Adventures with Benzodiazepines and SSRIs

[AmZ]

Thanks for the info Steve.

It's still a bit like another language to me (!), but starting to understand more. I literally saw it being called an NRI, so makes sense as to the way you describe it etc.

I haven't been able to find much information on it, in terms of people's experiences, but maybe that's a good thing anyway!? Somehow feel like a guinea pig or something haha, but I know it is approved in more than 50 countries and also in the UK, which is useful as long as my plans today go accordingly, at least I will be in country in which it is being used and approved, so can fully get any advice etc I may need there about it.

Hoping it'll be good for me

---------- Post added at 09:06 AM ---------- Previous post was at 08:45 AM ----------

Did anyone read that it is used for anxiety also?
(I hope it works for that also!!)

 

[David Baxter PhD]

Yes it does. In effect, all of the newer serotonin and/or norepinephrine reuptake inhibitors are effective with both depression and anxiety disorders.

 

[AmZ]

Thanks DR. Great.

Well, so far, so good. My psychiatrist has said that he can give me a months worth of the new medication tomorrow morning before I fly back to England. Just need to get my boss' permission at work and book my ticket, and should be good to go...

---------- Post added at 12:10 PM ---------- Previous post was at 11:09 AM ----------

O well, my boss said no. Says I need to wait until next week until a few things are sorted out at work and I can go.
I'll have to do it the other way around. Start taking the medication tomorrow and hope all will go OK with that, try to be around people the most I can until the beginning of next week and then hopefully I'll be OK at the beginning of next week to book my flight and be back in England mid-next week.

 

[Retired]

Thanks DR. Great

We call him that too!...

 

[AmZ]

Haha.

Dr David Baxter The Great.

Wish I had a Dr D.B The Great here in Israel

 

[AmZ]

Had the worst day of them all... But keeping positive.
After a night full of bad dreams, I woke up this morning with a heap of emotions like I've never had before and just ended up crying and crying uncontrollably.
If I've gone from feeling no emotions and/or feelings/knowing what is going on in my head to now this, then I can only see it as a positive thing I hope.

Went to the psychiatrist. He's put me on Effexor (75mg, half a tablet for the first 4 days, and after a month or so go up to 150mg if all goes to plan) - so an SNRI. I asked about the whole issue of mine where the serotonin adjustment for me was a problem, but for whatever reason, he's decided that I should give this a go, and as a last resort to try Reboxetine. I know it's his decision that was made so I am going with it, but would be interesting to hear if anyone can see the pros in trying this med or perhaps if it's a known thing that maybe some people can tolerate SNRI's a lot better than SSRI's? (Even though the SNRI still does half of what the SSRI does so I would wonder why someone could still tolerate it in an SNRI).

Thanks.

 

[Retired]

He's put me on Effexor

Many people have found they can tolerate Effexor quite well. It was one of the more recent (in relevant terms) additions to the antidepressant arsenal (circa 1995) when the technology of targeting was more developed than with the earlier SSRI's. There are many reasons, from the way this medication targets its receptors to the way it is metabolized in the system, that contribute to why this particular medication is well tolerated by so many.

The gradual increase in dosage is sensible, and after the first four days on half the dose, if you happen to experience any adverse effects, don't hesitate to call your doctor to ask if you can extend the half dose a bit longer until you fully adapt to the Effexor.

Many people find relief of symptoms at the 75 mg dosage level, but some require the increase as your doctor has suggested.

Hopefully this one will be the right one for you, and as you have experienced, it can take a few tries with various medications at different dosages to find the one that is right for your particular body chemistry. It's just the nature of this kind of treatment in today's understanding of the treatment of the illness.

maybe some people can tolerate SNRI's a lot better than SSRI's?

There are numerous studies indicating Effexor is better tolerated than SSRI's with which it was compared, probably because it is said to target receptors more effectively without affecting receptors responsible for the common side effects seen with other SSRI's. However individual response can very, which is why you need to keep in close communication with your doctor. Most common is nausea that tends to subside after about ten days; however since you have already had exposure to a previous SSRI, this timeframe may be less if you experience any nausea at all.

You are to be commended for your tenacity and your courage in following through with your doctors. Your hard work should pay off in the long run when the right medication is found for you, when hopefully the symptoms should begin to subside.

