Help with venlafaxine

Hi there

?Firstly let me thank you so much for replying to my plea for help.

?You are quite right, I started venlafaxine in September 2014 and when I got well, I was fine and so though in January this year that I didn't need the tablets.  How wrong was I!!!!!

?So I had been well for a minimum of 2 years.   Sadly I cannot remember how long it took me to feel normal again.  As I said earlier, I have only been on the tablets for 4 weeks now, 75mg for 16 days and 150mg for 12 days. Do you think I am expecting too much too soon?  It is so very hard to get through the days.  Have not had a diazepam for two days and I really think I am going to have to take one soon.

?I don't want to be alone in the house although I have a dog.  This must be why I feel the need to go to be with someone during the day.  Strangely, I can relax in the lounge after 6ish in the evening when my husband is in there and the television on.  I am normally a strong person but when I go down with this anxiety, I fall to pieces.

?I agree with you that I have relapsed, probably due to coming off the tablets too quickly.  I followed the GP's advice and look where it got me.  I think you are right to have taken so long to wean off the tablets and I will listen to your advice, not that of the doctor, when that time comes although the way I am feeling, I'd rather stay on them for life than go through this yet again. 

?It would be lovely to hear from you again, messages like yours give me hope.   I have no interest in anything and what I do manage to do takes such an effort and wears me out.  I'm so glad when bedtime comes.

Hi. Don't worry about diazepam right now. Although lorazepam or Xanax are always kinder to the anxiety sufferer. Diazepam used to make me feel hungover the next few days. Psychiatrist was not impressed that GP chose diazepam and put me on regular small dose Xanax (3x per day) for a couple of months after my last relapse to keep the brain and body from spiking and tensing until adjustment and stabilization began on Venlafaxine. Then he weaned me off Xanax entirely. I never looked back and never needed to take any again. His rationale was that by being on steady levels of a sedative it would more quickly diminish the fear and sense of failure than when left to take something IF needed. Further, stabilizing responses speeds up adjustment and kick-starts therapy. However most people I know managed just fine on a need-to basis self-dosing but then felt terrible whenever they felt they 'failed' and had to take one don't shoot yourself in the foot here. If you need one, take one. Better to be balanced now in the first weeks to let your brain stop screaming 'panic'.

Your relapse will probably be a blessing in disguise like mine. I learned a lot, stopped rushing and stopped fighting the process and this freed me up to pure patience and drive to learn the ins and outs of my condition. This way if I ever slip up I know what it is, how it works and I certainly know it gets better. I know when to rest and when to try harder. I also know when to seek help before it escalates should it ever return again. I had to go through 2 relapses to learn my lesson. The last one was terrifying. Final stretch of therapy was steady progress all the way though, as mentioned, it does take a while after a relapse so yes, give it another 4 weeks or so and trust that it is working because you are not getting worse at this point. Meanwhile, forget your current 'weaknesses'. It is so normal to be reliant and feel weighed down at the start. You will regroup and every day your confidence will grow a little. And confidence is the actual cure. My psychiatrist called it little triumphs of managing basics, then going a bit more advanced and finally feeling like you are back in the driving seat.  Oh and learning to let go of everything you can't control and only focusing on 'what can I actually do'. Never forgetting to also check 'what is it that I need right now to feel more comfortable'. One step at a time. And after this, chances are that you will be even more capable and positive than before. Regeneration is what it is. For me it was certainly transformative. I wish you at least that much. x

Hi there

?WOW!!!!! you are amazing.  Without doubt, you certainly know your stuff, having suffered so much in the past.  And miles better than a GP who has never experienced the crippling illness.  I can't thank you enough for the time you have spent in explaining things to me. 

?I am so impressed that I am going to print your message and keep it in my bag to remind myself how to cope.  Everything you say makes perfect sense to me, especially the advice on 'weaknesses', letting go and what to focus on.

A million thanks, my friend. xx

Glad if I could help offer at least some relief or helpful reflection. Do let us know how it goes. Being able to see another's journey mapped is so helpful to everyone coming on here.

Feel better soon. <3

Hi Purpledobermann,

i just started on 37.5 XL 7 days ago. I had that genesight test that reccommaned all the expensive new antidepressants or Effexor or Prossaic both on low doses because I'm a slow metabolizer. I was on Zoloft 50mg for 23 years and it worked beautifully in this past June. They kept raising the doze for 12 weeks to 175 and I had a breakdown. I have only had stomach Nausea as a side effect so far. How long does it take to kick in. As I am an suffering with anxiety I take a Klonipin.5 a day or more as needed. Did the Effexor help you with both anxiety and depression. At age 66 I am not worried about coming off as I will stay on it till it pops out like Zoloft. There are so many scary stories on here about what a horrible drug it is. I hope it works for me. 

Hi Lynn. Nausea is the most common onset symptom, so this is a good thing if this is all you had so far. No issues with falling or staying asleep after the 3 day mark? Dry mouth? Increased agitation? Somnolence? Extreme thoughts or urges? 

As 37.5 is below therapeutic dose it may offer mediocre relief or slow progress. However, in your case it pays to take it slowly and use the Klonopin crutch for a longer time than ideal so as not to aggravate your system as you have already recoiled from Zoloft and could be reactive.

They are likely to try upping to 75mg after a couple of weeks minimum and up to 4 weeks later and letting you stabilize on that for 3-4 months. This is what I think they will try, at the most. At 75, if it turns out tolerable for you, you would see results very gradually, first in terms of anxiety responses and then depression. Mood lifts after anxiety tension starts to release usually. Though there are no hard rules.

I can't say (and neither can your doctors) how you will respond to this small dose given your specific chemistry. A good way to gauge progress is, by rule: no worsening of initial symptoms after about 4 weeks. No new symptoms after adjustment phase. Gradual but steady relief from adjustment disturbances over the course of about 3-4 weeks too. Sometimes longer. After the first 4-6 weeks, you should start feeling some relief from the most disturbing symptoms of your condition. Usually progress is slow but steady at this point.

If it feels experimental, this is because it is. Personal chemistry is to blame so patience is needed.

Any other unrelated supplements or medication may affect  progress too. Blood thinners, certain antibiotics, anti-inflammatories, even vitamin C...all sorts of things can affect metabolism of the drug. So can any gut imbalances. Only time will tell.

Adequate rest, and light activity is recommended. Keeping hydrated helps. Soothing easy to digest food is also helpful - soups, chamomile tea for example help relax you. Avoid stimulants until adjustment is complete. No alcohol is advised obviously.

There are plenty of horror stories about many drugs. It really depends on how good of a match the drug is to your system and how skilled the doctor treating you is in mapping and estimating your progress. Venlafaxine is a very potent drug and usually either fits or decidedly does not - there are no in-betweens. Are you comfortable with your doctor? Are you consulting a psychiatrist?

I see my doctor next Tuesday she will probably up dose to 75 then.  It will be two weeks then. Did you have any side effects? 1 started sleeping better at night and eating . Sometimes can just fall asleep in afternoon on the couch but stay awake so I can sleep at night.  Do have a lot of anxiety so I take a .5 Klonopin when I take Effexor in the morning. My husband was going away for five days but cancelled it because I didn't want to be alone. Did you have lots of anxiety before the AD kicked in. Thank you for responding. I might need to be talked through this. 

I lost my 26 year old daughter in a car accident four years ago and the anniversaries of her birthday and death were in July and August. I think this triggered a relapse. She lived in Montana far from Vermont and it’s taken me this long to face she is not coming back. I only got to see her a couple of times a year, so in my head I could just imagine she was still in Montana. I have been crying a lot again which relieves a lot of stress. It seems that the mornings are worse and by late afternoon /evening start to feel better. Sorry to unload all this. 

Thank you for opening up.

I am so sorry for what you have been through and what you are going through.

The info provided helps.

From the top: yes I had terrible adjustment phase on Effexor each of the three times it was started/reinstated. The final relapse was the worst and anxiety worsened to the point where it was far worse than ever before.

It subsided as described in my post above. And from exchange with a lot of people taking Effexor it is regular - particularly when taken for a relapse or anxiety untreated for a long time.

I had issues falling/staying asleep, dry mouth, monster nausea and dull persistent head throbbing and pressure sensations. In the first few days of starting it I also had intrusive thoughts and felt very removed from reality/out of touch. There was NO WAY I could be alone at that time and most people here will agree - this is so natural.

It was an almost constant state of panic. After the first 10 days the adjustment started to ease off gently but it was a good 4 weeks plus, for me to start recognizing the actual levelling out. So yes...it is gradual.

The way you describe it, it sounds like you are not worsening notably and if you are able to sleep and eat a bit better it is a very very good sign. If my hunch is correct, you are likely to see a notable improvement after balancing out on 75mg (provided your body accepts it - but even here your chances do improve if you manage to stabilize on introductory 37.5).

