When does the venlafaxine start to work?? Advice please

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Hi I had been taking venlafaxine for 4years at 150mg with pregablin 150mg. After putting on 4 stone went to doctor and she changed me to sertraline which I took for 5 weeks before anxiety came back with a vengeance. Back to go who increased me to 100mg sertraline and only lasted 3 days before going back to go. She has now decided I need to be back on venlafaxine so I stopped the sertraline and started on 75mg 1 week then up to 150mg on second week. Was managing fine till Thursday when I cried all day had terrible thoughts. Back to gp and now taking 150mg venlafaxine morning and 75mg at night but the anxiety is still awful yesterday I had to take kids to Christmas display and put a face on I wanted to feel happy as I love my kids and Xmas but I’m finding this so hard just now. Had to take diazepam 2mg yesterday but doctor said iv only to use them sparingly?? And help and advice will be greatly appreciated.

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  • Posted

    Hi. This is  bit complex due to the switches you were subjected to and as you are now relapsing along with withdrawal/adjustment disturbances of both agents intermingling it may take a bit more time. You can take your diazepam as needed now to ease you through the worst of it so try not to worry about that part too much. Diazepam is the least of your concerns right now to be honest.

    I am trying very hard to refrain from constantly repeating myself here when I say GPs tend to mess this process up mainly (sadly keep on being proved right in 90% of cases) because it is not their area of expertise. GPs tend to perform abrupt alterations and jeopardize an otherwise straightforward process for most people.

    Again: The best way forward would have been stabilizing you on Thursday by use of any benzo or other sedative class of choice (diazepam itself is actually not the best for this especially where depressive sensations are escalating as it can worsen those) for a couple of weeks at least - not adding a night time dose of venlafaxine as that could agitate your reactivity even more due to messing with your sleep pattern.

    Are you on extended or regular release? Extended release is hardly ever (more like never) prescribed to be taken at night. If a top up is needed (in odd cases) it is done by taking first dose morning and 2nd dose no later than early afternoon. Exception to this rule is where both doses are Immediate release version.

    "She has now decided I need to be back on venlafaxine so I stopped the sertraline and started on 75mg 1 week then up to 150mg on second week. Was managing fine till Thursday when I cried all day had terrible thoughts. Back to gp and now taking 150mg venlafaxine morning and 75mg at night "

    Even if we ignore parts of this - each component of this on its own is so wrong.

    Are you being treated for symptoms where depression is prevalent or anxiety symptoms are more notable? How bad is the depressive part of the ordeal or rather, how bad was it before the switching started compared to now?

    "After putting on 4 stone went to doctor and she changed me to sertraline which I took for 5 weeks before anxiety came back with a vengeance. "

    I am almost afraid to ask...but how were you switched from one to the other? What kind of a time-frame was followed and method for weaning off one and introducing the other? 5 weeks time-frame is indicative of withdrawal. Book-case in fact.

    Your GP means well and wants to help, but so much of the little you wrote seems wrong. Unless there are other details that may have contributed to these, otherwise somewhat reckless, decisions that I am not in the position to know.

    In any case, do not take my word for any of the above : instead seek a second opinion if you are in a position to do so - opinion of a qualified psychiatrist. One that your GP should have referred you to or sought advice from before taking the decision to switch drugs, restart you on 75, up to 150 in a week and finally top up with a night dose of what I presume is extended release caps...while not providing any aid during the rebalancing.

    You WILL rebalance (provided you are not upped and downed recklessly from this point on, the 75mg top-up is moved to early afternoon latest (if at all)). Drink a lot of water, chamomile tea and avoid excessive use of stimulants. Sleep is of vital importance. Light movement throughout the day is beneficial.

    Psychiatrist evaluation of this procedure, in my opinion - necessary. If for no other reason then to make sure you get the best attention needed to not prolong unnecessary suffering at this time and make some headway.

    Sending best wishes.

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    • Posted

      Hi thank you for replying it is Effexor XR capsules I take. I went from 150mg to 75mg in 1 week then added 50mg sertraline. For 1 week before stopping Effexor and only being on sertraline. Then upto 150mg sertraline for few days riddled with anxiety and droppedto 50mg for 3 days before restarting Effexor 75mg 1 week 150mg second week now 225mg. I was in it for depression initially and I took 300mg of  pregablin for anxiety. When my anxiety subsided I cut it to 150mg and was fine but it was psychiatrist who gave me this medication for anxiety. Dr says I don’t need the extra pregablin. 
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    • Posted

      Wow PurpleD. Great explanation of things. You have brought good insight on this drug Effexor. I as bumped up to 112mg’s exactly a month ago with mixed reations. I feel great for 4-5 days followed by feeling a bit off for the same amount. I have been getting weird headaches also. I attribute this to Effexor. I see mu Dr tomorrow and will bring forth a few concerns I have. Have a great evening......
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    • Posted

      Hi Dawn. Hope you are feeling a bit better meanwhile.

      The procedure was not correct and this is why you have escalated during this time.

