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Offline dan_76

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Starting venlafaxine
« on: March 28, 2014, 04:47:51 AM »
I was prescribed 75mg of venlafaxine / day and continue the use of oxazepam as needed for anxiety disorder. I have written about my struggle in GAD section. See the link in the signature :)

What kind of side effects should I be prepared to get from fenlafaxine and how long those could last? I am going to have an appintment with psychiatrist in 2-3 weeks and hope that the outcome of the medication would be cleared by then.

I have been taking oxazepam (15-30mg/day) as follows:
- 10 days on
- 4 days off
- 3 days on
- 4 days off
- 5 days on
- 4 days off
- and now on it again

...should i be concerned about developing dependence / addiction?
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Re: Starting venlafaxine
« Reply #1 on: March 28, 2014, 07:38:24 AM »
I was prescribed 75mg of venlafaxine / day

Is this the XR slow release, or immediate release? If the latter I would suggest you start on half that dose, but get the okay from the prescribing physician first as there may be reasons why a higher start dose is indicated.

Quote
What kind of side effects should I be prepared to get from fenlafaxine and how long those could last?


Like most antidepressants it can produce a range of side-effects which I'm not going to list because experience shows that it is a 'good' way of ensuring you will develop them all. The one that causes folk the most grief is heightened anxiety. Not everyone experiences side-effects, and for most they are a fairly mild. The thing to keep in mind about side-effects is that while they can be unpleasant, they don't actually cause any harm. If they occur they may last from days to weeks.

Quote
I have been taking oxazepam (15-30mg/day) as follows:
- 10 days on
- 4 days off
- 3 days on
- 4 days off
- 5 days on
- 4 days off
- and now on it again

...should i be concerned about developing dependence / addiction?

You won't become addicted. This study will give you some idea of what addiction is and what those that are addicted will do. Nor are you likely to become dependent while taking oxazepam the way you've listed. However, you will almost certainly become dependent on venlafaxine and will need to wean off it slowly, or switch to a long acting antidepressant like Prozac to taper off it as it can be one of the more difficult antidepressants to discontinue.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dan_76

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Re: Starting venlafaxine
« Reply #2 on: March 28, 2014, 08:20:06 AM »
I was prescribed 75mg of venlafaxine / day
Is this the XR slow release, or immediate release? If the latter I would suggest you start on half that dose, but get the okay from the prescribing physician first as there may be reasons why a higher start dose is indicated.
We have different trade names here, but I assume it's similar to XR slow release since it's a depot capsule.

Quote
You won't become addicted. This study will give you some idea of what addiction is and what those that are addicted will do. Nor are you likely to become dependent while taking oxazepam the way you've listed. However, you will almost certainly become dependent on venlafaxine and will need to wean off it slowly, or switch to a long acting antidepressant like Prozac to taper off it as it can be one of the more difficult antidepressants to discontinue.
Interesting fact about venlafaxine. I didn't really consider this. But I guess this cannot be as difficult as it is to taper of from benzos?

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Re: Starting venlafaxine
« Reply #3 on: March 28, 2014, 08:51:36 AM »
We have different trade names here, but I assume it's similar to XR slow release since it's a depot capsule.

If it is in capsules then it probably is the slow release version. Does it mention whatever the Finnish is for extended, slow, or controlled release? Googling the trade name will likely give you the info if it doesn't.

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Interesting fact about venlafaxine. I didn't really consider this. But I guess this cannot be as difficult as it is to taper of from benzos?

Some would disagree. It and Paxil (paroxetine) are generally considered the hardest of the antidepressants to get off, for much the same reason, their very short half-lives (3-7 hours for venlafaxine, about twice that for its metabolite), and most believe venlafaxine produces the more severe discontinuation syndrome. Which doesn't necessarily mean you will have a problem as not everyone is affected the same way.

