Effexor, fantastic and fears

[Skywatcher]

I’ve been fighting some depression symptoms and an increase in anxiety this past year. It’s all kind of coming to a scary point, so my p-doc recommended trying effexor xr in addition to my 1800 mg of trileptal. I had already tried 3 ssri’s, Wellbutrin, and cymbalta. This one seems to actually be working—my system is calm, less reactive and sad, but I woke up at 3:45 am and have been awake for 2 hours now. I think my concept of time has been a little off so maybe I was dozing, but my mind is thinking about a lot of things right now and I’m having a sinus headache. I’ve been reading about withdrawal and wondering if I should really get involved with this one, but it’s so nice to feel much calmer and have my panic tapered down. It feels like a bandaid to what could become a bigger problem, so will it be worth it, if it helps me live?

 

[Sideways]

it’s so nice to feel much calmer and have my panic tapered down.

This is exactly what meds are for. So when you ask this:

It feels like a bandaid to what could become a bigger problem, so will it be worth it, if it helps me live?

my personal thoughts? Is that, for me, the deep, deep lows of my depression can use all the bandaids I can get my hands on. Because absolutely it can mean the difference between staying alive through this episode, and not.

I can't progress with therapy when I'm in those deep lows. In fact, most of my life tends to slide backwards. But, even though there's always a lingering depression, the deep lows are episodic. So if you want to minimise your medication use? Then maybe talk to your doctor about how effexor has provided that relief, but you'd like to only use it where necessary. Episodic use of effexor to use as back up when your mood dips?

The med regime I'm on, my and my pdoc tinker with doseage on a fairly regular basis, and we both keep our own versions of some kind of log of med changes and their impact. My ideal world is one where I'm on as few meds as possible, but when I'm experiencing a deep depression, it makes sense to temporarily use whatever helps shorten those episodes and get me back to stable.

It's a bit like someone having a sore throat, and not liking the idea of medication. Yes, they could try to white knuckle through it, but...why? Why put yourself through that if you've found something that helps?

As a side note? When I up my Pristiq (the anti-depressant I increase during bad depressive episodes), the impact is pretty huge. And fairly quick. Within a week, my ordinary sleep cycle has changed, so that suddenly my usual sleep routine is more than I need. I also have more thoughts, clearer thoughts, and my thinking speeds up. When you're used to being in a depressed state, that throws me. Every time. I suddenly feel like, I'm hyperaroused, hyperactive, dysregulated... and that kind of makes me panic.

What I'm actually experiencing? Is a sudden shift from depressed (sleeping a lot, low energy and having trouble thinking anything) to not-nearly-so-depressed (needing less sleep, having more energy, and being able to think a lot cleaner. It's not a side-effect, it's the medication actually working (what the...!?!).

Is it possible that may account for what you're experiencing?

 

[Skywatcher]

Quite possibly. I have major pmdd (maybe even bordering on phychosis). I just had a really bad episode with it and happened to talk to my p-doc in the middle of it which prompted him to try me on this. I don’t know if it’s the meds or the stop of my period that has made me more calm. Only time will tell. I asked him if I could just take it for pmdd and he scoffed that it wouldn’t work that way, but I have since done research and it says it is possible to take it during the luteal phase. They have done studies that this showed 80 percent improvement. Regardless, he does let me try stuff my way, so I might do that. I’m having some side effects like worsening teeth clenching. A headache that I’m not sure is related. Other than that, I think it helps a lot and I’m actually sleeping and not freaking out from my terrifying dreams. I hate the thought of how difficult this one would be to get off of. Especially with the current state of our world. You never know what could happen with jobs, drug availability. This may just be a part of my GAD. I guess I’ll try it for awhile.

 

[coraxxx]

Effexor isn't a medication you can go on and off just like this unfortunately. But if it's working for you, the question is to see the benefits risk. I tried it a week ago and had a response so brutal that the remedy clearly was worse than the problem (slight dissociation, mild to moderate depression). Sure, depressed and anxious I wasn't. But I just couldn't do anything without falling asleep as soon as I stopped, and feeling high all the time. It's certain I would have adjusted after a while but my pdoc didn't think it was a good idea since a brutal response like this might indicate it just wasn't going well with me. However, if I was being suicidal and in a crap environment the calculation could have been different. Because it did cut the GAD and it also did cut the dissociation, vlaf, that was very much evident. It was just way too powerful, even in the lowest dosage.

So you might want to see, after a moment on it, if it's fitting your goals and if you want to continue on a regular basis. Because you can't do it and stop, the rebound effect is very strong. Even after a few weeks you can already rebound, albeit not too badly. It really depends on you there isn't a way to tell exactly. But if it's for something that variates like seasonal depression I don't feel like it's a good candidate. Wellbutrin I liked it because I felt much more like myself but any small stress would cause me to dissociate on it.

But well I'm also a pedestrian so all I can tell you is my experience that wasn't really concluding at all with effexor, I do believe it can be a very good medication, but not for the person I am now.

 

[barefoot]

I have a vague recollection that Effexor isn’t available anymore in the U.K. though a version of venlaflaxine still is. Can’t remember why that is. Or perhaps I’m remembering wrong..

