Changing from sertraline to venlafaxine

[Honeymoonmummy]

Hi all,

Please bear with me for this essay, am trying not to drip feed!

I had sertraline (150mg) for PND with both my children (now 5 and 3) - came off them when my youngest was just under 2. They worked well for me for PND. No mental health issues previously.

I have been off work sick since Sept last year with wrist/hand pain, stress and anxiety, all relating to a situation with a stressful job/ nightmare colleague before I went off. I went back on sertraline in Sept. The symptoms however feel different to the PND - more stress and anxiety and less mood swings/irritability (altho still get them!). The Sertraline has helped I think but hasn't really brought the stress and anxiety under control.

Also, around Jan/ Feb, I started to get dizzy spells on standing up/ bending over then standing up. I haven't blacked out but felt like I was, everything goes black for a couple of seconds but I'm conscious. I have seen a cardiologist and the first thing he said was it was probably the sertraline because I am not drinking enough water with it. Moving on a few months, my heart/BP are fine and therefore it looks like it might be the sertraline. I have tried to up my fluid intake but can't seem to ever quench my thirst.

Saw my GP the other week and I am now weaning myself off the sertraline (fairly quickly on GP advice - I normally take it much more slowly - 100mg for one week then 50mg for one week which is where I currently am then venlafaxine starting next week).

I asked GP for a medication which will not make me so thirsty, would be more aimed at the stress and anxiety rather than depression per se and would not make me put on weight (am currently dieting and have lost 1 stone 4 so far, still obese).

I spoke to my father yesterday about the venlafaxine, he has had severe depression and anxiety for years and has been on loads of medication none of which have worked well and he said venlafaxine was one of the worst for him, actually increased his stress and anxiety although he was quick to point out that everyone has a different reaction to medication.

I have also finally had a diagnosis for my hand/wrist pain this week, they have diagnosed joint hypermobility which I hadn't heard of before but from a bit of googling can cause dizzy spells (along with a long list of other symptoms!).

So, I'm just looking for advice/experiences/suggestions for possible alternatives to venlafaxine before I start on it. I am hoping to start back at work in July on a phased return so don't really have time for "trial and error" although I appreciate this is often the only way. I am supposed to be starting on 75mg on Tuesday next week but haven't cashed in my prescription yet . I am going to try to get in with the GP on Tuesday (she works part-time) to discuss the hypermobility with her for the first time and see if it changes her view of the venlafaxine.

If you have read this far then thank you! TIA.

Am just googling now and seems a few people have experienced weight gain on venlafaxine . GP also mentioned Prozac as an alternative?

Has anyone found a website with a great table/chart showing which are best/worst for anxiety, weight gain, thirst? I need to give up googling now, my hands are aching!

Put on a lot of weight on venlaflaxine personally. It took a long time to wean off it as it is often a difficult one to come off due to how it affects people. Been lots of threads on it here. It can work very well if you do not get side effects. If you do not like it and come off it you may find you need holiday time off work to do that, I personally found this ( well took months to come off it in the end as had a reaction to withdrawal).

But equally others will post how good it is with treating them.

I've been on venlafaxine for the past 18 months. It's the only thing that dragged me out of the suicidal mess I was in(citalopram failed, mirtaxapine failed). I found it made me tired and hot flush-y at first, but no side effects now. No weight gain, but i was a bit chubby to start with.

Of course I now have to stop taking them as I'm.pregnant.

Good luck, OP!

My DH has been on Venlafaxine for years. He came off it last year and the withdrawal was really terrible. His depression and anxiety also returned with a vengeance, and he is now back on the Venlafaxine, and his symptoms have disappeared.

In his case, Venlafaxine is the only medication that has worked. He has also tried citalopram, Prozac and something else but I forget which one it was now .. Venlafaxine is a different type of anti-depressant to Prozac etc, so it may well work for you, but be aware that you may need a lot of support if you need to stop taking it at any point in the future.

He has no side effects at all when taking Venlafaxine, apart from occasional low blood pressure / dizzy spells if he stands up quickly, but he is a huge bloke (6' 3") and his blood does have to travel quite a way to get from his heart to his head, so I'm not convinced that it's the medication that causes this!

However: speaking as someone who has hypermobility and fibromyalgia, is it possible that you would benefit from counselling/CBT to help with stress and anxiety, and Physio/hydrotherapy etc to address the pain? You said in your OP that the anxiety was caused by a situation at work, so I'm just wondering if there are other avenues to explore before going onto hardcore medication? Can your GP recommend you for counselling, or can you self-refer to your local mental health team? (In our area you can do this). Your GP should be able to refer you to a Physio to help you manage the pain of hypermobility.

Just thinking that drugs may not be the way to go here at all. And I wouldn't wish Venlafaxine withdrawal on my worst enemy, I had a thread about it last year and I was unable to articulate then how truly, truly, dreadful it was.

Good luck x

Hi all, thank you for your replies. I am really confused now as to what to do! I can't do a huge lot of internet surfing / Mn searching as my hands start to ache with the hypermobility.

I am seeing a counsellor which has helped tremendously, thanks, and am going to ask for a Physio appt (although they didn't help much when they thought I had tendonitis!)

