I’m not sure who these doctors are that do not provide a side effect list or discuss pros and cons of stating medications. I would usually say something like if you plan to discontinue the medication please let me know so we can work together to taper off appropriately. The SNRIs are good medications slightly more effective than SSRIs. They can be more difficult to tapper off the way to avoid this is use the extended release formulation. Hope this helps. If you haven’t subscribed to the channel please do and spread the word about what we are doing.

​​@@ShrinksInSneakers Hi, The effexor xr half life is 4 hours. Interdose withdrawl every day and iatragenic injury from effexor is horrendous. That's why many people can't drive on this stuff, miss your dose you may run off the road. That's why people can't get off of it because so many committ suicide. It needs to come in smaller dosages as well. Ive been counting beads for years. I developed noradrenaline mediated withdrawl syndrome.

This is the worst antidepressant so far when it comes for withdrawal, period!... Even stopping from 37.5 mg extended-release gives literal nightmares, brain zaps, vertigo etc... I had to then take 37.5 mg IR once daily for 10 days, and then reduced it to 18.75 mg IR once daily, and then reduced to 9.375 mg IR once daily... EVEN THEN, it gave withdrawal symptoms! Better never to use this drug at all!

@@dianemorrell9638 I hate this drug & I hate that it’s legal.

@@jjj5918 Start Tricyclic antidepressant alongwith the withdrawal, you'll be fine

The term comes from Steven Stahl who was practicing in California when he first started using the combination. The theory is that patients should have increased energy from all the norepinephrine. Thanks for the comment, I’m happy to answer additional questions

Hello Aileen, did you experience weight gain from this combination?

@@dianamonicamanta9289 Hi, Sadly I saw significant weight gain. 30 lbs+ But I went on Abilify and Lithium about the same time so it's hard to judge what contributed most.

All generic medications should meet a standard set by the FDA for bioequivalence. They must demonstrate that they work at least as well as the brand medication. Now there have been cases of faulty extended-release mechanisms in generic bupropion causing dumping, I have I video explaining this. In general, I use generic medications because many community mental health patients cannot afford brand name drugs and I want to be mindful of all aspects of medication prescribing including cost. If you feel the same with the various generic brands its likely a good sign that they are equivalent. The reason for suggesting Venlafaxine be taken with food is to prevent nausea it is not required for absorption like other medication e.g. lurasidone or ziprasidone. Hope this helps, I appreciate the comment

It's reasonable to try a medication in another class for example SNRI if there was not response to an adequate treatment trial of an SSRI. Hope this helps

This is not medical advice, and you need to talk to your doctor before making any changes to medical treatments. I'm not a big fan of adding antidepressant to anyone with a history of bipolar disorder especially those who have a history of mania induced by antidepressants. There are multiple schools of thought on this but some believe antidepressants in bipolar disorder are mood destabilizing and can result is rapid cycling and overall worse outcomes. I personally never prescribe them unless someone is already on and titrated appropriately with a mood stabilizing medication, but that's just me and like I said others will have their opinions on this. Hope this helps

I think before you get into the medications it sounds like the diagnosis has to be cleared up. The treatment for all these disorders is very different, so that is where I would start when you talk with your doctor. Trintellix does not work and is not approved for anxiety or PTSD, see my video on it where I talk about this in detail. Sexual side effects are possible with effexor. I think its best to sit down with your doctor and have a good discussion. Hope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here.

A slower taper is a always a good idea

Pristiq is the active metabolite that I talked about in this video O-desmethylvenlafaxine which forms when venlafaxine is metabolized by CYP 2D6 in the liver. It does have greater inhibition of the norepinephrine transporter compared to venlafaxine. It still has the same issues with withdrawal syndrome and higher risk of death in overdose. Other options include Cymbalta. We need to make a video on Pristiq to talk about some of the differences. I appreciate the comment and I'm happy to answer other questions

It depends on the medication in the case of duloxetine it theoretically starts blocking norepinephrine at lower doses than venlafaxine. Venlafaxine is unique in the need to increase to 225 mg/day or better to get the full norepinephrine effect. From a clinical standpoint I don’t think there is much difference in antidepressant effects.

There are really not selective, a better term for them is just a serotonin reuptake inhibitor. The most selective of the SRIs is escitalopram but again clinically I do not think there is much difference in efficacy.

Tricyclics fell out of favor mostly because of the side effect profile. You could just use a tricyclic in place of venlafaxine, combining them would be a little dangerous. I made a video on older medication being more effective and newer medications having less efficacy but a better side effect profile. Honestly the most effective antidepressants we have are monoamine oxidase inhibitors which target serotonin, norepinephrine, and dopamine, but again the side effects and special dietary requirements (avoiding tyramine containing foods) limit the use.

I would move to tricyclics in a patient who has failed multiple trials of SSRIs and SNRIs and does not want to do TMS, ECT, or ketamine. You could start amitriptyline in a patient who understands the risks and side effects and has no history of existing cardiovascular disease. You should get an EKG prior to starting just to be safe. I would start with monotherapy with an SRI and titrate to an effective dose, if that doesn’t work a switch to SNRI would be a good second option, after that you can start looking at augmentation strategies like adding bupropion or mirtazapine. It will be on a case by case basis and patients preference for treatment.