If it makes you feel any better - mornings were the worst for me throughout my long therapy. I was always better in the afternoon though sometimes had escalations at night too...usually when alone. The rationale is, where there is underlying major depression - the weight of having to go through a whole day is overwhelming. It gets better when symptoms of anxiety ease up and you can start filling your day with more positive action and confidence.

Medication does not heal - it gives space and cushioning for gentler rebalancing. The healing comes from within...on your terms...believe it or not.

The fact that you are able to cry is positive. If you feel any relief at all after a good cry it means you are already healing. When I was at my worst I could not cry. I could not do anything. I was completely out of touch. I do not remember that darkness fondly.

Lynn...it sounds to me like you have been through the worst. I wish you to find your center and drive. We are all here for a moment only if you think about it. Whatever you can do to show compassion to yourself or another will return some sense of purpose.

Or...you can put it this way - nothing can be worse than what you have been through. Nothing. So what you are going through now is just aftershocks. Adjusting to medication? I would not worry too much. It should be piece of cake compared to what you have already gone through. Try to give yourself some credit and confidence on that account at least. We tend to forget how much we have endured and only focus on the momentary apprehension. It sounds to me like you are still in control. Which is admirable.

Sending you much love.

Always here for a chat and if I can help ease your mind with at least the medicine then one less worry for you...I will be glad.

 

Day 10 today, last night sleep was hard did you take anything to help you sleep at night?

I was kept on steady doses of alprazolam (Xanax) throughout the day (3x per day) for over 2 months to make sure I remain close to baseline until medication kicks in. The daytime dosage was low but doubled-up at night. It was not left to me to choose - I had to take it. I was a wreck and the doctor was very strict on this point in my specific case. Did you take Klonopin last night or tried to 'brave it' ?

I woke up at 3:00 and took a .25 xanax and fell immediately back to sleep. Have both xanax and Klonipin.  I am going to start taking them 3 times a day no need to suffer like this, if I don’t have to. Thank you for being here>

Ah Lynn, see how easy it is to send the wrong message I was just answering your question about what they did in my case.  It is really important that you be closely monitored by a competent doctor if you are going to be taking regular steady doses of any sedative. This is why I highlighted that it was advised by doctor for my specific case.

Taking them as needed is usually advised in the beginning of treatment for most. If you feel you are not coping, I would rather suggest you ask your doctor for advice on whether it may be a good idea to take regularly for a week or two. I would not advise doing this on your own exactly because of notable underlying depression. Sedatives can make that part worse and you may end up seriously derailing treatment. I would stick to night-time dose for now and ask doctor about alternative approaches and see what they say. Is this possible? I mean do you have easy access to your prescribing doctor? 

 

I too was prescribed.25 Klonipin 3 x a day by my psy. I have xanax prescribed for emergency at night for sleeping. I was seeing it as a failure on my part if I took them as perscribed. After your post I realized why am I suffering and hurting myself by not taking them as perscribed. It was nothing to do with your situation. I have to throw out the shoulds and thinking the Meds show weakness on my part. You just gave me a sensible reason why they were perscribed for me to take> 

Oh, by all means then do follow your doctor's advice. It is not failure to adhere to treatment prescribed. This is exactly how I eventually got better after years of doing it 'my way' and struggling needlessly. Once I complied and shifted perspective I also had the chance to realize that it was still me doing the recovery. Medication is just a buffer. There is nothing to prove to yourself. Weakness, as I have learned from watching those close to me, is choosing not to seek help when needed and suffering alone. We have some benefits of medication and doctors to help us bridge some acute physical suffering that stems from mental anguish now. Nobody seems to give second thought to taking a painkiller or supplement, but when it comes to psychotropic we get all defensive and it stems from faulty assumptions such as: not being in control (e.g. "I should be able to do this on my own" or surrendering to zombifying medication or that the doctor just wants to keep us drugged and paying...things like these. Yes, I vaguely remember feeling like a failure. Now I thank my lucky stars I had the option of being treated so I can keep feeling alive and thriving under incredible pressure. 

Once medication kicks in the doctor will gradually reduce dosage of Klonopin but may opt to keep the night time dose for a while longer than you will deem necessary. If this happens it is because they want to make sure your sleep is as deep as possible since this is the first driver of recovery - adequate sleep cycle. Once they estimate you are well, they will try to reduce night time dose, then space it out and finally maybe try without, leaving you with a prescription to take if and as needed for a short while. If therapy progresses you should be able to do without entirely after a few months. However if sleep is poor, in your case they may wish to allow you to always take a sleep aid as needed. My mother in law (80) has been advised to always take a sedative at night ever since the loss of her daughter many many years ago. She does only when needed.

Hang in there.

Hi how high a dose did finally work for you? Morning anxiety is the worst going to do a relaxing tape.

In the first two weeks did you feel like you would never get better when you first woke up.  No nausea or stomach pain now heartburn ,the side effects sure move around

The first 2 weeks? I was SURE I would never get better. It felt hopeless. Constant tension. Mornings felt like a brink of death or catastrophe. This went on for more than two weeks though if I remember correctly. More like 4.

Interesting you mention that. Indeed heartburn kicked in after nausea for me too. It was the first time in my life I had heartburn. I remember thinking the medicine must be killing me. Nausea lasted about 10 days, heartburn for about two weeks. Somewhere during this time headache started (medium to mild dull throb but constant - notable for me because I rarely got headaches so having one every day was scary). That took about 2 weeks. Then nothing. And then the symptoms gently started to lift. It was a good 3 months into therapy at my final dose that I truly felt relief and apprehension started to wane a little. Tentatively though It takes time. It doesn't get that bad overnight and it cannot be resolved overnight. The body and mind have been through a lot. Healing always feels worse at first.

My final dose was 150 XR. They tried pushing up to 187.5 but that didn't work out and the final dose was thus locked. Stayed on it for a total of 6 years and then tapered without any issues at all. This in reference to horror stories I know you have read. It is a potent drug, for better or for worse. I was lucky it sat well with me. Wish the same for you. It is bad enough with the condition - having to also go through various drug adjustment processes and tapers is really tough.

How long did you stay on each dose hike. If my doctor thinks I should go up to 75mg on Tuesday l will, it will be 2 weeks. Did you start at 75 or 35.7. This morning I woke up feeling depressed which is new, not jumping out of my skin like usual. Don’t know which is preferable. Anxiety feels less intense at the moment, but symptoms change quickly in this process. Didn’t want to get out of bed with the sadness, but it’s alleviated 2 hours later. Coming into the grayness period of Northern New England sitting next to my happy light.  Do you live in England or Australia. Thanks for being here Purpledoberman,you are so empathic and kind.

 

About 7 days on introductory 37.5, then 75mg for a little less than 4 weeks. Then another 37.5 was added for about a week and then 150 total reached. So all in all adjustment dosages took less than a month and a half in my case. It is different for everyone. Depends on reactions you have while adjusting.

Depression and anxiety will interchange in waves for a while. It is the recalibration. If you note extreme depression with new symptoms appearing it is wise to follow up with a doctor immediately. But most of these swings are normal.

I mean, the sadness has to come out somewhere - it is seeking outlet. The reason why you have anxiety to begin with is unprocessed grief or holding on too tight for the fear that you will somehow lose your grip. Grief flows. You likely tried to subdue it. It is ok to feel sad. It is not ok to beat yourself up with it. Just now, for a moment let it be ok to feel whatever you feel and see where it goes. Eventually it will become easier and easier to process. We are so tough on ourselves, demanding of ourselves  and so afraid of doing things wrong. Sometimes it is ok to just let it be what it is and hold yourself tight and wait for the wave to pass. Waves always pass, if you are kind and loving to yourself. This is the toughest part of it.

Sending much love.

I have been on Venlafaxine for 9 months and felt better for a while, but now feel worthless, overwhelmed, sad, lonely-not happy, not me.

I have may friends, live a wonderful life and shouldn't be feeling this way. and so much of those feelings aren't reality.

Were you consulting with a psychologist while on the drug?  Did this help with your recovering.

Taking 150 mg

Thank you for any advice.

 

Hi Elizabeth.

I was treated by a neuropsychiatrist throughout recovery. I am off drugs for 4 years now but I still choose to see him periodically, once every 3-4 months to gauge if remission is steady. So far so good.

Can you estimate how long since the sadness started to creep in again? Have there been any circumstances that may be contributing. Don't look outside for answers, but how you feel and why you think this may be do? What were you treated for initially? What were the symptoms you first started with? And are you taking any other drugs, prescription or non-prescription at this time? And how is your health other than this?

