Venlafaxine - Venlaxafine - 7 weeks in and wondering whether to increase fro. 150?
Question posted by SallyCinnamon7 on 14 Jan 2023
Last updated on 11 June 2023
I’ve just completed a 6 week cross taper from 200mg (Max Dose) Sertraline to Venlafaxine ER. The Sertraline stopped working after 16 great years and anxiety and depression returned. I have now been on Ven a total of 7 weeks (3 *75, 2 *112.5 and 2 * 150). I’ve just completed cross taper from 200 Sertraline (max dose). For some weeks now, I have the feeling that you are on the cusp of serotonin filling your brain and feeling better but it stays on the verge and then goes back to feeling bad again. Like you are on the cusp of recovery. It’s so frustrating as it’s almost taunting you about how you could feel if recovered.
I’m wondering that 150 might not be enough given I was on max Sertraline dose but trying to wait it out before increasing again. Looking for advice from people who have recovered on Venlafaxine and also those who gave cross tapered? Thanks.
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Answers
WI
WildcatVet
14 Jan 2023
Sally, if it were me I'd give it a little more time for two reasons. Your metabolism has gone through a lot in these past few weeks and may need to settle into this new routine. Also, although you've been on the medication for a while it usually takes several weeks after an increase for the drug to become fully effective. It sounds like you're in the "roller coaster" phase where you feel improvements and then... BAM... it feels like you're back to square one. It is frustrating but it really just means your system is still adjusting and many people experience this. The recommended maximum daily dosage is 200mg/day so you have plenty of room for an increase if you need it. Talk to your doctor and the two of you can decide what to do at this point.
Votes: +2
SA
SallyCinnamon7
14 Jan 2023
Thanks Wildcat. I was hoping you were still active on here as your advice is always wise. I’m on the Extended Release so I think the maximum dose is 225mg if I’m not mistaken. I know you can go up higher for treatment resistant depression if agreed with a Psych. I will hold on 150 a little longer. The key issue I have is I also suffer from SIBO ( Small Intestine Bacterial Overgrowth) that impacts drug absorption and mechanism and ultimately impacts mental health so it’s a vicious circle. I think the SIBO was induced by long term antidepressant use so I’m sort of stuck in a situation that the medication that is helping me is also driving a root cause. Psych and Gastro consultant agree that my theory may well be correct but they just don’t know enough about the gut brain axis at the moment to give a satisfying diagnosis and resolution. Venlafaxine was a throw of the dice to see if it would change things up. I’ve already stopped drinking alcohol, given up smoking, improved my diet, gentle exercise and yoga but nothing has resolved so far :(
WI
WildcatVet
16 Jan 2023
Thank you! Are you feeling any better?
SA
SallyCinnamon7
16 Jan 2023
The same really. Just got to be patient but so hard when you’re feeling crap. I’ve been drinking ‘TRIP’ (CBD drink) that takes the edge off the anxiety. It definitely helps a little. GP won’t prescribe Diazepam and has asked me to use Promethazine (antihistamine) but I get enough antihistamine from the 15mg Mirtazapine as it is :)
SA
SallyCinnamon7
16 Jan 2023
The same really. Just got to be patient but so hard when you’re feeling crap. I’ve been drinking ‘TRIP’ (CBD drink) that takes the edge off the anxiety. It definitely helps a little. GP won’t prescribe Diazepam and has asked me to use Promethazine (antihistamine) but I get enough antihistamine from the 15mg Mirtazapine as it is :)
SA
SallyCinnamon7
16 Jan 2023
The same really. Just got to be patient but so hard when you’re feeling crap. I’ve been drinking ‘TRIP’ (CBD drink) that takes the edge off the anxiety. It definitely helps a little. GP won’t prescribe Diazepam and has asked me to use Promethazine (antihistamine) but I get enough antihistamine from the 15mg Mirtazapine as it is :)
WI
WildcatVet
17 Jan 2023
When did you start taking the mirtazapine? For sleep or depression/anxiety? BTW, congrats on the changes you've made in your lifestyle!
SA
SallyCinnamon7
18 Jan 2023
Been on mirtazapine for 3 years as it was added to the Sertraline when it pooped out initially 3 years ago. If you remember, i'd spent the last few years experimenting with dose combinations between these 2 to try and get them to work
SA
SallyCinnamon7
18 Jan 2023
Been on mirtazapine for 3 years as it was added to the Sertraline when it pooped out initially 3 years ago. If you remember, i'd spent the last few years experimenting with dose combinations between these 2 to try and get them to work
WI
WildcatVet
18 Jan 2023
Hang in there! I spent many, many years sometimes feeling bad or just okay until we hit the combo cocktail I'm on now and I feel really great. Good luck on your journey to health!
