Changed my mind about meds--now what?

August 3, 2011 2:32 PM

My doctor prescribed Effexor, and after filling the prescription--I'm chickening out.

I recently went for a regular physical (with a new doctor) and on the long sheet of "things that have ever applied to you" I checked "yes" for anxiety and depression. I was also, literally, in the middle of the worst day I've ever had at my current job. She wrote me a prescription for the lowest dose of Effexor, after we discussed my on-again-off-again lifelong issues. I've always been somewhat "high-strung" but not to a debilitating degree.

Now I've got the bottle in my hand, and I just can't do it. There are just so many withdrawal horror stories online, and the info that came with the pills talks about how important it is to take at the same time every day. My schedule is crazy and unpredictable, I might be up until 2AM one day and in bed by 9PM the next. I also enjoy a drink or two on the weekends (which the doctor knew), and it seems like that may be a big no-go.

Yes, I'm too anxious to take anxiety meds. I know they work for other people and I'm not philosophically opposed to them. I feel like I have them if I ever really need them, but things are ok right now. My question: now what? Call the doctor and tell her? Call the doctor and ask for a talk therapy recommendation instead? Wait until my next scheduled visit (in 6 weeks)? Or do I just get over myself and figure out a way to responsibly take these meds?

Throwaway e-mail is [e-mail].

posted by anonymous to health & fitness (26 answers total)

You're in the best place you could possibly be to take these right now - when you're feeling ok. The worst part about any sort of mental ailment is that it's trying to stop you from getting better - it's going to sabotage you. While this isn't hardcore depression, it's something that you can get help with using the medications in your hand.

If you call the doctor, what are you going to tell her? That's you don't want to take them? I don't think you need to call her and tell her that. If you decide not to go through with it, just don't take them. That's your prerogative, though.

My magic combination has been several meds and talk therapy, but it's not the same for everyone. How are you going to know if you don't try?
posted by SNWidget at 2:40 PM on August 3, 2011

Call the doctor and ask for a talk therapy recommendation instead

That sounds right to me. While I hate the canard that anti-depressants and anti-anxiety drugs are "overprescribed," I find it odd when MDs offer these kind of drugs just based on a few checkboxes. You have nothing to lose and a lot to gain by talking to a therapist. S/he may be able to help you with just talking and, if not, the pills will always be there. And now you'll have someone knowledgeable to walk you through the process.
posted by drjimmy11 at 2:41 PM on August 3, 2011 [1 favorite]

If you're primarily concerned about withdrawal and such, you can look into longer-acting SSRIs which pose less of a problem in that respect. Either take one with a long halflife or consider the weekly version of Prozac.
posted by needs more cowbell at 2:41 PM on August 3, 2011 [1 favorite]

Well, I have been on Effexor! And I was a normal person with, like, a job and a life and stuff. Effexor, despite the TERRORS you will read about on the Internet, is not a terribly altering drug. I think you might actually like it quite a bit! I found it EXTREMELY pleasurable--and it was just a tiny shift. (Honestly every drug, when you read about it on the Internet, is basically heroin + crack but WORSE.)

I can promise you that nohing "bad" is likely to happen to you. Low-dose Effexor is very low-dose. (That being said, maybe don't go crazy on the coffee with it. Just jitters!)

Effexor, for the most part, cuts out a little bit of noise and makes you want to be productive. It's really quite remarkable! I remember springing out of bed with a song in my heart! (I do that now, pretty much, but without the drugs--it was just new to me then.)

That being said, just speaking from experience, it's nice to take these things along with there being a "plan." For instance: going on it, being in therapy, digging into some stuff, coming out the other side, going off it.

Also, for a therapist recommendation, I would advise you to get one through a friend or an acquaintance.

Anyway it's your call. Your withdrawal from low-dose Effexor will likely be unnoticeable. (It's a drug you should taper off, like most of these, but no biggie. Go to half, go to half every other day, etc.)

