View Full Version : I'm afraid to take venlafaxine (Efexor)... Help!
I just came from the doctor. He said my brain is marvelous and my heart is perfect. He gave me venlafaxine. I'm supposed to take 75 mg per day and increase gradually until 300 mg per day. BUT, I've read the information leaflet and it says that venlafaxine inhibits not only serotonine recapture but as well that of NORADRENALINE. Besides, it says it might increase heartbeat and cause palpitations. Now, that is exactly what I feel all the time: palpitations and all kind of heart symptoms that drive me crazy! Why? Because I'm allegedly anxious and I panic. Why? Because the threshold of my fight or flight response is very low and consequently my adrenal glands secrete way too much noradrenaline and adrenaline! So how is a medicine that increases noradrenaline supposed to cure me? I'm confused... What are your experiences with this medicine? Did you get worse? Did you get better?
PS - He also gave me melperone, an antipsychotic that also acts on anxiety. Its potential cardiac adverse effects are even worse than venlafaxine, like QT interval prolongation, all sorts of arrhythmias and weight gain (I'm trying to lose weight!). I definitely won't take this one. Have your ever taken this? What was it like?
Medical professionals are well aware of the potential side effects the drugs can cause. The drug companies list every single one of them as they have to do. The vast majority of people never have any of them or if they do, they're minor and not an issue. If you listen to the drug commercials on TV and all the side effects they list, you would never take them, but millions do and do quite well.
If he felt there would be a negative effect on you, they wouldn't have been prescribed. You went to the doctor in order to help you with physical issues resulting from anxiety issues.
So... you have a choice... don't take them and everything stays the same or gets worse, or give them a try. Worst case, they don't work for you and best case, your quality of life improves.
My daughter has tried three different SSRIs before they found one that works for her and she's doing great! The meds along with therapy have helped her tremendously.
Positive thoughts
hello junot
I currently take 300mg of venlafaxine and have done for some time when I first started I had a few of the side effects such as tiredness , dry mouth , problems sleeping etc but they have helped me and most of the side effects went after about a month as fishmanpa says its your choice but they all have side effects to some degree my only word of caution is you will need to come off of them very slowly with small decreases in the amount of the meds
hope that helps a little
nomorepanic
17-07-14, 17:17
Hi
This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your problem.
This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.
angels22165
17-07-14, 17:48
Hi
I commenced on Venlafaxine 12 days ago now on 75mg a day, 37.5 in a morning and 37.5 in an evening, I was on Citalopram before this and did a straight swap so they probably started working a bit quicker than starting from scratch but after the first week I can feel a difference to my anxiety. I have GAD and panic attacks and they are helping. The first week I just had a couple of disturbed sleepless nights and felt a bit rough, but to go through that to how I feel now was worth it.
Hope that helps and you decide what to do for the best
Take care
Julie
I'm on day 10 of venlafaxine,75mg per day.I was on mirtazapine and did a straight swap,no major side effects,few aches and pains but manageable.give them time,try and keep busy and see how it goes
Hi
I'm on 185gm of the xl daily.
I also take a very low dose of an anti psychotic (Olanzapine), and that has really helped my anxiety. Good luck :)
Thank you all for your helpful replies. I still haven't had the courage to take them though. I've been through various medications since 2006. The first one was paroxetine, then I switched to venlafaxine (prescribed by a different doctor about 5 years ago). I changed doctor (the one I have at the moment) and he gave me fluvoxamine, it worked a while but then we've had to switch to fluoxetine and now he proposed me to switch to venlafaxine (fluoxetine wasn't working anymore as it should and I had stopped taking it in April this year by my own will). So venlafaxine is not really new to me, but this time I'm afraid to take it for its side effects and specifically due to noradrenaline recapture inhibition. Besides, all these antidepressants have made me gain weight, have risen my prolactine blood levels, which in turn have enlarged a bit my breasts (I'm a male), and have caused me some hair loss. Doctors always say that antidepressants make us lose weight (especially fluoxetine) but that seems to me to be an utter lie: all the persons I know who've been through this sort of therapy have gained weight, many to the point of becoming overweight/obese. Moreover the treatment is rarely effective in the long run, as I can attest by my own experience. In the beginning I feel very well and extremely relieved but after a year, a year and half or so all the anguish of anxiety, panic and so on starts coming back and there we go, we switch antidepressant and the cycle begins again. I don't know what to do anymore... Maybe I'll stick only to benzodiazepines when I get anxious, at least while that's effective. In fact I think that if my life doesn't change, if the problems that haunt me don't go away, no medicine will ever "cure" me.
Hi all, I am a visitor here for my first time and wanted to follow this thread, as I am just starting effexor. Was on Pristiq first but it was too expeensive so I switched to this. Unfortunatly I am not having as good a success from relief as I did with the Pristiq. In fact, my panic has returned. I did not know how to become a follower of these posts so I thought writing here would get me in. I hope you don't mind. I am desperate for relief as I am sure you all are.
