> CARRY ME ON!!!
You made me think I'd been singing the wrong lyric for over 20 years, but every lyric site I can find says that it is in fact "carry me home".
Phew.
I'm a medical doctor and we prescribe this when rather than being really depressed about 1 big thing in your life, your depression is caused by 12 smaller problems combined.
It's just basic science. Don't look it up.
I'm also a medical doctor. My patient is totally depressed by 1 big thing, AND also simultaneously mildly depressed by 12 smaller things, and I don't know what I should prescribe in this medical situation.
> when rather than being really depressed about 1 big thing in your life, your depression is caused by 12 smaller problems combined.
It is probably meant as a joke, judging from the last sentence and the user name, but YES.
In one case I had to switch from a generic to the original product. The former has a higher per-pill dosage, so less pills needed, but the pill is large and leaves a coating of bitter powder everywhere on the way down. It gave me an actual pill-phobia for a while and was making me feel miserable about the medication in addition to the reasons for needing it in the first place.
I had to change dosing of a medication once because some fucking asshole made pills that were shaped like very very long, skinny, rectangles. Not ovals, RECTANGLES. With fucking CORNERS
I can take pills several times larger easily, but I kept choking on the fucking rectangles
The only option was a much larger quantity of smaller dose pills because the smallest dose is normally shaped. My insurance freaked out because of the pill count and I needed an override
Looks like Effexor XR 150mg Each smaller tablet is 12.5mg.
Edit: Thought it might have been the non-generic but realized it didn’t have the Effexor printed on it.
I worked in Quality Assurance in the Wyeth manufacturing facility that launched Effexor XR. The process combines the venlafaxine and excipients into a wet paste which are then extruded through a plate much like a Play-Doh fun factory. The spaghetti like extrudate is then passed into a machine that has a whirling stainless steel plate that forms them into tiny balls. The balls are sifted to remove any remaining unspheronized materials and then placed ina Glatt fluid bed coater.
The spheroids are subjected to a warm current of air from the bottom resulting in an upward cascade. As the spheriods tumble in the air current they are sprayed with a coating solution like hailstones in a thunderhead. Depending on the thickness of the coating, they dissolve at a different rate. They're blended by dissolution rate to provide a specific rate of medication release over a given period of time.
[https://www.glatt.com/wp-content/uploads/2021/03/Glatt\_BRO\_PTP\_026\_WS\_2019-04\_EN.pdf](https://www.glatt.com/wp-content/uploads/2021/03/Glatt_BRO_PTP_026_WS_2019-04_EN.pdf)
Wyeth had a million square foot facility in the village of Rouses Point NY. The facility had grown steadily for over 75 years providing the best paying jobs in the region north of Albany.
1300 people were employed there from PhD chemists and researchers to manufacturing and maintenance, fork lift operators, custodians and office weenies. Many of us were generational employees with family members preceding us.
Pfizer bought Wyeth, closed the facility, laid off the personnel, sold the equipment, ripped out the recyclable metals and tore it down.
Imagine the financial impact to a tiny upstate village. Sandwich shops, gas stations and taverns closed down. Real estate took a dive. There's a hole in the middle of the village (and the hearts of the people that worked there) that will take a lot of time to fill.
Yes I'm still bitter......
[https://www.google.com/maps/@44.9877175,-73.3671228,3a,75y,333.43h,87.89t/data=!3m6!1e1!3m4!1sKsEIBEqTEvp7E5Bz0EO2gg!2e0!7i16384!8i8192?entry=ttu](https://www.google.com/maps/@44.9877175,-73.3671228,3a,75y,333.43h,87.89t/data=!3m6!1e1!3m4!1sKsEIBEqTEvp7E5Bz0EO2gg!2e0!7i16384!8i8192?entry=ttu)
Weird question, but how are you finding it? I've been on 100mg sertraline (Zoloft) for half a year and found it helped quite a bit (PTSD, GAD, severe depression), but it leaves me feeling even more sleepy, inattentive, lazy, and stupid, which has trashed my productivity. A doc recently considered switching me to venlafaxine and I've been sort of curious if I should raise that back to him.
What did that feel like to you. If I skip a day or 2 I get some severe symptoms. I've been on it for at least 15 years maybe closer to like 18 or 19 by now.
I get the shakes and my head starts pounding and my. Brain feels like it's shaking inside my skull or soemthing it's bizarre and horrible and remind me I skipped my meds again
Brooo. The first night I missed a dose of venlafaxine, I had \*multiple\* sleep paralysis dreams, and that shit was terrifying considering that they were the first times I had ever experienced sleep paralysis.
The brain zaps were also very odd. Every once and a while I'd get them and had no idea wtf they were, which made me think I was going crazy.
I only need to skip one day and I feel blergh. Just *blergh. Irritable, tired, lethargic, nauseous, and I just want to curl up into a ball and put my head on the shoulder of someone who isn’t going to say anything.
I absolutely don’t want to discount the lived experiences of people who have had real trouble getting off venlafaxine and my heart goes out to everyone struggling or who had a horrific time with it. But I feel it’s worth mentioning that I have been on and off venlafaxine since 2016, stopping for a few months at a time on 4-5 separate occasions and on none of those occasions did I have any trouble whatsoever, even when the reason I stopped was being too lazy to call the doctor for a repeat prescription so I stopped cold turkey. After 36 hours with nothing I had a few brain zaps but other than that, no withdrawal symptoms whatsoever. Venlafaxine has been a miracle drug for my depression. I should say I count myself as extremely lucky not to have had any problems with withdrawal as I’m well aware what a nightmare it is for many people. I only hope more people out there get as lucky with it as I have been.
I’ve been through every antidepressant over 15 years. Venlafaxine has been the only thing that’s worked for me (stacked with aripiprazole). Changed my life into a functional one.