I turned 70-don't feel a real sense of purpose, gained weight. Reviewing my life and regrets and mistakes.  Not sure I made the most of my talents.  Can't let it all go. I have a loving husband and family and security.

all about self esteem

2 weeks in now, hope they raise my dose tomorrow. One improvement is less anxiety the past two mornings. I have not had to rush to take the klonipin with the AD. The waves of emotion I feel are so much like when Kyra died. I went into my garden and sat on my bench and had a good cry, when I stood up the sun burst through the heavy cloud cover and I smiled first time in awhile, thinking it was her acknowledging my love for her. I have these waves of exhaustion that come and go, and motivation to work comes in spurts too. I thank  you for being here. When they raise your dose how bad are the side effects again. I have not gotten to where they are gone yet. The worst being the tiredness and sleeping well at night even with xanax. Does this ease after a while

Did you get waves of anxiety at 2 weeks in. Sometimes they come on so quickly. I guess that’s why they prescribe the anxiety Meds so they don’t get out of hand.

Most of us have trouble accepting that we have not done everything we perhaps could, should or wanted to. People like us are our own worst critic and enemy. But we only do what we can with what we have been given. Life is not a test. It just is what it is and we only do that which we can. It is so easy to be wiser in retrospect, looking back over what was and how you think you could have done things better. But at the time this was for whatever reason not possible. You are different now to what you were like. And the sooner we release this attachment from that nagging voice, the better for us.

What do you think it is that sabotaged your self-esteem? When did you begin to feel this way?

If you have a loving husband and family, obviously you did not waste your time here. It is usually difficult to be everything. So we tend to forego some options in favour of others. Is this what it is? The cost of trade-offs?

Are you in therapy with a psychiatrist, psychologist/therapist or just GP?

Waves of anxiety will persist for quite a while. As will waves of sadness. They will take turns and sometimes crash simultaneously. The first 4-6 months of therapy tend to be the most turbulent, though the waves start reducing in intensity or frequency gradually during that time and certainly moving forward. For me It took 2 years for the waves to properly subside entirely and then another 2 years for subtle symptoms to gently fade away.

What you are describing sounds very promising. Even a brief moment of relief gives reference to your brain to bank on. The more often you have these breaks, the sooner the brain will crave them and seek them out. Just do not feel defeated with the first next down. because it will come. It is supposed to. You go over it again and again until you retrain responses and begin to gain confidence in your ability to pull out.

I have not had any worsening with dosage increases. The most was return of a dull headache and some anxiety increase that was far briefer than the onset adjustment. A few days of feeling unsettled. 75mg in particular tends to be well tolerated if introductory dose adjustment goes well - as is clearly the case with you.

The only issue with increase I had was when they pushed to 187.5 which gave me a strange feeling lasting for over 10 days with head pressure and feeling ... just off. The doctor recognised the dosage was off and not conductive to helping me settle (although I did not ask for a reduction - by this time I was not afraid and trusted the process). He pulled me back to 150 and I was on it until the weaning as described.

Kyra - what a beautiful name. It put a smile on my face. And what a beautiful moment you shared. Sometimes you have to really be turned inside out to grow. And the moment you describe, if nothing else, was worth  some of this anguish. Because now you can start to truly feel the things you did not. So when you stop fighting the process you will certainly see clouds parting to let some light in. Grief is not the same as anxiety disorder, nor the same as clinical depression. Trauma was the cause as trauma short-circuits the grief response and blows it out of proportion. Grief on its own is not an illness. It is a necessary process of coming to terms with loss.

I think you are doing beautifully, reconnecting with yourself and the parts in you and around you that Kyra has touched.

I thank you for sharing this moment with us. I am lucky to meet wonderful people like you on here and be part of the journey in any small way. For me it is a privilege and a blessing and healing. When I was ill I was in it alone. Meeting people over the years made me realize how important others are in our journey. Much can change with a word, a thought or spark of hope or inspiration. Here we are all searching for a better way ahead.

Sending much love to you.

yes sedatives are used as a buffer against the expected ups and downs during adjustment, until the actual AD begins to effect a good baseline.

Elizabeth44925, by the way, have you had blood tests to check your thyroid function, full blood count including iron and liver function tests since starting treatment with Effexor? If not I would advise you to discuss this with a doctor. Are you also in touch with your prescribing doctor regarding this worsening of symptoms? And are you taking any blood thinners, heart or blood pressure medication etc? There are many medications and even herbs and supplements that can affect your treatment with Effexor or any other psychotropic drug.

Telling yourself you should not be feeling this way because you have a wonderful life and should feel grateful is like trying to convince yourself that you are crazy and ungrateful or weak. Which you are not. Something is making you feel the way you are and IF it is not physical, it is psychological. Our minds do not purposefully set out to deceive us or trick us and make us feel bad. When our minds get to this point they do so because something is off either physically OR emotionally/psychologically stemming from our past, our environment or the way we do things and treat or neglect ourselves on a deep level in small or big ways.

To get better one must be stubborn in understanding why.

xx

 

They increased my Effexsor dose to 75XL starting tomorrow. The doctor said I should not have as bad side effects being raised. I have been walking 4miles for the past two days. When the anxiety calms down I will go back to the gym. I asked her way I have gotten very quick mild buzzing in the back of my head occasionally. She said it was because when I started the Effexsor I had been on 20mgs of lexapro for two weeks and they stopped my 50 zoloft after weaning done for 3 weeks from 150mg. She said that why she wanted me on 37.5 for two weeks> 

I shouldn’t worry if I am still getting quick waves of different side effects after 2 weeks should I 

Hi Lynn!

Let me know how it goes on 75mg on the next 5 days or so when you start responding properly. You should be able to see some difference in brief waves. I will agree that side effects will not likely be notable following the warm-up on 37.5, which seems to have gone really well, especially considering you were also withdrawing from prior medication.

 

No, no worries about transient side-effects, various ones. After about a week to 10 days you should not be experiencing any new ones though. That is, 7-10 days since switching to 75mg. But for this week...most possibilities are game Then they should slowly start to become muted. Very slowly though And again, even then, you can expects ups and downs for the first few months.

The spacing is adequate, the approach seems regular and it sounds like you are in good hands. It also sounds like you are really doing your part and striving to get things moving. Great attitude. Because, remember - at the end of the day it is all about how YOU grow from this and what you do, believe and aim for. x

Going to call the doctor I think the 75 is to high for me intense anxiety after one dose and sweeting last night had diarriah and horrible gas, 

Please make sure you take the dose in the morning and no later than midday. You need to persevere for at least a few days before deciding it is 'too high'. 75 is a small dose. I would certainly call the doctor for advice but it is honestly not indicative of dose being too high. I would rather suspect minor adjustment issues. Gas, bloating and sweating (which resulted from gastrointestinal complaint by the way) is normal at first. Foul smelling loose stools are also common and transient. Diarrhoea will be concluded if it persists with more than 3 loose stools in 24 hours, explosive watery stools and continued similar situation the following day. Up the liquid intake and do take the medicine with a meal. Light, easy to digest meals until you normalize.

Let us know what the doctor said and how you are feeling tonight/tomorrow.

After this, because of anxiety spike and psychosomatic responses, you will likely feel very tired and sluggish the next day. Low mood is likely too. You may feel achy (muscular tension) and feel like you have a cold/flu. Normal responses.

Higher than ideal dosage manifests a little differently and not after first dose. Typically after about 3-5 days and there is no mistaking it.

Hope you feel better tonight and tomorrow.

I tried to call the doctor today but she was not in. I will try tomorrow. I was so scared after last night I only took 37.5  this morning, after one day of 75mg. I went to grief therapy and then spent an hour at the gym, got my oil changed and made a beef stew. I was scared to stay at 75XL because tomorrow I have to drive my husband to have complicated dental surgery and I have to drive 90 minutes each way to get him there. After tomorrow I will not have to be as worried about increasing medicine> 

Had a good day yesterday drove 50 miles four times to take my husband to dental surgery. I felt 80% better. No anxiety Meds needed. Still couldn’t get a hold of doctor. Today back to feeling sad and anxious and stomach side effects it’s day 19. When you were beginning the first month on Meds were some days much better than others. My husband is going to work st my daughters today so I will have a chance to get express my tears. I am trying to hang on to yesterday’s of feeling good and persevere through today. I am going to try acupuncture next week to see if that holds some benefits. The 75 dose I took scared me. Thank you for being here.

Are there any good websites or reading material to recommend for depression/anxiety/ or Effexsor?

