*Using Effexor? Please read! Useful tips!*

[SADnomore]

Hi, all,
First of all I would like to say that I am quite sensitive to medications, but even so, have made it through start-up side effects and have been doing fine with Effexor XR (One week at 37.5 mg, then 75 mg since.) Now at 10 weeks in, my memory is finally coming back, not so apt to lose things or forget what I'm supposed to be doing, yay! This had been a real problem for me before, but I suspect a lot of it had to do with my untreated depression. I have been diagnosed with Seasonal Affective Disorder, which is a form of MDD. I expect to be kept at this dose for another couple of months and then titrated up for the winter. I imagine I will be on it year round, and am very hopeful of its working out for me long term. It is also prescribed for GAD and OCD and is useful for pain as well. Dosing can be adjusted to account for not only serotonin, but norepinephrine and some dopamine levels, and certain other medications can be added on if needed.

I realize that many people are given tablets, and then when it is felt that the dose is right for them, they may be given the extended release capsules to carry on with. I was fortunate in that my doctor had in mind what he wanted for me to try, and started me right off with the extended release form. I say this because by all accounts, this form has the least number of problems with the spiking of side effects that can occur with the standard release pills. For example, suddenly increased anxiety. You may want to ask your doctor for the extended release form from the start. Capsules are available as low as 37.5 mg.

Some people don't experience any start up side effects with Effexor/venlaxafine, or these are made less when they are crossed over from another medication. I started from "scratch", and as I say, I have experienced side effects from all meds, which I think is more common than not. This is what I found helpful.

IT IS CRITICAL TO TAKE THIS MED AT THE SAME TIME EVERY DAY. If you miss it, you will know all about it after a couple of hours. Eat and take it and you'll be fine again. I only had to do this once.
*Sleep disturbance - Pharmacist suggested I start by taking my dose in the morning, and only switching to evening if it created daytime sleepiness. I did, and it didn't.
*Constipation - hugely common. Pick up a gentle laxative and some dried prunes. There will be days when you need the laxative, days when you can get by with the prunes. It will go on for weeks, be prepared. Not the end of the world, just constipation.
*Nausea - Pharmacist said to take it with food. I take it after breakfast (not just a piece of toast, something substantial). And a full glass of water, sipped at slowly. On HERE I LEARNED: Eat even if you don't feel like it, lightly and often throughout the day, every couple of hours if possible. IT HELPS! This goes away for the most part, after the 3rd or 4th day. I manage any occasional queasy feelings with soda crackers and sometimes ginger ale. I find I still have to eat often throughout the day.
*Dry mouth - OMG, I thought I was dying of thirst! Carry water with you wherever you go. Also sugar-free hard candies to suck on or gum, which work when you are talking or away from your water bottle. Apparently it is "just" dry mouth, but our brains send a strong signal out that we are thirsty. This eases off eventually. You probably needed to drink more anyway!
*Muscle tonus - Not mentioned often, but it is the continuous and partial contraction of muscles. It affected my arm and leg muscles and gave me the sensation of knots-in-the-stomach. TIP FROM HERE. Taking a number of long, slow deep breaths in, long slow deep breaths out through my nose helped. This would always dissipate by bedtime. Went away at the end of the 4th week. This may be felt as increased anxiety for some, but for me it was just a physical thing.
*Foggy head - This is probably why I didn't get too excited, it was very hard to put two and two together, lol! Drove me nuts until I found out on here that it's normal to have this for the first few weeks. It gets better.
*Visual snow - Came with it. Like a constant visual fuzzyness. Sometimes euphemistically referred to as "lightheadedness". It goes away, be patient.
*Muscle weakness - Felt at the same time as the muscle tonus, it was a little debilitating. You may just want to sit around. Might get a bit of jelly legs getting in and out of vehicles. Take your time.
*A bit of a delay to starting your urine flow - With all the water in, water out, the added few seconds to have to release your bladder may not be a bad thing!

All of the above are *perfectly normal start up side effects* from Effexor/venlaxafine. Don't freak, don't panic. All normal. You may get some or none. You may also feel dizziness, sedation, sexual side effects such as delayed orgasm, unusual dreams (gotta love em, ha ha! ), weight loss, sweating and tingling in extremities. Manageable. At least they were for me.

