt ask for that analogy or rant, but you got it anyway 😅.
This isn't medical advice, and just my opinion, but the fact that you become stable once reinstating a higer dose tells me that its a dependency and drug related. Not a true representation of your mental health and who you are. I say this because I experienced (and currently experiencing) the same thing. I used to internalize this and would tell myself that this is how I am, I have horrible mental health and im mentally ill. Two things can be true, and I do struggle with mental health, but not like this. This isn't me, and some of the reactions and spirals ive experienced as a result of medications tells a different story.
Anyway, thanks for the welcome and hope things go well. Always remember its a marathon, not a sprint. Hyperbolic taper should be tailored to how your body reacts to dose reductions.
Effexor — ~258.79mg — 3 years — actively tapering | without clinician
Currently Taking: Pregabalin 600mg, Dexedrine 60mg, Mirtazapine 15mg, Effexor 258.79mg
Previously Taken: Setraline, Seroquel, Prozac, Vortioxetine, Trazaodone, Escitalopram, Cymbalta, Effexor, Abilify
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