Finally talked to doctor she said it takes longer than 12 hours to notice side effects from dosage raise. She said if you are that afraid to raise it stay on the 35.7 until I see you,by then it will be a month, more than enough time to see if we need to go up. Thanks for your guidance, Purpledoberman. My husbands surgery went well. Everyday I feel I am healing and slowly getting used to the ups and downs. I see my new counselor on the 20th 

It takes longer than 12 hours and closer to a couple of days...but it is wonderful that you have made progress on the little you do take already so I am pretty sure you will be ok on 75. It is also wonderful that your doctor was considerate and not too pushy - letting you ease yourself into all this. It is so important. It is quite amazing how you took control and managed taking your husband to surgery. It is very unusual for people at start of new therapy not to crumble when faced with added responsibilities. It sounds really good so far. I really do wish the rest of the process goes smoothly and you can begin regaining confidence in your own ability and strength. Keep in touch.

I am slowly seeing the light at the end of the tunnel. I must be very sensitive to Meds like the gene sight test said if this low dose is having some effect. I have been getting by with .25 Klonopin in the am most days. The anxiety is not as bad as it was most days. I am still having side effects like stomach aches and gas which come in waves and some afternoons I could still fall asleep on the couch. Have been going to the gym again and last night I was able to go to my parent grief group. It’s hard to understand why some days are so much easier than others. Yesterday was three weeks on effexsor 37.5. I wish the side effects were not so frightening afraid if I go up in dose I will be much worse. Next Tuesday will meet with the doctor. I am trying acupuncture to see if it will help with anxiety and side effects from the antidepressant. Trying to clean up my gardens and wishing I lived in a warmer climate. Winter is endless here. How long into recovery did you need anxiety drug. I hope getting off them is not going to be a problem. Everything about this illness is scary. It is so reassuring to hear of your success. 

Hi Lynn! You are really fighting this and working through it. It sounds really good.

Like the Moon and the tides...I guess our emotions too go in waves and, when they do, they pull the strings of tension and anxiety and certainly in your case also grief.

I have heard of a few cases managing to recover on 37.5 but these are isolated cases. Who knows maybe you will be one more to add to the list I have noticed, from exchange with others that the higher doses are easier to tolerate for those in their 30ies-early 40ies and lower doses seemed preferable for  anyone over 50. But this is an observation and not a scientifically confirmed fact so please don't hold me to it.

After about 2 months of taking Xanax 3x per day as advised, the taper was initiated by the psychiatrist and first he halved the midday dose for a week or so. Then he halved the evening dose (wanted to take the morning one but I protested passionately so he humoured me - I could sleep fine by this point but mornings were still very hard for me). Then he forced me to halve the morning dose. Once I was ok with that, one dose was dropped (Midday one), then the evening one and finally the morning one (that one was the hardest for me but I was still allowed to take one on days I found it difficult to cope). I was advised to take a small dose as needed for a couple of weeks and then stop. I was given a prescription so I could have access to them if I worsened but I was asked to note down on paper the frequency of taking them this way. When the doctor noticed that the frequency was higher than he liked, he upped Effexor instead. Eventually, I believe it took a total of 6 months when I found I no longer needed them at all or once every blue moon. I had some in my purse for the following 2-3 years but they expired and I never renewed that prescription.  

I did not have a notable increase of panic symptoms when tapering from Xanax. I was apprehensive and tense but it was not as daunting as I expected. I did try to keep busy though. I liked feeling more 'in control' eventually.  I missed the relief of the tablet for a while after stopping, but not enough to succumb. I was too busy taking my life back I guess.

Again, if doctor advises, it will be ok to have some on hand for any emergency. Because of the nature of your condition. But judging by your overall drive to regroup, I would not worry whether or not you have to continue taking them and focus on savouring the good moments. May they keep multiplying!!

 

Iam slowly getting better, it will be 4 weeks on this coming Tuesday. I feel the worst when I wake up, still so anxious especially if I stay in bed. I have decided to go up to 75 when I see the doctor on Tuesday. I know it is my own anxieties causing me to delay the increase. I am so afraid it will be like the sertraline was like. I can always take the Klonopin I was perscribed if I get afraid. You are a very strong woman. I was reading back through our posts. I have been exercising everyday and carrying on with my day but my confidence is not back. Hope you are well. Lynn

When did you start resuming your regular activities like shopping, seeing friends, and socializing with others. Was it after a month?

Finally 3 days now without needing a Klonopin. Anxiety is becoming less. Yesrerday felt long waves of sadness but worked in the garden. My husband was away all day. Tomorrow l go back to Doctor and will go up to 75 if she advises. If the side effects are bad I will just take the Klonopin again. Thanks for all your help. The acupuncture was a relaxing experience like deep meditation go again on Thursday.

You decided to not take it regularly after all huh?

You are regrouping nicely. I hope you continue having a smooth progress. I am not sure what is harder to cope with - waves of anxiety or waves of sadness. Both are disruptive but both are necessary. And both pass like waves always do. I used to comfort myself saying that for it to surface it means it exists and if it exists it must flow. Once the fear and feeling defeated subsided it was so much easier to manage.

"When did you start resuming your regular activities like shopping, seeing friends, and socializing with others. Was it after a month?" Oh, it took me ages. I remember trying to get out of the house but failing miserably, often returning before even reaching the intended destination and then making up some excuse. It took me months. I was terrified and so exhausted. I could not hold a conversation, watch television or read a book. Some days I just paced around the house. Was raising a newborn so it was all really hard to balance.

I vividly remember the first morning I woke up feeling good. Must have been about 4-6 months into therapy. It was from that point that I started getting some hope back and slowly started to emerge.

I trust it will go a bit faster for you based on how you sound

Hi

I have been improving and am feeling more able to cope.   But over the last few days my anxiety seems to have worsened.  I am shaky and feeling afraid again.  Last week I did not feel the need to take any diazepam all week but today, I was fed up with the internal shaking so I have taken 2 diazepam today.  Is this normal to seem to have an increase in anxiety?  Is it just a wave that will pass,  one of the ups and downs of anxiety?  I have now been on 150 mg slow release for nearly 7 weeks.  Your advice would be most welcome. 

Great advise

Hi June!

Can you think of anything that may be contributing to the spike? A cold, a tummy upset, some added responsibilities or change in routine? Ups and downs are quite expected in the beginning (the first few months. The brain takes time to recalibrate. But usually there is a trigger - obvious or subtle.

Hi Purpledobermann

Thank you very much for your reply. This uneasiness started last Saturday and was continuing until yesterday (Monday) when I took the diazepam. The only thing I can think of which may have caused the spike is that last Friday, I had a very very busy day. Now usually, I am not capable of doing what I did on this day. Went to see my daughter, took dog a walk, called to see my friend who had just had an operation, went for an assessment for CBT and then did the weekly shop. Too much in one day? Is this what could have caused the anxiety to heighten?

Definitely. By rule if the spikes continue for more than a week and then start getting more intense or new symptoms emerge - this is when to worry. It is still early therapy so it is all game and ups and downs are normal - you are still in the recovery phase and tired. But it sounds like you just went into a bit of an overdrive. I would take a step back and see how it progresses over the next few days. Chances are you will feel very very tired for a few days and then start to regroup. If anything else comes up (unusual symptoms) or you feel the need to reinstate more regular sedatives I would call the doctor.

Do the side effect waves ever completely go away.  I saw the doctor today and she called in a prescription for 75. I hope the side effects don’t get much worse again. I am a month in today, she said it was up to me. Did you feel better when the dose was raised.  She said 75 was still a low dose and I should not worry. I see her again in two weeks.

I would not expect massive spikes at 75mg after a month on 37.5mg.

The adjustment side-effects go fairly quickly overall.

Waves of anxiety and depression take longer depending on your progress, mind-set and personal chemistry.

 

Last night woke up with a lot of gas and later stomach cramps can side effects still come and go like that after a month

 

Yes they can even if they are side-effects and not a reaction to increased anxiety/apprehension about starting a higher dose

This morning when I woke up they were gone side effects are crazy

Took my first day 0f 75mg of effexsor,and since they were perscribed by doctor, I will use my Klonipin during the day to help the added anxiety should it arise. I have an acupuncture appointment at noon which will help. I bought some Metamucil yesterday to help with constipation.  Did you take any over the counter medication for nausea at increases, if any side effect increases that will be the one. Thanks for all your encouragement I have no one at home to talk about these things.

Effexor gave me heartburn in the beginning and the only thing that took it away was a spoonful of ice cold vanilla ice cream. I’m serious 

I will try it, better than Pepcid ac. Side effects so far at raised dose seem to be anxiety.

Three days on 75mgs and my anxiety about raising the dose was much worse than it’s turned out to be. Thank you for all your assurance. I was able to connect with a therapist who does EMDR. Which treats PTSD and other anxiety disorders. I start seeing her next week. I really need to take a dose of Klonipin at night so I can sleep after raising the dose. Insomnia has always been a problem and I hope I can settle at this dose for a while and it will bring me back to where I was 6 months ago.