I know a month or so sounds like a very long time, but really, start-up side effects are to be expected with any of the meds we are going to be prescribed by a doctor. Be gentle with yourself. If you can, take some time off work. Lighten your schedule. Watch some movies. Pet your pets. Eat healthfully. DRINK lots of fluids. Avoid alcohol during this time. Make friends on here. Read success stories. Go for walks if you are able. Fresh air and sunshine do us good when they can be found.

IF YOU REALLY WANT OFF EFFEXOR: Please for God's sake don't cold turkey it and then come on here to "warn" everyone of the "hellish" withdrawal symptoms. Go see your doctor and get a discontinuation schedule going and follow it. Don't be a hero. It's a bad idea, and it doesn't work with any of these meds.

Thank you for your time, guys, and if any of this helps anyone I'm a happy girl. It was all of your support on here that got me through the start up (doctor hadn't said what to expect), and onward to success.

Namaste,
Marie

[Gemical]

Thank you so much for this post!!!

I started Venlafaxine 7 weeks ago at a starting dose of 37.5mg, now been at a dose of 225mg for 1 week. Not feeling any better yet but these reading these tips has been really helpful.

Best wishes, Gem

[SADnomore]

Best of luck to you too, Gem! I see you've met our aprilmoon! I'm sure you'll be a great support to one another! I really do feel blessed that my doc decided to skip to the chase and give me venlaxafine. It does take awhile to kick in, so try to hang in there until it works for you, okay? Honestly, I am also hopeful that it helps eventually to help a little with my chronic pain as well. It is indicated for it, and if so, it will be well worth the wait all around! I am waiting until I've been titrated up with the ven, and then will propose the addition of the mirt at a good point. I am really hopeful to be able to do away or reduce my sleeping pill then! If we can make real headway for it all with just these two meds, it will be awesome! xx
Marie

[Gemical]

Hey Marie,

Thanks for all of your hope and encouragemnet. I really am over whelmed by the support on this site!

I was told that the Ven might help with my physical health condition - that really would be incredible - even if it helped just a little bit would be so good...will have to wait and see. After reading your posts and a few other responses I do feel like I am doing the right thing by staying on the Venlafaxine and giving it my best shot - got nothing to lose. It's just hard having hope sometimes when you feel like nothing is ever going to help because you have tried so many things and it feels to good to be true that something could change (I am guessing you already know this feeling)

You said about potentially adding Mirtazapine in at some point in the future. I personally have found it has been so helpful for sleep. When I said in one of my other posts that things got really bad - wasn't sleeping, eating etc, etc and my Doc put me on Mirtazapine he also prescribed me Zopiclone 7.5mg sleeping tablets as I was a total wreck and was literally disintergrating from lack of sleep and anxiety. As my body slowly started to get back into a pattern of sleeping again I gradually went down to 3.75mg Zopiclone. By this time the Mirt was really kicking in, helping me sleep so the dose reduction of the sleeping tablet was fine. I was a little anxious before I did this as I thought I might go back to not sleeping - but it was ok. Then after a little while I cut back to half a 3.75mg tab (using a pill cutter) and that was still fine - I kept it like this for a while to let me body slowy come off it get used to the reduction again. Then I got to a point where I was nibbling half of the half of the half of a 3.75mg (sorry if this sounds like a riddle) again I did this for a while and now I don't need any sleeping tablets because the Mirtazapine works so well. About an hour to 2 hours after taking it I feel sleepy and I sleep! I do wake up in the night because I am in pain or really uncomfortable due to my other condition but the brilliant thing is I get back to sleep and most of my anxietys about insomnia, though still lurking are mostly a distant memory. So to cut a long story short I think it would be really worth trying the Mirt when you and your doc decide it would be a good idea and when/if you decide to come off your sleeping tablets just do it slowly and take your time. Also I believe that even low doses of Mirt can have a powerful effect on sleep so you might only need a low dose.

