Venlafaxine and Ven ER

[Tims]

Hi, just started this med last week at 75mg for panic/anxiety, it's just the normal, not extended release, but I read the er is more effective for anxiety disorders compared to standard one, anyone here have any knowledge on this?
Greatly appreciate any feedback. :)

[Pipkin]

Hi Tims,

The ER isn't more effective, just more even in its dose with Ven having a short half life. I started on the standard tablets (37.5 mg, twice a day) and eventually moved to the extended release. The important thing is to start feeling better and take it from there. The active ingredients are the same, it's just the delivery method which is different. This just possibly means fewer side effects but no better result. Trust me on that one!

Stick with it - it's been a life saver for me.

Pip

[Tims]

Hi Pip

Thanks for that :) it's only been 12 days since starting Ven and I can see noticeable differences. I'm feeling much more relaxed and better overall. I was previously on cymbalta/duloxeteine 60mg which wasn't doing anything for me really, but due to both meds being snri's the doc said the switch would be fairly straight forward.
Can I ask do you take anything else with the Ven, and are you taking it for depression and/or anxiety?

Thanks

Tims

[Pipkin]

Tims,

I'm taking it for anxiety. I also have propranolol to relieve the physical symptoms but I haven't taken these for a long time. Diazepam is also a back up but again, I haven't taken it for ages. Ven and determination are enough for me. It's just reassuring to have a back up plan if things get really bad.

As I've always said, meds help but the real success is achieved through hard work and determination not to let it beat you. The most important piece of advice I could give is not to sit around and let it beat you. Don't fight it either, just keep active and get out of the house, no matter how hard it seems. This may seem ridiculously simplistic but, to me, it's crucial.

Take care

Pip

[Tims]

Pip

What dose of Ven are currently on, and what's you're experience on other doses if any?

Thanks

Tims

[Pipkin]

Currently on 150 mg. I've been on 75 mg but it wasn't quite right for me. Build up slowly and stick to the minimum dose that works is my advice.

Pip x

[MyNameIsTerry]

You've withdrawn from one SNRI that was working on both serotonin and norepinephrine which starts at 60mg for Duloxetine but it doesn't start for Ven until 150mg so if you have had no issues with withdrawal it's a really good sign you tolerate them well by the sounds of it.

Hopefully you will find the dose that suits you but feeling benefiys so quickly is a very good sign to me.

[pulisa]

All I would say is don't be persuaded to increase your dose too quickly. As Pip says, the minimum effective dose of ven is your best option. Good luck-you seem to be making very good progress already!

[Tims]

Thanks guys for your input. I'm presuming the nonrephenerine is purely for depression and might make anxiety worse being a so called stress hormone, so planning to stay under 150mg.
I also managed to get my Ven changed to the xr from the standard ones to avoid the need to take more than one dose a day. :)

Tims

[MyNameIsTerry]

Duloxetine is licenced for Major Depressive Disorder (MDD) and GAD at 60mg starting. So, you would be treated with both elements of the drug whether depression or anxiety.

The issue of whether norepinephrine reuptake inhibition is one that puzzles me as it would make sense it would make anxiety worse, although thats not the only thing it works with, and would make sense in people with depression (who have no anxiety elements) but there are plenty of people on doses that would interact with their adrenaline and have anxiety disorder yet feel the benefit. I really don't know why these meds work for anxiety as it seems contradictory.

Did you find Duloxetine ramped up your anxiety at 60mg? Did you find your symptoms changed to new ones you never had before and what were they? This is what I have experienced and it has never gone away, merely reduced, so I suspect that I can't tolerate the norepinephrine element but I felt better on the 30mg.

Another issue is the half lives. Both Ven standard & XR don't provide 24 hours and Duloxetine provides 12. I do wonder whether we suffer some of the problems we do because of this issue as when I was on Citalopram it was over 24 hours. Sertraline is only about 22 but at least thats not going to mean much. With my Duloxetine, it's range is such that I could go to 12.5% of the med left in my blood plasma in 24 hours, or 25% at the Mean. It's truly bizarre.

