Increase on Venlafaxine has caused old habits

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Hi all.

My pdoc recently increased my effexor ER from 150 to 225 after I came in one day and was just having a really bad time. It has probably been about 3 weeks now. First week all I noticed was a decrease in appetitie, which was welcomed. Last week I did my very first group therapy session, which I think will be really good for me. But basically for the better part of the week I just felt lost. I haven't felt this way in so long. Then Ive been up and down but today I found myself returning to old habits like cutting. I really don't want to give up, I know meds take time. But.....Will it get better? Was this the right decision? Effexor has worked well for me so far..Was I just having a bad day and he attacked it with meds? I know 225 mg starts to hit your norepineprhine (sp) and I already take adderall 15 mg ER for ADD. Is my brain being zapped or do I need to wait it out? I don't want to cause my doc to wave me into a hold or anything.....I can make it if it gets better....but will it or is this bad? Thanks yall. 

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  • Posted

    150mg extended release 'hits' your norepinephrine just fine smile so that's not it.

    More likely upping by 75mg was a bit rough - could have done a 37.5 mg increment instead - but I assume this is an experienced psychiatrist who has his own reasons for doing it this way. Is the same doctor prescribing adderall as well? If you have harm tendencies the doctor should consider lowering ven by 37.5 and keep you there until you even out again or temporarily lowering adderall as it can contribute to your escalation. His call, but something needs to give.

    How long were you on 150mg for before going through this rough patch that prompted an increase please?

    And how long were you on 15mg adderall?

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    • Posted

      In case it was not clear from my response: steady worsening over the course of 3 weeks is notable and a sign that the doctor needs to reconsider. Please contact the doctor immediately.
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    • Posted

      I actully emailed him last night bc things just kept getting worse. Of course he wants me to make an appointment sooner and blah blah blah. Instead of just saying go back to 150 until I can see you. I bad been on 150 for probably 4 months and was doing fine, just had a bad couple of days due to issues we all face in life. Ive been on adderall for 6 months and it has changed my life. I really think he caught me on a bad day and just thought why not? But im a firm believer in drugs dont fix everything. I go to therapy every week and i do my homework. And i just started group to add to it. On 225 i found myself feeling so disassociated, so out of control, all i wanted to do was drink and smoke -which wasnt helping my brain! I was having emotional outbursts. I just think after 3 weeks you are probably going to know, especially if its not a new drug to you. I am actually going to talk to him when I go back about possibly adding some wellbutrin to help with cravings - food, cigs and otherwise. I used to take it but had issues with headaches. Now I have those under control so guess we will see! Thank you so much for your input!!
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    • Posted

      Actually, it may help you to know that most good psychiatrists attempt a dosage boost at some point in early therapy (in the first year or so), even if the patient seems to be faring well. It is important to examine the reaction on a higher dose before deciding the optimal level for you. What this one could have done differently is to not work with 75mg increments - from what I read below you had previously moved from 75 to 150 smile 37.5 mg increments are much kinder, especially when moving above 150mg, unless there is a major escalation that needs aggressive handling. (e.g. sudden worsening to suicidal or harm tendencies which i gather was not the case). So in short, good call to up the dose and see what happens. If he is open to going a step back, it may help you adjust easier.

      Great that you are actively working on your own therapy. But please understand that since you are already on medication, the dosage level shoul not be of interest to you as long as you are balancing out. I mean that you are not losing/gaining control of the situation by increasing/decreasing the dose. This is totally irrelevant to your other therapy. The drug most certainly does not fix everything. It is a temporary balancing agent. Whether optimal balancing is achieved at 150 or 350 is not important. You are still going to heal through work that you do while on the drug, not get healed by the drug itself. I think it is important to not feel like the drug is somehow taking over. That's really not what the drug is there to do. In that sense, if it turns out that a level above 150 is needed do not feel defeated or like some mean doctor is drugging you senseless. Other than pushing a bit harder than he perhaps could, it all sounds pretty much by the book.

      Having said all this, I do think that you are right in that this dosage is perhaps not optimal and believe the right way to go about it would be for the doctor to drop down by 37.5 and monitor closely for another 3-4 weeks before deciding on the next move. But he is the doctor, not us and he knows your full history and all so I would be inclined to trust him as well as initiate conversation whenever in doubt.

      Meanwhile...hang in there smile

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  • Posted

    My dose of 150mg took 6 to 7 weeks to kick in. I felt pretty bad before that.
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    • Posted

      When i made the jump from 75 to 150 i dont remember having any major problems. But this jump made my brain flip so I can understand. When i was younger I had a doc put me on 100 mg of zoloft after I lost a parent. And it made me crazy. I was NOT in control of my life.....and thats what this has made me feel like. I was doing so good with therapy and using skills I had learned. Yesterday I lashed out at someone close and didnt use anything I had learned. And thats not who I am these days. I always say, i want to feel things. I want to be happy, mad, sad - not a robot! But emotional for the right reasons! Ive been in the mental health world long enough to be pretty familiar at this point with what works and what doesnt. And this move was wrong IMO. Thank you for your input!!
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