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Need Some Help (Effexor)


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I'm having a rough time.

I'm on Day 13 of a dosage increase and I've felt markedly worse.  Is this typical or a sign the drug isn't working?

I have that jittery/nervousness feeling all day long.  No appetite, etc.  My depression also feels worse.

I feel like so far all I've had is side effects with no benefits.

I'm a bit worried that Effexor has stopped working.  For those of you who Effexor worked, how long should I give it to kick in?  I'm gonna try call my PDoc next week and talk about this.

Are the first two weeks generally bad for you guys when you up dosages?

Edited by BrianOCD
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It's very common to have side effects when upping the dose of a medication. Sometimes as bad as when you started on it in the first place, but hopefully they won't last quite as long as the initial start up. I think talking to your Pdoc about it is probably a good idea, it might set your mind at ease as to whether this is normal and they can make a decision about whether this is best for you or not.

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I'm having a hell of a time adjusting to the 150mg.

The stimulant effect is quite unpleasant.

I'm having better days though as far as my mood goes, but I'm also restless and agitated at times.  It seems like it's getting better, but I'm not sure I can tolerate this dosage.

Also had to up my Ativan at night.  Just thinking outloud here....

Anyone else gotten this from Effexor in the first month?

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8 hours ago, BrianOCD said:

I'm having a hell of a time adjusting to the 150mg.

The stimulant effect is quite unpleasant.

I'm having better days though as far as my mood goes, but I'm also restless and agitated at times.  It seems like it's getting better, but I'm not sure I can tolerate this dosage.

Also had to up my Ativan at night.  Just thinking outloud here....

Anyone else gotten this from Effexor in the first month?

It sounds like Effexor isn't really the right drug for you (to me anyway) from what I've read.

Have you considered adding Remeron to the Effexor?

Have you also considered switching to another SNRI? (Pristiq, Cymbalta?) Or giving some of the SSRIs you haven't tried a chance? (Zoloft, Prozac, Celexa—although it's related to Lexapro...) or even giving the newer SMSs a try (Viibryd or Trintellix)?

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It's hard to say Mikl, at 300mg I felt great for years...This dosage just isn't agreeing with me though.

Never did do Remeron, but if I come off Effexor this time around it's likely going to be a trial of Trintellix....

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On 8/23/2017 at 11:46 PM, BrianOCD said:

It's hard to say Mikl, at 300mg I felt great for years...This dosage just isn't agreeing with me though.

Never did do Remeron, but if I come off Effexor this time around it's likely going to be a trial of Trintellix....

Trintellix works completely different from Effexor, but it causes the release of the same, actually more, neurotransmitters, but I don't know if it matches the volume and rate of Effexor. I personally didn't like it, it didn't make me feel anything at first, and then worsened my depression. But I'm weird and have weird side effects and reactions to meds... lol. Don't listen to me! :P I really hope you find something that works, or that your dose of Effexor starts agreeing with you.

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Just now, mikl_pls said:

Trintellix works completely different from Effexor, but it causes the release of the same, actually more, neurotransmitters, but I don't know if it matches the volume and rate of Effexor. I personally didn't like it, it didn't make me feel anything at first, and then worsened my depression. But I'm weird and have weird side effects and reactions to meds... lol. Don't listen to me! :P I really hope you find something that works, or that your dose of Effexor starts agreeing with you.

Well me too...

How long would you give a dosage increase before saying, "this just isn't working"

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Just now, BrianOCD said:

Well me too...

How long would you give a dosage increase before saying, "this just isn't working"

Mmmmmmmmmm......... I would personally give it 2-4 weeks, but that's just me.

What problems are you having? If you don't want to publically say, you can PM me. Or if you don't want to tell me or anyone on here, that's understandable too... lol.

