Prozac to Effexor

[Munchlet]

So I had a 30 minute appt with the GP last night, she had a really long chat with me and said she's not happy about me being on prozac as the last few times I've been on it I've had to come off due to my anxiety not being controlled and due to the current state I'm in she doesn't think it will be enough to bring my anxiety levels down.

So after a very long chat and her offering a lot of reassurance she wants me to stop taking prozac and switch to effexor. I told her last time I freaked out after a day due to a headache and panicked.

She said I need to stop reading side effects and just take the medication, she also thinks the effexor works a lot quicker than some of the other meds and should start controlling my anxiety within about 7 days. She also advised me to do the CBT course with Anxiety Alliance, recommended a website called MoodGym which she said is like an online CBT and suggested I look into some kind of meditation/relaxtion techniques.

I did say to her was it ok to just switch from Prozac to Effexor and she said yes because the Prozac will slowly come out my system as I start taking Effexor but I've read online you should have a wash out period so needless to say I'm worried about Serotonin Syndrome. I only took 12 days of Prozac at 20mg and my starting dose of Effexor is 37.5mg, I also didn't take anything yesterday so my last Prozac was Tuesday.

I know I need to trust my GP but does anyone have any experience of switching between these meds.

thanks

[MyNameIsTerry]

These GP's really do like treating us like lab rats! If she had concerns that Fluoxetine wasn't going to be enough, why bother in the first place? She could have sparred you the side effects of this.

http://www.gpnotebook.co.uk/simplepage.cfm?ID=1630863432

Maudsley guidelines state washout period. What she is saying is due to the overlapping of SSRI's method of action but thats for short half life SSRI, Fluoxetine is a long half life one.

Personally, I would consult a pharmacist because of the possibility of local guidelines and then go back if needed.

I don't know what other people think but I have found your GP to be a little over optimistic about how fast these meds work. Side effects can be 4-6 weeks on these meds and until you get out of those windows, I doubt improvement is going to be seen. However, I will say that my med, Duloxetine, was much shorter in terms of the side effects window (8-10 days on second stage taper dose) so it doesn't mean it will take that long.

I really would create a thread on the Ven board about this, you will get more responses. They are a very supportive group with a lot of experience of this med, including one of our admins (Pipkin)

MoodGym is an Australian CBT for depression. Why didn't she tell you about the UK ones the NHS & NICE advise? Seems strange. It's free so it's always worth it, but look at the NHS ones on their Moodzone pages such as FearFighter or Beating The Blues. (http://www.nhs.uk/conditions/stress-anxiety-depression/pages/low-mood-stress-anxiety.aspx)

If you want to try relaxation, look for Progressive Muscle Relaxation (PMR) which is an old technique from the 1920's which the IAPT therapists still give out now. If you can't Google, I will paste you the worksheet links. If you want to try some meditation, look at the Mindfulness thread in my signature. Most of the downloads are free and the ones from Professor Mark Williams are very trusted as his treatments are NICE recommended for recurrent depression (the downloads are just ones from his book though).

[Munchlet]

To be fair to her she didn't prescribe the Fluoxetine it was another GP at the surgery, when she found out I was on it she said that she wasn't happy it would work due to me coming off it in the past for that very reason.

She just said in her opinion and experience Fluoxetine isn't good at controlling severe anxiety in most people and she felt Effexor would work better for me given my symptoms.

It does seem strange that she mentioned the MoodGym but not the UK ones, I will have a look at them. Thanks for the links.

I think I will check with the pharmacist as I haven't been on Fluoxetine long but I don't want to run the risk of a big increase in side effects.

Thanks

[MyNameIsTerry]

Ah, ok. That other GP might have thought to put you back on one from before, thats a guideline for them, but I guess they didn't read the notes about why you came off it.

Ven is a second line style med, like mine. But it does have a reputation for being hard to come off along with Paroxetine. GP's are told to discuss this. But there are some people on here who say it has really helped them so they are worth talking too. I've spoken to them about mine as it's similiar and I found them to be very knowledgable and very supportive.

The one think I can say about mine, Duloxetine, was that the initial side effects of the 30mg dose mimicked SSRI's because thats all it's really doing at that stage. When I went to the 60mg dose where it starts working on adrenaline as a full SNRI, I found the side effects very different. In Ven, you won't see that until you reach 150mg so side effects may be similiar to what you have experienced in the past BUT please keep talking to the people on the Ven board because they've adjusted their doses upwards and they will keep you on track about what is a side effect but with your HA you are bound to read too much into them.

Your GP is very right about the side effects in the leaflet. They can be scary. Given you have HA, you are going to be very suspectible to focussing on those rarer & more scary ones (which are very very unlikely to occur) that are in those leaflets so you need to use your rational mind to fight that off and give them a go.