I have learned alot already just from reading all these posts. How can I get them automatically sent to me? Anyone know?
MyNameIsTerry
18-10-14, 03:35
Medical professionals are well aware of the potential side effects the drugs can cause. The drug companies list every single one of them as they have to do. The vast majority of people never have any of them or if they do, they're minor and not an issue. If you listen to the drug commercials on TV and all the side effects they list, you would never take them, but millions do and do quite well.
If he felt there would be a negative effect on you, they wouldn't have been prescribed. You went to the doctor in order to help you with physical issues resulting from anxiety issues.
Maybe this is a difference between the US and the UK FMP? I don't feel that medical professionals do in the UK and this seems to be a recurrent experience of those on this website, others I've seen and when I used to attend the charity walk-ins. I think if you are talking a psychologist or psychiatrist, you are right, but if you are talking GP's then I don't. My GP only ever says side effects are restricted to loose bowel and sweating which is very far off the mark. On one occasion I was unlucky enough to experience one of the less likely side effects which he stated was my anxiety despite the fact I have never experienced this effect in the 8 years spanning starting that medication. I had the worst 8-10 days of my life and my anxiety was far higher than when I initially went asking for help.
You have to bare in mind that these medications are not really there to treat anxiety because they are antidepressants.
I can't agree that the vast majority never experience side effects, we see people talking about them on here all the time. Thats not rare. The drug companies themselves list side effects as common in the leaflets with the medications, which says they don't agree that side effects are rare. I don't think that I or any of these people would suggest they are 'minor' at all, they are well known to have the ability to greatly increase anxiety levels and this is see commonly.
Take a look at the view of the UK's NHS on one common SSRI, Citalpram:
http://www.nhs.uk/medicine-guides/pages/MedicineSideEffects.aspx?condition=Anxiety&medicine=citalopram%20hydrobromide
That starts at 1 in 10 people. Thats very common. 1 in 100 is classed as common.
The problem is that whilst a side effect may be deemed 'minor', they are not necessarily minor to someone suffering from intense anxiety. The guys & girls with HA, for instance, are going to find that hard going as it could mean new symptoms for them.
The sooner the medical community finally complete research into other non chemical methods such as electrical stimulation treatments so we can walk away from these medications, the better.
Venlafaxine is an SNRI which, as you said, works by inhibiting reuptake of serotonin and noradrenaline. It doesn't act on noradrenaline until about the 150mg level, so starting on 75mg will give you a feel for any side-effects that may occur before the noradrenaline is impacted. For anxiety, they should be using the ;extended release' version of venlafaxine, which acts more slowly on reducing reuptake of the noradrenaline, reducing the possibility of anxiety side effects. Reducing reuptake of noradrenaline doesn't necessarily mean it will cause you to experience more anxiety either, but it is really difficult to explain the mechanisms of action (I have a motion picture of how it works in my mind - unfortunately this doesn't convey into words).
Melperone is traditionally an antipsychotic medication, however research suggests that melperone in low doses is effective for managing anxiety symptoms. The side effects listed are generally more common in the higher doses uses to treat psychotic symptoms, and regular blood tests are recommended with the use of Melperone to monitor for possible side effects. Some research suggests that it may be a viable substitute for benzodiazepines, so I assume this is the reason your doctor has prescribed it. Benzos tend to stop working as your tolerance for them increases, meaning that you need to increase your dose. This is risky because Benzos can be quite potent and dangerous in high amounts. Benzos also have addictive properties and people using them regularly can develop dependency issues.
Omigosh, Terry, I just now "got it". People with health anxiety worry that if there is a possibility (however remote that can be) of getting a side effect, then "surely" they will get it. I never really understood that attitude. Now I think I see ... Anxiety itself seems to be the reason they gravitate towards believing themselves to be the 1 in 10 or 1 in 100 or whatever who has reported having had it. Obviously as well then, if they believe they are going to have it (headache for example) they are going to gravitate towards believing that in their case, coincidentally they have developed an aneurism or brain tumour ... Knowing that this is how their anxiety works, they will refuse to take it so that they don't have to fear having the health anxiety response take over. Personally, I find comfort in knowing what to expect as confirmed by people on here when I read the threads. Then when the headache starts I can say to myself "yes, that's a side effect" whereas they find it horrifying. Because they're not able to think things through rationally. The anxiety does all their thinking for them! I don't mean that to be as rude as it sounds. I just mean that I can see how, as long as the anxiety rules their decision-making capacity, they will end up refusing or soon bailing on the very medications that could help them. And meanwhile not believing the doctors who tell them they're fine. Their health anxiety won't let them.