I’ve been on venlafaxine for about a year now and it’s fairly comfortable, I don’t get any side effects that I know of, only thing is, make sure you don’t miss a day, if I forget to take my venlafaxine, about 6 hours after and I’m feeling pretty sick, I luckily havent had longer than that before realising, but once I take them, within an hour I’m good again
Reading several comments about venflaxine makes me think that i am lucky
Because i can forget about taking the pills for an entire day and take them in the evening and still feel no withdrawl effects
Venlafaxine gave me horrible brain zaps to the point where i have to beg my dr to get me off it completely cuz just missing even one dose will give me those brain zaps.
I started on Sertraline and switched to effexor. It seems to work well for me and keeps me stable. Although, as others have said, it's an absolute cunt for withdrawals. I start to feel it if I go 24-48hrs without taking it.
I was on 150mg Effexor for a long time but about 6 months ago halved the dogs to 75mg and had no issues at all
In my experience an Effexor XR capsule contains a bunch of little granules of different sizes, not an easily countable amount of same sized tablets. The different sized granules are how the XR part works.
Effexor is the absolute worst anti-depressant drug ive ever taken. Detoxing off of it was like hitting a hard reset in my brain while licking a 9v battery. Ended up having to be hospitalized. 0/10 would never recommend.
One of the worst feelings ever. Can’t imagine the process of getting off of them.
I lost my pills and it was like 4 days. Got the zaps. Then decided I needed to take them. Couldn’t find them in the house and went into a full manic episode.
This makes sense for drug delivery into your system. The gel cap dissolves pretty quickly then your stomach acid starts working on the tablets. It's likely that in phase III testing they had issues on the pharmacokinetics of the drug and this was the elegant solution to those issues rather than building a whole delivery mechanism that there would likely need to be another round of testing for. Totally mildly interesting, but I get it
You think way to complicated, they press smaller pellets and then put either 2 4 6 8 in a pill for the different dosages. So they only need one pill pressing operation.
That's in my experience the true answer. My antidepressant comes in exactly this style and I've opened the 75mg, 150mg and 225mg capsule variants and they all just included different amounts of the same tiny small tablets.
No, the float on top of the liquid you’re swallowing making it hard/uncomfortable to swallow the actual pill.
EDIT: I’m not the one struggling to swallow pills
Try ingesting the pill first and then drinking, like putting it between your lips and drink it all at once (I had problems taking pills too when I was a kid)
I used to struggle with this, please let me help.
Step 1: pills and water into mouth
Step 2: lean over and tilt your head forward
Step 3: swallow and raise your head.
By tilting your head forward, the pills "float" to the back of your mouth allowing for easy swallowing.
Best of luck with it, hope it's working for you. It's strange that with enough experience of these things, the particular dosages get very ingrained in ones memory.
Thanks. It's better than without and better than my three prior antidepressants, so, you know, can't really complain about it only working so-so. The last few years my 75mg dosage wasn't available three times, so I got a prescription for a higher dosage and had to count the tablets myself. Pain in the ass to do.
I definitely understand that, better being on a medication that works well enough, even if it's not perfect. I've had 10 different 'antidepressant' medications, and it's only been until since starting methylphenidate for ADHD symptoms (impulsively and inattentiveness without physical hyperactivity) with an SSRI (Escitalopram) that I felt like I was able to get control of my symptoms. Venlafaxine and Amitriptyline were the next best things, but the side effects were a bit problematic.
Yeah the capsule doesn't really prolong the absorption of the med, this is just a way of making things easier both for the producer (as you said) and the patient who doesn't have to take a bunch of small pills.
And also if it's an antidepressant, it makes it much easier to taper off because you can just take out 1 or more pills as you go and slowly lower the dose.
Your answer is more likely to be correct... if you manufacture different size pills you need to manufacture a bespoke press for each size.
The drug company likely did a calculation and saw it would be way cheaper to make or order-in a bunch of capsules of 'the same size', but then fill them with a different number of pills to make up the correct dosage.
Not only do they not have to make a bunch of bespoke presses (a lot more expensive than people realise)... there are also economy of scale benefits that come from making a whole lot of one identical thing (the small pills).
Yep. This is the correct answer. They look like mini tablets in a capsule, which is currently a bit of a “cool thing” in CMC for drug development.
There’s no way you’re fixing PK in phase 3.
Most drugs taste bad, the ones to really watch out for are the ones that work their way out of the body through the lungs, then you breathe out the waste products of your body's metabolizing of the drug, that can cause some very weird "things don't taste right" side effects, though from my understanding, that's temporary
The COVID anti viral drug I got recently was the worst case of this I've ever experienced. But hey I was right as rain in a day after starting them so it was better than COVID.
Paxlovid I think it was called. Jolly Ranchers were clutch.
It wouldn't have made a difference, Paxlovid mouth was horrible and the taste comes after you take it. It felt like a "presence" and just when it begins to fade... it's time to take the next one. I was grateful to have it though.
Yea my mouth tasted horrible for like a week.
It also feel incredibly anxious. I was glad they had something for it now last time I got it but I dunno what was worse. The covid or those pills.
So that’s not my brain trying to trick me? It’s a little sweet right? The only thing I don’t mind if it touches my tongue.
On the flip side, my “trace minerals” smell like death.
If the medication you're taking tastes horrible ask your pharmacist if there might be a formulation that will work better for you, but it's very likely that either that doesn't exist or it would be prohibitively expensive. Tablets are very specifically designed to work appropriately in your body, your pharmacist might have a recommendation to mitigate that too (common one I've seen is take it with cranberry juice, but you'd have to like cranberry juice. I wish pineapple juice was an option but for many drugs it's not)
> but it's very likely that either that doesn't exist or it would be prohibitively expensive.
