Effexor: The Hot Flashes Made Me Do It

My Secret Addiction to Effexor and How I Made It Through.

Effexor for Hot Flashes

{Art by Andrea de Santis}

My name is Caitlin Marcoux. I am a breast cancer survivor, and for the last 4 years, I have also been a drug addict. An SNRI called Effexor has been my captor.

Did that get your attention? Great.

Because if you’re considering taking an SNRI, I want you to have some of the information I didn’t, before you make this really important decision. I’m not a doctor, and I’m not about to offer any medical advice. I am here to share my story with Effexor though, because I wish I had read it before jumping on the SNRI bandwagon myself.

First a little background.

Effexor Withdrawal Symptoms, Hot Flashes

The particular type of breast cancer I was diagnosed with in March of 2013, was estrogen driven. I was 36 years old, still feeling quite fertile, and not even close to the onset of menopause. As those of you who followed this blog know, I went through chemotherapy and surgery and then more chemotherapy. Fantasies of having another baby faded into the distance, and I turned all my attention on regaining my health.

I don’t want to go back into all the cancer stuff here, so let’s jump forward to October 16th, 2015, when I found myself back in the OR for a full hysterectomy and oophorectomy. The hysterectomy was because of cancerous cells on my cervix, the simultaneous oophorectomy (removal of the ovaries) was done to mitigate the risk of my breast cancer’s return.

With the removal of all my female parts now including both breasts, both ovaries, uterus and my cervix, I awoke from that operation in full blow, surgically-induced menopause. My time as a reproductively viable woman was over.

It was, in the beginning, emotionally overwhelming. On top of the grief I was consumed with, the physical symptoms of menopause were immediately challenging. The weight gain was frustrating (15 pounds!), the hot flashes were unbearable. Sleep was illusive. I was weepy, moody, and compulsively checking my chin to see if yet another f-ing hair had spouted.

Let me just get this off my chest, and then I’ll get back to the point of this blog: Of all the symptoms of menopause, for me, the hot flashes were and remain, the worst. If you feel this way, please know YOU ARE NOT ALONE.

I don’t really understand the complex physiology that causes hot flashes, suffice to say, sisters, the struggle is REAL.

“There’s no mistaking it: the sudden, intense, hot feeling on your face and upper body, perhaps preceded or accompanied by a rapid heartbeat and sweating, nausea, dizziness, anxiety, headache, weakness, or a feeling of suffocation. Some women experience an “aura,” an uneasy feeling just before the hot flash that lets them know what’s coming. The flash is followed by a flush, leaving you reddened and perspiring. You can have a soaker or merely a moist upper lip. A chill can lead off the episode or be the finale.

Every woman’s experience is a little bit different. However, the faster you transition from regular periods to no periods, the more significant your hot flashes may be. Some premenopausal women who have their ovaries removed can experience severe hot flashes due to surgical menopause. Chemotherapy-induced medical menopause can cause hot flashes, as can hormonal therapies such as tamoxifen. Overall, the severity of hot flashes can vary from mild to moderate to severe.” ~BreastCancer.org

Effexor for Hot Flashes, Withdrawal Symptoms, Menopause So, what’s the treatment, you may be thinking. Well, lots of women can mitigate the symptoms associated with this transition with HRT, hormone replacement therapy. Unfortunately, because of the estrogen sensitivity of my breast cancer, the bioidentical hormone replacement therapy, available to many women, was not an option for me, and it may not be for you either.

Enter Venlafaxine.

Venlafaxine, aka Effexor, is an SNRI used to treat depression, generalized anxiety disorder, panic disorder, and social anxiety disorder. It is also used “off label” to treat vasomotor symptoms, doctor speak for “hot flashes”, in women who are not candidates for HRT. When I asked my team what else could be done to help me my sanity, a daily dose of Effexor was the answer. I was so thrilled at the prospect of reducing the time I spent swimming in night sweats, I excitedly agreed to start the drug right away.