Another couple of days until it begins to settle a bit. The first 5-7 are the hardest so after that you should be feeling better. I really hope it goes smoothly for you after all you have fought through. xxx

Day 7 on 75. The side effects have been not so bad. The anxiety has come back a little but have been having some good days. Sleep is hard for me. I take my anti anxiety med at night which helps. Today I see a therapist for trauma. Hoping it will help me with Kyra’s death.. I have made it this far on Effexsor and I hope I will continue to see gradual improvement. Did You still need the Xanax occasionally after you raised the dose. I still need reassurance normalcy will come. Thank you for being here for me.

Is it unusual to have a wave of anxiety after having none for a few days needed to take a Klonopin this morning.

Is it common for the anxiety to come back a week after raising the dose

Hi Lynn

At the stage you are at I was still on regular 3x per day Xanax so I guess it was smoother for me because of it. But I still sometimes needed more than what I was prescribed. And even a month or so later when I was weaned off Xanax I still needed an occasional one for a couple of months or so. Nothing to worry about.

The brain does not take kindly to being forced to change gear. Anxiety spikes are expected and provide a great opportunity to practice calming yourself through them. The medication does not make anxiety disappear. It helps you manage it better and more effectively, eventually helping you prevent escalations.

Hang in there. The more you go through, the better your brain can reference the regrouping process later.

Hi June,

just wondering how you are doing? Hope the increase in your Effexsor dose has helped your recovery. Let me know how you are doing. I have been trying acupuncture and it seems to be of benefit. Gray November is here in Vermont in the states and I pulled out my light box to help. I use it all winter here where it gets very cold and gray. Not looking forward to winter.

Hi  Lynn

​Thank you for your message.  I have been on 150mg Ven for 9 weeks now.  Had a bit of a hiccup 2 weeks ago but seem to have got over this.  I still have nervous stomach in the morning which can stay all day but mostly, I carry on and try to ignore it.  I am most certainly a lot better than when I started.  I have been experiencing waves of sadness recently but having re-read all your posts and replies from purpledobermann, it would appear this is normal.  As she says, these waves will eventually pass.  I only take 2mg diazepam if I feel particularly anxious but this could be maybe once a week or less.  If I need it, I take it - I am not beating myself up anymore with guilt/feeling a failure.

​I am 69 years old but have been blessed with my two daughters and am involved in both their lives, together with my three grandchildren.  I cannot imagine the grief and trauma you have undergone concerning the loss of your daughter.  It is heartwarming to hear that Ven is helping you.  My step-grandson took his own life nearly 3 years ago, at the age of 14, and I witnessed first hand the devastation caused.  The memories surface periodically and sadly, sometimes they become overwhelming, understandably.  And so I think you are doing very well and would encourage you to take all the help you can get, including the medication, to cope with what life throws at you.  Life can be very cruel and we must do whatever it takes to deal with the hand we are dealt, however unfair it may seem. 

If I can be of any help in any way, just let me know.  You have my support always.

June

Glad things are getting better. For me they raised my dose to 75mgs last Thursday so four weeks on 37.5 and now a week on 75. I am getting noticely better my horrible anxiety is really reduced, and don’t need the anxiety Meds much now. I was feeling a little odd the past 2 days but realized it’s the side effects resurfacing after the increase, waves of feeling woozy, stomach nausea, cramps, along with little appetite. Another week until they go again but optimistic now. I am going to visit my other daughter and her boyfriend who live in Vermont but over an hour and half away this weekend. Keep me posted. I turn 67 on the 8th of November.

I am doing better, last night I went out to a movie and dinner with two old friends who have stuck by me through this. Ironically we went to the same restaurant where my anxiety started to get real bad in June. Tonight I am seeing my daughter and her partner for mine and his birthday dinner. Going out two nights in a row is something I have not done in a very long time. 9 days on 75mgs. I have been taking the Xanax as needed now. I still have been getting stomach and intestinal and my appetite comes and goes. Did you take any over the counter medications for side effects until the Effexsor was fully tolerated by your body? I have a long way to go but finally encouraged that something seems to be happening. Thank you for your sharing your experience and giving hope to others in this situation.

Hi Lynn! Sounds very normal, everything you have described. Beyond normal, quite a rapid response with limited upheaval considering everything.

Two nights out in a row is something I have not done in a long time either. And I am 40 No energy at the end of the day! So all I can say to that is WOW

No, I dislike taking symptomatic relief type medication so I just sat tight. Only my Xanax and Ven until I normalized. I think my intestines and tummy took about 3-4 months to be back to what I would consider normal. Appetite improved around 3 months into therapy but to this day when I am a bit more stressed it is again reduced for a few days. I began to understand that when adrenaline/cortisol goes up...appetite goes down. So instead of fretting I rest a little, walk a little, drink some water (to flush it all out), some chamomile tea and the next day I force small regular meals until the ball gets rolling again. I feel much better following the cues my body sends now, after treatment.

I hope you continue to gain strength and confidence and feel a little better every day.

Sending best wishes!

xxx

I reread some of the conversations and saw a mention of a happy light and question: "Do you live in England or Australia" haha no in the Mediterranean!! Sunshine all around We have a couple of days of rain here and there but it is just to clean the air. So blessed on that front! But you must appreciate the greenery you have that we do not. On murky days I look at thriving flowers and they replace the sun quite nicely, I think. Plus you get to see butterflies. We rarely do. We only get reptiles. Which is, again fine by me. I am adaptable like that!

You are so fortunate to have sunshine all around you. It has been gray or raining for about a week, but the fall was beautiful.  My husband and I will be traveling to Corfu and then Sicily next May looking forward to being completely better and traveling again. I am now having good days along with not so good ones. It’s hard to accept the down ones after the ones in which I feel the light again. I was 40 when I had my second daughter and well remember the exhaustion of having 2 very young children and trying to do to much. Going back to get my masters, working and being a mother was to much which brought on an episode like the one I am now having but was 23 years ago. I am looking forward now which is so much better than before, those 15 weeks of raising the Zoloft and having it not work was so detrimental to my hopes of ever recovering again. Five weeks on Effexsor have given me hope,along with your positive and encouraging responses have helped me immensely. I am able to think about the good day when I feel shaky and lose faith in my recovery I couldn’t before. Raising the dose to 75mgs ten days ago was a necessary move in getting better. 

 

Hi Purpledobermann

I did take a step back and the anxiety seemed to return to its normal intensity. But I am a bit worried about your comment about anxiety getting worse or new symptoms arising, which would be a time to worry. There reason is that over the last couple of days, my anxiety has increased and I have taken 2 diazepam , 2mg, both days which does relieve the anxiety. Is this a normal down, part of the rollercoaster of anxiety, or do you think that I've not given venlafaxine enough time. It's been just over 9 weeks now at 150mg. Or is it something to worry about. Or is my dose not correct, too high/too low. Your thoughts on this would be most welcome. I don't want to think I am going backwards as I then start to lose hope.

June

Hi June

So it's been around 10 weeks on 150mg?

What could be going on is a minor blip (these can last a few days on end). Typically they are preceded by one of the following:

- added stress/responsibility/anticipation of some event that you are not looking forward to or even positive stress of something you are looking forward to

- minor illness including colds or tummy bugs

- self-sabotaging behaviour - poor sleep or eating habits for a few days in a row, alcohol consumption, overdoing it on stimulants or high sugar foods or inadequate hydration for a few days

- hormonal imbalance (transient)

- low iron, some thyroid complaints, liver acting up.

So, typically you would wait to see if you feel better over the next few days. In my case for example it usually took about 5 days and then I would feel very tired and low for another few days (adrenaline and cortisol fallout). If NEW symptoms appear or you continue to worsen and diazepam seems to not be taking the edge off within this time-frame, something may be up. If it starts to lessen, just a blip.

So if in the worst case scenario you continue to feel like you are regressing over the week, consult your doctor, explain how and when it started and ask their advice. You may wish, at that point, to also ask for bloodwork to exclude : low iron, thyroid complaints and assess the state of your liver. And a full blood count of course.  Bloodwork should be done every 6-9 months for anyone taking regular medication.

Hope it is a classic blip and you start regrouping soon.  