People also fixate on any of the rare cases of really dire things that have happened while patients have been on the medication. Regardless of the fact that the emergency is probably due to something totally unrelated to the drug (e.g. heart attack, in a person with pre-existing heart problems), simply because it occurred while the person was also taking the med, then it must be listed as an adverse event. There will always be a couple of adverse events occurring at the same time whenever a large number of people are taking a medication. It's called co-incidence. Happened at the same time, that's all. People have heart attacks while sitting in traffic. But that doesn't mean we shouldn't drive, I don't think. Unless we have a pre-existing heart condition and also know that we get stressed out sitting in traffic!
I don't have a heart condition (that I know of). But I guess if I knew that I had health anxiety, then I would also know that my health anxiety will tell me that the discomfort I feel under my breastbone after eating is a heart attack. So I'd better not take the medication if anyone has had a heart attack when taking it, because that's straight where my mind will take me.
Health anxiety seems to be kind of like an addiction. The person's mind keeps coming up with one reason after another why they can't move on, to let go of the HA and just live life on life's terms. Which means you're just like everyone else. You can't control what may or may not happen to you healthwise, beyond sensible measures like proper diet, exercise and the like. You need to accept that. To own it. Then you can let go of the fear that you may be putting yourself at risk. Any more than you are swinging your feet out of bed in the morning. People have died doing that, too, no doubt, at one time or another around the world. But ... we keep on doing it!
---------- Post added at 22:20 ---------- Previous post was at 22:16 ----------
Junot, I hope if you are able to take the Effexor, then it won't "poop out" on you like the others. xx :hugs:
Marie
MyNameIsTerry
18-10-14, 08:40
Venlafaxine is an SNRI which, as you said, works by inhibiting reuptake of serotonin and noradrenaline. It doesn't act on noradrenaline until about the 150mg level, so starting on 75mg will give you a feel for any side-effects that may occur before the noradrenaline is impacted. For anxiety, they should be using the ;extended release' version of venlafaxine, which acts more slowly on reducing reuptake of the noradrenaline, reducing the possibility of anxiety side effects. Reducing reuptake of noradrenaline doesn't necessarily mean it will cause you to experience more anxiety either, but it is really difficult to explain the mechanisms of action (I have a motion picture of how it works in my mind - unfortunately this doesn't convey into words).
Melperone is traditionally an antipsychotic medication, however research suggests that melperone in low doses is effective for managing anxiety symptoms. The side effects listed are generally more common in the higher doses uses to treat psychotic symptoms, and regular blood tests are recommended with the use of Melperone to monitor for possible side effects. Some research suggests that it may be a viable substitute for benzodiazepines, so I assume this is the reason your doctor has prescribed it. Benzos tend to stop working as your tolerance for them increases, meaning that you need to increase your dose. This is risky because Benzos can be quite potent and dangerous in high amounts. Benzos also have addictive properties and people using them regularly can develop dependency issues.
Hi anthrokid,
Is venlafaxine a lower strength of SNRI because the standard dose for depression and GAD seems to be 60mg in Duloxetine which is also an SNRI? I am interested in this because the side effects tapering up from 30-60mg of Duloxetine were pretty bad and I can think of another member on here who is struggling with it and may find it easier on venlafaxine if that is easier to taper on.
---------- Post added at 08:40 ---------- Previous post was at 08:30 ----------
Omigosh, Terry, I just now "got it". People with health anxiety worry that if there is a possibility (however remote that can be) of getting a side effect, then "surely" they will get it. I never really understood that attitude. Now I think I see ... Anxiety itself seems to be the reason they gravitate towards believing themselves to be the 1 in 10 or 1 in 100 or whatever who has reported having had it. Obviously as well then, if they believe they are going to have it (headache for example) they are going to gravitate towards believing that in their case, coincidentally they have developed an aneurism or brain tumour ... Knowing that this is how their anxiety works, they will refuse to take it so that they don't have to fear having the health anxiety response take over. Personally, I find comfort in knowing what to expect as confirmed by people on here when I read the threads. Then when the headache starts I can say to myself "yes, that's a side effect" whereas they find it horrifying. Because they're not able to think things through rationally. The anxiety does all their thinking for them! I don't mean that to be as rude as it sounds. I just mean that I can see how, as long as the anxiety rules their decision-making capacity, they will end up refusing or soon bailing on the very medications that could help them. And meanwhile not believing the doctors who tell them they're fine. Their health anxiety won't let them.
People also fixate on any of the rare cases of really dire things that have happened while patients have been on the medication. Regardless of the fact that the emergency is probably due to something totally unrelated to the drug (e.g. heart attack, in a person with pre-existing heart problems), simply because it occurred while the person was also taking the med, then it must be listed as an adverse event. There will always be a couple of adverse events occurring at the same time whenever a large number of people are taking a medication. It's called co-incidence. Happened at the same time, that's all. People have heart attacks while sitting in traffic. But that doesn't mean we shouldn't drive, I don't think. Unless we have a pre-existing heart condition and also know that we get stressed out sitting in traffic!
