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.
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.
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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Last reviewed: 15 May 2009