      Your doctor is right that you should not be needing pregabalin ... that is you would not be needing an added crutch for anxiety portion of the condition IF your dosages and chemicals were not tumbled up the way they are now. Right now I would guess (but it is just a guess) you would benefit from : Stabilizing on a proper dose (NOT taking 150 mg in the morning and topping up with extended release in the evening. If she wants to top you up to TEST 225 dose she should have used a short half-life version...i.e. Immediate Release. It is really simple actually...she just tied herself in a knot here - and took you along for a very unpleasant ride). WHILE allowing you SUFFICIENT time to rebalance on any chosen dosage (...more than a week) she should have been using sedatives (milder benzo than diazepam would do or any class) and that part should have been done preferably in a steady manner: even dose spans to keep the brain from going into overdrive. Or, take as needed if the doctor trusts you. Anyway, whatever I say is superfluous now. You were mishandled and ALL this because of weight gain on Effexor. Were actual blood tests performed before the decision to change drugs that were giving you stable results?

      You will find, in psychiatry, they tend to avoid replacing drugs if they have given results unless medically necessary. People I know who have had weight gain issues on psychotropics were urged to start a new exercise regime and rebalance diet as a first step. Blood tests performed to check for diabetes and thyroid dysfunction next. IF all else fails, then they were carefully put on a replacement plan. This requires steadiness and care. You do not achieve balance over the course of a week. And you certainly do not achieve balance by being upped the way you were. Too much, too soon and without aid.

      I am telling you all this to hopefully push you into getting a second opinion. Psychiatric one to supplement (not necessarily replace) your GP procedure and to clean it up a bit. Right now it is a bit messy. Especially the top-up part on XR and lack of appropriate sedative crutch for the adjustment. Benzos of choice where depressive symptoms are prominent are usually Ativan, alprazolam (Xanax) and sometimes lorazepam. Not Diazepam (Valium) as they tend to cause more of a downer on an already depressed individual. There are other drug classes that can be used instead but I am not well versed enough in those to suggest. Besides - it is your doctor's job to know this better than us here. If she does not, a psychiatrist is necessary to help guide her decisions and your recovery.

      I wish you a smooth resolution either way and to feel much better very soon.

       

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    • Posted

      Hi John

      Weird headaches are common at start or at slightly below or slightly above optimal doses. What are you taking it for? Are you on extended release? How long since you were first put on them and for how long were you on 75 before being moved up?

      The intervals you mention are not ideal. Likely you still have not reached optimum dosage. Is this the first time you are taking a psychotropic medication? Are you taking any other kind of medication/supplement (especially any acid suppressants or laxatives or strong doses of vitamin C for example; also blood thinners, BP medication...anything at all biggrin? Any alcohol consumption? Are you eating/sleeping well and are you hydrated?

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    • Posted

      Hi PurpleD. I was on 75mg’s for 10 weeks prior to being boosted up to 112mg’s.  Its XR and I take it for anxiety and depression. I was on E for 7 yrs and one day felt really weird so I thought it had stopped working. I went to my Dr and he doubled my dosage to 150. I knew nothing about AD’s at the time!!!!!!!  After 2 weeks and no improvement, he put me

      on Bupropion. That didnt seem to work so he put me in Celexa. He increased the dosage of that and it didnt seem to work either. This past May I started back on Effexor, 37.5 mg’s. Was on that for 3 months before being boosted up to 75.  Thats the dosage I was on for 7yrs. There for 10 weeks and now on 112 for 4 weeks. I see my Dr this morning. I take 20mg’s of reactine, one vit D3 and fish oil daily. I eat well, dont drink or smoke and I also work out daily. I’m hoping with more time that this dose I’m on levels me out.  I feel good for 3 or 4 days followed by feeling crappy for the same. I also do accupuncture. And that is my story!!!!!!  Lol

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    • Posted

      Hi John.

      Your case is not too bad in comparison to the OP. What probably happened is that there was no appropriate assessment during the 7 years you were being treated on minimal therapeutic dosage of 75. Let's say you felt better but you still had at least mild symptoms every now and then that persisted throughout therapy, that the doctor did not note and you thought: "this is as good as it gets". If, no attempt was made to test your dose in those 7 years then you basically did not reach an equilibrium solid enough that would keep you from vacillating in a way that left you vulnerable.

      Doubling to 150 was probably a bit harsh but many doctors opt for that increase (and it is not in itself of major concern)) if they are worried. They rush to get to the SNRI effect of the drug which offers much better results for anxiety especially. SNRI effect kicks in at around 150mg. Up until that point you are mostly getting SSRI benefits.

      My guess is that the doctor seeing you is aiming to gently (probably because you wanted gentle treatment) is aiming to test you back on 150.

      3-4 days cycles are not really typical which can be confusing to your doctor. Do you keep a journal of anything else that may be contributing to this cycle? Sleep habits/days you exercise (adrenal overload?), anxiety over specific things you have to deal with on days when you get the bad days etc? And when you get bad days, is it mostly anxiety or mostly feeling very low? How does it FEEL?

