AIBU to consider changing from Venlafaxine?

[Rebecca496]

Hi all, I am considering being open to having my medication changed but am a bit worried as I know that the medication I am currently taking has a bad reputation to come off.

I have accidentally missed doses before (e.g. when I have been away for the day and forgot my medication) and it the side effects - physical and mental - have been awful.

I take 375mg of Venlafaxine per day, which I also understand is quite high.

I am 28 (just mentioning age for context). I just wanted to ask if you have had any personal experience coming off Venlafaxine?

Venlafaxine has served me quite well over the first 3 and a half years I have been taking it, but not during this most recent six months where it has not stopped me feeling really low and impulsive. I think since August 2023 I have been to A and E 8 or 9 times on MH grounds, and am about to be admitted when I am transferred back to the midlands tomorrow.

I have been on the maximum 375mg dose since January 2023 now for Venlafaxine. I just don't think it is working anymore, or it is not stopping me get down and overwhelmed.

Does anyone on here have any experiences with TCAs or MAOIs? I have tried Sertraline, Fluoxetine and Citalopram in the past but all to no avail. How do they work?

I know that the TCAs/MAOIs are stronger which may help? I do worry about them being too strong though as on my second-last discharge from A and E (I was in A and E twice in February before this current visit) I saw the medic wrote on my notes "[my name] is at risk of accidental death due to miscalculation/misadventure] as I kept on taking too many tablets. I have now been moved to weekly prescriptions to stop this from happening, but I do worry about being prescribed something too strong that if I have an overwhelming day/episode (possibly due to my autism), I impulsively take too many. It was very sobering to read that and it worried me a lot.

Am I basically on Venlafaxine for life due to the severe withdrawal symptoms, or is it possible to change ADs to something that could be more effective?

Sometimes doctors will add other types of medications ontop of antidepressants. So you could take venlafaxine alongside a mood stabiliser or an antipsychotic (not always used for psychosis - can be used for depression).

It's definitely possible to swap from venlafaxine to other drugs however. It just has to be a really slow taper.

I know that the older types of medications like TCAs do carry a higher risk of overdose, so maybe your doctor won't want you to take those.

I'm sure your doctor will come up with a plan for you though. You are definitely not the first person who doesn't find venlafaxine works!

Thanks! I just feel a little sad as Venlafaxine has worked so well for me up until 6 months ago, but having 9 or so A and E visits in the last six months when I have had none in the 3 years before is telling me it is no longer working as I am at the max dose now.

Hi OP, I was on venlafaxine for 10 years (can’t remember the dose but it was high) it worked really well for about 9 of those years, the reason I changed was because I too felt it had stopped working for me-my anxiety in particular had got really quite bad. I was changed to escitalopram as that helps both depression and anxiety and it has been brilliant. I think I’ve been on it for about 6 years (approximately). Regarding coming of venlafaxine, I don’t recall any issues at all. Hope this helps.

Just to add, before I settled on venlafaxine I tried cirtalopram and possibly sertrailne too and neither helped on the slightest. I think I slowly came off venlafaxine by just reducing dosage over a few weeks. It’s great you’re trying to be pro active in helping yourself OP.

I've been on it for 18 years and am coming off it - I have tapered down from 250 to 37.5 over the past 4 years as it s a slow process but the effort of cutting that last dose is huge and I am really struggling. First I would say that if you aren't already you need to be on the XL (slow release) as it smooths the impact of the drug over the day. (It costs more so you really have to fight for it but it makes quite a difference). Secondly when I was at my worst my psych preferred to prescribe a less than max dose of venlafaxine plus an evening "kicker" of trazadone which helped as the venlafaxine - taken in the morning - wore off a bit and also calmed me down a bit before bed. Might be worth discussing adding something else in (which might also help with tapering off the venlafaxine).

Hi, yes, I am on the XL (modified release), and have been from Day One, as that was always the best way for me.

Are MAOI's like Tranylcypromine prescribed in the UK? I have read that these are used in the US sometimes? There is another one I can't remember the name of. I am going to discuss all of this with the MH Team when I am admitted as I feel so overwhelmed looking online and reading of the side effects and trying to pick one myself.

I don't want anything that caused weight gain as this has had a real adverse impact on my depression in the past.

I was on venlafaxine years ago and came off it. It is a terrible medication to get off and needs to be done very slowly and reducing the dose. I had brain zaps coming off it and couldn't drive because of it. I used to count the little beads in the capsules (180) and reduce by 10 each day until I got off it. I would speak to your Mental Health team and see if they can introduce new medication to take whilst coming off venlafaxine, so you are introducing a new medication at the same time as coming off one.

I know it’s easy to say, but try to stop looking at different medications. It’s not your job to pick which drugs may help you - obviously you need to be comfortable with what’s eventually offered - but the psychiatrist is the specialist here.

They will be able to taper or add medications as necessary. TCAs and MAOIs may not be the best option for you; just write a list of questions about what’s important to you regarding medication and discuss it with the doctor.

I can't really advise on swopping to another medication from venlafaxine as I tried and failed! (Also have been unable to come off it, but even if I did I would need to take something). I was going to ask if you were on the XL version as that works better for me, but I see now you are.

One Dr switched me from venlafaxine to mirtazipine, but they told me to just stop taking the venlafaxine and begin the mirtazipine, and obviously I had horrific withdrawal from the venlafaxine and ended up suicidal so another dr put me straight back on the venlafaxine and stopped the other.

However I now have a CPN who seems very good with medication (she got me switched to the XL) and she said to me that if I wanted to try a different medication I could, but I would start on a low dose of the new medication and gradually build that up whilst gradually reducing the venlafaxine. So you may be able to do it that way. The drug she mentioned to me was duloxetine. But as the xl version solved the issues I was having I didn't end up going down that avenue.

As other posters have said your best bet is to talk to your mental health team, but see if there is someone with good knowledge of medications as IME some people seem better than others as I think some favour particular medications and seem very loath to prescribe others.