@@ShrinksInSneakers Thanks, I will gladly watch the other videos! This channel is much more informative than university, lol. What literature do you read? I really like Stephen stahls books

We can do this

At least another week, but this is a low dose and may require adjustment by our doctor to maximize the potential benefits. Hope this helps best of luck with treatment

Thanks for the reply. What would be the best dose for anxiety/depression? I have never suffered anything like this before. Was put on 45mg Mirtazapine but my doctor also added 75mg of venlaflaxine 4 weeks ago now. I feel it’s working but how will I know if I need to go a bit higher? What is the best therapeutic dose to rid myself of this condition. A couple of my friends are on it and they do well on 75mg. Thanks

@@ShrinksInSneakers I just started Effexor and Kolonopin how long will I be allowed to be on Kolonopin?

Medication is not always the answer, I hope you found something that fits your life

I really cannot tell you what to do, you need to talk with your doctor about the plan and ask about the medication choice. What i can say in general is antidepressants are mood destablizers for most patients. Not to say they are never used in bipolar diagnosis but they are certainly not first line. When I treat bipolar disorder with medication the focus is on starting a mood stabilizing medication like lithium, valproate, carbamazepine, or lamotrigine. If these options cannot be used second generation dopamine blocking medications are also approved for bipolar disorder. Many times people do well on a mood stabilizer alone without the need for an antidepressant, but like I said talk with you doctor about the situation

@@ShrinksInSneakers thank you for your response!

I have the same fear for this product , did u start taking it ? how did it go ?

Yes, the withdrawal syndrome is known to be more severe with this medication. What you described here is consistent with this, usually we will restart the medication and tapper it very slowly or use a medication with a long half life like fluoxetine. please talk with your doctor about options, hope this helps and I appreciate the comment

I've been on 75mg venlafaxine XL (the once per day pill) for 3 years for depression/anxiety. When I first started taking it, I didn't feel any relief of symptoms until around 4-6 weeks of taking it. It's a good medication although it takes ages to start working when you first start taking it. I'm able to get by at 75mg daily, but some people need to increase the dose if there's not enough relief of symptoms. The only 2 other antidepressants I've been on are citalopram (which was useless for me at every dose), and deluxotine (it worked for depression although I had excessive anxiety and neusea as a side effect which made deluxotine intolerable).

@@dbrown8191 hey thanks for sharing your experience. I'm on the slow release tablets once per day, I normally take in morning so I can sleep at night. That's over 3 weeks I have been on them. I feel kinda OK but will keep with them for another couple weeks. How where you/are you with the sleep aspect of them?

​@@GLA1888 That's no problem. it took 4-6 weeks before I felt any relief of symptoms, so it sounds like you're doing good for over 3 weeks. If I take venlafaxine at night, I get bad insomnia, whereas I'm OK if I take venlafaxine in the morning. If I'm naturally worrying about things at night, it can affect my quality of sleep although I guess that's only natural. To try and elaborate, years ago I used to be on a high dose of venlafaxine (300mg at one point), but I was a complete zombie at high doses (I didn't feel happiness/sadness or anything). I've tried to be completely without medication a few times, but I can't do it, so that's why I try to get by on the least amount that works for me now. I sometimes wish that my venlafaxine were a bit stronger than 75mg because the stronger it is, the more releif you get (but unfortunately also, the more side effects you get), but I've never reached the point of requesting it be increased this time around. I do get occasional sadness at 75mg but never depression, although knowing when situations make me feel sad is important to me. When I'm not on medication, my anxiety is off the chart, but 75mg mops most of my anxiety up. Although the emotional feelings of anxiety are somewhat numbed at 75mg, I still sometimes get physical symptoms of anxiety such as nausea and my hands occasionally shaking, but I don't remember that ever going away when I was on higher doses of venlafaxine in the past. I remember increased numbing of emotions as the dose goes up, which can be a good thing (if someone needs it).

37.5mg does wonders for me but did take 3-4 weeks to kick in.

Awesome glad you found a good medication that helps

It depends on the diagnosis and what you are treating. There are many options for depression treatment if that is the case.

Vilazodone is really good. You should definitely try it.

My APRN dropped my Venlaflaxine from 75 mg. To 37.5 I at the same time she added Pristiq 50 mg and I’ve been in bed for a week and I’ve been quite agitated and anxious

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it's known as the medication with the worst withdrawal syndrome. At 225 mg and able the norepinephrine effects are significantly higher. Interestingly it seems that 150 mg/day is a good dose where the side effects are less and the efficacy is good.

​@@ShrinksInSneakersI started Venlafaxine 1 and a half weeks ago, I feel terrible sleep, I keep yawning all the time, feeling tired, headache, hand tremors

Good luck tapering off.

@@jjj5918 wasn’t bad, done it twice

You will know after what Effexor will do to your brain🤣🤣🤣🤣🤣

@@hassan....6518 huh? been off a while I’m fine

This is not medical advice anything written here is intended for educational purposes only. 225 mg is the dose where we start to see norepinephrine activity at lower doses it’s primarily a serotonin reuptake inhibitor. I’m glad you had success with the dose and medication. I appreciate the comment

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Hypertension and preexisting cardiovascular disease are good reasons to start with other options prior to using an SNRI. There is some evidence that venlafaxine is more dangerous in overdose as well because of the cardiovascular complications. Appreciate the comment, if you haven't subscribed to the channel please do, and spread the word about what we are doing here.

@@ShrinksInSneakers Okay,i clearly need a online consultation whit you.Is ot posible ? I have ben on almost all SSRI but the isue is sexual problems!! Right now trying to lowet my Lexapro dosage on 5mg.Is low dose of ssri like microdoaing lsd effective ? And is some cine new antianxiety drug coming Greetings for Latvia, Iam Phyiseotherapist

it's hard to get off of due to withdrawal syndrome, it's more risky in overdose, and it's not much better than other options. it's not a first line option in my practice