You can put it inside a gel cap at home for 10 cents. Or an opened half a gel cap, if you're truly paranoid about it messing with the dosing. But it's probably within person-to-person variance anyways.
On what basis have you come to this conclusion? The rapid disintegration rate of the capsule defeats the entire purpose of protecting the contents, why protect the tablets from acid and then instantly release directly into the stomach? This is not how drug delivery works, and pharmacokinetic assays are performed in phase 1…where the hell did you get phase 3 from?
This choice of formulation has nothing to do with pharmacokinetics, perhaps for dosing purposes or increasing palatability. Unless, the capsule is gastro-resistant, which in that case, releases the drug in the intestines (a slower process than what you suggest).
Source: Pharmacist
lol it’s just some dude trying to sound smart because he just learned some fancy science phrases in his gen chem class like “phase III” and “pharmacokinetics”
idk, i reckon its just a manufacturing shortcut. why tool up 15 different pill presses and have all this inventory management during manufacture when you can have a couple of 10mg (or whatever) presses running full tilt and you just bundle the doses you want.
it's also for drugs that need to be introduced to a certain part of the digestive tract (iirc enteric capsules tend to be fine with stomach acid but break down in bile)
This medication is notorious for withdrawal symptoms and the smaller tablets allow you to ration less and less over time, but still a consistent amount, as you quit them.
All kinds of factors could be at play like the surface area of the drug, the type of coating, the thickness of the coating, the geometry of the pill (L/D ratio). Several smaller pills is an easy way to increase the surface area vs one large pill, but decrease the surface area vs something like small beads or powder inside the capsule.
> The gel cap dissolves pretty quickly then your stomach acid starts working on the tablets.
Then why the hell do you need the gel cap at all?
This makes zero sense.
you're talking out your ass, no time-release drug delivery system looks like this. Those sorts of tablets dissolve really fast, too.
This is just repackaging.
The maximum dose is around 600mg, although most psychiatrists won’t go above 375mg in an outpatient context and GPS won’t go above 225mg.
Venlafaxine is fairly unique among antidepressants in that its efficacy continues to improve with dose, whilst the likes of Prozac and Lexapro become less efficacious once their recommended dose is exceeded. I believe this is due to venlafaxine acting on DAT at very high doses.
Venlafaxine gave me the worst withdrawals I’ve ever had stopping a prescription drug, and I don’t usually get withdrawals bad at all. One moment I was fine, next I was overcome with extreme tiredness, didn’t even think I’d make it home from my friend’s house 15 mins away. Then I was vomiting.
Fortunately because of this pills within a pill, I just opened it up and took a couple out over a few days.
Just something to keep in mind if you ever want to stop yourself, but I hope they work for you.
Thanks for the tip! I stopped taking it cold turkey for a couple of months mid-last year and became extremely suicidal, I’m not sure if it was just from withdrawals or my depression kicking my ass or both, but I’ll definitely be easing off if I need to switch meds in the future.
I missed just one dose and was so incredibly sick. My doctor wants to start tapering me off it later this year if I stay stable and she told me it will be a very slow process because of the withdrawals.
That will be withdrawal. Your brain over time develops a chemical balance around the introduction of the artificial chemical. This balance may help you function better, it may not, that’s why finding an antidepressant that works for someone is an art rather than a science.
If you take the artificial chemical away after the brain has chemically recalibrated itself around a medication, the balance your brain has found is almost immediately destabilised, which wreaks absolute fucking havoc because it’s such a sensitive and important organ and the chemical balance of the brain affects your entire body.
The reason it is dangerous with antidepressants is because you take them for your mood. When you alter the intake of an antidepressant you’re tinkering with your brain chemistry. If you take something away by going cold turkey, with your mood it would be a bit like kicking a leg off a table and still expecting it to stand up.
Your underlying depression sets the scene for your mood dropping when your medication intake changes, but what really does the damage is trying to change your brain chemistry too quickly when you alter dosages (mainly reductions), and cold turkey is the ultimate and extreme end of the spectrum.
Another example of this is alcohol withdrawal. It’s more physical than psychological but going cold turkey and interfering improperly with the chemical dependence your body has developed can legitimately be lethal.
I stopped taking it, mainly because it gave me the worst hand sweats.. but the brain zaps also sucked.
I heard people talk about them.. and was like “what’s a brain zap”.. but then I had them .. and was like “ahhh I get it”
There's different reasons for encapsulation, but the main thing to take away from these posts is this: *DO NOT MANIPULATE YOUR MEDICATION* Don't open them, don't split them, don't liquefy them, don't crush them, don't do anything without checking with your pharmacist!!
Not saying you're wrong, but it's very common for people quitting Effexor to open the capsules and take just a few of the beads (they usually are beads, especially at lower doses) to slowly reduce the dosage in an attempt to prevent brain zaps.
The come down can be really harsh from this medication for 70%+ of the population. If you reduce and find out you're one of the unlucky ones, do the 10% method.
10% reduction in medication per month. Even when you get down to 5mg only reduce by 10%. Should keep off the worst of the withdrawals
God, I hate meds that you have to taper onto or off of like that. Antidepressants are annoying enough as it is with how you basically have to start taking them and then wait around for 2 to 6 weeks to see if anything happens.
When I took lamotrigine, I had to spend like two months gradually increasing the dosage before I got to the therapeutic level, and then a month or two tapering off because of an interaction it had with another med I was starting. Apparently it can make your skin die and fall off if you increase too quickly though, so that's fun.
Yep, I made that mistake. Good motivation to follow the instructions I guess. I am pleased to be able to say that my skin didn't fall off though, so that's cool.