I don't have a heart condition (that I know of). But I guess if I knew that I had health anxiety, then I would also know that my health anxiety will tell me that the discomfort I feel under my breastbone after eating is a heart attack. So I'd better not take the medication if anyone has had a heart attack when taking it, because that's straight where my mind will take me.
Health anxiety seems to be kind of like an addiction. The person's mind keeps coming up with one reason after another why they can't move on, to let go of the HA and just live life on life's terms. Which means you're just like everyone else. You can't control what may or may not happen to you healthwise, beyond sensible measures like proper diet, exercise and the like. You need to accept that. To own it. Then you can let go of the fear that you may be putting yourself at risk. Any more than you are swinging your feet out of bed in the morning. People have died doing that, too, no doubt, at one time or another around the world. But ... we keep on doing it!
---------- Post added at 22:20 ---------- Previous post was at 22:16 ----------
Junot, I hope if you are able to take the Effexor, then it won't "poop out" on you like the others. xx :hugs:
Marie
Thats the additional challenge for the HA guys, the added exposure of new symptoms or the possibility of increased intensity of an existing one. Then they catastrophize.
I have real problems with physical sensations and I tend to obsess over them and they will ruin my day very easily. So, when you start on these medications and feel these symptoms worsening or even new physical sensations, you tend to make them part of your anxiety. I guess its harder for the HA guys because they don't have the same limit to their thoughts in terms of these issues because I can say "I hate this, it's killing me, but I know its a side effect" whereas they will progress beyond that point into all sorts of cancers and tumours, etc.
I agree, I prefer to know up front. Its not pleasant and it can put you off, but you just have to suffer it and come out of the other end. The first time, I didn't know anything about anxiety and within days of starting Citalopram I was a massive mess and back on the phone to my GP. When I relapsed and went onto Duloxetine, I just got on with it. At some points by saying this I found some comfort and symptoms would ease but going up to the standard dose was much harder and I only got through that by just telling myself it might break tomorrow, it might break the day afterwards, because I knew my GP wouldn't help me. The first time with the Citalopram he said "wll all you can do is carry on or ocme off, there are no other medications" and I was very annoyed with this later when I learnt more about anxiety, which only came from the internet, to find our own National Health Service (NHS) telling patients that they should move between them, quoting various medications, until they find one that is more bearable and at that point I started to view my GP with suspicion.
Health anxiety seems to be kind of like an addiction. The person's mind keeps coming up with one reason after another why they can't move on, to let go of the HA and just live life on life's terms. Which means you're just like everyone else. You can't control what may or may not happen to you healthwise, beyond sensible measures like proper diet, exercise and the like. You need to accept that. To own it. Then you can let go of the fear that you may be putting yourself at risk. Any more than you are swinging your feet out of bed in the morning. People have died doing that, too, no doubt, at one time or another around the world. But ... we keep on doing it!
This makes a lot of sense. HA especially is a form of obsession and the addiction part comes in because there is comfort in pursuing their anxiety as well as a compulsion. The train is being driven by these thoughts and you become a hapless passenger, instead of being the driver as nature intended. If nature had intended us being a passenger, we would have been created as a robot, and that state clearly goes against our natural being. The result of all this is conflict and contradiction - being pulled in many directions at once - and further feeding anxiety. Until the vicious cycle is broken by understanding this and as you say owning your thoughts I don't see how you can escape. You become a victim of your own mind.
I didn't take neither venlafaxine nor melperone. I've been relying on benzodiazepines so far. But the symptoms are much worse now than ever before. Valium 10 mg isn't enough to put me to sleep or feeling drowsy, at least. I will see another psychiatrist on October 23. Hope we get along. I'm going to tell him from the very beginning that I won't take anything that might prolong the QT interval, interact with beta-blockers (which I'm taking) or cause weight gain. First, due to my obsessive heart worries; second, I wouldn't be able neither physically nor psychologically to regain the weight I've put off these past few months, which is a lot of pounds/kg.
I didn't take neither venlafaxine nor melperone. I've been relying on benzodiazepines so far. But the symptoms are much worse now than ever before. Valium 10 mg isn't enough to put me to sleep or feeling drowsy, at least. I will see another psychiatrist on October 23. Hope we get along. I'm going to tell him from the very beginning that I won't take anything that might prolong the QT interval, interact with beta-blockers (which I'm taking) or cause weight gain. First, due to my obsessive heart worries; second, I wouldn't be able neither physically nor psychologically to regain the weight I've put off these past few months, which is a lot of pounds/kg.