(NOT A DOCTOR, THIS IS NOT ADVICE, DO NOT SUE ME, ETC.)
posted by RJ Reynolds at 2:52 PM on August 3, 2011 [3 favorites]

I guess this depends on how you feel about medication and risk in general. There are unquestionably side-effects to anti-depressants, and there are lots of serious questions about whether they work at all. (Just google "anti-depressant effectiveness.") There are also lots of other alternative treatments for anxiety and depression that do not have side effects, but may be more expensive and time-consuming. So you really need to weigh how serious your problem is, vs. the risks, vs. the alternatives. Personally, it makes sense to me to try the less-invasive options first (therapy, exercise, diet, de-stressing techniques) than the more invasive ones (medication).
posted by yarly at 3:00 PM on August 3, 2011

I have been on Effexor XR for several years for depression. While my depression is largely situational and situations in the last year or so have improved, I have been considering weaning off of it. My dose is 150mg daily. I, too, am frightened by the horror stories of withdrawal.

I can't speak to getting off of it, but I can speak to how it is on it. Now, of course YMMV, but for me it doesn't matter if I take it at OMG THE EXACT SAME TIME OF DAY. Like, for instance, I take mine before bed. Every once in a great while I'll forget or fall asleep without having taken it. I wake up the next morning and take it. Effexor has a shorter half-life than other SSRIs, so I think that's why they stress taking it at exactly the same time of day every day, so you have a constant dose in you.

When I miss a dose it's not a huge deal. I do get more restful sleep with it in my system, though. That's one of the main symptoms I notice of not taking it - my sleep is dream-filled and weirdly not restful. The other is that I notice myself getting irritated/angry much more quickly.

Having said all of that, the WORST side effect is the terrible effect on the sex drive (marked decrease in desire, trouble climaxing, less than stellar orgasm). However, I felt that was a price I was willing to take to feel better. The good news about this side effect and the short half-life of Effexor is that you can take a "pill vacation" for a day and have these effects wear off in time to... enjoy it.

Effexor has been a help. You shouldn't worry about trying it for a few weeks. At such a low dose your withdrawal should be minimal, if any, if you choose to get off of it. Feel free to memail me if you want.
posted by Falwless at 3:03 PM on August 3, 2011

Oh P.S.? I'm not a big drinker, but on occasion I will have a few drinks (and on rarer occasions a few more than a few). I don't ever see any ill effects when I do so.
posted by Falwless at 3:05 PM on August 3, 2011

My experience was not like RJReynolds's or Falwless's--I had to take the pill at the same time every day and if I ever forgot it I'd feel drastically different (dry constricted throat, tense, fighty, weepy) within six hours. This happened to me a few times; each time when I returned home to check the meds' snap case I'd find that that morning's still had the medicine in it.

When I was on Effexor, I felt apathetic and unmotivated rather than suicidally depressed. It was an improvement, sure, but going off them cold turkey (as my previous doctor suggested) put me in the emergency room two days after stopping the pills. (I'm not going to link the video, and you might have seen it already, but you can find it at Youtube if you search for effexor cold turkey.)

Supposedly I should have been able to go off Effexor and start taking an equivalent amount of another SSRI at the same time with no ill effects. My (new) doctor assures me that my reaction was severe and my experience not at all typical.

Which is not to say that Effexor couldn't be great for you--maybe it could.

If I had it to do over, I'd request a different anti-depressant and try talk therapy at the same time. Regardless of what you think about Effexor, there are numerous studies showing that antidepressants work best in conjunction with therapy.
posted by johnofjack at 3:22 PM on August 3, 2011 [2 favorites]

Is your doctor a GP? An internist? If so, I strongly, *strongly* recommend that you speak to both a psychiatrist and a therapist/psychologist before starting an Effexor regimen. The Internet exists to record the extremes of any given opinion, phenomena, or experience. A psychiatrist exists to diagnose and prescribe mental health issues. Effexor is probably not as bad as web hand-wringing would have one believe, but neither is it something to use unless you are in the care of a specialist.
posted by sideofwry at 3:26 PM on August 3, 2011 [2 favorites]

I'm on Effexor XR right now, for the second time in my life. IIRC, it's usually used for major depressions, not really an intro-level med. I went off it (and 2 other meds) cold-turkey the first time, I don't remember what my dose was but probably in the mid-range -- and I had some side effects (mainly creepy dreams).

