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Thread: Increasing Venlafaxine to 300mg

  1. #1

    Increasing Venlafaxine to 300mg

    Hi. I hope everyone doing ok today. I could really do with some advice if anyone is able.

    I’ve been on Venlafaxine 225mg for panic disorder and anxiety for the last 4 years. I was previously on Paroxetine but that stopped working for me. Switching was pretty rough but, to be fair, I’ve not been doing too bad on it since. I don’t think we are ever ‘cured’ are we, but things were much more manageable.

    Since lockdown things have changed. The situation brought about some triggers for me, and the panic returned. High level panic lasting days at a time. Racing thoughts, trembling, the full works . I know myself quite well and i know I fear the fear itself. Doctor gave me some diazepam 2mg for the worst moments, but of course I was even anxious about taking these!

    I’ve never considered myself to have depression, but over time I’ve been feeling increasingly tearful, hopeless and unable to enjoy or even engage with anything. This has been accompanied by a spaced out disconnected feeling (depersonalisation?) which freaks me out even more.

    I was lucky to get a psychiatrist appointment, and she has recommended increasing the Venlafaxine to 300mg. Now, I know 225mg is considered the maximum dose for anxiety and panic, but 300mg or higher can be given for clinical depression. At higher doses I also know the drug behaves differently and can increase adrenaline.

    How is this going to make me feel? Could this make my anxiety/panic worse? Will I feel even more spaced out and drugged up at this dose?

    I know there are no definite answers and it’s a case of see what happens, but wondering if anyone has any experience of 300mg, especially anyone more prone to panic and anxiety than depression.

    Best wishes to everyone.

  2. #2
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    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by Cornish Andy View Post
    I was lucky to get a psychiatrist appointment, and she has recommended increasing the Venlafaxine to 300mg. Now, I know 225mg is considered the maximum dose for anxiety and panic, but 300mg or higher can be given for clinical depression. At higher doses I also know the drug behaves differently and can increase adrenaline.
    Although venlafaxine is classified as a SNRI it is really only a SSRI, Andy. It only begins to inhibit noradrenaline (NA), aka norepinephrine, reuptake at around 225mg/day, but even at the maximum recommended 375mg/day the NA inhibition is still weak. It doesn't increase adrenaline release. Several SSRIs actually inhibit NA reuptake more strongly than venlafaxine does, albeit still only moderately compared to other SNRIs and some TCAs.

    How is this going to make me feel? Could this make my anxiety/panic worse? Will I feel even more spaced out and drugged up at this dose?
    You'll probably feel not much different once any side-effects triggered by the dose increase subside.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  3. #3

    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by panic_down_under View Post
    Although venlafaxine is classified as a SNRI it is really only a SSRI, Andy. It only begins to inhibit noradrenaline (NA), aka norepinephrine, reuptake at around 225mg/day, but even at the maximum recommended 375mg/day the NA inhibition is still weak. It doesn't increase adrenaline release. Several SSRIs actually inhibit NA reuptake more strongly than venlafaxine does, albeit still only moderately compared to other SNRIs and some TCAs.

    You'll probably feel not much different once any side-effects triggered by the dose increase subside.
    Thanks so much Panic_Down_Under. This is reassuring. I forgot to mention I’ve been taking an additional 37.5mg add on for the last couple of months as recommended by my GP, but this wasn’t extended release so the psychiatrist didn’t think it would have had much of an effect. The 300mg is now all extended release. I’m just hoping it’s enough to calm me down and give me a bit of boost.
    Last edited by Cornish Andy; 01-02-21 at 19:38. Reason: Hit ‘post’ too soon!

  4. #4
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    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by Cornish Andy View Post
    I forgot to mention I’ve been taking an additional 37.5mg add on for the last couple of months as recommended by my GP, but this wasn’t extended release so the psychiatrist didn’t think it would have had much of an effect.
    The extra 37.5mg may have been doing more harm than good because of the med's very short half-life - 5 hours +/- 2 h. It would have been setting up a yoyo effect as blood plasma levels rose and fell over the day.

    I’m just hoping it’s enough to calm me down and give me a bit of boost.
    There is a good chance it will, however, it will take some weeks. Antidepressants have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and they take time to bud, grow and mature. For more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act.
    __________________
    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  5. #5
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    Re: Increasing Venlafaxine to 300mg

    Hi Andy, there is a thread on here from a user called Nicola1980 and she increased to 300mg and had anxiety rather than depression. She did well on this dose from reading it.

    I've just been through an increase myself after being stable on ven and it took 8 weeks to settle completely although things started improving before then, so hang in there.
    Ava x

  6. #6

    Re: Increasing Venlafaxine to 300mg

    Thanks both. Panic_down_under, thanks for the really useful links and information. It’s great to have someone practical like you on the forum to talk about what these medications are actually doing.

    Ava, I’m glad you’ve had a positive experience, and hope you continue to go from strength to strength. I’ll check out Nicola’s posts too. Thanks for your kind words of encouragement.

  7. #7
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    Re: Increasing Venlafaxine to 300mg

    Please don’t be anxious about taking diazepam if you need to, they really can take the edge off and you won’t get addicted if you only take them occasionally.

    Your post sounds exactly how I am feeling at the moment. I have OCD anxiety and depression and am currently on 337.5mg xr but my psychiatrist wants me to go up to 375mg 😬. On my previous increases I have had increased anxiety for 3-4 weeks but it does settle. I used diazepam to help with it and only when I really needed to.

  8. #8

    Re: Increasing Venlafaxine to 300mg

    Thanks Jo. I do take the diazepam very occasionally but usually no more than two 2mg per day, and then for as few days as possible.

    ive been on the increased Venlafaxine for 2 weeks now, and it’s been going quite well. I know it’s still early days, but it feels like it’s had a positive effect so far. I’ve had no real side effects other than a few head zaps from time to time, and I’m generally not feeling as anxious.

    Jo, if you are on 337.5 are you taking a 37.5mg tablet that isn’t extended release (because they don’t do XR in that dosage)? I was doing this previously, and I think having all extended release definitely works better. Either way, look after yourself. There are bound to be ups and downs, but you’ll get there.

  9. #9
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    Re: Increasing Venlafaxine to 300mg

    Hi Andy, all my tablets are extended release, even the 37.5mg. They are called Venlalic XL. I have also had 37.5mg extended release capsules.

    I definitely agree with you that the extended works better. When I started venlafaxine 18 months ago I was given the standard tablets and was taking the whole dose in the morning and was up and down like a yo-yo. Nobody told me the standard tablets had to be taken in split doses am/pm 🙄

  10. #10

    Re: Increasing Venlafaxine to 300mg

    I had been doing well on the increased dose. It’s only 2 and a half weeks so I know there’s longer to wait for the full effects, but it felt like I was improving in the meantime. Now, all of a sudden, the old shaky feelings are back. A big problem for me is anticipatory anxiety and I’m probably focusing on, and dreading, a change of routine that’s coming next week. I know I shouldn’t but it’s very hard not to. I guess I was hoping the increased dose might prop me up a little better to help cope with it.

    I hope everyone else is doing ok today.

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