As for benzodiazepines, withdrawal seems to be highly patient cohort specific. Those with anxiety disorders tend to find withdrawal difficult whereas it is much, much less an issue with epileptics even though the doses they take are usually considerably higher (about the equivalent of 400mg/day of oxazepam would be typical, twice this not unheard of) and the brain biology much the same which suggests there is more going on than physical dependence.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dan_76

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Re: Starting venlafaxine
« Reply #4 on: March 28, 2014, 08:59:16 AM »
We have different trade names here, but I assume it's similar to XR slow release since it's a depot capsule.
If it is in capsules then it probably is the slow release version. Does it mention whatever the Finnish is for extended, slow, or controlled release? Googling the trade name will likely give you the info if it doesn't.
It says "pitkävaikutteinen" which means long term acting. So I assume it is the same as the slow release  :yes:

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Offline dan_76

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Re: Starting venlafaxine
« Reply #5 on: March 28, 2014, 09:37:03 AM »
Thanks for the comments Ian
Interesting fact about venlafaxine. I didn't really consider this. But I guess this cannot be as difficult as it is to taper of from benzos?
Some would disagree. It and Paxil (paroxetine) are generally considered the hardest of the antidepressants to get off, for much the same reason, their very short half-lives (3-7 hours for venlafaxine, about twice that for its metabolite), and most believe venlafaxine produces the more severe discontinuation syndrome. Which doesn't necessarily mean you will have a problem as not everyone is affected the same way.
I did some reading about venlafaxin and got some (not some actually a lot of) second thoughts. My doctor was originally going to prescribe me citalopram because I have taken that before. But I said that I could try something else since the citalopram caused some serious weight increase (and for several reasons, I should lose some now) and quite severe sexual dysfunction. So then he picked up venlafaxin. Little did i know.

I did arrange a phone call with my doc for next Tuesday, but now I am wondering what to do the days in between. Should I continue venlafaxin? If I do, is that for any good, if I am going to which to other SSRI in few days? I guess few days should not cause any issues with stopping. Or should I just drop it before even getting into them. If I do this, there is a change that my doctor doesn't really care about possible withdrawal issues and wants me to stay on this drug. Then it would be few days lost from hopeful recovery. If I would have known at the doctors office I would have asked for something else.
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Re: Starting venlafaxine
« Reply #6 on: March 28, 2014, 05:24:25 PM »
But I said that I could try something else since the citalopram caused some serious weight increase

Citalopram isn't particularly known for causing increased weight, but this seems to be a very individual reaction to antidepressants with some losing it and others gaining it. And it may not all be the med, at least some of it seems to be because people feel better and begin to enjoy their food more.

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and quite severe sexual dysfunction

Unfortunately, there are only 3 antidepressants which are unlikely to cause this. Wellbutrin (bupropion) which is usually too stimulation for those with anxiety, Remeron (mirtazapine) which is the antidepressant most likely to stop working, and trazodone (Desyrel) which often enhances the libido, but can be very sedating at lower doses. However, there are some things you can do which may ease SSRI induced sexual dysfunction.

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If I do this, there is a change that my doctor doesn't really care about possible withdrawal issues and wants me to stay on this drug.

There is an argument for remaining on antidepressants permanently, especially if you've had more than one episode of anxiety, and/or depression requiring medication. There is growing evidence that antidepressants become progressively less effective every time they are stopped and restarted, requiring higher doses to achieve the previous level of control. They may also produce more severe, and sometimes different, initial side-effects. According to one study the odds of antidepressants working after each restart drops by nearly 20%. Note that this applies to all antidepressants, not just those taken previously.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dan_76

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Re: Starting venlafaxine
« Reply #7 on: March 29, 2014, 05:18:53 AM »
Thanks again Ian.

I have considered this venlafaxine issue and come into conclusion that I will try it out few weeks, if it works or not. If not, then I think I want to change to some other med rather than start increasing the doze of this.

I took the first pill yesterday morning when I was feeling rather okay after taking oxazepam earlier in the morning. Late afternoon I noticed that I was feeling rather restless and it was difficult to stay in one place. By the night when I was ready to go to bed I was feeling not so good. My legs felt weak and shaky and my body all stressed out. I decided to sleep wihtout oxazepam anyway and managed to get decent sleep, but was feeling the same still in the morning.