Just a reminder, at this point that everyone has ebbs and lows, good days and bad days - not just those taking psychotropic medication. This reminder used to help me accept blips as just temporary. Eventually, what used to be a blip - turned into feeling mildly unsettled: like a 'normal' person often does

Sending love

I am feeling much better these days. The good feelings stay longer. I have been on 75mgs for 20 days now. As I look out my window snow flakes are coming down and when this episode started it was the beginning of summer. I still need something to sleep at night but it’s been 7 weeks in total that I have been on Effexsor. I still feel apprehensive that I will fall back in the hole again but I guess it will take a few months for my confidence and my mind to settle. I will have a racing thought come, or anxiety come back and think i’m Slipping. I hope this will pass. I am waking up most mornings with no anxiety which is a wonder I am thankful for. I have started feeding the winter birds again and watch them through my dining room window. I have a doctor’s appointment with my psychiatrist today and I hope she will still  prescribe my Meds instead of releasing me back to my family doctor. He doesn’t know enough about these Meds. Hope you are well. Lynn

Thank you so much for sharing. Most people disappear when they start to feel better. But letting others know how it goes can be so helpful for their own recovery. Especially when they can reflect on cases approached the right way.

Yes, the apprehension takes quite a while to subside. The mind needs much convincing. And in truth, I do not think anyone is ever back to laid-back and carefree after a major anxiety spin. But confidence that it is manageable grows over time and then, what used to send us into a frenzy, no longer goes as deep. Medication does quite a good job of preventing escalations. You still get them but they feel different. Numbed somehow. Eventually, the fear lessens and your own body starts to change the way it responds. It really is about retraining yourself to trust your body, to understand how you feel, why and to strive to be better to yourself over time. I found the experience liberating. When it started I could not understand what was wrong with me. I was only 20 and in a fairly good place in life. I thought. But everything I was doing was somehow repressing the things that I had not dealt with. Or, rather, things I did not even think or know needed dealing with. Until therapy progressed some years later and things started becoming clear. I had no idea how far away from myself I had been since being a young child.

The psychiatrist should follow you for about 2-3 months or until you are clearly progressing steadily. Then she will likely release you. But by this time you will have a grip and won't need her as much.

It will all work out well. You are doing great so far and there is no reason to worry as long as therapy is maintained and any changes moving forward done very very gently.

Keep in touch.

Had a real blip of anxiety this evening, needed to take my benzo., After having a great day. I guess I have to expect these waves and not get alarmed when they reappear. 

Typical - it also used to happen to me just as I would begin to get excited about feeling a bit better. Mind probably saying: no, no don't relax! It is not ok! haha well...it will pass, slowly...

I was starting to angst about my trip to Texas in February after my friend called about our planned cruise. I started to think about would I be well enough to go. You should be a counselor ,Purpledoberman you have so much empathy and knowledge. Thank you again for being here.

Had a really bad night last night, could not sleep and bad aniety. I got into bed feeling fine. It was 3 weeks yesterday on 75mg. Did you take your Xanax at night when you had problems falling asleep? I have always had problems sleeping,  but it made me very unsettled last night. Do you have any suggestions for getting better sleep? Does it get better after a few months. I have not needed the benzo’s during the day. 

 

Hi Lynn. Yes I took my Xanax 3 times per day as described earlier. For about 2 months! The night one was to be left last to be phased out as sleep is the most important part of recovery. In my case, sleep was not an issue so this was not a problem. My morning dose was the most critical for a long time. I believe it took minimum 3 months on optimum dosage to be able to only need a benzo once in a while and then never again at all It takes time. But if this keeps worsening over the next week the doctor will consider upping the dose of your Effexor to the next level. I think it is just recalibration you are going through and would not worry unless it starts to get like this every day for more than a few days. Let us know how it goes tonight/tomorrow. Wish you an easier night. You can take your night sleep-aid tonight regardless of how you feel and hopefully this will help you reboot enough to feel back in charge tomorrow night. This is what my doctor always advised. You can try giving your doctor a call for her take on this too. x

After re- reading all the posts we shared I realized, I am a type A personality, wanting changes to happen over night and expecting my recovery to be much faster than is possible. This week has been up and down since last Thursday, but went out to eat with my husband on Saturday evening and had a great time. Took a Klonipin last night and slept much better. Yesterday had some waves of anxiety after going to church which I haven’t done in weeks. I started EMDR therapy last week for PTSD from childhood and think this therapy will help. Thanksgiving holiday is on Thursday and my daughter will be here.  I am taking it day by day and using the Klonopin to steady me when needed.

I also noticed when the waves of side effects come back so does the anxiety. It’s 25 days today on 75

Hi Lynn.

I don't think you are a type A personality any more than any of us going through anxiety. That is what it does - makes you alert and impatient and vulnerable. That is how it manifests.

I may be worse: I get extremely agitated and unpleasant when I am ill by rule. I get impatient and feel like a day of fever lasts a week. I am at my worst when I feel afraid or vulnerable. And more so after going through anxiety, but with time I have learned how to shut up and force myself to not speak (and sometimes to isolate myself) so as not to ruin relationships until I recover. My family knows when I am coming down with something because the monster in me precedes it . During the worst of my anxiety I could not be comforted. I doubted my progress every step of the way. I kept waiting for another wave. I drove myself mad. I drove everyone mad. Except my psychiatrist who was pretty good at reassuring me. For a few days, then I was calm longer, then longer and finally out.

At 25 days you are nearing a decisive phase where it will be apparent if progress is 'good enough'. In the next week or two your doctor will be able to make the call on whether you will stay on minimum therapeutic dose (75) or move up a notch (+37.5).

It is not waves of side-effects. It is waves of the anxiety (chemical surges) at this point. They just mutate over time as your brain tries to adjust. It is referencing the last most 'palpable' perceived threat/discomfort (start of medication is stressful time and very confusing for the brain) and the sensations produced take on similar quality. It is, at this point, usually the condition showing and not the drug's fall-out. Within 2 weeks you can expect to start evening out. If the dosage is correct and no changes made (though I think they will likely make at least one attempt at increase - and this is correct as they may have to test the level to confirm the dose) then by the time you hit 2 months mark you should be able to see notable steadying of reactive symptoms.

When is your review? Next week?

Great that you started EDMR - it should be twice as potent now that you are steadying on medication too. I am really optimistic.

Do keep me posted how it goes.

Hi, I started EMDR and it is seems like it will help in the long run. Revisiting past emotional abuse is hard stuff. The day after I feel a bit wobbly. I have been on 75mg since October 26th so it’s a month now. I still get occasional waves of fight or flight anxiety but over all doing better. Some days I am 100 % . Saturday I went shopping with a friend and then out to lunch, while Sunday had a bit of anxiety in a grocery store. I  don’t know why this happens but I am coping with better when it does. It was good to see my daughter on Thanksgiving and went to work out at the gym with her. The side effects have faded for the most part but falling asleep is hard for me most nights, but I am not falling asleep on my couch at 4;00pm anymore. I go back to see med. nurse on the 12th of December and I will see about going up another 37.5. I am hopeful for more healing and steady recovery over the next month. I just received word that one of my former 7th grade students died from a drug overdose this past weekend at 27. It breaks my heart to hear these stories, but here in the states it’s getting bad. I hope you are well.

Were you seeing significant improvement at 75 when you moved the dose up on Effexsor. How do you know it’s time to move up when you are seeing improvement at the lower dose at one month in. Confused see NP on the 12th.

My 'significant improvement' started after starting 150. After a couple of months of stabilizing my psychiatrist wanted to make sure he is not short-changing me so he tested by going another notch up. Which didn't work out. So he pulled back on 150 and I sailed through the rest.

You don't always know if your progress is good enough. There are two approaches doctors follow. They ask a few targeted questions related to how you assess your improvement followed by how your mood, sleep, appetite and daily habits are and any psychosomatic remnants of the condition. They wage the overall feedback with the clinical picture and then they make a call - to either wait a bit more and see if anything escalates (conservative) OR they push up. Psychiatrists tend to be more likely to test higher dose and GPs tend to keep steady until something goes wrong.

At 75 a psychiatrist would be cautious and trigger-happy to try a higher dose. Which patients don't like and feel they are being drugged senseless. The reason they prefer to try going up is because 75 is a minimal therapeutic dose and the higher you go up the more neurotransmitters are targeted. (SNRI effects are full at 150 mg). However if the SSRI effects are satisfactory, especially in people over the age of 40 they will be more conservative as drug sensitivity can increase with age due to various factors.