SA
SallyCinnamon7
18 Jan 2023
Thanks. Glad to hear you're feeling great :)
WI
WildcatVet
18 Jan 2023
You could post an update in a couple of weeks if you want. :)
EN
EndTheSuffering
26 Jan 2023
Hi Sally! I’m in the same boat. Been taking the XR version of venlafaxine for about 6 weeks and was wondering the same. Am currently at 150mg/daily & was considering bumping it up again. I think I’ll follow WildCat’s advice and hold on a few more weeks as well.
Looking forward to an update on your status in a few weeks.
Be well!
SA
SallyCinnamon7
26 Jan 2023
Hello End the Suffering. Hope you're feeling better soon. I spoke with my GP and agreed to bump up to 187.5mg 2 days ago. Going to hold on this dose now for as long as possible. I'm definitely better than i was on the Sertraline but still not great. Need to be patient now on 187.5 and give it a few months to stabalise.
SA
SallyCinnamon7
2 Feb 2023
Update on 10 days in on 187.5mg and marginally better. Getting considerable hours in the day of feeling like i'm on the cusp of my brain going nice but never quite happens and then sinks back down again and i feel cold, jittery and depressed. It's like recovery is trying to break through but can't manage it. So tempted to sod it and increase up to 225 but just got to hang in there and hopefully it will start to snowball in next few weeks. It's like torture as it feels so tantalisingly close.
WI
WildcatVet
7 Feb 2023
I'm sorry this is so frustrating for you... I know... I've been there. So, 2 weeks at the higher dose and marginal improvement? Maybe try to wait it out a bit longer like you said but I wonder if you're going to have to go up to the max eventually. It makes it so much harder if you're resistant to these medications. Wishing you the best of luck!
SA
SallyCinnamon7
9 Feb 2023
I spoke with GP and have started on 225mg this morning. Going to give it long enough to justify an improvement. If i'm not feeling any better after 4-6 weeks on 225mg then my SIBO condition must be impacting the medication absorption. If 200mg Sertraline and then 225mg Venlaxafine both don't work then surely it can't be a coincidence?
SA
SallyCinnamon7
29 March 2023
Hi WildcatVet, updated status and some questions. I switched to 225mg Venlafaxine on 9th Feb, so approaching my 7th week. Still feeling very bad, depression and anxiety. Different symptoms every day from brain fog, head pressure, anxiety, low mood, rumination. I just want to break out of this vicious cycle and be myself again. I thought i would start to be feeling better by now on 225mg. I can't help thinking that my SIBO (Small Intestine Bacterial Overgrowth) is either impacting my ability to metabolise Serotonin or the absorption and metabolism of the venlafaxine. I have no appetite and just feel ill every day. When to see my GP on Friday as i was so desperate and there only advise was to go back and see the gastroenteroligist.
WI
WildcatVet
6 April 2023
I'm sorry I haven't been able to respond sooner... I'm in the middle of a major move across the country. I really have to wonder what's going on, whether it's the medication which certainly should be working by now or whether it's due to your physical condition. Whatever it is I hope you can get some relief somehow! Maybe things have improved since you last wrote???
SA
SallyCinnamon7
10 June 2023
Hi WildCatVet, Psych recommended 150mg and Mirtazapine 30mg. Been on this dose for 3 months but getting really high heart rate which I assume is due to the norepinephrine impact of both these combinations. I’m still getting bad head pressure from the Venlafaxine so I’m thinking that I should try and come off it slowly and either go back to Sertraline or try something else. I’ve given Venlafaxine a good 6 months and I just don’t think it agrees with me. Just want to feel normal again. So hopeless at the moment.
WI
WildcatVet
11 June 2023
If the tachycardia is due to the venlafaxine or the mirtazapine... it's common with venlafaxine and rarely seen with mirtazapine. The Interactions Checker doesn't list it as a side effect of the combination. You've given this much more than a fair trial so it's time to consider a different option. Be sure to get the reducing schedule from your doctor and discuss what to try next. Unfortunately, everyone responds differently and so prescribing is somewhat of a guessing game. Many people have to try several different medications before they find the the most effective one with the fewest (if any) side effects. But, as I said, this really has been going on too long. Time for a different treatment plan! As tough as it's been for you try to think positively. Don't give up... you will get relief and not to have to suffer.
