Venlafaxine

Thanks for the reply, yes that makes complete sense. I have been suffering badly from depression and anxiety since November. I didn't know it was even possible to feel so bad. So no wonder my body and mind are so exhausted. I'm trying hard every day to just keep going and not give in to the tiredness but it's so hard.

I started on 75mg on 1st April and this was increased to 112.5mg last week. I think it will be increased again so I'm worried the side effects will get even worse!

It's helping me mentally so I will stick with it a bit longer and hope the tiredness eventually passes.

Another side effect I have is that I feel very shakey all the time. Is this something you've experienced or heard of?

What dose are you on?

Clare x

You won't get worse on higher doses. Typically the closer you get to 150mg (SNRI kick-off on XR type delivery) the less tired you will feel, provided of course that the drug sits well with you.

Make sure you do not consume too much caffeine during the day to avoid caffeine crashes - it will prolong the adjustment.

The shakiness is the result of your blood chemicals interacting with drug chemicals. It is as if you are trying to enter anxiety crisis but are unable to as drug prevents it. CNS is reeling and you likely also feel physically weak due to exhaustion. That should start to ease up a little over the next few weeks. If it worsens you will need to mention it to the doctor though typical response will be to increase the dose. Pls remind me if it is a psychiatrist or a GP following you?

I was on 75mg for 4 years, undermanaging due to GP not really understanding my condition. This resulted in massive escalation after stopping it for pregnancy and ended up with post partum psychosis. I was reinstated on Effexor by a psychiatrist and pushed up to 150mg. Was on it for 4 years + 2 years maintenance after the symptoms all totally withdrew. Followed by 2 year taper. I have been off the drug for around 4 years now.

What you describe is very common and so far it appears regular. Have you been on any other medication prior to this and are you currently taking any other medicine for this or any other unrelated health condition?

Is your apetite good?

I don't have a lot of caffeine at all. Usually one coffee and one tea throughout the whole day.

I was having terrible trouble sleeping at night but that seems to have improved a lot over the last couple of weeks as has my appetite. I've lost over 2 stone dice becoming ill.

I am being treated by a psychiatrist at the moment as I have been in hospital but will eventually be signed back to my GP.

I was on citalopram for a number of years but came off it in August because I didn't think I needed it anymore. Stupid mistake to make! Was fine for about 6 weeks and then this awful depression and anxiety hit me like a ton of bricks! Tried to go back on it but it did nothing so then I was put on sertraline. That also did nothing so now I'm trying the venlafaxine.

The only other things I take are cod liver oil and a multi vitamin.

Sorry to see you've been through such a hard time. Lovely to see you've come out of the other side though.

Clare

How are you doing Clare. I am 1 week into an increase to 225 hope it works

I'm not too bad. Still struggling a little bit but trying to keep busy.

I feel completely exhausted though. Are you struggling with that? How are you feeling?

I have insomnia so very tired a bit of nausea have. Wen on higher dose for5 days not much change fingers crossed

How long have you been taking it for now altogether? Are you on the slow release ones?

Yes slow releases have been on it for for years 75 then 150 but this time I had to go up to 225 feel a bit better but long way to go. Are you still at 110 I have had depressio 

n for 25 years so far Effexor works the best hope that keeps up

Sorry for your experience. I imagine it was hellish. It was a good call on the doctor's part to try you on your original medication (cit) first. Good call also to try you on sert before attempting ven.

Problem with relapses is that they are always always much more intense and complicated than the original condition you were treated for.

You have been on Ven for less than a month and just pushed to above 75 (lowest therapeutic dose) in the last week. By all measures you are now doing great if your actual condition is not worsening and your main adjustment symptoms are tiredness and shakiness while your sleep and apetite are improving. It really does sound promising.

In terms of your presenting condition, you can expect ups and downs in mood and anxiety for a few months. You will know things are going well when the duration and/or intensity of low spells and anxiety spikes begins to decrease or the episodes become less frequent. Progress on ven in all the people i have met while taking the drug was typically very gradual. But usually the exhaustion and shakiness you mention slowly disappear over the first 3 months at your optimal dose. The issue you now have is finding that optimal dose. Just a heads up - the doctor will likely push a little higher even when you start feeling good, just to make sure you have reached optimal level. This is normal.

Sound therapy can't last less than 4 years in total including weaning and ideally no less than 4 years plus a year or two for weaning. Monitor your blood pressure and have regular blood tests for liver function.

I hope this is the last drug you'll have to deal with and that your therapy goes smoothly. Hang in there.

Are you also having any kind of counselling/psychotherapy? 

It has been a fairly horrendous few months I must admit.

I just want to get back to living my normal life.

Feeling a bit anxious today and this tiredness really is awful. I had a really good nights sleep but feel like I haven't slept at all!

Really hope that starts to improve soon.

Seeing the physiatrist today so am expecting him to increase my dose. Maybe getting to the 150mg will help?

Also just waiting to hear about some CBT which I'm sure will help.

To be honest if I can get to the right level and stabilise then I doubt I'd ever come off medication again! I'd be too scared!

Clare

I think they need to space out increases a little more than a week Probably he will advise you to take 112.5 for another week at least. 3-4 weeks are more typical though. No rush. Better for your brain to slowly shift gear UNLESS your depressive symptoms are worsening in any way. I am happy it is a psychiatrist making this call and not a GP at this point. 

CBT is a short terms "course" that leaves you with some insights into the causes of your condition but mostly focuses on giving you tools to override your subconscious tendencies. It is a means of teaching you to work on retraining your brain yourself and in that sense it is always useful.

I am wondering if at some point it may be a good idea to explore root causes of your condition as well just to give yourself a chance to process and better assimilate whatever it is that brought you to this point. There are always things we have not been able to digest and when they wreak havoc like they did to you - at some point it may be worth looking into it to see if perhaps the older and wiser version of you has a better narrative to attach to whatever it is that is bugging you.

Either way, for now just try to rest up and unwind. Treat yourself gently and regain strength. An improved sleep pattern and apetite will help get you there. Slowly you will find your center one way or another.

x

I'm not sure I can cope much longer with this extreme tiredness. I'm also worried that if it doesn't improve I will have to come off this drug and then have to deal with the horrendous withdrawal and then start all over again!

?I know the sleep and appetite returning is a good sign that the medication is starting to work so its just frustrating that this tiredness is causing such a problem.

Do you think it might help to take the medication at night instead of in the morning? that way I might sleep through the side effects?

?Definately need to look into the root cause of this but think I need to be in a better place mentally before I can really take it all on board.

Definitely not at night unless the psychiatrist expressly advises.

Have you tried shifting it to noon/lunchtime yet?

No I haven't done that yet. Will speak to the physiatrist today.