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Mental Health  (Expert Forum)
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Effexor XR
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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MedHelp Member's Question

Effexor XR

by guy-with-a-question, Oct 21, 2006 12:00AM
Hello,



I was diagnosed with Lyme and a co-infection about 2 years ago and was recently put on Effexor XR 150. I have been on it for about 2 months now and it has done wonders for me and my panic attacks and depression.



The big problem that I have is that it has caused me to lose an enourmous amount of weight. I saw my general doc. this week and he said that my weight loss was unacceptable. You see, I am pretty skinny as it is anyway. I do not have the weight to lose.I don't have any kind of eating disorder, it is just the illness that I have...



Anyway, he told me to give Paxil CR a try to see if I could stop the weight loss and possibly get some weight gain out of it. So he gave me a two week supply of 25mg's of Paxil to replace the Effexor XR. Now here is the real big concern that I have.



He told me to just switch over !!!



He said just start taking the Paxil in the place of the Effexor. I mentioned to him that I didn't think this was a very good idea but he told me that they do the same things in the brain so it was not a big deal. He said just switch.



Needless to say, I haven't exactly done that yet.



He didn't want me to taper off Effexor or lower my dosage at all. He just wants me to jump right on over to an unproven medication for me. I just do not feel comfortable doing this.



So would it be ok if I stepped my Effexor XR down to 75mg's a day and then added the 25 Paxil in with it ???



These are basically my options.



1. Do as the doc said and switch over with no weaning.



2. Taper down to 75 and then add 25 of Paxil.



3. Wean completely off Effexor and then start the Paxil.



I really do not want to do # 3 because Effexor is helping me out so much, minus the weight loss and night sweats of course.



I much rather like the idea of stepping down to 75 Effexor and then adding the Paxil, but is this acceptable ?  Or would this cause a bad reaction ?



Please, any help and answers will be greatly appreciated.



Also, he said that if the Paxil worked as well for me as the Effexor, then he would give me a script for it to replace the Effexor.



Thanks a lot !
Doctor's Answer

by Roger Gould, M.D., Oct 26, 2006 12:00AM
usually I tell people to listen and talk to their doctor, but in this case you might want to do what is comfortable for you and gradually reduce Effexor while starting Paxil.   Do it carefully and monitor how you feel, and talk to him or her along the way.
Member Comments (16)

by Jimmy1965, Oct 21, 2006 12:00AM
Hello,



This is my opinion but I dont think just switching over is a good idea. Right now my Doctor (psychiatrist)has me switching meds. I'm going from Zoloft to Lexapro and they are both SSRI medications. He wants me completely off of one before I start a new med. He believes this is because of side effects and withdrawal possibilities from these meds. In other words say for example you have withdrawal effects from Effexor XR as your coming off of it and you start Paxil and the Paxil causes you to have side effects. You are going to have a hard time figuring out what is what. I think it is safer to Slowly taper off of Effexor XR then you should find out what the half life of Effexor is. Meaning how long dose it take to get completely out of your system after you take you last dose. Once it's out of your system then Start the Paxil. I dealing with some Withdrawal symptoms after coming off of Zoloft and I personally want these to be gone before I start another SSRI and I tapered off of the Zoloft very slowly.  Another thing is to maybe talk to your doctor about giving you a small dose of a benzo to take if needed while you are coming off of one med and starting a new one.

by amythist2779, Oct 21, 2006 12:00AM
To: guy-with-a-question
If I were you I WOULD NOT just switch over. I was on effexor awhile back and lost some weight too, but then I started to get really bad sweats from it so they switched me to cymbalta. I didn't do this gradually, I stopped effexor cold turkey, and it was hell. I had wicked dreams that would wake me up. I also felt like I was being shocked from the inside out. I could not sleep or concentrate. I looked like **** because I had no rest what so ever. My family thought I was doing meth because I looked so 'strung out'. My head would get these massive volts, it was weird. This lasted for about 3 weeks until it was out of my system. If I would have known the withdrawl effects of effexor, I would have weaned myself off of it.



Like I said I now take cymbalta and its helped a great deal. I also have fibromyalgia and it has helped with some of hte pain that I also live with daily. I have never tried paxil so I can not give you any advice on it. Either way I hope you make the right decision. If you decide to quit cold turkey though, be prepared for the withdrawl effects, they suck!

by imcrazy2, Oct 22, 2006 12:00AM
My doc just switched me from paxilCR to effexor, and said the same thing--just stop the paxil one day, and start the effexor the next day.  I think it has to do with the specific meds which ones you are switching between, and their half-life.  I do agree with Jimmy about one thing, and that is having trouble distinguishing between withdrawl from one or side effects from the other if they overlap.  HOWEVER, I think that people who suggest waiting until one med is completely out of your system before introducing another have NO idea what life is like for those of us who NEED medication to function like a normal person.  I have panic disorder SO BAD that I will probably never try to live without medication (there's no shame in that, btw).  If I waited for one to be out of my system, I would be in the hospital coming out of my skin!

I stopped the paxil 2 days ago, and just took my 2nd dose of effexor XR75.  Will keep you posted on any withdwawl symptoms.  

