One week in...need some reassurance

[Icket]

Two weeks ago I was put on Celexa. The side effects were awful, but my dr thought they were too awful and switched me straight to venlafaxine 150mg day.

The first day I took it it felt like straight up speed. I was even checking my heart rate. What comes up must come right back down though. Two weeks I have just felt awful. The nausea, vomiting, and cold sweats are gone, but I have just a constant skin crawling antsy-ness, if that makes sense. About an hour after I take it in the morning, until about an hour before I have to take it again in the evening. I am really good at sleep, but I am waking constantly now. Last night I got two hours. I'm not having full on crying anxiety attacks where there is release, just constant anxiety. But at the same time I'm exhausted. I can't even be productive with it.

I just want to know if anyone has had this and if it stops. At this point I feel worse than before the meds. I know it can help, so I just need to know if this is going to stop.

With the lack of sleep and anxiety, I feel like I'm losing it.

[panic_down_under]

Two weeks ago I was put on Celexa. The side effects were awful, but my dr thought they were too awful

And I right in suspecting you were prescribed 20mg?

and switched me straight to venlafaxine 150mg day.

The recommended starting dose is 2 x 37.5mg for the immediate-release version, or 1 x 75mg for the extended-release XR formulation. Your doctor is a moron!

The nausea, vomiting, and cold sweats are gone, but I have just a constant skin crawling antsy-ness, if that makes sense.

These are all fairly common initial side-effects of most antidepressants caused by the increase in serotonin activity and made worse by the high starting dose.

Serotonin isn't just a brain neurotransmitter, it has many functions in the body. The skin makes and uses about as much serotonin as the brain, a bit under 2% of the total made. There it mediates blood vessel tone, constriction and dilation, hence the cold-sweats and crawling sensation. There can also be an increase in photo-sensitivity so be careful of sun exposure and wear sunscreen when outdoors for extended periods

While there is no way of avoiding these side-effects they can be minimized by starting on a low dose and ramping it up be the same amount at about weekly intervals. But that train has left the station for you. The worst is behind you so there is now no point in reducing the dose.

I am really good at sleep, but I am waking constantly now. Last night I got two hours.

SSRI/SNRI induced insomnia is quite common in the beginning. Ask your doctor to prescribe a small dose, 25-50mg, of immediate release trazodone (Desyrel). This is an antidepressant which at low doses acts only as a very sedating antihistamine. It has only a very short half-life, 3-5 hours, so unlike most 'sleeping pills' there is usually no sedation hangover into the next morning.

I just want to know if anyone has had this and if it stops.

Yes, the side-effects do usually stop with a couple of weeks, though they may return for a short while after dose increases.

With the lack of sleep and anxiety, I feel like I'm losing it.

Try to hang on as the results are usually worth it.

While you're asking your doctor for some trazodone also ask about taking a benzodiazepine for a week or so to help with the anxiety. If s/he is one of the increasing number of benzophobic doctors then hydroxyzine would be a good alternative. It is an antihistamine with pretty strong anti anxiety properties, not quite as potent as the benzodiazepines, but often potent enough to make a significant difference. It is also mildly sedating so you may not then need the trazodone.

[MyNameIsTerry]

Switching to the starting "N" dose is a poor choice even if he was trying to match the Serotonin element of you were on 30-40 mg. It opens up more side effect issues because you ate crossing the threshold where it starts working on more than the Serotonin that your old med was.

Tapering up would have been smarter to ensure the Serotonin element was settled first.

So, it might be worth reduction?

The agitation is very likely due to the "N" element. When I crossed the threshold for Duloxetine, it had me climbing the walls for weeks.

[Shazamataz]

That's a high starting dose so no wonder you feel dreadful! 150 is the equivalent to 40 of celexa (from what I've read) so you really will be feeling it!

I started on 37.5, then to 75 and have stabilized on 112.5 (slow release).

I did have start up symptoms but they were managable. You could reduce. Or since you've already done the two weeks hang in there as things WILL settle?

[panic_down_under]

The agitation is very likely due to the "N" element. When I crossed the threshold for Duloxetine, it had me climbing the walls for weeks.

Duloxetine is a far more potent NE reuptake inhibitor than venlafaxine with NE transporter (NET) binding values of 7.5 Ki and 2480 Ki respectively. Desvenlafaxine, the active venlafaxine metabolite, is slightly more potent at 558 Ki, but it is still only a very weak NE inhibitor. While classified as a SNRI, venlafaxine should really only be considered a SSRI for all practical purposes, imo.