Perhaps antidepressants aren't the way forward for you because to my knowledge all SSRIs, and SNRIs in particular, can have cardiac side effects. Prolonged QT interval appears to be rare (apart from citalopram) but things like palps, increased heart rate and cholesterol are certainly more frequent. One point I agree with, which you mentioned in an earlier post, is weight gain. There is a lot of guff about certain ADs like fluoxetine reducing weight but these are short-term effects and in my experience after being on numerous ADs is long-term weight gain. I would say that ANY psychotropic med has this potential when used long-term. So this is part of the weighing up process...but in my mind I'd rather be mentally stable and deal with side effects if and when they occur, as you must remember that you'll never know till you take the med. And even if you've taken it before there is no guaranteeing it will affect you in the same way (as many members here report).
Perhaps antidepressants aren't the way forward for you because to my knowledge all SSRIs, and SNRIs in particular, can have cardiac side effects. Prolonged QV interval appears to be rare (apart from citalopram) but things like palps, increased heart rate and cholesterol are certainly more frequent. One point I agree with, which you mentioned in an earlier post, is weight gain. There is a lot of guff about certain ADs like fluoxetine reducing weight but these are short-term effects and in my experience after being on numerous ADs is long-term weight gain. I would say that ANY psychotropic med has this potential when used long-term. So this is part of the weighing up process...but in my mind I'd rather be mentally stable and deal with side effects if and when they occur, as you must remember that you'll never know till you take the med. And even if you've taken it before there is no guaranteeing it will affect you in the same way (as many members here report).
Yes, I totally agree with you. And since you referred cholesterol, mine went from 230 down to 175 in about three months, after I quit fluoxetine. And the supposed weight loss effects were short-termed (secondary to nausea during the first week). I will have to discuss thoroughly my therapy options with the psychiatrist.
Hi, again!
Terry, I did a little research and this is what I found out:
"Duloxetine differs from venlafaxine in that it is comparatively more noradrenergic. Venlafaxine has a 30-fold higher affinity for serotonin than for norepinephrine while duloxetine has a 10-fold selectivity for serotonin6 (http://www.emedexpert.com/compare/effexor-vs-cymbalta.shtml#ref6). Approximate potency ratios (5-HT:NE) are 1:10 for duloxetine, and 1:30 for venlafaxine."
According to this piece, it appears that duloxetine is a much stronger noradrenergic (having the result of allowing for much greater levels of adrenalin to be active).
Also, I'm afraid I don't quite understand why this is, but they report:
"Nausea is the most frequent side effect with SNRIs, and may cause some people to stop treatment. The extended-release formulation of venlafaxine is less likely to cause nausea than the regular tablet. Cymbalta is more likely cause nausea than Effexor" XR1 (http://www.emedexpert.com/compare/effexor-vs-cymbalta.shtml#ref1)."
And, finally:
"Anticholinergic effects
Drugs that antagonize the muscarinic receptor cause anticholinergic side effects, such as dry mouth, constipation, blurred vision and urinary retention. Duloxetine (Cymbalta) has a higher affinity for this type of receptor than venlafaxine (Effexor), which accounts for the somewhat higher rate of dry mouth, constipation, and blurred vision with duloxetine than with venlafaxine. ...
Tolerability of SNRI antidepressants varies within the class.
Venlafaxine (Effexor) may be better tolerated than duloxetine (Cymbalta) in the initial period of treatment. In clinical trials, duloxetine 60 mg daily caused more discontinuations due to side effects than venlafaxine 150 mg daily1 (http://www.emedexpert.com/compare/effexor-vs-cymbalta.shtml#ref1),2 (http://www.emedexpert.com/compare/effexor-vs-cymbalta.shtml#ref2)."
http://www.emedexpert.com/compare/effexor-vs-cymbalta.shtml#7
Both have demonstrated substantial antidepressant activity (duloxetine as much as venlaxafine). Duloxetine is just as effective in the treatment of GAD. And for bonus points, discontinuation syndrome is much less a problem with duloxetine.
__________________________________________________ ____________
After a week at the starter dose of 37.5 mg, I then doubled my venlaxafine to 75 mg for a month, as per doctor's orders. In preparation for what I knew would be multiple increases in dose, I asked around on NMP and PMd someone who had also had to do the same thing. It was suggested that I ask my doctor for the half-dosage capsules which I had taken the first week, and instead of doubling each time, to go up in increments of half. This measure is presumably why I only get a short recurrence of mild side effects each time.
I'll bet the same technique would work for duloxetine side effects as well, but I have no idea if there is a "15 mg" dose available to your friend.
How are you coping now with the side effects, Terry? How long have you been at 60 mg, and do you expect to need to increase your dose at some point?