While to date, there are no known problems associated with long term use of venlafaxine, no one told me how addictive this stuff is. No one sat me down and invited me to take a calm risk to benefit assessment of the situation before I signed up. No one told me that if and when I wanted to come off Effexor, I might feel suicidal. No one said that I could expect sever withdrawal symptoms including nausea and diarrhea and a deluge of uncontrollable tears. No one said, “hey you might want to check out all these patient blogs and YouTube channels teeming with scary anecdotes about Effexor-related  “brain shivers”, “zaps,” and “brain flips.” You may want to think twice before you feel like your mind has been doused with “bottled lightening” ‘ Nope, no one said anything about that stuff. 

And so it was, that after 3 years of taking Effexor every night, my body, unbeknownst to me, had become totally hooked on a drug that would be nearly impossible to get off of. Yes, at a high does, it treated my hot flashes with only LIMITED success, but at what cost? It was hard to tell.

Every once in a while I would forget to take a dose, or worse, I’d forget to take it two or three days in a row. The first time I made this mistake, I got some sense of how addicted I had become, and wow did it scare me.

Tears about nothing, followed by vertigo, followed by the intermittently feeling like I was sticking my finger in a light socket, headaches, and a pervading sense malaise, were just a few of the things I felt, only 6 hours after a missed dose.

At first these seemingly inexplicable sensations would be mystifying. WTF was going on? Then the little voice inside my head would reply: “you forgot your pill, dummy” and I’d take my dose. Relief would wash over me within a few hours, and all the crazies would dissipate.

Once I forgot to refill my script, missed a day, and when I did remember the refill, the pharmacy was closed. I was so desperate to get my hands on any amount of Effexor, I posted about it on our local Nantucket Consignments FaceBook page to see if anyone had some I could take until the prescription could be re-filled. I was promptly kicked off the page!

When the pharmacy opened the next day I was there 5 minutes before they unlocked the door, fidgeting like a crack addict. I watched and waited as they filled the script, and downed the first of the missed doses, hands shaking, right there in the store.  Self-conscious about my behavior, I sobbed the whole way home. I was a stranger in my own body.

These withdrawal symptoms were only premonitions of worse things to come…

Then I fortified resolve.

The day I decided to terminate my relationship with the SNRI, I emailed my oncologist. I had cut Ativan cold turkey, a drug I was using for anxiety and insomnia at the hight of my cancer treatment, but I knew slaying this demon would require some support. (Man, was that an understatement).

My oncologist put me on the following schedule {I’m sharing it just in case it’s of help to anyone out there on the world wide web – but please, please, please, consult with a medical professional before attempting this on your own}

  • From 150mg of Effexor XR/day, I switched to 3 pills of 37.5mg (or 112.5mg) for 1 week
  • Then 2 pills (or 75mg) a day for a week
  • Then 1 pill of 37.5mg a day for 2 weeks
  • Then I’d be done. 

The process was to take one month, and by it’s end, I’d be free! The day I tapered to 112.5mg, I was over the moon excited. The thought of finally being free of all drugs and getting back to myself the way I was in my pre-cancer life was thrilling.

I made it without consequence through the first three weeks of the taper. The switch to 37.5mg was tough, with brain zaps here and there, and general moodiness, but the drop from 37.5 to zero was nothing short of brutal. In fact, the second day without any Effexor, I thought I was loosing my mind. It was the weekend, and both my PCP and my oncologist were off duty, so I called the MGH Cancer hotline to speak to a doctor, any doctor.

Attempting to explain what was happening to my body and in my head, to an oncologist I had never met, felt like talking under water. The words were coming out of my mouth, but I could tell they were landing on deft ears. He just kept telling me there was no efficacy in the 37.5mg does and that it didn’t make any sense that I would feel like “jumping off a cliff” by dropping from such a small dose to nothing.

I desperately wanted to reach through the phone and choke him.