I think the biggest thing to know is that the withdrawals apply more to higher doses -- 150 and up. My current dose is 300, and I do sometimes notice if I'm 6 or more hours late taking a dose. But again, my dose is pretty high (and I'm really sensitive). Just an FYI: I've heard that Abilify and Omega3s help tremendously with Effexor withdrawals (just throwing that out there in case someone else who needs the info comes across this thread).

If you feel unsure about taking Effexor, call the doctor back and tell her that, and also ask her why she felt Effexor was appropriate over all the other antidepressants out there right now. Zoloft is 'gentler' and worked well for me. To be honest, my regular doc was happy to rx celexa and zoloft but was not comfortable with Effexor at all -- you might have a better experience seeing a psychiatrist who really knows which receptors need to be nudged for *your* symptoms, and know how to tweak and mix meds in a way that works better for you.
posted by MeiraV at 3:28 PM on August 3, 2011

Oh, and crazymeds.us is full of good info and helpful people -- they would've known that johnofjack's doctor's trick switching SSRIs trick doesn't work with effexor . . .
posted by MeiraV at 3:33 PM on August 3, 2011

I recently went for a regular physical (with a new doctor) ...

Might just be me, but I'd be extremely suspicious of any doctor who hands out antidepressants on a first visit, especially if it was only based on the following:

... and on the long sheet of "things that have ever applied to you" I checked "yes" for anxiety and depression. I was also, literally, in the middle of the worst day I've ever had at my current job.

That is, is this something you thought applied to you at the time, or were you basing that checkmark wholly on past events? And did your doctor know that your mood at the time was significantly effected by that particular day's events? These are important things to know.

If the doctor in fact made no attempt whatsoever to clarify either of these two things, get a second opinion... or, rather, get a first opinion.
posted by matlock expressway at 4:19 PM on August 3, 2011 [2 favorites]

All the things people have posted above about Effexor are totally valid--not everything is right for everybody, and antidepressants can have serious side effects, which I'm sure you've probably looked up already. If you're able to talk to a therapist or psychiatrist, I highly recommend it--my best psychiatrist was fantastic about laying out the side effects and benefits of a variety of medications in a way that I'm thinking your doctor maybe didn't.

I personally have found Effexor pretty mild at low doses (75mg), compared to SSRIs. I've accidentally skipped doses, taken them at different times, and had drinks, and I've been totally fine. The thing about any of these, though, is that experiences are so wildly different for people that anecdotal evidence is poor advice--I've had other antidepressants send me into panic attacks or complete despondency after either taking or quitting them.

As far as I can generalize, though, low doses have rarely done anything noticeably bad for me, and one missed or late (low) dose doesn't equal withdrawal. I'm not really sure this prescription is the best thing for you, but if you do end up taking it, I doubt it's going to be that big a deal.
posted by Tubalcain at 4:24 PM on August 3, 2011

Yeah, be careful with Effexor. Some people have few or no problems with it. But for other people, myself included, the stuff is a complete nightmare.

The first time I took the lowest dose, I couldn't sleep for about 24 hours. That diminished fairly quickly, but I did have terrible night sweats (more disgusting than you can probably imagine if you've never experienced this-- think of a fever breaking, but *every night*). I developed serious jaw pain due to involuntary clenching and teeth-grinding while I slept. I had definite withdrawal symptoms if I forgot a dose for 6 hours too, all the way to the brain-zaps. And by the time I realized I needed to go off it, I was constantly feeling sick, exhausted, edgy, tense, and much stupider than usual.

Aaah, and then I *did* go off it. I weaned down, and I would not suggest to anyone that they do otherwise. Because it was still weeks of hell. My brain didn't work. Every time I moved my head I'd get the brain-zaps. I basically had to spend most of the time asleep. Going off it was worse than being on it. But it's over now, thank heavens.

I had a worse experience with Effexor than a LOT of people, mind. But it's a serious pharmaceutical. It's not a drug to be started lightly. It's also not a drug that should be prescribed as a first antidepressant. It was the third one we tried for me. I would definitely see a mental health professional rather than letting your GP stick you on this stuff. They don't always know what will work best for your chemistry immediately either, of course. But it's their job specifically to keep up with information on psych meds, and your GP can hardly be expected to be an expert in that.