Marie
As you've suggested, Junot, I think it's a good idea to discuss this with your new psychiatrist :) They are the gold class experts with psychopharmacology. They'll be able to help find an option that you are comfortable with. They'll be able to explain the risks and benefits associated with any treatment (and, in fact, they should!), and the prevalence of these. Long-term Benzo use isn't ideal, so I'm sure your psychiatrisat will be very thorough and helpful in finding a more effective treatment option :)
To my knowledge, the risk of QTc prolongation when using any medication that reports it as a potential side effect is relative to the person. Research reports that QTc prolongation and/or TdP tend to only occur in the presence of multiple additional risk factors. Your doctor wouldn't prescribe a medication with such effects if he thought you had enough said risk factors associated with QTc prolongation. Research reports the risk of QTc prolongation with venlafaxine as low, and the highest risk for QTc prolongation for venlafaxine appears in overdose situations.
MyNameIsTerry, it would appear that SADnomore found an answer to that question for me, thank you :)
MyNameIsTerry
19-10-14, 06:07
Thanks for checking back anthrokid.
Thanks Marie, some very useful detail that you've dug up there!
I think this explains what I wanted to know about the difference between the 2 SNRI's. Duloxetine is more likely to cause side effects relating to increased adrenaline. This makes a lot of sense because I suffered far worse anxiety when I increased from 30-60mg. All that extra adrenaline. It wasn't too bad starting on the 30mg but the nausea was bad the first day within 10 minutes of taking the stuff but it wore off after about 30 minutes. The second night wasn't as bad and after that the nausea was gone. Going to 60mg made my anxiety skyrocket and I could barely sit down for the first 6 hours of the day. I remember doing a lot of standing around and watching the birds in my back garden. The waking 1.5hr adrenaline rushes for 8-10 days were very unpleasant and the more the days went on, the worse things seemed to get. At day about day 10 I found it decreased significantly and the waking adrenaline rushes were gone. It was pretty horrible but my GP is useless over this medication so there wasn't much choice.
I've been on it a couple of years now so thats no longer an issue for me. I have had a few days where there has been an adrenaline rush though. Its not as pronounced as when I started on it but it was obviously a rush as opposed to panic as I felt positive with it and I had a real urge to be aggresive. I just kept walking faster & faster and I really wanted to shout aaaarrrgghhhhhh!!!! but as a release, not from anxiety. I guess it must have been far too much adrenaline but I can't tell you how much I just wanted someone to start a fight. I'm not like that at all, but I felt like I really wanted that to happen. The only other time I have experienced this is when I used to lift weights and used supplements and one day I mixed some things that were far too strong for me. It felt the same. Perhaps thats a little bit like how you feel on some steroids???
The guy I was thinking about on the depression board has really struggled to go onto 30mg and this is a half dose (his GP seems to think its a standard dose which is incorrect) so the question remains whether he will struggle even more going up a dose by following the pattern I had. Perhaps he is too sensitive to this stuff? I'm thinking that venlafaxine might be a gentler SNRI for him to try given its closer to the SSRI's and has less of an effect on adrenaline.
I don't plan on raising my dosage, I would prefer to find other ways because I wonder if thats like a crutch and I know thats going to make it harder ensuring I am ok to decrease it. I can cope on this dosage anyway. To be honest, my GP has said before that he can't raise them about standard dosages which I question and I don't know whether thats his ignorance of medication or just an unwillingness to try anything given he has lied about there being no other forms of antidepressant to me before.
I think that statement regarding Duloxetine's ability to cause more nausea is likely to be because its not an extended time medication so it gives a bigger hit over less time which might explain why its mg weight is much lower. Perhaps also it means that adrenaline has a higher capacity to cause nausea than serotonin?
Something I have wondered about Duloxetine is how it could be impacting on my fatigue. I can't remember having so many tired days on Citalopram and I wonder whether its this?
I also think that the side effect 4-6 week window is BS, to be blunt. I think thats the main time but having these adrenaline rushes after 12 months makes me think that side effects come and go due to the differing levels of serotonin and adrenaline.
Thanks for checking back anthrokid.
Thanks Marie, some very useful detail that you've dug up there!
I think this explains what I wanted to know about the difference between the 2 SNRI's. Duloxetine is more likely to cause side effects relating to increased adrenaline. This makes a lot of sense because I suffered far worse anxiety when I increased from 30-60mg. All that extra adrenaline. It wasn't too bad starting on the 30mg but the nausea was bad the first day within 10 minutes of taking the stuff but it wore off after about 30 minutes. The second night wasn't as bad and after that the nausea was gone. Going to 60mg made my anxiety skyrocket and I could barely sit down for the first 6 hours of the day. I remember doing a lot of standing around and watching the birds in my back garden. The waking 1.5hr adrenaline rushes for 8-10 days were very unpleasant and the more the days went on, the worse things seemed to get. At day about day 10 I found it decreased significantly and the waking adrenaline rushes were gone. It was pretty horrible but my GP is useless over this medication so there wasn't much choice.