      Because this has been dragging on some and you were tried on alternate medication I am guessing stabilization would take some time. But should not have extreme swings. A month or month and a half is good enough indication of progress. If doctor deems necessary, pushing to 150 will not be a bad idea at all. Then giving it time to work while closely monitoring progress. Your aim should be stabilizing with slow but definitive progress and confidence growing.

      May I ask your age?

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    • Posted

      Hi there PurpleD. Thanks for the reply. Gotta tell you first off that I’m 61 yrs old. And your absolutely right about no diagnosis on my first time on Effexor. I would just go in to see him once a year and he would refill my prescription. I asked him once how long I would have to take this and he told me probably for life. So I just kept on taking it. He retired and I went on to another doctor. He’s the one who told me there were no side effects to these head meds. And he always referred to the good book. The doctor I presently have is very thorough and listens to your concerns. When i feel off I’m mostly down and not anxious. When I saw her yesterday, we decided I would stay on 112mg’s for 3 months and see where that takes me. She did mention I could go higher if need be. I do watch my diet and I even eat foods that help with depression. I exercise a lot which seems to help. I walk my dog for about 1 hour a day and I ride my stationery bike about 5 times a week. On the other 2 days I play hockey.   I used to have a journal but quit writing in it quite awhile ago.  I know I’m starting to feel better but I certainly am approaching it with caution. Hopefully, in time it will all sort itself out!!!!!!  Enjoy your day
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    • Posted

      Hi John

      wow...well you at emore active at 61 than I ever was. I am 40 and don't do half of what you do. So, back to my New Year's resolutions list - I believe I never actually wrote one....good year to start. Back to you: Sounds good in the sense that you are comfortable with this current doctor. My only concern is that weird cycle of3-4 days on and 3-4 days off. Did you mention it to her? What does she say? It is a little unusual. Do make a note if the cycle starts changing one way or another. Venlafaxine is slow to pick up anyway but from what I have discussed with others I see that it tends to work on anxiety faster than it does on depressive symptoms so that could be why as you feel depressive symptoms are prevalent. I wish you an easy journey from this point on. And certainly keep up your daily schedule. And try to examine what it is that goes through your mind when you are low on your off days. Maybe you are in a better position now to start a new kind of inner dialogue. You sound driven and enterprising. Perhaps you should rely on these qualities more to see you through this as well. Your mind is not outside of your body...You are awesome. Let us know how it goes!

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    • Posted

      Hi again PurpleD. Forgot to mention i threw in some weight trg also as it is good for a man my age. You are right though as far as this working on anxiety. I dont feel anxious like I did a few months ago. In fact I’m starting to feel pretty good all around. And yes I think my Doctor is awesome. As I said she seems to take a keen interest in how you feel. I will keep you updated on how I feel and thanks so much for being here for us with your smarts concerning this type of med. I wish I would have know what I was getting myself into way back when but I will just adapt and overcome now!!!!  Enjoy youre day!!!
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    • Posted

      I feel very irritable and I’m finding this hard to hide from the children. Was at the doctor who had said because I felt good the last few weeks after the increase it means I should wait and see if I settle but the not sleeping and crazy dreams are weird any advice would be gratefully appreciated. 
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    • Posted

      Hi Dawn!

      Are you still on the same regimen as what you last described?

      If so, can you ask to move the dosages about to their rightful place - in the morning and up to noon. It should help with sleep.

      Other than this, is there any added responsibilities you have had or major issues in life that may have increased your frustration and made you more irritable?

      How old are your kids? It may not be necessary to hide this from kids but instead to explain that mom is not feeling great these days and just tone down your activities to something you are more comfortable with at the moment.

      Do not be too hard on yourself and you will find other things will be smoother too. x

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    • Posted

      Hi thanks for replying yes I take my last 75mg at dinner time about 6pm and my 225mg in the morning. My mood feels more stable so think it’s the anxiety that’s making me irritable. My kids are 13 and 5 so the older one is great sometimes but the younger one I find having to say things over and over and I then become really angry and irritated I keep telling my self calm down deep breathes but it only works some times. Iv been using a body scan app to relax also x
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    • Posted

      Ah...5...my eldest is 12 and really moody (she takes after me waaay too much) and the youngest is 4. All I can suggest is to make sure you are VERY selective when picking your battles with the little one now. Most things are not worth the hassle. It takes some effort, practice and finesse to disengage from a little one when you are vulnerable.

      Anxiety makes us irritable but so do higher doses of venlafaxine because they force the brain to handle things previously repressed. So it is something that has to run its course. And meanwhile it is good to actively seek practical solutions in life to pick ways of handling things that will detract instead of adding to tension or frustration.

      It is a conscious effort. The purpose of anxiety is to force us to find more appropriate ways of being. Something you have been doing, out of habit or by following the path of least resistance perhaps now seeks to be transformed so you can be more comfortable. If you view it as a condition with a definitive purpose, you can start getting insights into why you are feeling the way you are.

      x

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