Prozac to Effexor

[mourningdove]

I've taken prozac (20 mg) since I was about 4 years old (yes, 4 years old, I'm 22 now) and lately it hasn't had the efficacy and is actually seeming to do the opposite, and raising to 40 only made it worse. I spoke to my GP about this yesterday and the first thing she wanted to try was venlafaxine. Now, my mom took it for a while, and after I told her I'd been put on effexor she was very adamant that it is probably not the drug I want to be on; the withdrawl was HORRIBLE and upset her mitral valve prolapse. I've only been on this medicine for 48 hours, but I will say that I also take Focalin XR (40 mg) and this morning about an hour or two after taking them I felt like my heart was going to explode. I could feel my heart beat in my stomach. I also found it extremely difficult to hold still (twitching and shaking) and could barely hold a conversation with my friend that I was trying to study with.

Given a family history of heart issues and poor effexor tolerance, maybe this is not the drug for me? Also, from what I understand, effexor is pretty potent; is it strange that this was the second drug she wanted to try?

I called my GP and for now she's just wanting me to stop effexor and go to 20 mg Prozac. Honestly, I'm going to take it but eventually would like to try something new...any ideas/thoughts/what have you?

[MyNameIsTerry]

So, you took Prozac at 40mg one day and then switched straight to Ven the next? What was the Ven dosage?

[MyNameIsTerry]

I suggest you have a look at the guidance our doctors use over here:

http://www.gpnotebook.co.uk/simplepage.cfm?ID=1651179592

They advise a "wash out" period is needed when switching from Prozac due to it's long half life unlike all the other SSRI's. Ven has a very short half life too and reaches "steady-state" (as much going in as going out) within 3 days. So, if you have stopped and started how I mentioned above, I don't think your doctor has following the right guidance as it would be piling one load of SNRI on top of the SSRI you were already on.

The drug itself in Prozac, once use is chronic, extends to 4-6 days. So, until it reaches this minimum 4 days after the last dose, you are above 50% of the drug.

It's very possible that your experience of Ven has been blighted by this because you haven't been given the correct switching method. So, I wouldn't right it off just yet BUT please sort this out and perhaps re-stabilise on the Prozac before attempting a further switch and ensure your doctor understands the switching protocols.

Some people do take more than one med together e.g. Mirtazapine & Ven, Citalopram & Prebalin, etc. Some of these combinations increase the risk of Serotonin Syndrome. The risk is always heightened in any switch between meds that work with Serotonin anyway so doctors monitor to ensure nothing is reported. I don't know about the combination you are currently taking without realising, but they do both work with Serotonin so this does become a risk. BUT Serotonin Syndrome doesn't have to be dangerous, it can vary in intensity so please don't worry about the scare stories and work with your doctor.

[mourningdove]

The ven dosage was 75 mg. And nope, my doctor absolutely did not tell me to taper. Dang thats kind go upsetting. She could have really hurt me.

---------- Post added at 14:11 ---------- Previous post was at 13:58 ----------

So I started 75 mg ven tuesday, last dose was wednesday. Doctor is switching me back to prozac for now but at 20 mg which I took this afternoon. Will I be okay?

[MyNameIsTerry]

Well the Prozac would be hitting 50% between Friday-Sunday. So, really you only missed some doses and I'm sure you will be able to normalise it after a few more doses. There is the added complication of going back onto 20mg when you were on 40mg but if you weren't on 40mg for very long it may not mean much.

The Ven in between will have been working on your Serotonin on top of the Prozac so I expect this is why you have been having these more difficult problems. 75mg is a fairly normal dose and your GP may have been trying to match it to your Prozac dose but didn't realise you were still getting quite a lot of the Prozac so the effects have been more than you would normally expect. However, Ven can go up far higher than this dose so it's not like they put you on something really powerful.

I think your GP needs to do some research on how to use these meds. But getting you settled back on Prozac should be the priority and just monitoring you. I'm sure you will be ok, but keep in contact with your doctor if you are worried about any side effects you experience.

I really don't know what they were thinking and can only assume they just didn't understand the long half life issue of Prozac and looked at it like the other short half life SSRI's where switching the next day is fine as a cautious cross-taper (this doesn't mean going straight onto the expected dose though, hence the cross taper part).