I'd say Wellbutrin or Prozac or Lexapro would be better first attempts. They're a lot less insidious than Effexor. I'd probably still be on Wellbutrin if I hadn't turned out to be allergic. Look into that one, perhaps.
posted by Because at 4:29 PM on August 3, 2011 [2 favorites]

I take effexor, and it's been a miracle for me. I had crippling social anxiety - couldn't even go out on my own balcony because people could SEE MEE - now I'm out there all the time in my skanky house clothes and I do not care a whit. Ditto for hyper-overreations to criticism, suicidal ideation, feelings of worthlessness - I LOVE effexor.
The first few days when you take it you'll be revved up and might not sleep and might not be hungry, but you adjust (can take a few weeks but you said the dose is low). I have withdrawn a couple of times (once by choice, just to see, and once 'cause I ran out) and mainly I was tired and jittery and kind of out of phase with things, but nothing heavy.

It can make a huge difference in your life. If you could see me before and after, you wouldn't hesitate.
posted by L'Estrange Fruit at 4:47 PM on August 3, 2011 [1 favorite]

If at all possible, get your antidepressant prescription from a psychiatrist. From what I understand, only a GP would try Effexor first.
posted by Adventurer at 4:47 PM on August 3, 2011 [1 favorite]

sideofwry: "Is your doctor a GP? An internist? If so, I strongly, *strongly* recommend that you speak to both a psychiatrist and a therapist/psychologist before starting an Effexor regimen."

I've been on Effexor for at least 6 years. (Currently weaning off, but see below). I STRONGLY urge you to take sideofwry's advice and see a psychiatrist before getting on board with Effexor. My GP is currently handling my prescriptions, but she only reluctantly agreed to it after I'd already been on it under the care of a psychiatrist for a couple of years with no apparent ill effects.

MeiraV: "Oh, and crazymeds.us is full of good info and helpful people -- they would've known that johnofjack's doctor's trick switching SSRIs trick doesn't work with effexor . . ."

Firstly, Effexor isn't an SSRI, it's an SNRI. (See crazymeds for definitions.) Secondly, I am living proof that it is possible to wean off Effexor while ramping up on another SNRI without wanting to claw your brain out. I've been slowly easing off Effexor while starting Cymbalta, and I have had no severe effects (unlike the time I ran out of pills during Christmastime and could not reach a doctor to get my prescriptions refilled. That was a hellish nightmare, exactly as described all over teh internets.)

So, in short, OP, FWIW from a random stranger on the internet, I don't think you are wrong to second-guess this. Can you see another doctor soon to get a second opinion?
posted by SuperSquirrel at 5:14 PM on August 3, 2011 [2 favorites]

Anon, good for you for questioning the Dr. and not taking these. This isn't something that should be offered during a check up. If you had any mental health issues the MD should have referred you to a specialist/psychologist/psychiatrist for further evaluation and to determine the right method of therapy for you. This just isn't the right course of action.

I would call my insurance co. for a reference to a psychologist or psychiatrist if I wanted to take any action for anxiety or whatever else.

(This coming from a patient, NOT an MD but I am channeling my Pop who's a Phd clinical psychologist.)
posted by snsranch at 5:58 PM on August 3, 2011

My SO has been on Effexor XR for a couple of years now and has no problems with it, aside from being both lethargic and pissy the next day when she takes it more than a couple of hours late. Not terribly so, just enough that I notice a difference. On a couple of occasions she's forgotten it for an entire day and again, other than some minor-in-the-grand-scheme mood swings, she's been fine. When she once had trouble getting a refill on time, she was pretty anxiety-ridden because of all the talk on the internets, but Walgreen's was kind enough to advance her a few pills until it could all get straightened out and it was fine.

She drinks pretty heavily on rare occasions, and that hasn't given her much trouble, other than being afraid she'll puke up the pill when she really goes overboard.