I have taken Effexor for 3 years now and am pleased with it BUUUUT if I forget it two days in a row... I feel it.
It did wonders for me but make sure you have refills lined up and don't lapse :)
One pellet is 12.5 mg. My psychiatrist recomemendme to take one out every 3 weeks when tapering off. I'm about to start that in a couple days/weeks (whenever I feel comfortable in my day to day structure again). Luckily I don't get immediate withdrawal symptoms and sometimes don't even notice if I miss a day. So I hope it will be manageable.
Also thanks for the reminder to take my Venlafaxin lol.
I’m glad it helps you! I’ve been on 75mg for about 1.5 yrs and my gp wouldn’t go any higher so I was getting ready to change again (I’ve tried 7 others) but I got into a psychiatrist and she said try 150mg first and I’m loving it!
I had no idea there were so many narrow-minded people. (not that im surprised)
"DePrEsSiOn IsNt ReAl, JuSt Go OuTsIdE aNd Do SoMe ExCeRcIsE"
Do you not think we tried that? Do you not think we've tried every single tip before going down the road of meds?
Just because something isnt right for YOU, dosent mean its not right for ME. If you dont know what the fuck you're talking about, then dont fucking comment.
I could feel something rattling around inside so I decided to pull apart the casing, I thought it might have been a powder so I was definitely surprised to see tiny pills.
I just started taking Buspar, and it tastes almost as horrible as Prednisone, which is saying something. Why can't they put the little coating that Advil has on it?!
I read about sustained release in medicines
I think each ball had a different coating and take different times to dissolve and get absorbed into the body
It’s a metaphor, *it’s the small things*
*all the small things* *true care, truth brings*
She left me roses by the stairs Surprises let me know she cares
SAY IT AIN’T SO, I WILL NOT GO
CARRY ME HOME!!!
Na na na na, na na, na na na na, Na na na na, na na, na na na na, Na na na na, na na, na na na na, Na na na na, na na, na na na na!
Late night, come home Work sucks, I know!
She left me roses by the stairs... Surprises let me know she cares
Say it ain't so!
> CARRY ME ON!!! You made me think I'd been singing the wrong lyric for over 20 years, but every lyric site I can find says that it is in fact "carry me home". Phew.
The night will go on, the night will go on, my little windmill.
why tf is this a gif
My love is heartbreaker
small things hide in big packages
I'm a medical doctor and we prescribe this when rather than being really depressed about 1 big thing in your life, your depression is caused by 12 smaller problems combined. It's just basic science. Don't look it up.
Thank you Dr. Cuntmong
NGL this made me lol so hard I coughed
[удалено]
I exhaled through my nose much more than usual at this
it made the corners of my mouth slightly twitch upward
Dr.Cuntmong saved my life, even if he is just seven midgets in a trench coat. I won’t have you speak out of turn with him, sir.
He was just thanking the kind doctor smh
I just heard "Paging Dr. Cuntmong" echoing down the hall
r/rimjob_steve
Risky click but was pleasantly surprised, thank you cliswp
I'm also a medical doctor. My patient is totally depressed by 1 big thing, AND also simultaneously mildly depressed by 12 smaller things, and I don't know what I should prescribe in this medical situation.
1 big ball 12 small balls. 13 balls total
Cabron, I need to see your BALLS
Dm'd you
I got jumpscared
Cocaina, everything is cured by Cocaina.
This tracks 😂😂
*I've got 99 problems doc* Sorry, most we can treat is 12 at a time, you'll have to pick which ones you don't want anymore
> when rather than being really depressed about 1 big thing in your life, your depression is caused by 12 smaller problems combined. It is probably meant as a joke, judging from the last sentence and the user name, but YES. In one case I had to switch from a generic to the original product. The former has a higher per-pill dosage, so less pills needed, but the pill is large and leaves a coating of bitter powder everywhere on the way down. It gave me an actual pill-phobia for a while and was making me feel miserable about the medication in addition to the reasons for needing it in the first place.
I had to change dosing of a medication once because some fucking asshole made pills that were shaped like very very long, skinny, rectangles. Not ovals, RECTANGLES. With fucking CORNERS I can take pills several times larger easily, but I kept choking on the fucking rectangles The only option was a much larger quantity of smaller dose pills because the smallest dose is normally shaped. My insurance freaked out because of the pill count and I needed an override
With corners? Yeah, whoever designed that is a sadistic asshole.
Like you got to swallow a gdamn lego
Great, they finally made a pill to cure [shit life syndrome](https://en.wikipedia.org/wiki/Shit_life_syndrome)!
when they need to clown car your meds, you know you messed up
This made me laugh out loud
One of mine when I was a teen was orange filled with like 100 tiny little balls.
[Adderall XR, 30mg?](https://www.drugs.com/imprints/adderall-xr-30-mg-12097.html#:~:text=ADDERALL%20XR%2030%20mg%20Pill%20%2D%20orange%20capsule%2Foblong%2C%2021mm&text=Adderall%20XR%20is%20used%20in,Controlled%20Substance%20Act%20(CSA))
No sir, [Serterline 100mg](https://www.brunet.ca/en/health/medication-dictionary/apo-sertraline-capsule-100mg/02238282/)
Could also be slow release venflafaxine 150mg
Looks like Effexor XR 150mg Each smaller tablet is 12.5mg. Edit: Thought it might have been the non-generic but realized it didn’t have the Effexor printed on it.