Thanks again for your support!, Gem x

[SADnomore]

Aw, thanks gf! Well, hey, the support surely goes both ways, you have been such a help with this reply! ... I am going to speak to my doc about a prescription now for the 3.75 zop as well as the mirt. If he isn't willing to have me try the weaning off yet, as my venlaxafine dose hasn't been titrated up to where he wants it, then I will for sure be asking for it as soon as possible. I feel so relieved now, knowing how to do the weaning too! I still think zopiclone is great for short-term use, and yes, insomnia itself contributes to depression, so we can't go on without sleep for long. But if insomnia is chronic, as mine is, then I feel we need options. It is so amazing to hear that there are finally other psychotropic, non-hypnotic meds that help with sleep, I'm excited! Lol!
Marie

[Gemical]

Hey Marie,

That all sounds like a good plan. I really understand how horrific chronic insomnia can be. I really think the Mirtazapine has a good chance of helping you. Even though it hasn't done anything for my depression and general day time anxiety/panic it has given me back my sleep and I no longer fear bed time so I don't know what I would do without it - for now at least.

If/when you do start taking it then take it in the evening about an hour or two before your usual bedtime. The next morning you might still feel really 'out of it' and sleepy for a good few hours - I was like a zombie and it really zapped my energy at first, but over time, if you can stick with it for a few weeks this eases off and you end up feeling ok in the mornings again. Every time you up your dose (if this is the plan) you might get the groggy feelings again but they soon pass. Then once you stay on a set, stable dose for a little while everything will probably level out

But definitely no need to rush coming off the Zopiclone - nice and gently at your own pace.

Lots of love and , Gem x

[SADnomore]

Thank you Gem! Back at ya, girl! If you can remember, how long were you on mirtazapine before you felt able to step down to the 3.75 zopiclone? Was it a couple of weeks, or more like a month? Just trying to figure on how many more to get prescribed. xx
Marie

[Gemical]

Hi Marie,

As far as I can remember this is how it worked for me, though it may be a little or a lot different for you but I hope this helps....

So I started both meds at the same time

Week one - Mirt 7.5mg, Zopiclone 7.5mg
Week two -Mirt 15mg, Zopiclone 7.5mg
Week three - Mirt 22.5. Zopiclone 7.5mg
Week four -Mirt 30mg, Zopiclone 7.5mg
Week five - Mirt 37.5mg, Zopiclone 7.5mg
Week six - Mirt 45mg, Zopiclone 7.5mg

I stayed at Mirt 45mg and Zopiclone 7.5mg for about another 6 weeks then I started to feel a bit more confident that Mirt was really helping me with sleep. So then I reduced Zopiclone to 3.75mg and spent about another 2 months like this. Then I started having half of a 3.75mg tab (about 1.875mg I guess) and again stayed like this for another 2 months. Then after that I stopped taking it altogether so all in all the whole process did take a good few months but it worked. And I still have some tabs left over so I know if I really need one or am having a particularly tough night they are there which is a good safety net for me.

If you haven't already got one then I highly reccommend getting a pill cutter, that way you can half and quarter the pills really accurately. It may be an idea for you to keep ordering the 7.5mg Zopiclone and use a pill cutter to halve it to make a 3.75mg tab. That way if you try it but you don't feel ready to reduce you can go back up to taking one whole 7.5mg and try again in a week or so. Or, you could even drop down from 7.5mg and use your pill cutter to make one half and a quarter so you can make an even more gradual reduction from 7.5mg to 5.625mg and to then 3.75 mg and so on and psychologically knowing you still have the option of going back up to 7.5mg might make it feel less daunting.

So my advice would be settle on the Mirt for a little while first - a couple of months or so before starting to lower sleeping tab. But you never know you might find that you feel you are able to start reducing sooner than this??

Iv'e got crazy a crazy clenched jaw from the Venlafaxine at the moment - its like my top and bottom teeth are glued together and Iv'e been feeling real tense and I think all the tension is what causes my headaches - been taking Diazepam to see if it will help me relax a little and am taking on board what Aprilmoon so wisely said about being kind to myself. My partner has taken my boy out for a few hours so I am just gonna rest in bed with a hot water bottle, drink lots of water and watch something silly. Do you think the jaw clenching and muscle tension wears off over time?

