With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past weeks, we covered several commonly used SSRI antidepressants, including Prozac, Paxil, Zoloft, Celexa, and Lexapro. This week, we turn our attention to another class of antidepressants known as SSNRI’s, the most popular of which are Effexor, Cymbalta, and Pristiq.
SSNRIs are Selective Serotonin and Norepinephrine Reuptake Inhibitors. They work by increasing the levels of two brain chemicals – serotonin and norepinephrine – in the synapses between brain cells. Like serotonin (described in our Prozac post), norepinephrine is important in regulating mood and anxiety, along with alertness and concentration.
Effexor (venlafaxine) is approved for the treatment of Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), panic disorder, and social anxiety disorder (social phobia).
Effexor may also be useful in treating other anxiety and mood disorders, including the following:
Typical adult doses of Effexor range from 37.5 mg to 225 mg taken twice daily. Effexor XR (extended release) is taken once daily. Follow your prescriber’s recommendations on dose and when to take it.
Effexor can potentially cause any of several negative side effects, many of which it shares with SSRI antidepressants. The most serious are the following:
Effexor has a number of interactions with other medications, so it is important to review your entire medication regimen with your physician before starting Effexor or adding another medication while already taking Effexor.
Other less serious side effects can include the following (Note: Many of these side effects are transient and occur when first taking these medications but do not persist.):
Remember: Any antidepressant can take 2-3 weeks or even longer to become fully effective; it may take several weeks to work up to a therapeutic dose. This means that your depression may not lift for several weeks. I often tell patients however they feel in the first two weeks is unlikely to be how they feel in a month – so if they are feeling some early side effects, hold on because they will likely get better. Patience is important in getting these medications to work, but if you have any concerns about how you are feeling, you should contact your doctor. You will most likely have a follow-up visit with your doctor within a month or less of starting the medications; this is a good time frame for checking in to see if benefits have started or if side effects have faded or persisted.
Warning
Effexor can have some of the worst withdrawal phenomena of all of the antidepressants. If even one dose is missed, and certainly by the second or third dose, patients will often experience severe abdominal pain, nausea and vomiting or diarrhea, headaches, weakness, and other general kinds of significant discomfort. It is very important to take Effexor every day, as planned, and to decrease the dose when necessary only very slowly, as described by your prescriber.
Blood pressure should be monitored when someone is taking Effexor. If someone is already being treated for high blood pressure, the psychiatrist and primary care providers should communicate about the blood pressure readings. I have had a number of patients that have had to stop Effexor due to elevated blood pressure as a side effect.
A new version of Effexor is now available called Pristiq (desvenlafaxine), which has the benefit of being able to be started quickly – you don’t have to bring the dose up slowly, according to the drug maker. I have not had the opportunity to try this form of Effexor yet, so I can offer no observations about it.
For more information from the manufacturer, visit Wyeth’s Effexor XR page or the Pristiq page.
If you’ve taken any form of Effexor or Pristiq for bipolar depression or other conditions or are a doctor who has prescribed it, please share your experiences, insights, and observations.
Edited on 5/19/2009 to correct the class of medications Effexor belongs to. Thanks to “a grateful patient” for calling our attention to the slip.
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I have been on most antidepressants on the market fot total of 18 years. First one was diagnosed with pain given prozac not told it was could affect my thinking. Had a horrid reaction which led to more antidepressants to feel better and keep the drug induced crazies at bay. Now have learned about severe adverse reactions and how antidepressants cause bipolar in perfectly sane and stable people.
Took effexor for seven years had hypomania ruined my life and just learning all about it now as the information was not available to me before. Sad situation all the lives these drugs are destroying.
After seven years on effexor I have learned about serotonin syndrome which I know I had by taking more than one med together prescribed by doctors. It all ended when after years of hypomania I started having symptoms of ms/parkinsonism. I tried to taper off and in desperation to save my life went ct. Withdrawal is long hard and as life destroying as being on these meds.
For help or info you can try paxilprogress.org or effexoractivist good luck to all who you who take it.
What I have learned after 18 months of withdrawal is it will take even longer to become well and at time doubt it is possible. Many sufferring side effects or withdrawal are not treated properly and misdiagnosed as having bipolar. Terrible mistake.
Also the drug companies knew this all along and hid the bad press…they are liable. imho
Effexor is actually a Serotonin-Norepinephrine Reuptake Inhibitor (SNRIs) rather than a Selective Serotonin Reuptake Inhibitor (SSRIs)) as you have written. It works on 2 neurotransmitters: serotonin and norepinephrine as opposed to SSRIs which only work on serotonin. I am rather surprised to see an MD make this sort of mistake in writing about Effexor.