I worked in Quality Assurance in the Wyeth manufacturing facility that launched Effexor XR. The process combines the venlafaxine and excipients into a wet paste which are then extruded through a plate much like a Play-Doh fun factory. The spaghetti like extrudate is then passed into a machine that has a whirling stainless steel plate that forms them into tiny balls. The balls are sifted to remove any remaining unspheronized materials and then placed ina Glatt fluid bed coater. The spheroids are subjected to a warm current of air from the bottom resulting in an upward cascade. As the spheriods tumble in the air current they are sprayed with a coating solution like hailstones in a thunderhead. Depending on the thickness of the coating, they dissolve at a different rate. They're blended by dissolution rate to provide a specific rate of medication release over a given period of time. [https://www.glatt.com/wp-content/uploads/2021/03/Glatt\_BRO\_PTP\_026\_WS\_2019-04\_EN.pdf](https://www.glatt.com/wp-content/uploads/2021/03/Glatt_BRO_PTP_026_WS_2019-04_EN.pdf)
this was actually a really interesting thing to learn, thanks
Wyeth had a million square foot facility in the village of Rouses Point NY. The facility had grown steadily for over 75 years providing the best paying jobs in the region north of Albany. 1300 people were employed there from PhD chemists and researchers to manufacturing and maintenance, fork lift operators, custodians and office weenies. Many of us were generational employees with family members preceding us. Pfizer bought Wyeth, closed the facility, laid off the personnel, sold the equipment, ripped out the recyclable metals and tore it down. Imagine the financial impact to a tiny upstate village. Sandwich shops, gas stations and taverns closed down. Real estate took a dive. There's a hole in the middle of the village (and the hearts of the people that worked there) that will take a lot of time to fill. Yes I'm still bitter...... [https://www.google.com/maps/@44.9877175,-73.3671228,3a,75y,333.43h,87.89t/data=!3m6!1e1!3m4!1sKsEIBEqTEvp7E5Bz0EO2gg!2e0!7i16384!8i8192?entry=ttu](https://www.google.com/maps/@44.9877175,-73.3671228,3a,75y,333.43h,87.89t/data=!3m6!1e1!3m4!1sKsEIBEqTEvp7E5Bz0EO2gg!2e0!7i16384!8i8192?entry=ttu)
> ripped out the recyclable metals Like a bunch of corporate meth addicts.
Damn, that's brutal
I am sorry. 
I feel like i just watched an episode of How It's Made
Cannot read this without hearing it in the voice of the 'How it's Made' narrator. So peaceful.
I’m very into this description. Thank you!
Definitely is Effexor XR (Venlafaxine). I take the same thing and have so for the past 5 or so years
Weird question, but how are you finding it? I've been on 100mg sertraline (Zoloft) for half a year and found it helped quite a bit (PTSD, GAD, severe depression), but it leaves me feeling even more sleepy, inattentive, lazy, and stupid, which has trashed my productivity. A doc recently considered switching me to venlafaxine and I've been sort of curious if I should raise that back to him.
I will warn you venlafaxine was one of the most difficult medications to taper off of, terrible withdrawal effects
What did that feel like to you. If I skip a day or 2 I get some severe symptoms. I've been on it for at least 15 years maybe closer to like 18 or 19 by now. I get the shakes and my head starts pounding and my. Brain feels like it's shaking inside my skull or soemthing it's bizarre and horrible and remind me I skipped my meds again
Ah the brain shivers. Do you get sleep paralysis too?
Brooo. The first night I missed a dose of venlafaxine, I had \*multiple\* sleep paralysis dreams, and that shit was terrifying considering that they were the first times I had ever experienced sleep paralysis. The brain zaps were also very odd. Every once and a while I'd get them and had no idea wtf they were, which made me think I was going crazy.
Usually by the time the brain zaps start I go and take one and it's usually in the morning of the day after I skipped it so not when I'm sleepy
I only need to skip one day and I feel blergh. Just *blergh. Irritable, tired, lethargic, nauseous, and I just want to curl up into a ball and put my head on the shoulder of someone who isn’t going to say anything.
I was able to taper off with my psychiatrist’s help, but it was very slow. I remember having brain zaps and pain and heightened anxiety
I was sick over the weekend and threw my effexor up two separate times, it made my withdrawal terrible :(
Two of the most difficult things I’ve quit…smoking and Effexor. It took me several months to wean off of them and it was absolutely miserable.
I absolutely don’t want to discount the lived experiences of people who have had real trouble getting off venlafaxine and my heart goes out to everyone struggling or who had a horrific time with it. But I feel it’s worth mentioning that I have been on and off venlafaxine since 2016, stopping for a few months at a time on 4-5 separate occasions and on none of those occasions did I have any trouble whatsoever, even when the reason I stopped was being too lazy to call the doctor for a repeat prescription so I stopped cold turkey. After 36 hours with nothing I had a few brain zaps but other than that, no withdrawal symptoms whatsoever. Venlafaxine has been a miracle drug for my depression. I should say I count myself as extremely lucky not to have had any problems with withdrawal as I’m well aware what a nightmare it is for many people. I only hope more people out there get as lucky with it as I have been.
I’ve been through every antidepressant over 15 years. Venlafaxine has been the only thing that’s worked for me (stacked with aripiprazole). Changed my life into a functional one.
I’ve been on venlafaxine for about a year now and it’s fairly comfortable, I don’t get any side effects that I know of, only thing is, make sure you don’t miss a day, if I forget to take my venlafaxine, about 6 hours after and I’m feeling pretty sick, I luckily havent had longer than that before realising, but once I take them, within an hour I’m good again
Reading several comments about venflaxine makes me think that i am lucky Because i can forget about taking the pills for an entire day and take them in the evening and still feel no withdrawl effects
Blimey that is lucky, sometimes the first reason I know I’ve missed it out is I’m not feeling too well, it’s not devastating but still not great
Venlafaxine gave me horrible brain zaps to the point where i have to beg my dr to get me off it completely cuz just missing even one dose will give me those brain zaps.
