Should I stay or should I go, etc.

August 25, 2008 11:17 AM

As I increase Effexor dosage should I notice increased effectiveness or do we each have a threshold we have to pass before we start to feel anything?

I am at 225 mg, climbing about 37.5 mg every month. I don't feel anything besides side-effects. My doctor claims that I have to pass a threshold before I will feel anything so we have to keep climbing to see what my threshold is. This is costing time and money. What are your experiences with regards to progressing the dosage of effexor?

posted by GleepGlop to health & fitness (11 comments total)

H'm.

The highest clinically recommended dosage is 300 mg, so you'll top out soon.

And then you'll have to taper off over the course of as many months as you've been tapering on, otherwise you'll have profound side-effects.

I recommend getting a second opinion from someone who is a psychopharmacologist, not just a psychiatrist (and certainly not a primary care physician).

I say this as someone who took and loved Effexor for years. It doesn't work for everyone, and you're so close to the top dosage that if you're not seeing any positive effects, it doesn't augur well for the medication working for you in the long run.

Good luck. See another doctor.
posted by Sidhedevil at 11:26 AM on August 25, 2008 [1 favorite]

It depends.

Check out CrazyMeds, click on Effexor on the left sidebar, read the whole thing.

That is the best site for anyone on any psychotropic medication.

I'll quote from it:

Effexor's Dosage and How to Take Effexor: Effexor (venlafaxine hydrochloride) comes in immediate and extended release flavors, although hardly anyone takes the immediate release form anymore. Just be sure to check your prescription for that XR to make sure you are getting the extended release form. For the XR flavor, you start at 37.5 to 75mg a day, taken with food, at either breakfast or dinner, depending on if you're apt to get wired or tired. Once you get the wired/tired issue straightened out, you take the med all at once at the same time every day. If you start at 37.5mg you can move up to 75mg after a week. As with any antidepressant, it takes a month to feel any positive effect, so give it a month. Seriously, don't move up above 75mg a day for at least a month. You'll know if it's going to do anything then. If you feel nothing, give up and take a much easier discontinuation. After that you can move up in 37.5-75 mg increments, allowing at least a week between each increase until you reach the maximum of 375mg a day for the most severely depressed of patients. The older immediate release version is pretty much the same, except that the dose is divided into two or three doses a day.

posted by sondrialiac at 11:38 AM on August 25, 2008

And then you'll have to taper off over the course of as many months as you've been tapering on, otherwise you'll have profound side-effects.

The two people I know who've tapered off of Effexor still suffered terrible side-effects.
posted by mattbucher at 12:10 PM on August 25, 2008

Like all drugs, some people get side effects. Some don't. Like all meds, they work at different times for different people. Like a lot of drugs, sometimes they just don't work at all.

225 is high, but not unheard of. Hell, I've been at 375 before now and I wasn't exactly slitting my wrists in the doctor's waiting room (although I am rather a large bastard, so that may come in to it).

IANAD, but I'd have expected you to feel something by 225, even it's just the edges getting knocked off your mood.

Effexor isn't a normal first choice and it tends to be used for people who have had no success with SSRIs and the like. If you've not tried them, see if you can give them a try - they'll be cheaper I'd expect (but I'm in the UK where all pills are $15 a month...)

Be aware that even if you find the perfect dose, Effexor has a risk of high blood pressure so you'll probably end up seeing the doctor every month for a quick check over anyway...
posted by twine42 at 12:22 PM on August 25, 2008

My experience with anti-depressants is that I never actually "felt" anything such as you do with pain relievers or recreational drugs. Sure, the side effects can be nasty, and they were for me with some of the drugs I tried. But, the signs for me that my anti-depressant was working were smoother days with fewer highs and lows, less grouchiness and crankiness, and more general energy. It's no fun trying to determine the best anti-depressant for you, but if you are patient and persistent, you will find it. Good luck to you.
posted by netbros at 12:37 PM on August 25, 2008

I've always had a threshold with it. The one point I had to go up a dosage (150-225 iirc) after the "okay, let's see if this won't kill you" trial was because it just completely stopped working. Just flat-out, back-to-despair mode one day. So if it stops working when you top off the dosage, you might be in trouble.

As for unsolicited advice from someone who isn't a/your doctor but has some very unpleasant experiences with Effexor: if you do choose to give it up because it isn't working as it should, wean yourself off for the love of God.
posted by griphus at 12:38 PM on August 25, 2008

On post-posting preview: What Sidhedevil said .
posted by griphus at 12:41 PM on August 25, 2008

this might or might not help, but perhaps Effexor just isn't the drug for you.

i, too, am on 225 mg of Effexor after slowly increasing the dose.
i have been on 225 mg for 3 months and it hasn't done a damn thing. this is my second shot at an anti-depressant (first being Paxil) so i'm coming to understand why people say it's a long, sometimes awful process to find the drug that works for you.

may you find yours more quickly than i.
posted by gursky at 2:14 PM on August 25, 2008

The two people I know who've tapered off of Effexor still suffered terrible side-effects.

That must suck for them; I'm so sorry to hear that.

If they hadn't tapered off, odds are the side effects would have been much worse.

I've been tapering off a 300 mg dose for months (down to 75 mg now, yay!) and haven't had any side effects (which may be just my winning the biochemical lottery, but I attribute it to the excellence of my psychopharmacologist).

Effexor has a lot of up sides for many people--I have never had such good results with such few side effects myself, and this is far from my first antidepressant rodeo--but the down side for pretty much everyone is that getting off it is a long process.
posted by Sidhedevil at 2:42 PM on August 25, 2008

My SO recently went on Effexor XR for anxiety and mild depression. It made her sick as a dog for a few days, despite only being the 37.5mg pills at first.. She didn't really notice anything, just that after a couple of weeks she suddenly realized that she wasn't getting overly anxious over things and was just back to normal. It wasn't a sudden change..it was so gradual she didn't even notice. I noticed more than she did, apparently.

She still worries, but not to a debilitating degree as she was before.

She gets neither wired nor tired from it. It doesn't really do anything at all except make her feel normal.
posted by wierdo at 4:26 PM on August 25, 2008

Ditto my experience with antidepressants- I never felt anything except a reduction in anxiety. Not fun like booze or a benzo, just that it was ... absent. To me, the SSRIs are very gentle drugs- there's no buzz or high.

After years, however, I'm still re-learning to not be afraid of stressful or anxious situations. I can easily counteract the effect by consiously deciding to stress about something. And in some cases, lifting the veil of anxiety can lead to different problems. Realizing, for example, that depression isn't the only problem one is struggling with. IE "I'm not depressed any more, and my life still sucks- OMG, now what?"
posted by gjc at 4:51 PM on August 25, 2008