If you use FearFighter, you might need your GP to sort it out as it's otherwise chargeable. I wouldn't dismiss the Australian sites though, they can be excellent. I often use one that has the workbooks on for HA that people on here are using.

[Munchlet]

Yes she did say to me about the withdrawal effects if I wanted to come off, she said that I should never ever just stop it and if I did want to come off she would probably need to put me on something like a low dose of prozac to taper off.

Having said that she did say that if this works for me it might be worth staying on a low maintenance dose as everytime I try to come of meds I end up in a massive black hole that takes ages to get out of.

She's started me on a slow release 37.5 mg and said if that goes ok when I speak to her in a couple of weeks we can look to up it to 75mg but just take it one step at a time.

I'm not even going to look at the leaflet this time I spoke to the Pharmacist and she said yes it's fine to take it today as my last Prozac was Tuesday, I have to say I'm not so sure but if the GP and Pharmacist say it's ok I guess it must be.

[MyNameIsTerry]

That gives some confidence then, she understands the need to cross-taper to a slower withdrawal med in Fluoxetine. Thats the standard advice on a med with a very short half life like Ven.

There are people on the Ven board who stay on maintenance doses so I'm sure they will be able to help you with that.

Slow release is what I have seen them mention as the best format that brings least side effects, so thats a good start. It's a drug that can be adjusted a lot more than many others so you can find what works best and not everyone needs to go 150mg. If you do go that far though, please make sure you talk to people on here because the side effects can be different because the adrenaline can bring aggitation/anxiety and if you are not prepared for that, you could think your anxiety is worsening. You may never get that far but I want to get that across because people on the Ven board support each other through those difficult times and it can catch you out if you are not prepared for it. Don't worry though.

If they both agree, I guess it's worth a try. I find pharmacists understand meds far better than GP's so thats good. It really will take a certain amount of time for the Fluoxetine to exit your body, 4-5 half lives of the drug (75% will be gone after 3 half lives though and by the fifth half life it's under 5% and classed as medically insignificant) hence the washout period, but with your Ven dose being at SSRI level and quite low they must know it will even out and with you being new on Fluoxetine you won't need a long taper off period anyway.

So, see what happens. Let the Ven people support you. You do sound more positive at the moment though which is a good sign. It does show in how people post.

[nicola1980]

Hi i successfully take venlafaxine for severe anxiety and panic, im on 187.5mg which is the dose that works best for me, i started out on 37.5mg too and gradually increased my dose, the side effects when I first started were nausea so always take your ven with food even if it's just a biscuit as that helps, my pupils dilated which completely freaked me out but is a common side effect which does go, it's good you've been started on the slow release as I feel you get a much smoother ride on them. When I first started ven im not sure if it increased my anxiety or not as I was in a very bad way to begin with but when I increased from 150mg to 187.5mg that's when my anxiety rocketed as ven then works on more transmitters in your brain but saying that I'm glad I stuck it out as I feel the best I've felt in years, im living a normal life again which at one point I never thought would happen so for me ven has been very good especially as other AD's had failed. Good luck XX

[Munchlet]

Thanks Terry and Nicola, I took my first dose earlier, made sure I had a big bowl of porridge to take it with. I'm still struggling to eat but going to ensure that I have the tablet with food as I don't want the nausea to kick in.

I've posted in the Ven section too and will have a read at some of the posts in there. I've also started doing Moodgym today, apparently I'm not mad, it just feels like it. It did make me chuckle because it said that people with severe anxiety/depression often think they are going mad but they aren't because the fact you are thinking it shows you are still in touch with reality. Apparently if you are truly mad you don't normally recognise it yourself.

So I'll take that as a positive :D

[GoWhiteSox]

munchlet actually i transitioned directly from lexapro (ssri) to effexor about a month ago..for me the transition was ok...first night felt very wired and could not fall asleep and a bit more sweaty than normal for a couple weeks after but overall i think i am doing better on the effexor than i was on the lexapro..i used to have horrible anxiety in the mornings like dry heaving every morning but since i started effexor have not...dont get me wrong it is not a magic pill but it has helped...

[Munchlet]

Ah thats good to hear GoWhiteSox one of my problems with Fluoxetine is dry heaving in the morning coupled with the fact that I just can't focus on anything or do anything for about 4 hours it's just awful, it literally feels like I want to crawl out of my skin.

So I'm hoping the Effexor isn't as bad.

