Question

[Paradise10]

I am currently on 150mg ven and my anxiety has returned so my doctor has increased the dose which i am die to start today.
The last week though I have had the really vivid dreams back and the burning skin anxiety which i usually associate with an increased dose, although I havent started yet?

I have been on my current dose for a year so is this just my own anxiety?

Appreciate if anyone knows.

Thanks, Ava

[panic_down_under]

I have been on my current dose for a year so is this just my own anxiety?

It is most likely your mind at play, Ava. Not all the side-effects (or withdrawal symptoms) experienced are necessarily down to the medication. An anxious mind can generate the full catastrophe of our worst nightmares in Widescreen Technicolor with Dolby sound if given half a chance. All part of the rich tapestry that is life living with anxiety.

[Paradise10]

Thank you Ian. I was hoping you would reply.

[Paradise10]

So I have been on the 225mg for 9 days now. On day 5 I started with quite severe nausea, I still have it now so I called the doctor for some anti sickness tablets. He wants me to lower back to 187.5mg as he said the sickness was a sign along with my headaches that my dose is too high.
I just thought these were side effects which would pass... I have emailed my psych to see what he says.

[panic_down_under]

On day 5 I started with quite severe nausea, I still have it now so I called the doctor for some anti sickness tablets. He wants me to lower back to 187.5mg as he said the sickness was a sign along with my headaches that my dose is too high. I just thought these were side effects which would pass

You're right. If these were signs of excessive dosage then for many even the minimum dose would supposedly be too high.

Both nausea and headaches are caused by increased serotonin expression due to the dose increase - the most serotonergic organ of the body is the gut and its own brain, the enteric nervous system and serotonin helps regulate blood vessel constriction and dilation which can trigger headaches when ADs affect serotonin function. Both symptoms should diminish as biofeedback mechanisms kick-in to reduce serotonin synthesis and expression.

Over-the-counter anti seasickness remedies are often as effective as the commonly prescribed meds for it.

[Paradise10]

He did give me some anti-sickness but only for a week and he told me I am only to use them when it is really bad. (I wouldn't have called them for them if it wasn't really bad.) He also made a note on my file to say that by staying on the 225mg I am going against his wishes. Came out of there feeling so much better than I went in.... NOT!

How long do you think it's likely to last Ian, It started on day 5 of the increase to 225mg, no sickness at all on the 187mg for the two weeks I took that dose?

Ava.

[panic_down_under]

How long do you think it's likely to last Ian, It started on day 5 of the increase to 225mg, no sickness at all on the 187mg for the two weeks I took that dose?

Unfortunately, this is one of those 'how long is a piece of string questions' which can't be answered with any confidence, Ava. It all comes down to individual DNA. It could stop in 10 minutes, or 10 days. Only time will tell. Sorry

Any response from your psychiatrist?

[Paradise10]

Hi Ian, thanks for the response, yes he emailed me yesterday to say drop back to the 187 till our next appointment in 2 and a bit weeks and he will see how I am them. Never done a double dose up so quick before. I usually stay on one dose for 6 to 8 weeks to see how I am before I increase so maybe it was 2 quick.
Dropped back to 187 today and the sickness has gone but my anxiety is bad at the moment.

Guess I will keep on with it till I see him again.

[panic_down_under]

Never done a double dose up so quick before. I usually stay on one dose for 6 to 8 weeks to see how I am before I increase so maybe it was 2 quick.

The rule of thumb is not to increases doses sooner than 5 times the half-life of the med as that can increase the severity of any side-effects, but waiting longer won't significantly lessen them. The elimination half-life of immediate-release venlafaxine is 5 hours and 11 hours for extended-release.

Dropped back to 187 today and the sickness has gone but my anxiety is bad at the moment.

It takes just as long for plasma levels to settle down after a dose reduction as it does after increases, Ava. If there was an almost immediate easing of the nausea and headaches after dropping the dose then they probably weren't being purely driven by chemistry.

[Paradise10]

Hi Ian, to be fair the nausea is still there, at a much reduced rate but I just feel slightly sick now, headaches are still there though.

I'm used to ignoring my doctor as I find they don't really have a clue but when the phych said to drop down too then I thought I should. I have to listen to someone and he seems the best option out of the two.

Thanks for your help with my questions.