Effexor's actual max dose is 375 mg, but it is prescribed as high as 450 mg and even 600 mg in "heroic" cases as Stahl refers to them as. Past 600 mg, I think they start doing blood tests to check levels of venlafaxine versus O-desmethylvenlafaxine, and depending on the ratio of the parent and metabolite of the drug, they may recommend an increase or if it's not working at like 1050 mg and they see an abnormality in the ratio of the two agents, then they may call it quits on Effexor and start tapering you down/cross-tapering you to something else.

I have felt dosage increases as early as 2 days afterwards, but there have of course been many, many times with many meds where my pdoc would increase, increase, increase, increase, and I would never feel anything. Or I would get to the max dose and only then start to feel something, and would ask her if she would go past the max dose and she never will. 

 

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3 minutes ago, mikl_pls said:

Mmmmmmmmmm......... I would personally give it 2-4 weeks, but that's just me.

What problems are you having? If you don't want to publically say, you can PM me. Or if you don't want to tell me or anyone on here, that's understandable too... lol.

Effexor's actual max dose is 375 mg, but it is prescribed as high as 450 mg and even 600 mg in "heroic" cases as Stahl refers to them as. Past 600 mg, I think they start doing blood tests to check levels of venlafaxine versus O-desmethylvenlafaxine, and depending on the ratio of the parent and metabolite of the drug, they may recommend an increase or if it's not working at like 1050 mg and they see an abnormality in the ratio of the two agents, then they may call it quits on Effexor and start tapering you down/cross-tapering you to something else.

I have felt dosage increases as early as 2 days afterwards, but there have of course been many, many times with many meds where my pdoc would increase, increase, increase, increase, and I would never feel anything. Or I would get to the max dose and only then start to feel something, and would ask her if she would go past the max dose and she never will. 

 

You know the first few days when you first begin taking an antidepressant?  You feel jittery, tunnel vision, and some anxiety.  I've basically had that going on for 3 weeks.  Like it's almost impossible to get calm until I take sedatives at night.  So it has lifted my mood but brought with it a lot of uneasiness and anxiety...It's like I can't feel calm mentally.  Obviously it's from the noradrenaline hit I just don't know how to counter it.

I'm not sure what to do about this or even how to handle this with my Pdoc...I've considered taking seroquel to see if that levels it out, but I'm not sure...this sucks.

Edited by BrianOCD
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16 minutes ago, BrianOCD said:

You know the first few days when you first begin taking an antidepressant?  You feel jittery, tunnel vision, and some anxiety.  I've basically had that going on for 3 weeks.  Like it's almost impossible to get calm until I take sedatives at night.  So it has lifted my mood but brought with it a lot of uneasiness and anxiety...It's like I can't feel calm mentally.  Obviously it's from the noradrenaline hit I just don't know how to counter it.

I'm not sure what to do about this or even how to handle this with my Pdoc...I've considered taking seroquel to see if that levels it out, but I'm not sure...this sucks.

Yes, what you said is precisely what I was thinking. It's almost like one one side, the noradrenergic effects are necessary for the mood lifting effects because the serotonergic effects are maxed out, but on the other hand, that same effect is causing negative side effects, especially peripherally.

I'm not an expert, but these are just some ideas... Your doctor might try a lower dose of Effexor that is still in the range of being noradrenergic and combine it with at least 30 mg of Remeron, which would hopefully boost both serotonin and norepinephrine in a way that lifts your mood but doesn't make you jittery. Or you could stay on your current dose and ask about some sort of peripherally-acting adrenergic antagonist (you wouldn't want the centrally-acting effects to be blocked since that would abolish the mood effects), not sure which meds those would be. You could also try a different SNRI like Cymbalta, Pristiq, or Fetzima. Or, like you were saying, try an antidepressant with a different mechanism of action, like Trintellix (Trintellix sure does seem to be popular lately). Another possibility is to lower the Effexor back to a tolerable dose and add an atypical antipsychotic (not Seroquel) like Abilify, Rexulti, Vraylar, Latuda, etc. I would say go ahead with Seroquel but it's super sedating and causes weight gain and for antidepressant adjunct requires 150-300 mg (XR). Also Zyprexa, but omg diabetes and weight gain. I'm kind of running out of ideas. Oh, Effexor + Wellbutrin? Have you tried that before? I can't remember. There's also always Effexor + stimulant, but I highly doubt that anyone would go for that.