I've been on it a couple of years now so thats no longer an issue for me. I have had a few days where there has been an adrenaline rush though. Its not as pronounced as when I started on it but it was obviously a rush as opposed to panic as I felt positive with it and I had a real urge to be aggresive. I just kept walking faster & faster and I really wanted to shout aaaarrrgghhhhhh!!!! but as a release, not from anxiety. I guess it must have been far too much adrenaline but I can't tell you how much I just wanted someone to start a fight. I'm not like that at all, but I felt like I really wanted that to happen. The only other time I have experienced this is when I used to lift weights and used supplements and one day I mixed some things that were far too strong for me. It felt the same. Perhaps thats a little bit like how you feel on some steroids???
The guy I was thinking about on the depression board has really struggled to go onto 30mg and this is a half dose (his GP seems to think its a standard dose which is incorrect) so the question remains whether he will struggle even more going up a dose by following the pattern I had. Perhaps he is too sensitive to this stuff? I'm thinking that venlafaxine might be a gentler SNRI for him to try given its closer to the SSRI's and has less of an effect on adrenaline.
I don't plan on raising my dosage, I would prefer to find other ways because I wonder if thats like a crutch and I know thats going to make it harder ensuring I am ok to decrease it. I can cope on this dosage anyway. To be honest, my GP has said before that he can't raise them about standard dosages which I question and I don't know whether thats his ignorance of medication or just an unwillingness to try anything given he has lied about there being no other forms of antidepressant to me before.
I think that statement regarding Duloxetine's ability to cause more nausea is likely to be because its not an extended time medication so it gives a bigger hit over less time which might explain why its mg weight is much lower. Perhaps also it means that adrenaline has a higher capacity to cause nausea than serotonin?
Something I have wondered about Duloxetine is how it could be impacting on my fatigue. I can't remember having so many tired days on Citalopram and I wonder whether its this?
I also think that the side effect 4-6 week window is BS, to be blunt. I think thats the main time but having these adrenaline rushes after 12 months makes me think that side effects come and go due to the differing levels of serotonin and adrenaline.
I was shocked by your comments about your GP saying there was no other antidepressant than Duloxetine. Most GPs wouldn't even have heard of it unless they consult their little GPs' handbook lol. Surprised he never prescribed Venlafaxine tbh.
I lasted less than a couple of days on Duloxetine. It caused violent vomiting and I was depressed enough as it was. I also felt the sedation very strongly. Venlafaxine was nowhere near as bad on start-up. The nausea wasn't in the same league as Duloxetine. Although nausea is mainly a result of noradrenaline Duloxetine is also much more serotonergic than Venlafaxine. However, in the real world empirical data and in vitro measurements don't mean much. Venlafaxine is actually in the amphetamine group (phenethylamine class (http://en.wikipedia.org/wiki/Substituted_phenethylamine)) of drugs. Not much is mentioned about this for obvious reasons but it accounts for its activating properties (insomnia, agitation, high BP etc). It apparently also has a significant affinity for opiate receptors so it's much more complex than just serotonin and noradrenaline reuptake.
I'm glad it's worked well for you though.
MyNameIsTerry
20-10-14, 07:00
Thanks KK, it was a real battle but I just tried to think it would be over soon. It seriously intensified my anxiety for months after due to getting worse than when I went to my GP because I thought I couldn't take any more!
Sadly, this seems to be his way. He doesn't seem to understand them or he is lieing. I was very annoyed later when I checked NHS Direct and found a whole list of things that could be tried so now I treat his advice with suspicion. The sad thing is that its a good practice and in 30 years they had always been very good for any physical issue, but they seem woeful in terms of mental health. I think this is likely to be the case for many GP's.
I wonder about their intentions really because I've been told "psychotherapy can cause more problems than it solves" and due to the issues I experienced with medication I decided that this meant either "I can't be arsed" or "I will be charged for a referral so don't want to do it" so after my CBT, I was dead in the water and I haven't been back in about 15 months now.
You did very well to stick it out but still doesn't excuse the lack of choice you were given. Not that it's a bad med - probably just as effective as any other. TBH, I've found fatigue to be a problem with most ADs so there is no guarantee swapping to another will solve that. Bit of a gamble with a whole host of discontinuation and start-up issues.
I've been waiting over a year for psychotherapy. Just feel they throw you on the scrapheap and wait till your doctor chases it up, which I'll be getting my GP to do next week.