[Tims]

Hi

For me duloxeteine didn't seem to do much except increase anxiety if anything, and like you I stuck to 30 mg. To be honest I wasn't sure why the doc put me on this med. I had previously been on Paxil for quite a long time and it did a great job with the anxiety, but then I decided I wanted to come off all meds so I stopped them gradually. After a few months I ended up back with the doc and he suggested cymbalta due to low side effects.
I've now only started venlafaxine as I thought it would be an easier transition than back to another ssri.
I must say, so far so good, much better results for anxiety than duloxeteine/cymbalta, which is strange because they are both so similar I.e the nonrephenerine.
How long have you been on the duloxeteine and how was you're experience on the citalopram and Sertraline ? I've heard good things about both in regards to anxiety. I'm going to see how it goes with the Ven, but the test will come if and when I need to up from 75mg.

Regards
Tims

[MyNameIsTerry]

I'm glad you are getting better results. Given how quickly Duloxetine starts to work on norepinephrine, I wonder whether it's just too harsh for some of us. It's a ratio of effect and Ven has a much lower one than Duloxetine.

I've been on Duloxetine for maybe 4 years and I can't say it has been much help, if any. In fact, I still have side effects from it. Sadly, I trusted my GP who completely disagrees on this but as I've improved over the years due to working on my anxiety I have noticed patterns that point towards something to do with the med e.g. adrenaline spikes for several days and there are no triggering events to be found. These "blips" come about every 7-10 days and last for 3-4 days but initially they went on for weeks at a time hence why I couldn't see a pattern in there. However, the year after going on these was far worse than the one when I relapsed and I never had all the OCD before, which took me years to reduce.

Citalopram was much better. It was hard starting but part of this was again my GP who told me the side affects were only going to be "some sweating and loose bowel" so when I was not sleeping at all, unable to eat but very hungry, extremely low and in tears, etc he called in the Crisis Team. All I needed was some help with my sleep and within a couple of days I felt a lot better about the side effects and coped. My numpty GP told me to take Zopiclone daily, which the Crisis Team told me was incorrect in their follow up and after 30 days I had become tolerant to the stuff and had to withdraw which mucked my sleep up for months.

However, after I got through that (most of which could have been avoided if my GP had a clue), it did start to really help. I did need a bit of motivation to get back into work but within 6 months I had my confidence back and was working in a very stressful environment. I only ended up relapsing because my GP was pushing for withdrawal and with not having any help to understand about anxiety, I trusted my GP back then, I hadn't resolved the issues underneath. But I have to say it was much better than this experience and didn't bring all the nasty problems this med has with OCD that were never there before.

I've never tried anything else but there are plenty of people on here taking Citalopram or Sertraline who will be able to tell you how well it has worked for them.

Your GP sounds like he doesn't know much about SNRI's. NICE guidelines state GP's should tell people more about SSRI/SNRI's and which ones are associated with greater side effects when starting. I don't think they know much about this though and it's so individual anyway but I would have thought switching SSRI to SSRI would be preferable over moving to a dual system med like a SNRI. Also, Ven & Paroxetine are the two most difficult to withdraw from and GP's are supposed to explain this. I guess your GP wanted to avoid Paxil for that reason but I find it strange he then opts for Ven. Guidance I have read has been to try something again if it worked before but my GP just said "this one if more for anxiety" which just proves to me again that his knowledge is very poor. Usually SSRI's are switched to other SSRI's and I think it would have been better for me to try Citalopram again or something like Sertraline and it's really my GP's ignorance that has put me in this situation.

[Tims]

My past experiences with gp's or psychs hasn't been great either, so I like to do as much of my own research as possible now. I definitely would have insisted on an ssri rather than cymbalta if I could go back. I'm surprised and also not surprised about you're gp prescribing zopiclone daily, and this is another reason why I will never solely rely on any single docs advice again.
I can see why Ven would be difficult to stop, with its short half life and quite fast onset, the instant release in particular.
Overall I totally agree with what some have said this on forum about keeping dosages to a minimum wherever you can with all psych meds. The more effective a drug is for you the harder it will be to stop.

[MyNameIsTerry]

I never used to be like that but after talking to people on here and starting to learn about anxiety and my meds I now do take more control of treatment.

There is a lot of NHS prescribing information online so you can see what your GP's are supposed to be doing. I read these for information when I see people having problems with the GP's in case they can be useful to prove them wrong.

For instance, in this Walsall NHS doc you can clearly see Ven is a 3rd stage antidepressant:

https://lifestyle.walsallhealthcare.nhs.uk/media/188674/depression%20in%20adults.pdf

That might be why your GP has decided on Ven but something that bothers me about this type of advice is that sometimes we just don't seem suited to certain meds and rather than advance people up the chain, why not try others in the same class & level as sometimes people then start to respond?