 

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46 minutes ago, mikl_pls said:

Yes, what you said is precisely what I was thinking. It's almost like one one side, the noradrenergic effects are necessary for the mood lifting effects because the serotonergic effects are maxed out, but on the other hand, that same effect is causing negative side effects, especially peripherally.

I'm not an expert, but these are just some ideas... Your doctor might try a lower dose of Effexor that is still in the range of being noradrenergic and combine it with at least 30 mg of Remeron, which would hopefully boost both serotonin and norepinephrine in a way that lifts your mood but doesn't make you jittery. Or you could stay on your current dose and ask about some sort of peripherally-acting adrenergic antagonist (you wouldn't want the centrally-acting effects to be blocked since that would abolish the mood effects), not sure which meds those would be. You could also try a different SNRI like Cymbalta, Pristiq, or Fetzima. Or, like you were saying, try an antidepressant with a different mechanism of action, like Trintellix (Trintellix sure does seem to be popular lately). Another possibility is to lower the Effexor back to a tolerable dose and add an atypical antipsychotic (not Seroquel) like Abilify, Rexulti, Vraylar, Latuda, etc. I would say go ahead with Seroquel but it's super sedating and causes weight gain and for antidepressant adjunct requires 150-300 mg (XR). Also Zyprexa, but omg diabetes and weight gain. I'm kind of running out of ideas. Oh, Effexor + Wellbutrin? Have you tried that before? I can't remember. There's also always Effexor + stimulant, but I highly doubt that anyone would go for that.

Lowering it isn't an option unfortunately.  The reason we had to raise it up was my depression was worsening.  

That's the thing, Effexor is having an impact on depressive symptoms which is a good sign, but it's causing me agitation and aggravating my anxiety a bit...

The Seroquel I believe is an adrenergic antagonist I'm kinda holding off on the seroquel as a last resort, but I'm closely hitting that point...I had just hoped the ativan would have been enough.

Seroquel comes with a lot of mental side effects that I dislike...but it is calming.  Thanks for your input tho mikl, you'll never know how much it means at this point.

Edited by BrianOCD
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Well of course! I like to try; after all, this is the field I'm studying to go into. I hope you and your pdoc figure something out that works.

I don't know why this didn't occur to me earlier but another possibility would be a beta-blocker like propranolol or nadolol, but unfortunately blocking the beta-adrenergic receptors is blocking part of the antidepressant effect of Effexor too, and blocking them with or without an antidepressant has a chance of causing/exacerbating depression. But hey, I've taken propranolol up to a pretty high dose, nadolol, and acebutolol with no problems of depression exacerbation, so don't let that turn you away from that option. You could start real low like 10 mg propranolol or something (not saying how to take medicine or anything, just giving an example).

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2 hours ago, mikl_pls said:

Well of course! I like to try; after all, this is the field I'm studying to go into. I hope you and your pdoc figure something out that works.

I don't know why this didn't occur to me earlier but another possibility would be a beta-blocker like propranolol or nadolol, but unfortunately blocking the beta-adrenergic receptors is blocking part of the antidepressant effect of Effexor too, and blocking them with or without an antidepressant has a chance of causing/exacerbating depression. But hey, I've taken propranolol up to a pretty high dose, nadolol, and acebutolol with no problems of depression exacerbation, so don't let that turn you away from that option. You could start real low like 10 mg propranolol or something (not saying how to take medicine or anything, just giving an example).

Well i have a lot of seroquel I can use if I need to, I'm trying to "get by" without all that sedation hoping I'll adjust to the effexor, but it doesnt seem to be happening.

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