[GoWhiteSox]

i dont think its the flouxetine making you dry heave, it is the anxiety...hopefully for you the effexor can reduce your anxiety which will mean no dry heaving...sorry you are going thru that it is no fun :-(

[swajj]

Hi i successfully take venlafaxine for severe anxiety and panic, im on 187.5mg which is the dose that works best for me, i started out on 37.5mg too and gradually increased my dose, the side effects when I first started were nausea so always take your ven with food even if it's just a biscuit as that helps, my pupils dilated which completely freaked me out but is a common side effect which does go, it's good you've been started on the slow release as I feel you get a much smoother ride on them. When I first started ven im not sure if it increased my anxiety or not as I was in a very bad way to begin with but when I increased from 150mg to 187.5mg that's when my anxiety rocketed as ven then works on more transmitters in your brain but saying that I'm glad I stuck it out as I feel the best I've felt in years, im living a normal life again which at one point I never thought would happen so for me ven has been very good especially as other AD's had failed. Good luck XX

So have you been undertaking counselling so that you can eventually lead a normal life without relying on medication?

---------- Post added at 19:09 ---------- Previous post was at 19:02 ----------


Thanks Terry and Nicola, I took my first dose earlier, made sure I had a big bowl of porridge to take it with. I'm still struggling to eat but going to ensure that I have the tablet with food as I don't want the nausea to kick in.

I've posted in the Ven section too and will have a read at some of the posts in there. I've also started doing Moodgym today, apparently I'm not mad, it just feels like it. It did make me chuckle because it said that people with severe anxiety/depression often think they are going mad but they aren't because the fact you are thinking it shows you are still in touch with reality. Apparently if you are truly mad you don't normally recognise it yourself.

So I'll take that as a positive :D

Lol that's what my psych said to me the first time I ever went to see him. His exact words were "the good news is you aren't mad - the bad news is that you are going to have to work hard to get well". Its good that you were able to laugh munchlet. If you decide to persevere with the meds make sure you keep pushing for the counselling. You don't want to spend your life addicted to meds.

[Munchlet]

Yes Swajj I've been completing CBT exercises on MoodGym and I've called AnxietyAlliance to chase up the CBT with them.

[swajj]

Good work munchlet.:) You can probably tell I'm not a fan of medication. If individuals use it in the short term to help them manage the anxiety until they learn how to manage it themselves then that's fine. If individuals rely totally on the meds to manage their anxiety and don't work at managing it themselves then I'm opposed to it. You don't want to spend the rest of your life escaping through meds. Eventually you need to deal with the anxiety.

[Munchlet]

I agree I don't want to rely on meds the problem we have over here is there's always such a waiting list for CBT on the NHS, which is why I am pleased that I've found Anxiety Alliance as they seem to be really on the ball, I'm really hoping that I'll be able to start CBT with them soon.

In the meantime I've been doing some exercises on MoodGym and I'm also reading How to overcome Health Anxiety which again has some CBT exercises in it.

Will keep you posted on how it goes.:)

[swajj]

I can tell that you are trying hard to deal with your anxiety. I understand that getting counselling is a slow process over there. I think Anxiety Alliance is good for you until you can get face to face counselling. Moodgym sounds like it is good for you too. You actually sound better today. Maybe it's the meds lol. Definitely keep us posted please. :)

[GoWhiteSox]

munchlet-you can live a "normal" life with or without medication..being on medication does not make you not normal...some people need to take it long term some people dont..some diabetics need to take insulin shots every day some take some pills for a while and change their diet and they are fine..does not mean one is stronger or weaker than the other..yes be diligent with therapy as it is absolutely necessary to recover but do not feel guilt/shame about taking medication and if you do decide to come off the meds after recovery do so with a dr's supervision to prevent relapse..at the end of the day i guess it comes down to this, dont be ashamed of having an anxiety disorder...do what you need to do to get better

[Munchlet]

Thank you GoWhiteSox I really appreciate that. At the minute there is no way I could cope without meds as the anxiety is just so bad. Obviously I would like to think one day I could come off of them but that's not something I'm thinking about at the moment. I just want to get myself sorted, get some therapy and take it one day at a time.

The GP said to me, some people just tick along nicely on a maintenance dose she said similar to what you said about diabetics she actually said "if you had high blood pressure you'd take a tablet everyday and that's how you need to look at it". So I'm just going to take the meds, get some therapy and see what transpires but if I have to continually take meds then so be it.

One thing for sure is I never ever want to go through what I've been going through over the last few weeks it's be unbearable.

Thanks :)

[GoWhiteSox]

one more thing to think about...when you say "unbearable"..dont underestimate how strong you are and what you can bear..you create self-doubt when you fear something will be unbearable...youve gone thru tremendous difficulty recently yet here you are interacting with others..you are stronger than you think :-)