Questions About Effexor - Worsening Depressive Symptoms

Status
Not open for further replies.

subtleomen

Learning
I am newly diagnosed PTSD/MDD/GAD (suspect the psychiatrist is trying to narrow this down still). I have had issues with addiction on and off for 15 years as well, but am 7+ years sober.

Long story short, I was prescribed Effexor on 5/24 and began taking 37.5mg the first week and have increased to 75mg and am now at the end of the second week. This is the first time I have ever taken any psychiatric medication.

At first, I felt like I was taking low dose amphetamines. I felt functional and was able to engage with folks around me though I had some insomnia as a side effect. At the end of week 1, I had a depressive crash that lasted a day. Same thing happened this week when I increased the dose, and am now on day 2 of a depressive crash. Basically, I feel that with the medication, hypervigilance and anxiety has decreased but depression has increased.

Has anyone else experienced this? A worsening of depression symptoms when going on Effexor? Should I stick with it for a couple more weeks? My next psych apt is 6/25.
 

subtleomen

Learning
I have a call in to the doctor as of last night, so I am waiting for a response.

Depression is manifesting as physical weakness, slowness, anhedonia, low mood and passive suicidal ideation meaning feeling like death would be a relief, but not actually wanting to die.

This is different from the manifestation of pre-medicated depression which was heightened irritability, inability to concentrate/cognitive impairment, generally feeling like everything was really hard to get through and also some passive suicidal ideation.
 

joeylittle

Administrator
Gotcha.

Glad you called into the doc.

Here’s what I can tell you, based on my own experience w/Effexor. I’ve been on it for +/- 4 years.

Taken by itself, it does make me slow - tired, logy, subdued. Personally, I don’t experience a positive change in mood - it doesn’t really lift the depression - but it does help with the hopelessness. So the lows aren’t so bad.

I take it with a few other (different) meds that have a stimulant effect - so, the slow-down doesn’t affect me.

Effexor is an older drug, and an SNRI. It’s fairly potent. It can absolutely lead to a potentially dangerous increase in suicidal thinking. It can also appear to increase depression, b/c of the soporific effect.

You wouldn’t have experienced much of the drug itself in your first week, except for side effects. What you are feeling now (into the second week plus increase) is what Effexor does.

I’m not a doctor - so, here’s my opinion but please, take it with a grain of salt....

I’m surprised your doctor started with Effexor. It’s a hefty drug with extremely difficult discontinuation problems. If you don’t have MDD, Effexor is like bringing Thor’s hammer to a game of stickball. I’m not making light of the depression that people with PTSD experience - wanna be very very clear on that - but, MDD is a separate disorder.

If your diagnosis is still unclear (which is very understandable, in the early days of trying to get help) - it’s possible you’re learning that Effexor is much too strong for you, ergo, if you are dealing with MDD comorbid to something else - you may benefit from a lighter drug.

It would make sense to start you on Effexor if sucidality (or a suicide attempt) was a major reason you sought treatment. Problems with suicide are a valid reason to bring out the big drugs. BUT - even then - it’s possible your system is now being overwhelmed by it.

I’d really encourage you to
Track your symptoms - pick a few times a day to consistently make some basic notes on sleep, mood, energy, behavior, appetite - all these things will help you and your doc. Don’t rely on memory.
See your doc before you do another increase.
If you aren’t also engaged with some kind of cognitive therapy - try and get some. If that’s not an option, google “mindfulness-based stress reduction” and see if you can get some materials to walk through it yourself. There’s a fair amount of stuff out there.
Ask your doc about trying something (med) that is more geared towards short-term (12 week) use.

Sorry for the incredibly long post. Effexor is not a drug one comes off of, generally. It being your first psychiatric med, with your diagnosis still a little unclear - just as a peer, I feel pretty obliged to tell you that Effexor is a road you might not want to go down - not unless it’s necessary.

How’s your therapy set-up? You have someone you like?
 

subtleomen

Learning
Thank you for your response. I think the psychiatrist suspects MDD more strongly than I do. My main complaint was high anxiety/hypervigilance which it seems to be helping with so far despite the mood swings. He told me very specifically that I have the world-view of a depressed person. I was experiencing suicidal ideation, but that was not in the foreground for me.

He also said that Effexor is a first line medication for PTSD, and this is why he chose it for me. Both my wife and a good childhood friend of mine have dealt with Effexor tapering before so I am taking some comfort in their support just in case the Dr. decides that it is not the right drug for me.

I don't seem to be having a typical response to this drug based on other internet musings. I'll take some notes, that is a helpful suggestion. Thank you.