So how do you KNOW...you really don't. You will only know in retrospect. Unfortunately at that point it is all the more dependant on personal chemistry. Let the doctor assess and see what she feels. And see how you feel. x

Hi I am wondering if you could help me, I am 50 year old male who has really bad anxiety and fell down in a hole about 4 months ago, its the first time I have gone on anti depressants and I am really struggling, I have always controlled my anxiety with exercise and done it succesfully until I have had this big breakdown, I was first put on cymbalta and besides plenty of side effects I didnt get much relief I was on 60mg for 9 weeks, my doctor swapped me over to effexor 75mg and after 6 days I was on 150mg it was looking promising I had a couple of days here and there that were not great but pretty good compared to what I have been experiencing, then last week I got 6 good days in a row it was incredible no stomach pain in the morning I wasnt 100% but it was so much better than I had been, wanting and looking forward to doing things again, but now I have had 6 very high anxiety days again and so sad because I thought i was there, I spoke to my doctor who now wants me to add 30mg of Avanza he feels my body has adjusted to the 150mg and the chemical was not high enough for me to get relief, I tried 225mg but it was too high I didnt like the feeling, I have read most of your threads and your knowledge is amazing I was hoping it was just a blimp and my good days would return but each day seems a little worse or is it that i am just more disappointed that they have not returned the mornings are impossible, I really dont want to take another medication on top of this but i dont want to continue to feel this way either any advice would so appreciateive

I forgot to say I have been on 150mg for 5 weeks now

Hi Roger.

Your sense of hopelessness shows through in how you wrote this and I truly do sympathize. I would like to try to help put this into some perspective though.

First, it is important to know why this escalated 4 months ago. What happened? Were there any major life changes? Health concerns? What is on your mind when anxiety strikes? Something MUST be up. Yes it is about chemistry but important to know how you FEEL in the meanwhile.

Next, who diagnosed you? If it was your GP (which in this case is OK I will hope they also ran bloodwork and overall health check-up. Thyroid, iron levels, adrenal function, heart condition etc. For regaining a sense of control it is important to be in touch with your body. Plus especially the first two can contribute notably.

Then, how does your anxiety manifest? Is there a deep sense of also being stuck or weightless or unreal or anything else noteworthy? What is the main fear when anxiety strikes: loss of control/going crazy; anger; unbearable sadness/hopelessness; health worry/death; existential concerns...what is the colour of your anxiety?

How is your appetite/sleep/hydration?

Are you taking ANY other medication (unrelated to this) or supplements. Any alcohol/energy drinks/coffee or any time of basic stimulant (or depressant).

How do the anxiety crises start typically. You mentioned mornings are hard. This is common. Over 4 years AFTER therapy I am often most tense in the mornings. This usually has to do with many responsibilities, actual or perceived or immense frustration.

We can try to dissect this. Let me know whatever you can think of.

If you saw improvement on SNRI level doses quickly and then it stopped two things could be up: something else is going on that is causing anxiety; OR the improvement was placebo to begin with. I am leaning on the former but that is just my opinion based on the little you say.

Let me know.

Hang on in the meantime. It is usually NOT as bad as it FEELS Sending much love.

I have had high anxiety all , my life this is my second breakdown I had one when I was in my 20s, I think the pressure of getting older and being scared of most things has just built up on me and sent me in a downward spiral, I do have a little bit of heart disease but my physical health is pretty good I had blood tests done 4 months ago and they were very good, my appetite fluctuates in the little times I have been feeling I can eat I do, and my sleep is slightly improving but I take 2 mg of Valium to help me sleep, I do try and drink as much as i can, I find myself so preoccupied in my thinking and acceptance of taking the medication and often wish I never started. I just wish I could be sure this medication is working I dont know I am always scared, I feel my depression has lifted but my anxiety I feel is worse I am constantly agitated in the last week cant sit still. Do you feel it was too quick for me to see an improvement with effexor even though I had cymbalta in my system already before I switched, ?? I would continue with the Effexor by itself if I knew it would eventually get me there but the way I feel i might have to take the avanza as well my psych tells me he is trying to get my level lifted high enough so it will give me relief but im thinking the effexor is what is causing my anxiety to get worse but he said if that was the case you would have felt it from the start.

I woke up with horrible anxiety this morning like before it  started yesterday afternoon.I guess I need to go up. Took a Klonipin and will call the doctor tomorrow, can this happen out of the blue.

Hi Lynn. Yes it can happen out of the blue. It was always like this for me too. For no good reason or at least no rational obvious reason. I hope you even out soon after this.

 

Taken correctly, and with proper medical guidance, modern medication can only do two things: Help or not help. It sounds like you are already in a twist enough so that whether or not you had to take medication should be left to your doctor's best judgement. There are things we can't control. Aging and getting sick tend to fall outside of our mortal sphere of influence.

Anecdotally, what really helped me was the last time I had to have surgery. I was in a really bad place in my life in general - everything was going against me: except my kids and I wanted to be around for them. I struggled so hard to keep it together. Sudden turn in health was almost too much for me to handle. I lay on the operating table, terrified of something going wrong, terrified of the suspected cancer they were removing and more than anything: terrified of letting go in a hopeless situation: anaesthesia. My whole body shook and my heart rate was through the roof. And suddenly I realized that nothing I do or think changes anything. The ONLY option I had was to surrender and let it be what it may. It was a profound and liberating little moment that changed my outlook considerably moving forward. I tend to revisit it in my mind, since that day, every time I go to sleep. Surrender. And I look forward to the sensation. I wish you to find a way to surrender too. To let it all just be what it will.

I mean, you watch what you eat, exercise, look before you cross the road  do what you can. Beyond this: life will flow where and how it will. And so should we. No sense in wasting all that energy in applied tension over trying to control the uncontrollable. I wish you to find that place where you stop fighting. So much energy just wasted and making you uncomfortable. When you are anxious the hardest thing to do is renegotiate some perspective with a pent-up mind. It takes effort and determination.

As far as the choice of medicine goes, Mirtazapine can actually help touch parts that venlafaxine may be agitating. It has a more calming effect. From others' experiences here I note that they seem to collaborate really well.

Have you ever had any proper counselling?

I would like to insert a parenthesis here to remind you that medication does not zombify you. It serves only as an artificial balancing agent and a buffer to give us some space and energy to start healing. Any progress is always entirely up to us. And much of it happens subconsciously. Let yourself be grounded a little and then remind yourself of the fact that your track record for pulling through hardship is pretty good so far. It is just that you need to adjust to your changing circumstances better. A long standing history of adrenal overload is typically quite convincing to the mind that it always needs to fret and panic. I hope you have retained some sense of humour through this. It will come in handy during healing. And by healing I do not mean "numbing" symptoms. This is not what medication is actually about. I mean subduing those reactive symptoms long enough to allow yourself out of that protective shell. It is very very uncomfortable where you are.

You are a wonder. Gone by evening

Roger I understand your patience is at the limit. Before starting Effexsor, I was successfully being treated on the lowest dose of sertraline for two decades when it suddenly stopped working. They tried for 12 weeks raising the dose till it was at 175mg. When they realized it was time to switch antidepressants, I had no emotional reserves of hopefulness. Another doctor switched me to Effexor and I was on 37.5 for one month, I was terrified to increase my dose quicker because of my experience on Zoloft. My doctor pushed me to try 75mgs and I finally relented. I have experienced very good improvement after 5 weeks. I will try try another bump up of 37.5 when I see her next week. I also needed to take Klonipin an anxiety medication twice during the day, not just at night till the antidepressant started kicking in. I thought I was weak for taking it but it has given me the strength to continue to heal. I rarely need it now. When we are physically ill we go along with our doctors advise. I take blood pressure and cholesterol Meds everyday, but somehow we doubt the need for drugs for mental malidies. Purple Doberman has been such an informed empathic guide for me along with my doctor. You will get back to your former self, 

I had proper counseling with my psychologist just before my breakdown, I thought it was really helping me, but now I do most of my counseling with my psychiatrist, he also like you, have said  I need to just let go and let what will be and allow time, we have decided to stay on the effexor which I take 150mg at night and now have added 37.5mg in the morning, he feels the good days I had not long ago where definitely not a placebo effect and just that I need more chemical and I have dipped back down, Im hoping this additional dose will take me back up again I suppose only time will tell, he needs me to try and have some consistency, which means staying on the one medication and hopefully I can tolerate it,  I also need to recondition my expectations and accept there will be good times and bad, and I need to do alot more work on myself. I have read so many reviews where  peoples lives have changed in 3-4 weeks and I am always hoping that mine would too but I have been nearly 5 months whilst he thinks Ive come a long way I am no where near where I want to be.

Hi Lynn,

Thank you so much for replying to me, I always fear the fear, and I also take cholesterol tablets, I have always thought I could handle my problems without medication and have done successfully for a good period of time but things have changed so much, I have still managed to keep my job going which is a miracle and had a very small period of 6 days where I felt I was back to myself but its gone and my Doctor feels that I need more chemical, I have been so upset because I thought it can only improve from where I was, but I feel now I have gone backwards he assures me that the Efeexor is working for me and I just need to give more time and with the increase of chemical I will get my good days back.

Interesting that. I also got worse during counselling. It was my neuropsychiatrist who managed to ground me and return me back in the helm. Most people benefit from counselling. But I was up in the air and it really did not work out when I was at my worst.