 

[AmZ]

Thank you Steve as always for your share of knowledge and help!
I also very much appreciate you commending me and for your positive words of support

The gradual increase in dosage is sensible, and after the first four days on half the dose, if you happen to experience any adverse effects, don't hesitate to call your doctor to ask if you can extend the half dose a bit longer until you fully adapt to the Effexor.

Yes, I'm going to see how I am on the half dosage for 4 days. I may even ask if I can stay on the half dosage for 7 days, as I'd prefer to raise the dosage once I am in England already on the day I arrive there, rather than take it a couple of days before I go and maybe (of course, only maybe) have adverse side effects which could happen... Just want to make sure that I'll be feeling fine for traveling. (Last time I was on the first SSRI and I doubled the dosage, it totally messed me up and was being sick and feeling awful!) I'm pretty sure I read about this anyway, that with this med, (and all of these types in general) you double the dosage at a minimum of every 4 days up to 7 days. But will confirm with my psychiatrist that this is OK.

I started on the 37.5mg yesterday 2pm or so and now it's 8am the next day. I know from previous experience, that it can take longer for the side effects to show up, but so far so good. I slept very well also, 8 hours (with a small wake up at my usual 5am time slot lol), which I haven't done in many weeks. Maybe it's just because my anxiety levels are lower/my mind was more at rest for some reason.

Shall see how it goes but feeling absolutely fine so far.

 

[Retired]

Maybe it's just because my anxiety levels are lower/my mind was more at rest for some reason.

Or maybe it's because you might be tolerating Effexor better than the others and that you may have the medication that is right for you!

I may even ask if I can stay on the half dosage for 7 days, as I'd prefer to raise the dosage once I am in England

I agrre this might be a wise choice. Increasing the dose of medication at the same time as having to travel may just be a bit too much to deal with. If you are still taking the Ativan (lorazepam) you may ask the doctor about using it before boarding the flight (about two hours prior for maximum benefit) to help relieve the stress of the airport, and all its related intrigue.

Your initial reports are encouiraging, and our hope is that you will continue doing well with the new medication and that you might also find relief of your symptoms.

 

[AmZ]

Thanks Steve.

Or maybe it's because you might be tolerating Effexor better than the others and that you may have the medication that is right for you!

I don't want to tempt fate, but so far, so good. I took the first dosage Wednesday at 2pm, second dosage at 2pm today, and now it's 8pm and the only side effects I've had is now an ever such slight pressure headache in my temples and my eyes are feeling rather 'open' (!) and pupils are rather dilated. But that's it.

I doubt that the Effexor can work that quickly, but it's weird how good I slept and today I woke up with so much energy and 'get-up-and-go' and all day, I had a ton of energy from the moment I woke up (that I have never had before) and my head has felt clearer and I've been feeling very relaxed all day. I only took 0.5mg of Lorazepam also this morning instead of 1mg which may have affected me feeling less sleepy at work, but generally, I feel a lot different today, and I really don't think it's because I'm having a 'good day' because it was just like any other day and nothing different.

Can it really start to work that quickly? Maybe it's because I had already had the 9 days on the SSRI's? (But I guess a lot of that didn't stay in my system nor can it still be in my system much?)

I agrre this might be a wise choice. Increasing the dose of medication at the same time as having to travel may just be a bit too much to deal with.

Yeah, I'm definitely going to do that. It will mean that I would be on 37.5mg for 8 days and on the 9th go up to 75mg. I guess it's not a big deal really.... Unless I am missing something here?

If you are still taking the Ativan (lorazepam) you may ask the doctor about using it before boarding the flight (about two hours prior for maximum benefit) to help relieve the stress of the airport, and all its related intrigue.

Good thinking batman... I generally don't feel so anxious in situations, like if I miss my bus for example, it's more when something just creeps in to my mind and gets me going or if someone says something to me connected to life matters that make me anxious! But I will still, just to cover myself, take a 1mg before I leave home for the airport, and maybe have another half along the way later on if needs be

Your initial reports are encouiraging, and our hope is that you will continue doing well with the new medication and that you might also find relief of your symptoms.

They certainly are encouraging. Thank you. Like I said, I don't want to tempt fate, but I first took the med on Wednesday afternoon and now it's Thursday night... and hardly any side effects whatsoever. Maybe I can expect some after my next dose more or the next or at least of course when I raise the dosage, but all good for now.

