Re:effexor - Keri

[Guest guest]

Keri,

I have a friend who was put on effexor to stop, of all things, hot flashes.

She says it's working great. What are the side effects you mention of

stopping it?

Suzanne

[Guest guest]

I had been put on Effexor 2 different times. It is a wonderful

antidepressant, absolutely wonderful. My husband (who has RA) is also

on it. Both times that I went off of it I had side effects of " waves "

in my head. My husband has noticed this also if he forgets to take it

for a couple of days. The waves are an extreme dizzy feeling. As long

as you can stay in bed for a couple of weeks you are okay. It gets

progressively worse the first week then it slowly tapers off. My Dr.

said that no one else has mentioned this to her but my husband and

myself both have experienced this. If you can make it through this,

it is a wonderful drug! Tell your friend I wish her luck.

Keri in MI

> Keri,

>

> I have a friend who was put on effexor to stop, of all things, hot

flashes.

> She says it's working great. What are the side effects you mention

of

> stopping it?

>

> Suzanne

[Guest guest]

Keri,

You are not the only one that has complained of these feelings when

withdrawing from effexor.

It's been referred to as ³brain shivers.²

Brain Shivers

http://depression.about.com/library/weekly/aa052598.htm

There is a side effect registry at:

http://www.priory.com/sideven.htm

You can read what others say and register your side effect. There are

numerous web sites about the withdrawal side effects. It is well

documented.

Here are a few abstracts. There are many more to be found. I'm very

concerned about the safety versus benefits of the entire classification of

SSRI drugs. I'm not sure they know enough about serotonin to be messing

around with it.

Withdrawal reactions associated with venlafaxine.

G, Blennerhassett J.

University of New South Wales, Sydney, Australia.

OBJECTIVE: The aim of this paper is to describe discontinuation syndromes

associated with abrupt and tapered withdrawal fo venlafaxine, and to

document that withdrawal symptoms may occur after missing a single dose.

CLINICAL PICTURE: We report on two patients prescribed venlafaxine. One

developed a broad range of serious side effects after reaching a dose of 300

mg a day, and a severe withdrawal syndrome (including hallucinations) during

a slow taper regime. The second had severe discontinuation symptoms during

and aborting a slow taper regime, and described withdrawal responses after

missing a single dose of venlafaxine. CONCLUSIONS: As for the short-acting

selective serotonin re-uptake inhibitors, severe discontinuation reactions

may occur with venlafaxine, seemingly marked most distinctly by headache,

nausea, fatigue, dizziness and dysphoria, and may make cessation of the drug

extremely difficult. Two strategies for addressing the concern are

considered.

PMID: 9588310 [PubMed - indexed for MEDLINE]

Antidepressants and the serotonin syndrome in general practice.

Mackay FJ, Dunn NR, Mann RD.

BACKGROUND: As a consequence of the greater use of agents affecting the

serotonergic system, a syndrome of serotonin hyperstimulation has been

recognized more frequently. The serotonin syndrome is characterized by a

constellation of symptoms that include mental status changes, agitation,

myoclonus, hyperreflexia, sweating, shivering, tremor, diarrhoea, lack of

coordination, and fever. Deaths have been reported. AIM: To identify cases

of the serotonin syndrome among patients prescribed a new antidepressant in

general practice, and to determine doctors' awareness of the syndrome.

METHOD: Patients who were dispensed nefazodone in England between 1996 and

1997 were identified using dispensed prescription data. Prescribing doctors

were sent questionnaires as part of a post-marketing surveillance study.

Patients reported to have experienced two or more features of the serotonin

syndrome were identified, and specific questionnaires were sent to their

general practitioners. RESULTS: There was a 96.2% return rate of serotonin

syndrome questionnaires. Nineteen cases met criteria for the syndrome

(incidence = 0.4 cases per 1000 patient-months of treatment with

nefazodone). Eight patients developed symptoms while taking nefazodone

alone. Serotonergic symptoms were reported to a similar degree with five

other antidepressants studied by the same method. In total, 85.4% of

responding general practitioners were unaware of the serotonin syndrome.