I’ve been on most anti-depressants and Effexor XR (xr = extended release) is the only one that has ever worked for me. It is a good drug for those who are not helped by many other anti-depressants. I also told my pdoc i wouldn’t go on anything that made me gain weight as the MAO inhibitor did, and this drug didn’t cause any weight gain just as it claimed.
As a recent patient of this medication, I can tell you that the withdrawal symptoms are the worst I have ever experienced. It was like having the flu for 3 months. What was a problem was that the Dr. prescribed the med without explaining it in detail.
I was glad to see you mentioned the SEVERE withdrawal symptoms when going off of Effexor; however, I wanted to add that there are a significant number of additional symptoms that, for me, were UNBELIEVABLY difficult. I had “lightening bolts” in my head every time I moved my eyes, I cried non-stop for two straight days and couldn’t stop, I ached all over, couldn’t see straight, couldn’t drive, was dizzy (and can’t stress HOW dizzy I was… almost dysfunctional), felt like I was having a bad drug trip, was mentally confused and extremely distressed, and could go on and on… it wasn’t just physical either… I was seriously unstable. I ended up at my local Crisis Assessment Center after-hours (i.e. Emergency) and was almost admitted to the Inpatient Psychiatric Ward… I looked so terrible, they gave me a red bracelet that means you legally aren’t allowed to leave until they have finished assessing that you aren’t a risk to yourself or others, and they even called in nurses to check if I had some sort of severe illness… May not be this bad for everyone, but just thought I’d at least make an effort to warn people! (And fyi, I’m still on it, because I can’t BEAR the thought of having to go though the withdrawal again… I’ve never been so sick, miserable and mentally unstable in my life.)
If you want to gain weight Effexor is the way to go… and with drawls enjoy the voices.
Been there…..
In 1982 I experienced a major depression episode and was admitted to a physiatric ward. Medications were somewhat new at the time. I was prescribed several different medications during a period of a couple of years. When Effexor came out it was remarkable what a change, for the better, it made in my life. However, after years and years of taking Effexor XR I did try to wean myself from taking the drug. After several months experiencing tremors I went back on the drug and am still taking it. After years of experience with anti depressant drugs I know what works for one will not work for another and many seem to have different experiences. I endured migrain headaches for years and strangely after beginning antidepressants they became less frequent and then disappeared. Effexor XR helped me regain a life free of the pain of depression. GW
I have been taking Venlafaxine for three years. I became very depressed and had insomnia when diagnosed with cancer. The venlafaxine helped me, along with sleep medications, and I took 300mg of venlafaxine per day for two years.
I decided to stop taking it - I felt that I no longer needed it, and have read that it is intended for use up to one year, not really beyond that. For seven months I have been very gradually reducing the daily dosage. It takes me two or three weeks to reduce the dosage by 37. 5 mg on a graduated schedule. My physician lets me adjust it myself, so that if the schedule is too fast, I can slow down, or vice versa.
My physician warned me of the side effects when I said that I wanted to stop taking the medication. Together we planned the gradual reduction.
I want to recommend this to anyone wishing to stop taking venlafaxine (effexor). I do not have any side effects. On a couple of occasions I experienced some headaches when I tried to reduce the amount too quickly, but I adjusted my dosage and was fine.
I reduce like this: Day one: 300mg, Day two: 300mg, Day three: 300mg, Day four: 262.5mg
I repeat this a couple of times. Then I go to Day one: 300mg, Day two: 300mg, Day three: 262.5 and repeat the three day cycle a few times.
Then I go to reducing every other day. After doing that for a week or so, I go to this schedule: Day one: 262.5, Day two: 262.5, Day three: 300 mg. I do this a few times. Finally, I’ll take only 262.5 every day. I’ll stay at this level for a couple of weeks to stabilize. Then from 262.5, I’ll go through the schedule again, reducing by 37.5 mg. If I feel nervous or have a headache, I just stay where I am with the dosage without reducing or changing it for a couple of weeks.
It does take time, and after seven months I’m down to 150 mg daily. So I have another seven months to go. But it’s worth it. I generally have no side effects and feel better than I have for a long time. I have gained weight, but I now have energy to excercise, and I’m hopeful that in time the weight will take care of itself.
Tapering off very very gradually is the only way to go.
Sincerely, Terra G.
i love that my anti-spam word is “toast.”
HA.
that’s what i am on effexor. toast.
after reading about other’s experiences…i’m off this crap for good.