Hi, guys,
See, that's just it. I don't understand why if venlaxafine is an activating med (and it is, at least in terms of insomnia and agitation), then why/how is it that I am still fatigued? I'm taking something to sleep each night and still sleeping in way late. And even with periodic adrenaline rushes, I still can't get motivated enough to get the important stuff done. Like you, Terry, I just walk. Walk, walk, walk. Walk so fast that sometimes next day my feet and legs are cramped up. :P
I'm at 187 on ven now and will probably try 225 next month. I am really hoping the benefits outweigh the negatives of the higher dose - improved mood, more energy, etc. Then I will hang tough through January and start decreasing again by 37.5 each time. I have to be back down to 75 mg for maintenance over the summer months. Doc's orders. I find myself dreading the decrease due to all the noise about trouble decreasing ven, but it must be done. Sigh. Best I can hope for is to either get February also if it's helping, or else to bump up if needed to 300 or so in those critical mid-winter months. But I do have to be on 75 mg by at least June, so I don't want to make it harder on myself than necessary. Complete withdrawal isn't in my future, and for that I am actually grateful because I do believe it is every bit the pig-dog they say it is!
Meanwhile, I hear you Terry, adrenaline rushes are SO annoying, but I guess that's the trade-off, eh? SNRIs lift us up out of the worst of our depression/anxiety, but we have to pay the piper from time to time! If only it could be the right kind of energy, it would be so much easier to deal with, I have to say. I would LOVE that!
Good luck all ... :hugs:
M
Yes it is activating - just at the bloody wrong times! I feel fatigued during the day and seem to wake up after 9pm. I also take sleeping meds so could be that exacerbating daytime tiredness :lac:
MyNameIsTerry
21-10-14, 04:31
You did very well to stick it out but still doesn't excuse the lack of choice you were given. Not that it's a bad med - probably just as effective as any other. TBH, I've found fatigue to be a problem with most ADs so there is no guarantee swapping to another will solve that. Bit of a gamble with a whole host of discontinuation and start-up issues.
I've been waiting over a year for psychotherapy. Just feel they throw you on the scrapheap and wait till your doctor chases it up, which I'll be getting my GP to do next week.
Yeah, when I was chasing up my CBT High Intensity, the psychotherapy route was mentioned but when I contacted them (they were very helpful & understanding) they said it was a minimum of a 12 month wait to access Level 4 therapies. I luckily managed to get into Level 3 CBT High Intensity instead. The Level 4 was the only thing we had in our region when I first started with GAD 8 years ago so these stepped care levels at 2 & 3 were something I could access when I relapsed 3 years ago. Its a real shame the NHS used local primary care trusts who then decide what care to provide as I see threads/posts where people just don't have these levels in place due to the inconsistencies in managing these trusts.
I don't plan on swapping medications. I'm pretty stable on this so I would prefer to recover and come off it really. My GP would never understand tapering off to start a new one given past experiences.
---------- Post added at 04:31 ---------- Previous post was at 04:26 ----------
Hi, guys,
See, that's just it. I don't understand why if venlaxafine is an activating med (and it is, at least in terms of insomnia and agitation), then why/how is it that I am still fatigued? I'm taking something to sleep each night and still sleeping in way late. And even with periodic adrenaline rushes, I still can't get motivated enough to get the important stuff done. Like you, Terry, I just walk. Walk, walk, walk. Walk so fast that sometimes next day my feet and legs are cramped up. :P
I'm at 187 on ven now and will probably try 225 next month. I am really hoping the benefits outweigh the negatives of the higher dose - improved mood, more energy, etc. Then I will hang tough through January and start decreasing again by 37.5 each time. I have to be back down to 75 mg for maintenance over the summer months. Doc's orders. I find myself dreading the decrease due to all the noise about trouble decreasing ven, but it must be done. Sigh. Best I can hope for is to either get February also if it's helping, or else to bump up if needed to 300 or so in those critical mid-winter months. But I do have to be on 75 mg by at least June, so I don't want to make it harder on myself than necessary. Complete withdrawal isn't in my future, and for that I am actually grateful because I do believe it is every bit the pig-dog they say it is!
Meanwhile, I hear you Terry, adrenaline rushes are SO annoying, but I guess that's the trade-off, eh? SNRIs lift us up out of the worst of our depression/anxiety, but we have to pay the piper from time to time! If only it could be the right kind of energy, it would be so much easier to deal with, I have to say. I would LOVE that!
Good luck all ... :hugs:
M
Its strange really. I know I've piled on another stone, so I'm 2 stone overweight really but I can also see some additional muscle. My calves are like I've been lifting weights for years and this never happened when I was doing the same on Citalopram. I can also see more upperbody muscle despite not exercising for that.
So, maybe the impact on adrenaline is also impacting on that in the normal way that increasing adrenaline would? By influencing IGF? This would then make sense with the rushes as they felt very much like I had taken something. I don't get them much, maybe 3-4 times in the last 2 years but those first 8-10 days at the height of really bad anxiety were very rough. I really don't think GP's understand how much worse these medications make us feel.
I know there have been studies of electro based therapies so I'm hoping in that future years we will have non chemical options.
I was on Effexor for about 10 years. Did wonders for my anxiety but was a beast to get off of. And I mean a BEAST. It took 8 months of sloooow titration and head zaps, but I did it.
It's not one I would recommend to anyone who thinks they'll be on short-term.
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