Her diagnosis was mild depression with moderate anxiety, btw. It really helped on the anxiety front. She still gets overwhelmed at times, but her job is rather stressful, so I'd be worried if she didn't get that way on occasion. She started out at 37.5mg/day for a couple of weeks on her way to 75, but is now up to 150.

All that said, it wouldn't be a bad idea to see a psychiatrist. A good one. Not one that talks to you for 10 or 15 minutes and then sends you on your way. My SO and her then-new psychiatrist had a good hour long session and they stay in regular communication. I think they're down to every 3 months now, but at first it was 30 minutes every other week. She also did CBT with a psychologist at the same practice for a while, which helped in its own way. I strongly suggest the combo.

Seriously, though, be sure to find a good psychiatrist. A friend of mine had a really shitty one and wasn't aware it could be better until she happened to discuss the situation with my SO.
posted by wierdo at 6:05 PM on August 3, 2011

If you go by what you read on the internet, you'd never take another medication, ever. One thing to remember is that in all of the double-blind, control-grouped studies on medications, a wide number of sometimes severe adverse effects are reported by the subjects receiving placebos. This is even more likely to be the case in in studies for depression and anxiety meds.

Also, Nthing the suggestion to get a referral to a psychiatrist if you're going to start up on any psychiatric medication, as you should really be seeing the prescribing doctor monthly at the beginning, until you're acclimated.
posted by patnasty at 7:00 PM on August 3, 2011

I've been on Effexor twice — once for 1 year, and once for 2 years. I react strongly to it at low doses, and withdrawal is a bitch. Oh, and withdrawal starts 4-6 hours after you miss a dose.

I see that you had a really bad day and that you checked something off on a sheet, but that doesn't necessarily mean you need medication. Anxiety and sadness are part of everyone's lives at times. Clinically problematic anxiety and depression are not. Which are you experiencing?

When I've gone on Effexor, it's been because I couldn't stop wallowing and thinking of suicide or wanting to run away from everything. It helped, yes, but it also came with a boatload of side effects and withdrawal complications. Perhaps something a bit less intense would have helped just as much?

I was prescribed it by my GP, and I now think that they should have tried SOMETHING else before giving me that one. Effexor has been really heavily marketed by the pharma companies and that's where many of our doctors get their info about anti-depressants, but it doesn't mean that's the first drug you should try (if you should be trying drugs at all). There are gentler drugs.

CrazyMeds is a great site for information about this.
posted by heatherann at 7:55 PM on August 3, 2011

I do not recommend taking the Effexor. I can tell you from personal experience that the drug can be very problematic, and I question your doctor's decision to prescribe it for you.

SNRI drugs, of which Effexor is one, can be a godsend for people with recalcitrant depression and anxiety problems. But because of its side effects, timing sensitivity, and especially its discontinuation syndrome, it's not a good first-line of attack. Yes, people react different to Effexor, and no, not everyone ends up in a psych ward when they try to go off of it (like I did). But the risk of serious problems is great enough that the drug should be treated with care. A GP should not be giving you Effexor after a standard physical at which you report having a shitty day and a history of what you describe as non-debilitating anxiety.

This doesn't mean that there aren't courses of treatment to help you. There are milder medicines if you feel like that's a good option. There's talk therapy and books like Feeling Good which describe a program of self-directed cognitive behavioral techniques for mood disorders. I suggest finding a more knowledgeable doctor, preferably a psychiatrist, and getting a second opinion.
posted by bookish at 8:12 PM on August 3, 2011

I have been on and off meds for the last 12 years.

Usually docs prescribe prozac or paxil for the first go-round to see how it works for you. It's like the introduction to crazy meds. They don't really START with effexor. That's weird to me.