I am curious to see what the doc posts as a response, here.....tapering is usually good, but you do have to watch for seratonin syndrome since they metabolize at different rates.  From what I understand, Effexor's half-life is the shortest, and then comes Paxil, so hopefully you will be ok.  Good luck, and let us know!

by guy-with-a-question, Oct 24, 2006 12:00AM
I'd like to thank everyone for the responses.



I am slowly tapering my Effexor dose down to 75mg's.





I believe I may try to wean off completely or just do the jump like my doctor suggested. I'll make up my mind in a few days I guess.



I still don't like the idea of it all. I was doing pretty good on the 150 of Effexor. If it just hadn't made me lose so much weight and the sweating at night.







Anyway, I was wondering if a forum doctor would respond to my original question ?





Is it typical for a forum Doc to respond ?   Or should I just use my own good judgement here ?

by imcrazy2, Oct 24, 2006 12:00AM
To: guy
The doc should respond soon....seems like it can take a few days, but he should.......hang in there. I think (and this is my non-qualified opinion ;) ) that if you feel comfortable tapering your Effexor down to 75, you should try it, but be aware of the side effects of withdrawl---it sounds like they can be AWFUL.  If you get any withdrawl symptoms, then you should probably either just start the Paxil, which should stop the withdrawl, or bump back up to 150 Effexor.  Once you start the Paxil, you should stop the Effexor, since too much medicine can cause seratonin syndrome.  It probably wouldn't be a bad idea to call your doc & tell him that you are having some anxiety with the switch, and need a script for a benzo, even if you aren't having any anxiety, that way if you do have a panic attack, you have something on hand to take.  (Ativan, Xanax, Klonopin, etc).

I just switched the other way, hopefully Effexor will help me lose the 50lbs I gained on Paxil!!  (Well, to be fair, much of that was probably from 2 pregnancies, but whatever!)

by canuckmom, Nov 05, 2006 12:00AM
Hi there! I am so happy to come across this site. I have been on effexor 150mg for about 18months for anxiety. It really seemed to help, though I always still worried about my health because I still have this one "crutch" that I can not seem to break - quitting smoking. I have 2 children and worry all the time that I will not be here for them. So my doctor prescribed Wellbutrin for the Zyban part of it. I have been off effexor for abut 5 days and on the Wellburtin. My dr told me nothing about the withdrawals at all! I figured I was just going from one to the other. I have been having the "zapped" feeling constantly, nausea, etc. The upside is that I do not feel the urge to have a cigarette as much and when I do give in to the craving it tastes so much like **** that I never finish a whole one - that is the part that amazes me. I have an appt with my dr tomorrow morning to "blast" him for not telling me this, and to make sure that this is all it is - withdrawal symptoms. If this gets any worse, I don't know what I'll do. I still have a life to live, 2 active busy kids to raise. Thank goodness my husband is very supportive, though he is less than impressed with dr because of this, and may come with me tomorrow. I guess I am just writing here to thank you for all this information and so happy I am to know that I am not alone and this is normal withdrawal symptoms.

by Jillopop, Nov 07, 2006 12:00AM
It was so great to be able to come on here and find out there are other people going through what I am.  I'm a stay at home Mom of a 3 year old and since deciding to try for #2, my husband and I thought it would be safest to be med free during my pregnancy, since the effects of Effexor in pregnancy has not really been studied.  I took 75mg of Effexor XR for a little over a year for general anxiety.  I have been weaning for almost 3 months as gradually as I could.  My last weaning was for almost a month at 18.5mg.  I was going to do that a little longer, but started getting daily headaches and heartburn (which I never get), so I stopped it altogether.  The brain shocks happened for a couple days after and the heartburn completely stopped.  I felt nauseous for about 4 days and felt like I was on a merry-go-round dizzy.  Of course, since the daylight savings time change, my son has been waking up at 5:30am(two hours earlier than usual) and I am not getting enough sleep. I have been still feeling really out of it, really tired and no patience,kind of like I'm not really "present" and this bothers me since I'm the primary caregiver for my 3 year old son.  I have also felt like crying the past 2 days for no reason at all. I just wanted to share though that I take yoga 3 times a week and walk the other 4 days of the week and have really been trying to eat a perfect diet, well balanced, plenty of protein, a multivitamin, plenty of water, and absolutely NO caffeine or sugar, and I truly think all of that has been helping me to stay strong mentally while coming off...just wanted to share my experience.  I'll try to come back on and give an update!

by imcrazy2, Nov 09, 2006 12:00AM
To: jillopop
Hats off to you trying to go med-free for your anticipated pregnancy.  Please keep in mind, though, that a mentally stable, and emotionally healthy mom is just as important as a physically healthy one. There are safe alternatives to effexor for use during pregnancy--most notably prozac.  I switched to prozac from paxil for two pregnancies after HORRIBLE relapses following attempts at total withdrawl, and have two healthy, happy daughters.  I truly hope that you are able to accomplish your goal of going med-free, BUT do not forget that there are options if you do start feeling rough. PS....congrats on the decision to expand your family!!!!!