Which meds next - please help

[welshdory]

Hi all, I moved to venlafaxine 150mg 2 months ago after being on escitralopram for years.

I've had anxiety (GAD) for most of my adult life but developed depression almost 3 years ago when my husband was diagnosed with a terminal Brian tumour. He passed away in July last year and I feel horrendous.

I know a lot of what I'm feeling is grief but I'm desperate to find a med that suits me.

I've put on a few stone over the years so ideally one that doesn't cause weight gain.

Main side effects on ven is jittery, feeling flat/numb and emotional and bloating/constipation.

I'm having bereavement counselling but would like a med suggestion that might help top. Thanks in advance x

[panic_down_under]

Hi all, I moved to venlafaxine 150mg 2 months ago after being on escitralopram for years.

...Main side effects on ven is jittery, feeling flat/numb and emotional and bloating/constipation.

Antidepressants (ADs) typically take up the 12 weeks to kick in and this is especially so with depression which tends to take longer to resolve with SSRIs than anxiety (despite what it says on the box, venlafaxine is really only a SSRI, not a SNRI). The dose is also moderate. The recommended max is 375mg/day so there is still considerable dosing headroom. That said, the side-effects may persist long-term so switching to another AD might be a better option than upping the venlafaxine dose. Have you discussed the side-effects with your GP? If so what did the GP suggest?

I've put on a few stone over the years so ideally one that doesn't cause weight gain.

Then you may be interested in: How to control weight gain when prescribing antidepressants (PDF). It is written for doctors, but is a fairly straight forward explanation of the issues and how to deal with them.

I'm having bereavement counselling but would like a med suggestion that might help to

Fluoxetine and sertraline are likely to be the best SSRI choices. While fluoxetine is a little less likely to cause weight gain than sertraline it isn't the best SSRI to switch to from venlafaxine. The problem is fluoxetine has a very long half-life and venlafaxine has the shortest which complicates the switch so I'd try sertraline first. The usually weight neutral SSRI fluvoxamine (Luvox) is another possibly, however, it interacts with many meds which can be a problem if you're taking meds for other conditions.

[Jimmy M]

Hi there,

I too have been living with an anxiety disorder which was diagnosed about 27 years ago and with it came depression and some bad DP/DR.

Over the years I have tried Amatryptaline which is a very old style tricyclic type which made me feel like a zombie and did not suit me at all.

I then had Paroxetine 20mg for a number of years which seemed to help but back in around 2010 after a particularly bad situation triggered everything off again my GP tried me with Trazadone - again made me spaced out.

Finally settled with Sertraline 150mg and also Olanzapine 5mg at night time which for the most part has really helped over the past 13 years and continues to help now. It doesnt stop me feeling crap when I get triggered but it certainly makes recovery a fair bit faster. I am going through a bit of a rough patch myself presently.

From what I understand Sertraline is the most commonly prescribed anti-depressant for Anxiety disorders presently.

There are some initial side effects as with all of them, from recollection I felt a bit worse initially and they can take a few weeks to build up in your system. Some people get acid reflux and other side effects, and I know people who have quit Sertraline as they could not tolerate it, but it does seem to suit me.

It can be a bit of a lottery trying to find something that works and switching over takes a bit of time before you will know if it is helping as you have to stick it out for a few weeks, but with counselling and medication you will hopefully begin to see the light at the end of the tunnel soon.

I hope things improve for you, keep trying to smile :-)