Should I start Ven?

[MyNameIsTerry]

This will explain the motivation for it:

http://www.devonpartnership.nhs.uk/f...risonChart.pdf

Ven 75mg MR (that's Modified Release, so the XL version) = £22.08 (caps) or £10.45 (tabs) for 28 days.

The immediate release comes in at £2.45 for 28 days.

There is a detailed breakdown by one trust here but it's a bit older:

http://www.coventrywarksapc.nhs.uk/m...2-0d554e481900

So, the motivation is saving money. Even in this NICE guidance it shows that they are expected to weigh up the costs in using Ven against other meds:

http://www.gpnotebook.co.uk/simplepa...ID=-1375338426

NICE also suggest that, before prescribing venlafaxine, practitioners should take into account the increased likelihood of patients stopping treatment because of side effects, and its higher cost, compared with equally effective SSRIs

Notice in that doc what else NICE tell our doctors to be checking, like our blood pressure, but does that happen?

Page 10 of this NHS doc is interesting:

http://www.sept.nhs.uk/wp-content/up...Depression.pdf

In the table it shows both SA & GAD showing as Ven only in XL form. Yet pretty much everyone you see posting on here seems to start with standard release. GP's saving money? Technically that is "off labelling" but then so is prescribing Citalopram for anxiety as it's not licenced for it, which is common and seems to be accepted. Another one of the double standards employed by our GP's who refuse to off label other meds but will do it with these without hesitation, possibly because they can fall back on guidance that says "use a SSRI"?

This shows evidence that NHS trusts were looking to move away from licencing (I've seen others) to put all XL patients on immediate release to ensure savings unless they couldn't tolerate it:

http://www.swlstg-tr.nhs.uk/_uploads...20101014_2.doc

That's the NHS for you. It's a pity they aren't put on these meds when ill to feel how disruptive the side effects would be, they would be asking for the XL too.

NHS Scotland was at it as well:

http://www.dgprescribingmatters.co.u...MR%20audit.pdf

Basically, an example of when cost savings are driving patient care and not patient need.

[23fish]

After a lot of thought I decided against Ven. I've now been taking Sertraline 25mg for 11 days in the hopes that the side effects will be easier to deal with at that dose. So far I've had nausea for a couple of hours in for the first few days, and increased anxiety and panic attacks for the last week. Can't wait for them to pass!