I was on effexor for 3 or 4 years. i had to stop last summer because our insurance ran out and it was very expensive. i had wanted to stop for a couple of years before that, but was terrified of the withdrawal stories i heard about it (i had had bad withdrawal from ssri's and heard effexor was even worse. i was terrified.). but, i tapered off it and i was on wellbutrin at the same time. i literally had no withdrawal problems. i was so thankful. so it is possible.

but you don't have to take the drugs just because you were prescribed them. if you're concerned, ask your doc why she prescribed that instead of a "starter" ssri. ask her about withdrawal. ask her how important it is to take it a literally the same time every day. ask her all your questions. if she doesn't give you satisfactory answers, find a new doc. i have found that GPs/PCPs hand out ssris/snris like candy, but don't know all the ins and outs of them as they should.
posted by misanthropicsarah at 9:33 PM on August 3, 2011

Okay, this is one non-medical opinion but there is no way you should be coming out of a regular physical (and first time visit with a doctor!) with a anti-depressant prescription. Personally I like to keep my crazy doctors and body doctors in strictly separate domains (obviously I disclosed medications when I took them). The brain is a big deal, it deserves its own doctor. If I had some kind of weird liver disorder and there were like 18 different drugs that worked in all kinds of different ways and had all these different issues and side effects you know, I would demand to talk to a liver specialist before I signed up for any of it. I talked to a therapist a long time before I considered pills (and never considered the latter to be a substitute for the former), and had her recommend a psychiatrist based on our work to consider the ins and outs of specific medications. You don't have to take this medication just because a MD said "try Effexor". Talk about it at your next visit, if you don't have acute psychological issues there's no reason you need to follow up about it immediately.
posted by nanojath at 10:31 PM on August 3, 2011

Yeah, nth'ing what others have said. Effexor as a first anti-depressant is a bit... unusual. It's usually a 2nd or 3rd line choice after standard SSRIs haven't worked. Maybe he assumed you'd taken something before after looking at your form, and decided based upon your interview that you could use something? Prozac is much more common as a first line anti-depressant, as the 'come down' is very mild.

Personally, if I miss my (150mg) dose of Effexor XR, I get rather crabby (24 hours after last dose), and after 36 hours or so I get a bloody bad headache, but that's a mid-range dose of the extended release version that hangs around longer. It's not the end of the world, but it's not something to mess with lightly. Also, the hit on your sex-drive ain't any fun either, but that's generally pretty common to a number of a anti-depressants.

There's no fault in being wary of taking medication, it is after all your body. In the end of the day, anti-depressants help you cope with the symptoms of depression - lethargy, lack of will, fear, withdrawal from the world, feeling you can't cope, losing touch with friends and family etc, but don't address the underlying issues. Something like 10-15% of people will suffer clinical depression at some point in their lifetime, so it's not as rare as you might think. They're a very useful crutch, but not necessarily a solution per se.

So unless you feel your life is being continously and adversely affected - i.e. you're struggling to cope with stress, and every day is a new mountain to climb, jumping on effexor right off the bat may not be the best option for you. I'd probably seek out a 2nd opinion, or at least discuss it with your doctor further to at least discuss your doubts, and help decide if effexor is the right drug to start with. Although it's also a usual ask mefi trope, talk therapy is generally shown to be as clinically effective in dealing with depression, and may well be a practical alternative to medication to help you get your life going in the direction you want it to.
posted by ArkhanJG at 11:46 PM on August 3, 2011

Nthing what others have said, ish.

Effexor is a wonderful drug for a lot of people. It's an anti-depressant with an anti-anxiety sidecar built right in, and it can be a magical combination in terms of mood stabilisation. The drawbacks of dry mouth, a limited window range for time of day, and anorgasmia are not unique to Effexor. (The complete absence of dreams is something I only experience on Effexor and is not my favourite thing.)

Most people can taper safely off without issue. You will never read about those people on the internet because "and nothing happened" is not interesting to read or to write about.

However, without your medical history and working only from what you've written here, it's seems like a very odd drug to be prescribed right out of the gate. There's a pattern of escalation typical to crazy meds, and its way more typical to start out with generic Prozac, etc. If your depression is situational but the anxiety has been a lifelong recurring issue, an "as needed" scrip for Atavan or Xanax may be something to talk about.

To answer your actual question, if you are not comfortable with this and you are not suffering beyond manageable, situational breakup depression, it is fine to simply put them away and not take them. If you are coping day to day, you don't need to do anything until your next appointment. If you are, however, reluctant to take this drug but still casting about for help, go back and discuss your options in more depth with him/her.
posted by DarlingBri at 4:59 AM on August 4, 2011