CONCLUSION: Improved awareness of the syndrome is needed within general

practice. There is a need to distinguish the relatively minor serotonergic

symptoms from those of a severe, life-threatening serotonin syndrome.

PMID: 10818650 [PubMed - indexed for MEDLINE]

BMJ 1998;317:787 ( 19 September )

Papers

Drug points

Withdrawal reaction associated with venlafaxine

H ,  W P Bouman,  J Lawton. 

Nottingham Healthcare NHS Trust, Wells Road Centre, Nottingham NG3 3AA

We report an apparent withdrawal reaction to venlafaxine, a recently

introduced serotonin noradrenaline reuptake inhibitor antidepressant whose

use is increasing.

A 42 year old man with a first episode of major depression was treated with

venlafaxine after unsuccessful trials with fluoxetine and imipramine. He

fully recovered over four weeks while taking a dose of 37.5 mg twice daily.

This dose was maintained for 6 months and his mental state was stable. The

dose was reduced to 37.5 mg once daily, which he tolerated well. However,

within 36 hours after stopping venlafaxine treatment he developed positional

vertigo, which caused him significant incapacity, in addition to nausea and

light headedness. The symptoms resolved rapidly on reintroduction of the

drug. The dose was reduced to 18.75 mg daily for three weeks and then

discontinued. He had ongoing symptoms of vertigo, which resolved slowly over

three weeks. The patient's determination enabled him to discontinue taking

the drug, but he did so with difficulty. He had no previous history of

adverse drug reactions or withdrawal symptoms.

Other antidepressants have been reported to have withdrawal syndromes.

Attention was drawn to withdrawal of tricyclic antidepressants by Dilsalver,

who showed that cholinergic and noradrenergic hypersensitivity were

important mechanisms for these symptoms.1 Selective serotonin reuptake

inhibitors, particularly paroxetine, also cause withdrawal syndromes,

possibly through adaptation to the effects of serotonin reuptake

inhibition.2 Withdrawal of venlafaxine may share a similar mechanism, and

its short half life (5 hours) may add to its potential to cause withdrawal

symptoms.

At the time of writing, three reports had been published about five similar

cases, but the patients in all five cases were taking higher doses of

venlafaxine before treatment was discontinued.3-5 The possibility of a

withdrawal reaction is mentioned in the manufacturer's data sheet, but it

implies that such reactions are observed with doses of 150 mg daily and

above. Given the possibility of a withdrawal reaction with low doses of

venlafaxine, we suggest that this drug is used with caution and that care is

taken to gradually taper any dose before discontinuing treatment.

References

1. Dilsalver SC. Withdrawal phenomena associated with antidepressant and

antipsychotic agents. Drug Safety 1994; 10: 103-114[Medline].

2. Coupland NJ, Bell CJ, Potokar JP. Serotonin reuptake inhibitor

withdrawal. J Clin Psychopharmacol 1996; 16: 356-362[Medline].

3. Louie AK, Lannon RA, Kirsch MA, TB. Venlafaxine withdrawal

reactions. Am J Psychiatry 1996; 153: 1652.

4. Farah A, Lauer TE. Possible venlafaxine withdrawal syndrome. Am J

Psychiatry 1996; 153: 576.

5. Benazzi F. Venlafaxine withdrawal symptoms. Can J Psychiatry 1996; 41:

487[Medline].

a

> I had been put on Effexor 2 different times. It is a wonderful

> antidepressant, absolutely wonderful. My husband (who has RA) is also

> on it. Both times that I went off of it I had side effects of " waves "

> in my head. My husband has noticed this also if he forgets to take it

> for a couple of days. The waves are an extreme dizzy feeling. As long

> as you can stay in bed for a couple of weeks you are okay. It gets

> progressively worse the first week then it slowly tapers off. My Dr.

> said that no one else has mentioned this to her but my husband and

> myself both have experienced this. If you can make it through this,

> it is a wonderful drug! Tell your friend I wish her luck.

> Keri in MI

>

>> Keri,

>>

>> I have a friend who was put on effexor to stop, of all things, hot

> flashes.

>> She says it's working great. What are the side effects you mention

> of

>> stopping it?

>>

>> Suzanne

>

>

>