Instead, I took a deep breath, thought of all the shitty things I had already survived, and attempted to calmly ask him to extend the 37.5mg script for another 2 months. He seems confused and kept asking me if I was having any other neurological symptoms (did he think the cancer was back and in my brain?) but ultimately he called it in: 2 more months of Effexor at 37.5mg a day. It was back in my system later that night.

Clearly, this drug had a strangle on me.

That’s when I found Wendy Will’s blog I Did it: How to Stop Taking Effexor. It turns out that Wendy too had been prescribed Effexor for chemotherapy induced hot flashes, and she too had trouble getting off the drug. Finally I felt REAL. I didn’t feel alone and crazy any more. I felt seen, heard and VALIDATED! And best yet, Wendy introduced me to the Effexor-Prozac Bridge:

So what’s Prozac have to do with it? Prozac is an extremely long “half-life.” It takes Prozac 7-9 days to leave the blood stream (as compared to Effexor XR at 15 hours). Withdrawal symptoms are considered unusual when taking Prozac. When you are able to get to the lowest dose possible on Effexor XR is when you are suppose to replace – or bridge – it with Prozac. It’s up to you and your doctor when you decide to wean from the Prozac but apparently it’s supposed to be head and tails easier to do than Effexor XR.

There was HOPE! And below the hope, there were hundreds of comments from other people who had been through similar trials and tribulations. Not only did I have company, I had a whole brotherhood and sisterhood of companions out there who shared my struggles and had had some success with this method.

Did you know that in 2007 there were 17.2 million people taking this “black label” drug! I wonder how much money Pfizer would loose if everyone stopped taking it tomorrow?

Anyway, that’s what I decided to do. I decided to try again, and this time with the bridge.

I set up an appointment with a local psychiatric RN, and together we planned out my Effexor-Prozac bridge. She had me immediately replace the 37.5mg of Effexor with 20mg of Prozac. I took 20mg of Prozac for one week and then tapered down to 10mg for a week. Lucky for me, I got to do this last little psychiatric dance while at Kripalu for 5 days with my Prana Vinyasa kula against the backdrop of the beautiful Berkshire mountains.

As of Monday night, I am on nothing, no Effexor, no Prozac, nada. So far (knock on wood) I haven’t had any brain zaps, no vertigo, no need to pull the truck over for fear I’m going to cause an accident. Of course, it’s only been 2 days. The real test will come with the Prozac’s half-life (which lasts up to 9 days) is dead.

It’s been quite the experience; feeling powerless in the clutches of a pharmaceutical. Feeling at times beaten down and hopeless. Sobbing myself to sleep. Hiding my symptoms, in shame, from friends and family. But today, today I feel full to the brim with hope and almost giddy excitement to be both cancer-free and 100% drug-free for the first time in four years.

I have a spring in my step, and it has nothing to do with an artificial overabundance of Serotonin, and everything to do with perseverance.

Please do not misunderstand me, I am very grateful for the many advances in modern psychopharmacology. And certainly, there are thousands of people who derive great benefit from psychoactive drugs, and need them to function normally day to day. This is not a knock on anyone for taking prescription medication.  My hope, in sharing this information with the breast cancer community is to highlight the possible side-effects of SNRI dependance and withdrawal. And to reassure my Sisters in the Change, that you are not alone.

 

With great respect for your decision making process,

Caitlin

Effexor for Hot Flashes, Withdrawal Symptoms, Caitlin Marcoux

Have a hot-flash abatement tip?

Leave it in the comment section below! I’d love to hear from you. 

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{the beginning}

Author’s Note: This blog is an illustration of my own personal experience with an SNRI prescribe to treat symptoms of menopause, not clinical depression. Please do not use this personal account in place of professional medical advice. I am not and do not claim to be, a medical professional. If you are looking to taper or come off of an SSRI or SNRI, please consult your doctor. 

If you are feeling suicidal, please contact the National Suicide Prevention Hotline at (800) 273-8255.

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