I have my first appointment with a licensed psychologist who is a trauma specialist later this month. I have not seen this person before, but am hopeful about it being a positive experience.

Why the suggestion about short term medications?
 

Deanna

MyPTSD Pro
Taken by itself, it does make me slow - tired, logy, subdued. Personally, I don’t experience a positive change in mood - it doesn’t really lift the depression - but it does help with the hopelessness. So the lows aren’t so bad
I'm wondering why it would be prescibed alone, by itself, anyway. Effexor is usually prescribed with a mixture of other drugs or is with me anyway. I take 75 mg of Effexor @ 3 times a day. I really don't notice anything because its part of my medication, not all of it.

As Joey said.. Contact your physician as who prescribed it to you, O.P.
 

joeylittle

Administrator
He also said that Effexor is a first line medication for PTSD
It is, now - though I still think it's off-label for PTSD, as far as the FDA is concerned (if you're in the US). Meds for PTSD aren't necessarily effective - they won't address everything. So, the doctor will generally target the group of symptoms that is proving most difficult to manage, and prescribe towards that. Since the anxiety and hypervigilance were your primary difficulty, it's good the effexor is helping. It does make a little more sense to me, now, why he'd go for effexor. (LOL, not like it needs to make sense to me - I'm a rando on the internet :tup: )
Why the suggestion about short term medications?
Simply because you may not need them after going through trauma processing. It sounds like you've got familiarity with the discontinuation process for effexor - and as you're aware, it can be severe. But - it's good that you have people in your life who have experience with it.
I'm wondering why it would be prescribed alone, by itself, anyway
It can be. It's not as common now to do so as it was a decade-plus ago. I only discovered what it was like to go solo with it when I needed to briefly come off my other stuff.
I have my first appointment with a licensed psychologist who is a trauma specialist later this month. I have not seen this person before, but am hopeful about it being a positive experience.
Glad that's coming up for you soon. Please, keep us posted.
 

subtleomen

Learning
Doc is switching me from Effexor to Pristiq. Basically he thinks the muted anxiety is a positive response and that the mood swings are exacerbated because I am metabolizing the drug quickly. Longer release action of Pristiq should smooth it out.

I’ve only been on the Effexor for two weeks. He says I can just cut stop it and start the other, but I think I want to cut down to 37.5mg for a week before I drop it.
 

Deanna

MyPTSD Pro
I’ve only been on the Effexor for two weeks. He says I can just cut stop it and start the other, but I think I want to cut down to 37.5mg for a week before I drop it.
Just stop it and start the other. No sense in knocking it down to 37.5 for a week before you stop Effexor, because for number one it's messing with your head as it is anyway, and its not long lasting as Pristiq is-- says your doctor ( who is 100 percent right)
 
Last edited:

joeylittle

Administrator
Just stop it and start the other. No sense in knocking it down to 37.5 for a week before you stop Effexor,
Disagree - with effexor, better to be a little cautious and go slowly.
Basically he thinks the muted anxiety is a positive response and that the mood swings are exacerbated because I am metabolizing the drug quickly. Longer release action of Pristiq should smooth it out.
Glad he was responsive, quickly. Good luck with the switch.
 

subtleomen

Learning
Thank you. Day 3 of pristiq. No real side effects, but no real effect yet either!

I gave cold turkey a shot with Effexor and aside from feeling like I was coming down with a cold that afternoon, I didn't have any other problems with it.
 

subtleomen

Learning
I am now on pristiq for 15 days and no more drastic mood swings. Only thought of suicide once in this time, and that was right after a therapy session.

This is heading in the right direction because I feel more like myself, or more like I can engage authentically with the world. I am finding myself spending less time with my cognitive distortions, or the "Committee" as I like to refer to them. This is a good change for me because my default state has been that of a fringe observer, outsider...almost an alien-like existence. Psychiatrist says full effect should take 6-8 weeks.

I also find that this medicine does not really help with episodes of dissociation, but does help slightly with emotional dysregulation and mood swings by making the episodes less protracted and modulating the amplitude of the swings. I am noticeably less irritable and aggressive, but can still become this way if I am overwhelmed.

The only two side effects are night sweats (not bad but noticeable) and insomnia. It is now taking me 2-3 hours to get to sleep. I did not have this problem before, but did have trouble with waking up and not being able to get back to sleep. Trazodone for the insomnia now and started that last night @ 50mg.

Overall, not a cure all and I did not expect that, but I think this will be a positive experience for me and I feel good about the direction treatment is moving in.
 
Status
Not open for further replies.
Top