I am so pleased I have found you and Aprilmoon. Honestly it has really helped me so very much. All my love and , Gem x

[SADnomore]

Gem, hunni, I hope you got some good rest in! Yes, the jaw clenching is normal, I had it too. Chewing gum helps to work the pain out. I kept a pack on me for awhile, can't remember when I no longer felt the need, but it did go away! The physical tension is called muscle tonus and is a side effect that I got too. It was the very last to leave, somewhere between weeks 4 and 5. Both of my arms and legs and my abdomen (knots in the stomach) were involved and yes I hated it; long, slow breath in through the nose to the count of 4, hold a couple of ticks, then slowly breath out through the nose to a count of 6. Repeat several times. It seems to stop it temporarily. Do it again when you notice it building. I felt a kind of weakness at the same time, which drove me nuts, lol! It does seem to go away at bedtime every night, thank the Lord! Hang in there, it is just a side effect and it will go away. I thought of it as the smooth muscle in the gut (which is where 90% of our serotonin receptors are!) being activated as the SSRI's "reuptake inhibition" took effect. The tension being from all the "little doors" being slammed shut in these receptors there and elsewhere in the body, ha ha! The serotonin would keep trying to get (back) in, and the doors were held firmly shut until it gave up each day. Made perfect sense to me and it helped me wait it out. The tension would let go for a bit longer each day towards the middle of that 4th week, and finally by the end of that week it quit altogether. Hallelujah!

As for any anxiety, I think Rossthekid's explanation is the best! SSRI stands for Selective Serotonin Reuptake Inhibitor. That's the first function of venlaxafine and it continues, it doesn't stop at the higher doses. We want this, as it keeps the serotonin in our synapses (space between nerve cells) longer, which means we feel better! But not right away ... Ross says:

"SSRIs cause your serotonin levels to drop when you first start taking them.

(This is because a small part of the serotonin cell called an autoreceptor senses when the serotonin is not being reuptaked, (doors are slammed) and so it tells its cell not to release more.)

Your serotonin levels will not rise until the autoreceptors in your brain have stopped working (become desensitised). (That is, until they give up and the cell releases serotonin again. That's why you feel anxious, your symptoms spike, etc. during this period).

This takes time. For some people it could be a couple of week, for others a month or more."

I got through the lag and the side effects and am so glad I stuck it out! It has the effect of steering my mind away from negative thoughts, it helps me to remember and to think more clearly, and my carb cravings are gone at last. I don't get all anxious and fretful, and I haven't dissolved in tears for weeks and weeks. The effects are subtle at first, and it takes a good while, but it really does work!

You've been ramped up really quickly, so I imagine your doc decided this was war on your depression and it was time to be aggressive, no holds barred. Let's get your serotonin, your noradrenalin and at least some dopamine going asap so you feel better faster! But, if dealing with the side effects til then gets to be really too much, do speak to him. Certainly you can try propanolol, which is a beta blocker lots of us take for physical symptoms of anxiety. (I'm going to ask my doc tomorrow for it to take along with my next increase, so the side effects aren't so acute.) And if you still feel overwhelmed, then he may titrate the venlaxafine down for a bit.
Hang in there, sweetheart, hopefully you can ride it out with the diazepam and maybe some propanolol. Fingers crossed, but if you need to take it down then he should be open to discussion.

Thank you so much for all your advice on the zopiclone. I don't think many people realize how stuck we get with it and how long we need to plan for withdrawal. I wouldn't have known to give it as long as you did, and probably would have had wicked rebound insomnia, bad news for sure! Now I feel better already not being in a rush. I know it'll work out All my love to you too, Gem! Myself and I know, aprilmoon are both here for you always!

Marie

[loreen]

Marie, that is so interesting.

I am just so happy venlafaxine is working for me, I have not really questioned how it works !!! Having tried many SSRI s I do wonder why they did not help, and ven really has ? I gave it at least 3 months on each, but had no luck. I know venlafaxine is a SSNR so maybe that is the subtle difference.

Still got the constipation, but am managing it. Its a small price to pay for feeling human again,and not a tearful wreck....

keep posting xxxx