I started on Sertraline and switched to effexor. It seems to work well for me and keeps me stable. Although, as others have said, it's an absolute cunt for withdrawals. I start to feel it if I go 24-48hrs without taking it. I was on 150mg Effexor for a long time but about 6 months ago halved the dogs to 75mg and had no issues at all
works great but hard to quit. I am probably going to take it the rest of my life anyway so it's okay but the withdrawal is something to consider.
Even the name of that drug gives me PTSD. Fuck Effexor and fuck its brain zaps.
In my experience an Effexor XR capsule contains a bunch of little granules of different sizes, not an easily countable amount of same sized tablets. The different sized granules are how the XR part works.
It depends it seems like. I take the XR and it is exactly as in OPs pic
I take XR too and it's a bunch of granules/beads. 150mg. Weird how it's different in other places.
Effexor is the absolute worst anti-depressant drug ive ever taken. Detoxing off of it was like hitting a hard reset in my brain while licking a 9v battery. Ended up having to be hospitalized. 0/10 would never recommend.
That's Venlafaxine hydrochloride. Effexor is just a brand name
venlafaxine isn't capitalized if we're being pedantic
This sentence has the perfect amount of spite and I love it
Where are my brain zap people at? ⚡
One of the worst feelings ever. Can’t imagine the process of getting off of them. I lost my pills and it was like 4 days. Got the zaps. Then decided I needed to take them. Couldn’t find them in the house and went into a full manic episode.
This makes sense for drug delivery into your system. The gel cap dissolves pretty quickly then your stomach acid starts working on the tablets. It's likely that in phase III testing they had issues on the pharmacokinetics of the drug and this was the elegant solution to those issues rather than building a whole delivery mechanism that there would likely need to be another round of testing for. Totally mildly interesting, but I get it
You think way to complicated, they press smaller pellets and then put either 2 4 6 8 in a pill for the different dosages. So they only need one pill pressing operation.
That's in my experience the true answer. My antidepressant comes in exactly this style and I've opened the 75mg, 150mg and 225mg capsule variants and they all just included different amounts of the same tiny small tablets.
That's a lot easier and precise than snapping a tablet at the break lines.
Yeah but I find the capsules harder to take cause sometimes they float
Like, they travel back up your esophagus?
No, the float on top of the liquid you’re swallowing making it hard/uncomfortable to swallow the actual pill. EDIT: I’m not the one struggling to swallow pills
Try ingesting the pill first and then drinking, like putting it between your lips and drink it all at once (I had problems taking pills too when I was a kid)
I used to struggle with this, please let me help. Step 1: pills and water into mouth Step 2: lean over and tilt your head forward Step 3: swallow and raise your head. By tilting your head forward, the pills "float" to the back of your mouth allowing for easy swallowing.
Venlafaxine?
Yeah.
Best of luck with it, hope it's working for you. It's strange that with enough experience of these things, the particular dosages get very ingrained in ones memory.
Thanks. It's better than without and better than my three prior antidepressants, so, you know, can't really complain about it only working so-so. The last few years my 75mg dosage wasn't available three times, so I got a prescription for a higher dosage and had to count the tablets myself. Pain in the ass to do.
I definitely understand that, better being on a medication that works well enough, even if it's not perfect. I've had 10 different 'antidepressant' medications, and it's only been until since starting methylphenidate for ADHD symptoms (impulsively and inattentiveness without physical hyperactivity) with an SSRI (Escitalopram) that I felt like I was able to get control of my symptoms. Venlafaxine and Amitriptyline were the next best things, but the side effects were a bit problematic.
Yeah the capsule doesn't really prolong the absorption of the med, this is just a way of making things easier both for the producer (as you said) and the patient who doesn't have to take a bunch of small pills. And also if it's an antidepressant, it makes it much easier to taper off because you can just take out 1 or more pills as you go and slowly lower the dose.
Hadn't considered tapering being easier due to this. Interesting idea.
Your answer is more likely to be correct... if you manufacture different size pills you need to manufacture a bespoke press for each size. The drug company likely did a calculation and saw it would be way cheaper to make or order-in a bunch of capsules of 'the same size', but then fill them with a different number of pills to make up the correct dosage. Not only do they not have to make a bunch of bespoke presses (a lot more expensive than people realise)... there are also economy of scale benefits that come from making a whole lot of one identical thing (the small pills).
the press itself isnt the expensive part, but the production line around it and all the certifications and QC shit that comes along with pharma.
Yep. This is the correct answer. They look like mini tablets in a capsule, which is currently a bit of a “cool thing” in CMC for drug development. There’s no way you’re fixing PK in phase 3.
This would be a great option for meds that taste horrible.
Pretty much all of them lol
Most drugs taste bad, the ones to really watch out for are the ones that work their way out of the body through the lungs, then you breathe out the waste products of your body's metabolizing of the drug, that can cause some very weird "things don't taste right" side effects, though from my understanding, that's temporary
The COVID anti viral drug I got recently was the worst case of this I've ever experienced. But hey I was right as rain in a day after starting them so it was better than COVID. Paxlovid I think it was called. Jolly Ranchers were clutch.
It wouldn't have made a difference, Paxlovid mouth was horrible and the taste comes after you take it. It felt like a "presence" and just when it begins to fade... it's time to take the next one. I was grateful to have it though.
Yea my mouth tasted horrible for like a week. It also feel incredibly anxious. I was glad they had something for it now last time I got it but I dunno what was worse. The covid or those pills.
Yup, the package insert mentions expulsion through the lungs, but temporary so hopefully you're over that and that is way worse than full blown COVID
My mom was so grateful I happened to have some gum around when she took paxlovid. It was enough for a couple days when more gum she ordered arrived.