Anyway - I took it for depression about 20 or so years ago. I remember coming off it was pretty hell-ish… The ‘brain zaps’ were pretty brutal. Though I don’t know that it’s the same drug now as it was then. Also, I can’t remember how I stopped taking it…have a feeling I may not have done sensible tapering…!

Not sure I have much of value to add here but really just posting to say: SSRIs - and other groups of antidepressants - can be highly disruptive to sleep.

I have a non-REM sleep disorder (night time hallucinations and night terrors) and I’m under a sleep clinic and take melatonin for that. I was given amitriptyline (not an SSRI, I don’t think, and it’s not really used as an antidepressant here these days…) for my IBS and it completely counteracted my melatonin. Cured my abdominal pains over night…but triggered multiple night terrors per night. When I spoke to the sleep clinic pharmacist and told him about these spikes in my nighttime symptoms, he was pretty baffled. As soon as I then mentioned I’d recently started taking amitriptyline for my stomach, he groaned!

It’s so unfortunate that so many psych meds seem to have common side effects of disrupting/disturbing sleep.

That said - really pleased that it’s having such positive effects in terms of calming your system and easing anxiety and panic.

No other advice, info or suggestions…sorry, not sure why I’m posting really, but I will post it seeing as I’ve now written it all out! Sorry…tired, hot brain here…!

 

[Sideways]

I asked him if I could just take it for pmdd and he scoffed that it wouldn’t work that way, but I have since done research and it says it is possible to take it during the luteal phase.

Pristiq (the one I take - I have previously tried effexor) is desvenlafaxine, a modified version of effexor. I maintain a small baseline dose, which I jack up during difficult periods, rather than coming off it completely each time.

It's very individual how these meds work, tinkering with the dose makes a lot of sense to me. I hope it works out well when all the moving factors are taken into account.

 

[coraxxx]

Not sure I have much of value to add here but really just posting to say: SSRIs - and other groups of antidepressants - can be highly disruptive to sleep.

I’m not sure, but if I remember well Effexor/Venlafaxin is a serotonin and noradrenalin reuptake inhibitor and not only serotoninergic? I might be wrong and in any case it doesn’t change much to what you’re saying.

Pristiq (the one I take - I have previously tried effexor) is desvenlafaxine, a modified version of effexor. I maintain a small baseline dose, which I jack up during difficult periods, rather than coming off it completely each time.

Interesting. I have heard of this one and to be entirely fair my pdoc suggested that we could even tinker the dose further the lowest available, I just didn’t want to because it would have required a lot of engineering with the pharmacy to have the right preparation and all. It might still be an option. I’m curious to know what you think of the differences between venlafaxine and desvenlafaxine, as if I understood well one is the metabolite of the other so the way of absorption is different? And good to know it’s possible to tinker with the dose on another basis of 0 or 1, it’s an idea that quite makes a lot of sense.

 

[Sideways]

I’m curious to know what you think of the differences between venlafaxine and desvenlafaxine,

The short and long versions are both the same: one helped, one didn't!

I tend to need higher doses of meds for them to be effective, and even then, most anti-depressants I tried haven't touched the sides, except to give me horrendous side effects.

Pristiq definitely helps. But I do get side effects, which is motivation to keep the dose low when I can. Fortunately, it's not a drug that makes me put on weight, where so many of them are. It can crank my anxiety a bit, makes me clench my jaw, sweat a lot (which is especially gross in summer). But like you said, sometimes these compromises are necessary to get me through a rough patch.

 

[Skywatcher]

@Sideways how do you deal with the jaw clenching. I seem to be doing that now on this med. I wore my mouth guard all night due to this. In the day time I notice it and keep telling myself to relax over and over again and try to hold my jaw differently and relax my tight neck muscles as well.

 

[Sideways]

how do you deal with the jaw clenching

I suck on mints throughout the day. I'm always carrying mints with me - yes, they can be helpful with grounding, but they're extremely helpful relaxing my jaw throughout the day. Giving my jaw something else to do basically, so I'm guessing gum would potentially work too.

I also check in regularly, and without mints, I press the centre of my tongue gently across the top of my mouth - something I learned from someone here who had the same problem if I remember right. There's a way that I can do it that drops the jaw down and forward. That's especially good when I'm trying to get to sleep.

 

[Skywatcher]

Well…today was the day that I tried to move my dose up to 75. I was doing well on 37.5. This new dose had some weird stuff. I had immediate diarrhea after taking it, but that wasn’t a big deal. Then at lunch time I started to fall asleep. Went for a drive and felt some derealization. Also some SI. I sat in a park and felt high. It felt like the leaves were somehow communicating with me. I knew it wasn’t real, but it was weird. I had a similar affect back when I tried cymbalta. All of this unreal stuff and beauty made me feel like I didn’t have control which increased my anxiety. Once I settled down from that I felt a warm burning feeling in my lower stomach that felt good. Things tapered off a bit and by evening I felt mildly depressed. I think I’ll go back to 37.5 for the time being. Also, wtf is wrong with me?

 

[coraxxx]

There isn't anything wrong with you, the medication is potent and requires assistance during the increase of doses. Of you're feeling too high or incapacitated and have unusual Si, talk to your pdoc immediately