My mum has fibromyalgia so I'm concerned about that but gp says no indication of this at present.

It sounds like the venlafaxine is quite hard core? I would say my anxiety is only moderate.

I found Venlafaxine to have the worst side effects of any pill I've taken. Everybody is different though!

I was told my by psychiatrist that venlaflaxine is prescribed in this area as a second line medication, after other SSRI's have failed to ease the symptoms.

I had to come off it as it raised my prolactin levels so I could not conceive. Not that affects everyone - I did out on 3st personally.

Did they suggest other SSRI to you - citalopram and Prozac?

Venlaflaxine did help me - I was hospitalised and could not cope so I know I needed it.

I think you should ask to see a psychiatrist for their recommendation as this is reasonably complicated, not 1st line and I suspect GP may be out of their depth

Generally venlafaxine is considered a very good effective antidepressant but has worse side effects and withdrawals than others and one of the main side effects is postural hypotension which it sounds like you already have (dizzy on standing) so I think you are perhaps right to question that choice.

For anxiety a straight SSRI is usually best like the sertraline you are already taking. Instead you could try citalopram, escitalopram or fluoxetine. There is also paroxetine v.g. For anxiety but nasty withdrawls.

Or you could see if you can manage on a lower dose of the sertraline that might not give you side effects.

Or CBT is side effect free! (This is quite distinct from counselling, GP would need to refer you)

Lots of options but I would ask your GP to get you some specialist advice.

At the risk of thread derailment and hijack I'd love hear any positive experiences of withdrawal. ·Tumbleweed·

Sorry I can't help on the positive withdrawal front - the two times I (stupidly) decided to self-wean from Venflaflaxine I thought I was dying from the physical side effects. Horrendous.

BUT

It has been a life saver when it comes to saving my mental well being. I have been in a terrible place - suicidal, in psychiatric hospital twice, and Venlaflaxine is the only drug that has kept me stable on the outside for an extended period.

I am starting on this tomorrow, has anyone found it boosted their energy/motivation?

Wow! Some serious stories here! I will see GP on tues and mention the other drugs listed here, it's just a pain when I have already been through 2 weeks of not feeling great on coming off sertraline to then have to put off a changeover. Incidentally, I never had the dizziness symptoms the first 2 times with sertraline....

OP, click here to read more about Venlafaxine - you shouldn't need to click too much so your sore joints won't take too much of a hammering! en.wikipedia.org/wiki/Venlafaxine

Venlafaxine is an SNRI, unlike Prozac etc which are SSRIs, so if they aren't working for you, Venlafaxine might. The link explains why. Basically it acts on different brain chemicals to the other anti-depressants.

Yes - it is very hardcore medication.

The link I've given explains it really well, and it ties in with what I've seen first-hand with DH, so I think you'll find it helpful.

My attempt to stop taking the buggers starts today - wish me luck! I'll post about it if anyone's interested.

Good luck at the doctors....

Good luck CatteLady

Are you switching to another anti-d while you come off the Venlafaxine?

Sadly not. I wasn't offered anything as the doctor thought it would be better to try to manage without because of the baby.

I think the answer to your query is it all depends - frustrating as that is, the one thing we do know is that different ADs suit different people and some people have side effects and others don't and just to confuse us even more, what works well in one episode of depression/anxiety may not work well in a subsequent episode.

I disagree mamadoc that the GP is probably out of her depth. GPs can and do prescribe venlafaxine and referral to a psychiatrist is made on the basis of clinical need, as with physical illnesses. I am in secondary care as have been an IP on 2 occasions so my mental health is overseen by a psychiatrist and I have a CPN. The psych added mirtazapine to my imipramine, and I think it's when prescribing more than one AD that GPs are "out of their depth."

My CPN tells me that people insist on changing their meds because the one their friend is on is working well........!! It is all trial and error and that just adds to the frustration I know.

I too am wondering Honey if the Sertraline worked so well for PND because that I think is hormonal isn't it, whereas the stress and anxiety you have now is related to a work situation which is quite different. Although it is a fact that after 1 episode of dep/anx we have a 50% chance of a second episode.

I too am wondering about counselling of some sort. Is your anxiety raised by the thought of going back to work.....if so I don't think any AD is going to help very much to be honest. Sertraline is one of the ADs that in a low dose is meant to be good for anxiety, but then again we are all different.

i was on 200mg of Sertraline for 13 years with one review in all that time,anyway i was then put on venlafaxine with no weaning of the Sertraline,omg i had the worst reaction ever,came out in hives and felt like ripping my skin to pieces,slept for 3 hs in 48 as the pain was so bad and a blardy bank holiday

it was immediattley stopped and put on medication to stop the reaction,it was the most painful reaction i can ever remember,anyway im now on anti-psycotics and working well

all i can advise is make sure you are weaned of propally,i wasnt and i will never go near that drug again though i blame the doctor for poor management

good luck op

Thanks all for your messages. I saw the gp last night (was going for other stuff too) and explained my nervousness around venlafaxine. We discussed it and decided to give it a go. I had the first one last night. Feeling pretty shitty ATM mood-wise, obv this is due to lack of medication but just want to sleep through the next few weeks Am counting the minutes until dh gets home.