Help with venlafaxine

Treatment and medication
1

I am searching for some help and advice please with mainly anxiety. In 2014, I was unable to function and hospitalised. I was prescribed venlafaxine and was on 150mg slow release per day. I got better and was normal so in January this year, having been well for over 3 years, I tapered off the tablets and took my last one at the end of March.

By May, I started to feel down and thought I would get over it but that didn't happen and I started to become ill again. Dread of being alone, couldn't stay in my house all day, unable to carry out all my usual activities but managed to do some. GP reinstated Venlafaxine 75mg slow release once a day. Nothing was happening after 16 days so I asked for dose to be increased to 150mg, the dose I was on before.

Been at this dose for only 9 days but I'm impatient for recovery. I do take diazepam 2mg, one when I get up and sometimes another one around lunchtime but only on some days. I am sleeping, although wake up in the night for the toilet.

Has anyone been in a similar situation? I have been on the tablets for nearly 4 weeks in total but does it only count from the last increase? How did you manage to get through the time? Any help, experience or advice would help me.

Thank you for listening.

June

2

Hi June. Try not to worry and hang in there. Your taper was too fast, likely a little premature and you are suffering with a relapse. Each relapse is much harder to reign in than the original condition. I have actually been in the same situation and it did take quite a few weeks to regain my senses especially because my relapse took a particularly ugly turn due to comorbid post-partum psychosis. I needed about 8 weeks to begin to calm down once back on the medication and it was nearly 6 months before I woke up one morning without anxiety clutching at my insides. Recovery took 2 years for the key symptoms to withdraw, another 2 years for the more subtle symptoms to 'dissolve'. This was followed by 2 years maintenance at therapeutic dose of 150 mg XR and a 2 year gradual taper where a minimum of 3 months interval was placed between each reduction, counting from the day any withdrawal agitation subsided. Some intervals took 3 months and some as much as 9 months as there was a need to also avoid periods of increased stress (negative and positive stress alike). Hope this helps you understand how gentle you need to be on the brain as it shifts gears in treatment for anxiety. I have been off the drugs for 4 years with a clean bill of health and only a minor hiccup during extremely challenging times (husband's sudden major illness coupled with extreme financial hardship) that was however quickly reigned in and brain quick to reboot from. Sending love and wishes for a speedy recovery and a smooth journey to total remission. x

PS don't count the days. Just keep focusing on treating yourself with nurture and kindness you deserve.

3

And you can't have been well for 3 years if you started treatment in 2014. How long did it take you to feel well again? You need to be entirely stable and symptom free before counting a minimum 1 year of maintenance. The longer the maintenance the lesser the chance of relapse once you are weaned. x

4

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.

5

Diazepam 2mg. help me immensely! I used to beat myself up because I needed to take one! If I need one now I take it, I don't get stressed over taking them! I'm not addicted to them as sometimes I can go weeks without any! Some days though, I might need 6mg during a 24hr period!

6

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

7

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

8

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

9

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. 

10

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?

11

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. 

12

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. 

13

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.

 

14

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

15

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' ?

16

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>

17

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? 

 

18

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> 

19

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&quot 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.

20

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