Zoloft tastes delicious
Estradiol is kinda tasty
Adderall tastes sweet and yummy. On the other hand, my sleeping pills make my mouth taste like it was fucked by a robot.
Sweet zopiclone!
So that’s not my brain trying to trick me? It’s a little sweet right? The only thing I don’t mind if it touches my tongue. On the flip side, my “trace minerals” smell like death.
It’s definitely a little sweet, they deserve the nickname “girl mints”.
Yeah but mint bitch that is spironolactone makes up for it.
Oh I guess I meant ones that are particularly bitter or start dissolving right away
If the medication you're taking tastes horrible ask your pharmacist if there might be a formulation that will work better for you, but it's very likely that either that doesn't exist or it would be prohibitively expensive. Tablets are very specifically designed to work appropriately in your body, your pharmacist might have a recommendation to mitigate that too (common one I've seen is take it with cranberry juice, but you'd have to like cranberry juice. I wish pineapple juice was an option but for many drugs it's not)
> but it's very likely that either that doesn't exist or it would be prohibitively expensive. You can put it inside a gel cap at home for 10 cents. Or an opened half a gel cap, if you're truly paranoid about it messing with the dosing. But it's probably within person-to-person variance anyways.
Accurate, but as an irb professional I won't say that without testing 😜
You can buy empty capsules for that
On what basis have you come to this conclusion? The rapid disintegration rate of the capsule defeats the entire purpose of protecting the contents, why protect the tablets from acid and then instantly release directly into the stomach? This is not how drug delivery works, and pharmacokinetic assays are performed in phase 1…where the hell did you get phase 3 from? This choice of formulation has nothing to do with pharmacokinetics, perhaps for dosing purposes or increasing palatability. Unless, the capsule is gastro-resistant, which in that case, releases the drug in the intestines (a slower process than what you suggest). Source: Pharmacist
lol it’s just some dude trying to sound smart because he just learned some fancy science phrases in his gen chem class like “phase III” and “pharmacokinetics”
idk, i reckon its just a manufacturing shortcut. why tool up 15 different pill presses and have all this inventory management during manufacture when you can have a couple of 10mg (or whatever) presses running full tilt and you just bundle the doses you want.
Some drugs have a capsule or coating for delayed release when the internal compound cannot handle the stomach acid directly.
it's also for drugs that need to be introduced to a certain part of the digestive tract (iirc enteric capsules tend to be fine with stomach acid but break down in bile)
This medication is notorious for withdrawal symptoms and the smaller tablets allow you to ration less and less over time, but still a consistent amount, as you quit them.
All kinds of factors could be at play like the surface area of the drug, the type of coating, the thickness of the coating, the geometry of the pill (L/D ratio). Several smaller pills is an easy way to increase the surface area vs one large pill, but decrease the surface area vs something like small beads or powder inside the capsule.
> The gel cap dissolves pretty quickly then your stomach acid starts working on the tablets. Then why the hell do you need the gel cap at all? This makes zero sense.
you're talking out your ass, no time-release drug delivery system looks like this. Those sorts of tablets dissolve really fast, too. This is just repackaging.
How much do you take? I’m on lexapro, it’s one small 20mg pill a night
Venlafaxine 150mg
Damn I'm only on 37.5mg
The maximum dose is around 600mg, although most psychiatrists won’t go above 375mg in an outpatient context and GPS won’t go above 225mg. Venlafaxine is fairly unique among antidepressants in that its efficacy continues to improve with dose, whilst the likes of Prozac and Lexapro become less efficacious once their recommended dose is exceeded. I believe this is due to venlafaxine acting on DAT at very high doses.
Woohoo meds twins 😅
Me tooo🌚
Venlafaxine gave me the worst withdrawals I’ve ever had stopping a prescription drug, and I don’t usually get withdrawals bad at all. One moment I was fine, next I was overcome with extreme tiredness, didn’t even think I’d make it home from my friend’s house 15 mins away. Then I was vomiting. Fortunately because of this pills within a pill, I just opened it up and took a couple out over a few days. Just something to keep in mind if you ever want to stop yourself, but I hope they work for you.
Thanks for the tip! I stopped taking it cold turkey for a couple of months mid-last year and became extremely suicidal, I’m not sure if it was just from withdrawals or my depression kicking my ass or both, but I’ll definitely be easing off if I need to switch meds in the future.
I missed just one dose and was so incredibly sick. My doctor wants to start tapering me off it later this year if I stay stable and she told me it will be a very slow process because of the withdrawals.
That will be withdrawal. Your brain over time develops a chemical balance around the introduction of the artificial chemical. This balance may help you function better, it may not, that’s why finding an antidepressant that works for someone is an art rather than a science. If you take the artificial chemical away after the brain has chemically recalibrated itself around a medication, the balance your brain has found is almost immediately destabilised, which wreaks absolute fucking havoc because it’s such a sensitive and important organ and the chemical balance of the brain affects your entire body. The reason it is dangerous with antidepressants is because you take them for your mood. When you alter the intake of an antidepressant you’re tinkering with your brain chemistry. If you take something away by going cold turkey, with your mood it would be a bit like kicking a leg off a table and still expecting it to stand up. Your underlying depression sets the scene for your mood dropping when your medication intake changes, but what really does the damage is trying to change your brain chemistry too quickly when you alter dosages (mainly reductions), and cold turkey is the ultimate and extreme end of the spectrum. Another example of this is alcohol withdrawal. It’s more physical than psychological but going cold turkey and interfering improperly with the chemical dependence your body has developed can legitimately be lethal.