 

[Retired]

The way this particular medication is metabolized, the so called steady state blood level, the point at which the amount of medication being absorbed equals the amount being eliminated is about three to four days. Therefore the way you feel after your third or fourth dose should give a pretty good indication as to how you might tolerate Effexor.

You may not experience symptom relief that quickly, but some of the effects you describe such as the throbbing headache might be associated with the medication. The fact is, it is in your system and beginning to reset the neurochemistry. Symptom relief does not usually occur that quickly because the process is thought to take a bit longer, however since you already began taking an SSRI earlier may affect the timing. The bothersome side effects usually subside after about ten to fourteen days as your body acclimates to the new medication.

As for taking 0.5 or 1 mg Ativan prior to your flight, follow your doctor's instructions tempered by your own experience on how much you should take for situational stressors. If you find you become drowsy or unstable with 1 mg and your doctor concurs, 0.5 might be a more acceptable dosage for you. You would not want to appear impaired when passing through security while boarding your flight. Bear in mind that with Ativan, the optimum effect is usually experienced after about two hours, although initial relief can be felt about one hour after taking it

You can also take consolation in knowing with the combination of Effexor and Ativan, there is no know drug interaction. I mentioned earlier there are benefits to the way each of these medications is metabolized, and this is one of them. Both Ativan and Effexor are "clean metabolizers" leaving no active metabolites and do not interact with other medications.

However, thinking of your flight, you would be well advised to not drink any alcohol while taking these medication, because the combined effect of these meds and alcohol can cause some impairment. These medications can cause an exaggerated effect to the alcohol you consume.

 

[AmZ]

Thanks for all of the info again.

Therefore the way you feel after your third or fourth dose should give a pretty good indication as to how you might tolerate Effexor.

OK, haha, I shall keep my mouth closed for now then! I must admit, after taking the first dose, I had no side effects whatsoever and now the second day, I feel my eyes a bit 'wired open' this evening, and a mild pulsing headache and definitely can feel the medication in some other ways also. So will be aware of the next couple of days and that they will most likely be like today but a little more 'intense'.

Concerning insomnia/lack of sleep on these meds (from what I have heard and experienced with taking the SSRI's at night), I'd like to take the Effexor right first thing in the morning but I've been taking it at 2pm so far. Can I gradually push this back an hour each day or so until I get to the hour I'd like to take it? i.e. tomorrow take it at 1pm, next day at 12pm etc. Shouldn't be a problem in doing that right, and better to do it very gradually like that anyway I guess just in case/general?

I decided to go down to 0.5mg (from 1mg) in the mornings starting from today with the Ativan. It was making me too drowsy and sleepy during the day. I'll still take the 1mg an hour before bed, but I'd like to think that from now, that smaller dose in the morning will be 'enough' for me in order that my anxiety is under control. Will see what happens there. The psychiatrist has been pretty 'un-structured' with me in terms of telling me when and how much meds to take. He said just take as and when I need pretty much. But of course I am keeping it structured so that I always have a dose in the morning upon waking up and a dose before bed. Just changed that 1mg to 0.5mg in the morning to see how I feel on it. Today was feeling a lot better from changing that. No falling asleep at my computer at work in front of my boss!

However, thinking of your flight, you would be well advised to not drink any alcohol while taking these medication, because the combined effect of these meds and alcohol can cause some impairment. These medications can cause an exaggerated effect to the alcohol you consume.

Thanks. I hardly drink anyway and am not drinking alcohol at all when/since I have been on medication, so we're all good there

I'll be very English and thank you once more for all of your advice Steve!! It's REALLY appreciated. You've taken more time to explain things to me and advise me than my psychiatrist has done (and I mean, a LOT more time!).

 

[Retired]

I'd like to take the Effexor right first thing in the morning

I don't think you specified if you were prescribed Effexor or Effexor XR (extended release).

FYI here is the prescribing info for each:

Effexor XR: The recommended dose for venlafaxine extended release is 75 mg/day, administered once daily with food, either in the morning or in the evening. Each capsule should be swallowed whole with water. It should not be divided, crushed, chewed, or placed in water.

Effexor: The recommended treatment dose is 75 mg/day, administered in 2 or 3 divided doses, taken with food.