Anyway, consistency is a word I like. It is the kindest thing you can do for yourself to let the doctor try to help rebalance you and then, in time you can take it from there.

As it is not considered a good idea to take Effexor at night, I am wondering if the doctor chose to do so due to your reactivity? To have you 'sleep' through side-effects?

Hopefully once you start avanza he will shift effexor to the morning as it should be and have you take avanza at night. I think you may see much better results like that because your sleep pattern will even out. As it is a psychiatrist following you I am less concerned but still good to keep in mind.

Oh definitely - we all have good and bad days. Just that when you are already reeling with anxiety the bad days feel incredibly hard. You will pull through.

Generally, the less you question the process, the sooner you can reign your mind in. Focus needs to shift to mundane until you are back in the flow.

I am of course curious what made you so anxious most of your life as you say. It is always something. If you are anything like me, even something small has a cascading effect throughout our lives.

Hang in there. x

PS It took me more than 3-4 weeks to start feeling better. Plus I was kept on steady doses of Xanax throughout the last bout of recovery. It does take time for some of us.

I am going up to 114.5 starting tomorrow. I am still getting anxiety out of the blue. My doctor would like me to get up to 150. The doctor said this raise should really level out the anxiety. I shouldn’t have many side effects at this point I hope. 

Did you go straight from 75 to 150 in one jump? Did the anxiety increase a lot. I still have my Klonopin if I need it. 

Hi Lynn

I expected she would want to push towards 150. No I did not have any issues rising to 150. Once 75 was established the rest was much easier. I climbed to 150 in 37.5 increments. This is the right way to do it for those of us without immediate risks such as suicidal tendencies. Out of curiosity, did she indicate how long she wants to wait between increases at this point?

She said I could go straight to 150 but I said I would like to be on 114.5 for a few days. She has already sent the 150 script to the pharmacy for when I am ready.  She said when I see her next week on Thursday we would probably push it up. I have been engaged in a lot of activities and with the EMDR therapy it could be pushing to much to soon.

All this activity could be heightening my anxiety level too.  I canceled on going shopping with my friends to the city malls today for Christmas shopping. I felt going to my book club tonight and the gym this afternoon was enough stimuli.

I agree you should maybe tone activity down a little. You are still fragile and tired so no need to push whatever is unnecessary. Yes, 37.5 increments will be nicer and kinder to your brain for sure. Glad she allows you the option. Many psychiatrists would roll their eyes at that but it does get easier to handle (obviously when there is no urgency). Keep me posted. I do hope you feel relief either way.

How are you doing Roger, I just raised my dose to 114.5 yesterday. The increases make me feel tired. I had a bout of stomach cramps, anxiety and sweating when I first woke up. I seem better now. 

Hi Lynn, what a roller coaster this trip has been, I think I am starting to stabilize on my new dose (187.5) Ive had 3 above average days with still some depression hanging around, I was always under the impression that i would wake up one day and I would be perfect, hahaha how wrong I have been my appetite is getting better and sleep is sort of improving and certain parts of the day I actually feel like doing things, every since I have understood its just going to take time I think I am a little more at ease, Ive had those stomach cramps and sweating too and still have not as bad the morning are the worst

Your right some days you feel like a yo-yo, up and down . How many days have you been on the raised dose of 187 mgs. Usually takes a week or two to adjust. Only three days on my new dose. Anxiety not bad yet. I actually slept the past two nights without Klonopin. I just feel tired and a little fuzzy in my head. Keep in touch with your progress.

Hi Lynn,

Ive been on it 6 days I am feeling just ok better than I did on 150mg I am moving in the right direction Im sure I will have some more bad days (wish I wouldnt) still take my 2mg of valium at night to get me off to sleep, I have kept myself  busy this weekend going to the beach didnt go out at night I am praying we will be both pretty good by Xmas

Lucky you I am looking out the window at 6 inches of snow. I live in Vermont, just the start of winter here.i am scheduled to be on a cruise to the Caribbean in mid- February. Need to be 100% by then. Do you still feel a lot of anxiety during the day or just at bedtime. My anxiety is much better. I still sometimes fear I will lose it in public. Hope this dose does the trick.

Hi Lynn

I actually feel anxiety the most in the morning my nights are not to bad, I am just trying to get myself into a better sleep pattern I an going to start taking the valium every second day even though its a very small dose, I still think about the medication all the time I am sure that will pass when I feel my old self, I am probably at around 70% this last 30% will probably take the longest, How are you going ?? I am nervous to go away but I really want too, I used to go away every year and have done for the last 20 years

I am looking out my window at 6 inches of snow and seeing the birds at the feeders. You were so right the jump in dose to 114.5 was much kinder with side effects. It’s been five days now and since the increase I have been able to fall asleep without the Klonopin. I will give this dose a few week trial before stepping up to 150. The EMDR takes a lot out of me. Still not completely convinced that dredging up the past will help me. It has given me confirmation that I was a loving and kind parent to my own children,which is the greatest gift I could give them.  Life is hard enough without having the weight of an

unhappy childhood. It is traumatic enough waking up to another day with Trump.

hahahaha well...let's be optimistic about Trump. He is certainly different and different can be good. Even if only indirectly. Maybe it is the beginning of a rebirth as opposed to slow and painful political collapse LOL

Everyone is different. I prefer to dig around when I am stable. I was taken for psychoanalysis when the anxiety first started and it was a horrific experience. It just wasn't the right time, I was still very immature and the doctor was forceful. So I sort of imploded. But for most people it can help digest and assimilate. The subconscious may need some forced decluttering periodically. We do tend to accumulate and it can sneak up on us when we are vulnerable. I wish you to feel lighter soon. Enjoy the winter. Perfect timing. Time when we can regroup and slow down a little and see what new growth the spring brings. I am big on seasons and cycles. Love them all. Well except August heat where I live. It is just unacceptable.

Take your time.

Just a quick Hello to see how you are

Been feeling better the past couple of days, i’ve been on 114.50 ten days now. I woke up a little bit shaky today, anxiety rearing it’s ugly presence. I think it has to do with sending out Christmas gifts to family and thoughts of my daughter who died who will not be with us another holiday season. She would always visit us for a week this season. I don’t think the deep hole will ever go away and this time of the year is the hardest for me. Luckily I will see my other daughter next weekend my youngest who is 27. I am sorry for babbling. I think I need to go exercise and hope this bout of sadness and anxiety will soon depart. When I get in my car I seem more able to release the tears. I hope you are well. Lynn

Hi Lynn,

I have the same it comes and goes I am thinking of you at this time and hope you will feel better soon.

Have been feeling much  better. Last night had some anxiety with my chest tightening up, but I did some relaxation exercises and was able to fall asleep. Woke up this morning and decided to take some Xanax. I always think the anxiety will not go away again when it rears it’s ugly self. How are you? Almost 2 weeks on raised dose

Do you ever get anxiety anymore? Having a little blip again needed to take a xanax. Almost 2 weeks on 114.5. I Have been better on this dose

 

Hi,

just a question. I have been on 112.5 for 17 days now and doing better. Some days I feel perfectly like before. I still have anxiety at a low level sometimes but I seem able to calm myself and sleeping much better. My doctor said I seem much better so I will stay at this dose until I see here again on January 9th.

i wanted to ask you if you can improve after 2 weeks on a dose you feel comfortable with or are noticing improvement on. I have not hardly needed any Klonipin. Did you gradually get better when you were on your therapeutic dose or did it happen immediately. Please advice. Hope you are enjoying life.

Yes Lynn I still get it I have good and bad days still, I just hope in time it pans out to be all good or at least mostly good

[hi my names kalie ive struggled with anxiety and panoc disorder for many years ive been on all kinds of medication venlafaxine used to work wonders for me i had to come of it a year ago as i was pregnant i was put on citlapram but 3 weeks ago it stopped working for me it was upped but still didnt wrk 2 weeks ago i was tested positive for covid 19 i instantly was cryong saying im going to die since then my anxiety and panic attacks have got s much wprse every single day im thinking im going to stop breathing im going to die ive had numerous ambulance call outs a visit to a and e ive had ecgs bloods xray done and all was perfect my sats was 100 yet i still cant seem to shift them i started back on venlafaxine 11 days ago 5 days at 37.5 and 6 at increased dose of 75 i seem to have one good day and one bad day where im having attacks again im so scared this is my new norm and im not going to fee myself again i know this was posted over 3 years ago but not sure if you stoll get notifications of replies i just want to fee myself again i feel really tired shaky and just like i cant breathe wjen i know i can any reassurance that thngs will start kicking in soon i hate this feeong i feel as if im not here but the worlds going by thank you to anyone who is able to read this