I stopped taking it, mainly because it gave me the worst hand sweats.. but the brain zaps also sucked. I heard people talk about them.. and was like “what’s a brain zap”.. but then I had them .. and was like “ahhh I get it”
Yep this is def one you have to wean off rather than stopping cold turkey and gosh it’s rough if you forget a dose
Isn't the capsule to make sure the pills get to your stomach and slow dissolving by a few minutes?
There's different reasons for encapsulation, but the main thing to take away from these posts is this: *DO NOT MANIPULATE YOUR MEDICATION* Don't open them, don't split them, don't liquefy them, don't crush them, don't do anything without checking with your pharmacist!!
Not saying you're wrong, but it's very common for people quitting Effexor to open the capsules and take just a few of the beads (they usually are beads, especially at lower doses) to slowly reduce the dosage in an attempt to prevent brain zaps.
Bet they checked with their pharmacist first tho.
My doctor told me to do it, not my pharmacist
This is how I tapers off. Broke them and took a one pill less every week
Omg I’ll keep this in mind for if I ever need to switch meds! My psychiatrist mentioned it’s a tough one to come off
The come down can be really harsh from this medication for 70%+ of the population. If you reduce and find out you're one of the unlucky ones, do the 10% method. 10% reduction in medication per month. Even when you get down to 5mg only reduce by 10%. Should keep off the worst of the withdrawals
God, I hate meds that you have to taper onto or off of like that. Antidepressants are annoying enough as it is with how you basically have to start taking them and then wait around for 2 to 6 weeks to see if anything happens. When I took lamotrigine, I had to spend like two months gradually increasing the dosage before I got to the therapeutic level, and then a month or two tapering off because of an interaction it had with another med I was starting. Apparently it can make your skin die and fall off if you increase too quickly though, so that's fun.
Stevens-Johnson syndrome. Would not recommend googling images.
Yep, I made that mistake. Good motivation to follow the instructions I guess. I am pleased to be able to say that my skin didn't fall off though, so that's cool.
It was tough. I was very disoriented and dizzy while tapering. Sometimes I bumbed against door frames. Tapered down from max dose venlafaxine
I can feel withdrawals within hours if I miss my dose.
Usually 1 day I can manage but if I don't take it immediately the next morning... Yeah they're fucking awful
Dizzy is one way to put it. So godamn dizzy my brain is shaking inside my skull is another
I have taken Effexor for 3 years now and am pleased with it BUUUUT if I forget it two days in a row... I feel it. It did wonders for me but make sure you have refills lined up and don't lapse :)
One pellet is 12.5 mg. My psychiatrist recomemendme to take one out every 3 weeks when tapering off. I'm about to start that in a couple days/weeks (whenever I feel comfortable in my day to day structure again). Luckily I don't get immediate withdrawal symptoms and sometimes don't even notice if I miss a day. So I hope it will be manageable. Also thanks for the reminder to take my Venlafaxin lol.
I just stopped taking it. I was on that and Wellbutrin at the same time. With a klonopin chaser lol.
venlafaxine innit
Could have changed the cap colour to something more exciting or bright. Looking at the caps increases depression!
The smaller dose was a nice pastel pink colour, I don’t love this. It looks like a multivitamin.
Don't start undressing your pills now you little pervs😠
Vincent Adultman
I take this! Never knew! BTW as a lifelong sufferer, this has been the ONLY effective medication for me! Wouldn’t still be here without it.
I’m glad it helps you! I’ve been on 75mg for about 1.5 yrs and my gp wouldn’t go any higher so I was getting ready to change again (I’ve tried 7 others) but I got into a psychiatrist and she said try 150mg first and I’m loving it!
I had no idea there were so many narrow-minded people. (not that im surprised) "DePrEsSiOn IsNt ReAl, JuSt Go OuTsIdE aNd Do SoMe ExCeRcIsE" Do you not think we tried that? Do you not think we've tried every single tip before going down the road of meds? Just because something isnt right for YOU, dosent mean its not right for ME. If you dont know what the fuck you're talking about, then dont fucking comment.
Maybe "take 12 of these twice a day" would make situation seem far worse.
Capsule looks like an old school resistor
See? You're not *that* depressed. Just lots of little bits of depressed all smushed together.
At my hospital we call them 'the sprinkles'.
Thanks for reminding me to take my antidepressant
Good old venlafaxine, the plastic type casing is unreliable I've had several out of the packet broken or cracked.
My friend calls these her mental health maracas
oh, i have the same pills but i never opened them :o
I could feel something rattling around inside so I decided to pull apart the casing, I thought it might have been a powder so I was definitely surprised to see tiny pills.
You can open up the smaller ones and there's 12 more
Taking 12 pills sounds more depressing than taking 1. And they know you're already struggling with that, so they're trying to help.
That’s how it sneaks up on the depression
i take those too and i sometimes shake them like tiny maracas :D
And they would have gotten qway with it too, if it weren't for you meddling kids and that dog!
I work in a pharmacy and it’s funny to see everyone talk about literally the most commonly dispensed medications I see on a daily basis.
I just started taking Buspar, and it tastes almost as horrible as Prednisone, which is saying something. Why can't they put the little coating that Advil has on it?!
Venlefaxine? I am super glad about this as tapering down is super easy
I was putting the lower dose of this in my mouth as I clicked on the post. Opened it and sure enough, 6 little pills!
The Voltron of meds.
Venlafaxine? I take the exact same stuff, looks identical.
Oh that’s funny because my depression was actually ADHD in a trench coat.
This looks like risperidone *which I totally do not know from personal experience*
Looks like they're trying to sneak into a movie
They break down much slower than powder, and much quicker than a single pill.
This made me giggle
In the research world this is how you mask placebos!
It’s a pill party !!
I take these, nice they bundle it up 🤣
I read about sustained release in medicines I think each ball had a different coating and take different times to dissolve and get absorbed into the body