Based on what you said, that you seem to be taking your Effexor once a day at 2 pm, if I understood well, I would suggest moving to your morning dose in two steps....11 am and then 8 am. Double check with your pharmacist or doctor to be sure, but based on my understanding of the how the medication is absorbed, that's how I would do it. I am not a doctor, nor health professional, though I have had some training in this field, which is why I suggest following the advice of your own health professionals when making any modifications.

 

[AmZ]

Hmm, the Effexor XR is only in capsule form or pill also?

I am taking one dosage a day (and will be doing so continuing in to the future also). I have 75mg tablets which for now I am splitting in half for the first four/several days until raising to a full tablet once a day in the morning (I will do as you recommended and double check that this is OK).
So, Effexor XR it is!?

The psychiatrist said that after a month of so, will also probably go up to 150mg. But not looking that far forward yet of course!

---------- Post added at 10:00 PM ---------- Previous post was at 09:51 PM ----------

OK, seeing a slight discrepancy here!!! I am not on Effexor XR, as they are not capsules. However, I am not splitting the dose up with the tablets during the day, just 37.5mg for now once a day and will be 75mg once a day tablet form also once I raise the dosage...

???

 

[Retired]

To be certain, please check with your pharmacist, because dosage forms can vary from one part of the world to another. I based the information I posted from a North American product monograph, but there may be differences in Israel, which is not uncommon with medications.

 

[David Baxter PhD]

I am not on Effexor XR, as they are not capsules. However, I am not splitting the dose up with the tablets during the day, just 37.5mg for now once a day and will be 75mg once a day tablet form also once I raise the dosage...

???

That's normal. 37.5 mg is the usual starting dose for Effexor, which is then increased to 75 or 112.5 or 150, etc., as required.

 

[AmZ]

As I am not taking capsules, the description of Effexor was that the tablets are split up and taken 2-3 times daily, but I am only taking once daily. So, that's still OK?

To be certain, please check with your pharmacist, because dosage forms can vary from one part of the world to another. I based the information I posted from a North American product monograph, but there may be differences in Israel, which is not uncommon with medications.

I guess that is the case. I checked the label again and it says 1 tablet a day, and they are 75mg. So (once I am on this dosage anyway) it doesn't say to split the tablet and take it at different times of the day. (Even though, that sounds better to me lol!)

I am a walking nightmare I tell ya... I woke up in the middle of the night with a terrible pain in my jaw and the bone sticking out more on one side in front of my ear. Somehow managed to dislocate my jaw - Well, I know what it's from and nothing connected to my mental health, but something else to worry about now! I got a brace on my bottom teeth a few months ago to sort out overcrowding and as soon as the orthodontist put them on, I couldn't bite down properly. He said that my bite will adjust over time, and now it has adjusted and I can bite down properly, but it has pushed my jaw over to one side now causing it to not 'sit well' there and that's why it dislocated. So another fun visit to the hospital and push that back in place and some nice local anesthetic and now strong painkillers...

Flights booked for England for Tuesday already.. so I'm going. GET ME OUT OF HERE!!!!!!!!!!!!!! Everything is a darn nightmare!!!!!!

 

[David Baxter PhD]

The only reason for splitting the dose up would be to minimize certain side-effects. If you're not having a problem with side-effects, when you take the medication and whether it's once or twice a day isn't critical.

 

[AmZ]

The only reason for splitting the dose up would be to minimize certain side-effects. If you're not having a problem with side-effects, when you take the medication and whether it's once or twice a day isn't critical.

Thanks. I guess I'd say that I'd like to do this when I go up to 75mg but probably not a good idea because the morning dose would be OK, but if I took the second 37.5mg at night or in the evening, it'll probably keep me awake all night, so don't want to do that!

Will see how it goes when I take it at once.

Have a good weekend ;-)

 

[AmZ]

So I've been on 150mg for the last 4 days - If I've already been taking the Effexor for 4 weeks at 75mg and 4 days at 150mg, would that mean that the 150mg (if it were the correct dose) should take less time to 'work' as it were as I've already been taking the medication for a month, albeit at a lower dosage, but that it's still been doing something?

The psychiatrist said to take the 150mg for a month and then go back again to see him.
Question is, if after another couple of weeks, I am still feeling no relief from the medication at 150mg and feeling as bad, then maybe I should go back earlier and raise it another 75mg? As long as another 2 weeks is a long enough time in order to be able to see that.

Thx.