So I took oxazepam and 2nd pill of venlafaxine. I think the oxazepam helped a bit, but the relief is not as good as it has been. Could this be because of the venlafaxine?

I am just starting to feel hopeless, because I have trusted that oxazepam would make me able to function, but now this seems to be so-so solution.
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Re: Starting venlafaxine
« Reply #8 on: March 29, 2014, 07:02:43 AM »
I think the oxazepam helped a bit, but the relief is not as good as it has been. Could this be because of the venlafaxine?

Indirectly, yes. Venlafaxine won't directly affect oxazepam, but the extra serotonin can increase anxiety levels which may then need higher benzodiazepine (BZD) doses to adequately control. OTOH, oxazepam may inhibit venlafaxine from initiating neurogenesis to some degree, but the benefits of the BZD in limiting anxiety outweigh that disadvantage.

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I am just starting to feel hopeless, because I have trusted that oxazepam would make me able to function, but now this seems to be so-so solution.

The heightened anxiety is usually a temporary problem which diminishes within a few weeks. A small dose increase may resolve it so discuss a dose adjustment with your doctor.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dan_76

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Re: Starting venlafaxine
« Reply #9 on: March 30, 2014, 09:13:28 AM »
I am on my 3rd day and I have lost my apetite totally. I think I could do entire day without eating.

Yesterday I realized in the late afternoon that I haven't eaten anything all day and wasn't feeling hungry even by then. I forced myself to get some dinner, but not much. Still today, not feeling hungry at all.

Is this normal side effect which should subside?
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Re: Starting venlafaxine
« Reply #10 on: March 30, 2014, 04:43:02 PM »
Is this normal side effect which should subside?

Yes, it does happen. But you may also find that later you are hungrier than before and put on weight. All part of the 'joys' of the antidepressant journey. It's never dull in the beginning. :(

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dan_76

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Re: Starting venlafaxine
« Reply #11 on: March 31, 2014, 07:36:53 AM »
Is this normal side effect which should subside?
Yes, it does happen. But you may also find that later you are hungrier than before and put on weight. All part of the 'joys' of the antidepressant journey. It's never dull in the beginning. :(
Well, looking from the positive angle... I really have some weight to lose... otherwise I don't really notice much difference. Anxiety level is difficult to assess because it has been rather bad anyway and changing day by day. Oxazepam seems to carry me through the day somehow.

But so far no headache, nausea or anything "new". Well.. having said that aloud, I think it will be matter of hours when those will strike.
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Re: Starting venlafaxine
« Reply #12 on: March 31, 2014, 07:57:30 AM »
I really have some weight to lose

Exercise is good for both the waistline and anxiety/depression as it has a positive effect on neurogenesis. There's no need to run a marathon every day, a 20-30 minute stroll 4-5 times a week is enough.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline dan_76

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Re: Starting venlafaxine
« Reply #13 on: April 03, 2014, 08:53:51 AM »
So, it has been one full week on venlafaxine (75mg). I would not dare to say, but I think I am seeing light at the end of the tunnel. My mind feels more clear than what it has been in more than a month. I don't feel so tense, stressed and faint. I feel rather normal occasionally.

Not sure if it's the venlafaxine kicking so soon or is it just the oxazepam making me feel better. I am taking 15mg in the morning and then try to get through the day with that. Although last weekend with the same or higher doze of oxazepam and just started venlafaxine I was feeling much worse.

Is it possible to feel the benefits of SSRI medication this soon, or is there something else going on? I read that the therapeutic effect should come somewhere around 3-4 weeks of use.

Well, tomorrow is the last day at work this week and if it still feels like this, I am going to try to skip the oxazepam on Saturday and see where it goes from there.
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Re: Starting venlafaxine
« Reply #14 on: April 03, 2014, 05:05:30 PM »
Is it possible to feel the benefits of SSRI medication this soon, or is there something else going on? I read that the therapeutic effect should come somewhere around 3-4 weeks of use.

While some seem to get a quick benefit it is probably the placebo effect which can sometimes last until the real therapeutic effect kicks-in. Antidepressants typically take 3-12 weeks to reach full effectiveness.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

 

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