(Ki is the amount of the chemical required to occupy, i.e. block, 50% of the transporter molecules in nanomoles per litre (nmol/l), so the lower the Ki value the greater the inhibition potency)

[Barnabas75]

I wonder how you are doing now? Hopefully better. I am glad I read your post as I saw the Doctor today and he wants to switch me from 10mgs of Lexapro straight onto 150mgs of Venlafaxine. I am not going to do it now unless maybe he starts me on 75mgs instead. Like PDU said , my Doc must be a moron also..I just dont know what to do. Been on Lexapro 6 weeks today and feel no better at all.

[panic_down_under]

Doctor today and he wants to switch me from 10mgs of Lexapro straight onto 150mgs of Venlafaxine. I am not going to do it now unless maybe he starts me on 75mgs instead. Like PDU said , my Doc must be a moron also

Make him a deal, you'll take the 150mg if he does too.

When I achieve world domination one of my first acts will be to make every doctor take a SSRI for a month. I predict the treatment of mental disorders will then improve dramatically.

Been on Lexapro 6 weeks today and feel no better at all.

Personally, I'd give it more time, at least another 2 weeks and maybe also up the dose to 15mg. Imho, no one can say an antidepressant won't work if it hasn't been taken at the maximum recommended dose for at least 6 weeks. Some of us just need a hefty dose to get anything out of these drugs.

[Barnabas75]

Yeah PDU, it should be standard that the Doctors take the meds and also withdraw from them so they can experience what we have to.

I read on another thread here that someones Doctor made them taper off lexapro before starting venlafaxine. SO why did the Doctor I saw tell me to to go straight to 150 of the ven. I am losing confidence in the Doctor. Maybe I will try 15 mgs first of lexapro. But I am taking Mirtazipine at night. Apparantly there is an interaction with that but hey Doctors are supposed to know better. He said a mirt plus ven was a better combo. Who the heck knows, when everyone has different opinions. I am feeling less and less like there is a way out of this vicious circle and I am losing hope. Losing motivation to do anything or go anywhere. The Doctor seems convinced that 6 weeks is enough to tell if the lexapro would work or not. I remember when taking sertraline 4 years ago it took nearly 10 weeks but I could literally feel the depression lift in my mind. I feel no different today than I did 6 weeks ago, maybe worse with an even lower mood. I guess I am hoping fpr a miracle but maybe there just wont be one this time. Bit of a rant ,sorry. Plus I have been reading how bad withdrawals are from ven and how it increases insomnia. I dont need insomnia as I already battle to sleep.

[panic_down_under]

I read on another thread here that someones Doctor made them taper off lexapro before starting venlafaxine.

Weaning completely off a SSRI to switch to a SNRI isn't necessary. In fact the only antidepressants which require a washout period when switch to/from them are the old, sadly much neglected, MAOIs. For most SSRI<>SNRI changes a straight switch, or short cross taper is usually relatively trouble free.

SO why did the Doctor I saw tell me to to go straight to 150 of the ven. I am losing confidence in the Doctor.

Because he is apparently clueless and is, imho, therefore not worth feeding.

But I am taking Mirtazipine at night. Apparantly there is an interaction with that but hey Doctors are supposed to know better.

Are you referring to serotonin syndrome? If so, that is not an issue despite what is often claimed even by the regulators, according to arguably the world's leading authority on the subject, P. Ken Gillman:

Contrary to the opinions expressed in many texts various other so-called ‘serotonergic’✻ drugs are not significant SRIs — such as trazodone, mirtazapine, lithium, buspirone, tryptans etc., see below for full list — and are not a risk for ST interactions: these references contain detailed evidence relating to these issues (3-6).

...in a sense mirtazapine is a ‘serotonergic’ drug, but an anti-serotonergic one that lessens manifestations of ST, not exacerbates them.

Not only cannot mirtazapine cause serotonin syndrome/toxicity, but as a serotonin 5-HT2a receptor antagonist it actually lowers the risk of hyperthermia, the large body temperature spike which does most of the syndrome's harm.

Plus I have been reading how bad withdrawals are from ven and how it increases insomnia.

If stopping meds completely, the best way to wean off venlafaxine is to first switch to fluoxetine and then wean off it. Fluoxetine has a very long half-life, about 6 days for the parent compound plus ~16 days for its active metabolite which does a lot of the heavy lifting, so it takes up to a month for fluoxetine to be metabolized and eliminated and several months for the metabolite making it essentially self tapering. OTOH, the half-life of venlafaxine is only about 4 hours and that of its active metabolite desvenlafaxine (marketed as Pristiq) around 10 hours.

Personally, I wouldn't take venlafaxine. It is really only a SSRI (fluoxetine, paroxetine and sertraline are much more potent noradrenaline/norepinephrine reuptake inhibitors), is more toxic than SSRIs and other SNRIs and has the withdrawal issues already noted. Its only real advantage is a slightly better side-effects profile. Duloxetine would be a better SNRI, though I would take clomipramine (Anafranil).