The rest of the meds world
March 27, 2015 8:20 AM Subscribe
What are SNRIs, and what are they like to take?
I need to take antidepressants, but for a variety of reasons I can't take SSRIs: any drug in that whole class. Not the best news. So I'm looking at other options now, mainly SNRIs. I don't know much about them except various horror stories I've heard, how difficult they are to get off of, how they make your liver explode (??), etc. Are they really that bad? If they are, I'd like to know, and if they're not...great!
Everyone's body chemistry is different obviously, I'll be taking the medication in conjunction with therapy, and I'm consulting a psychiatrist who specializes in this soon. But I'm just trying to get as much information as I can, and anecdotal evidence is helpful in this case. I'd be interested to hear about other non-SSRI drugs too, not just SNRIs.
I need to take antidepressants, but for a variety of reasons I can't take SSRIs: any drug in that whole class. Not the best news. So I'm looking at other options now, mainly SNRIs. I don't know much about them except various horror stories I've heard, how difficult they are to get off of, how they make your liver explode (??), etc. Are they really that bad? If they are, I'd like to know, and if they're not...great!
Everyone's body chemistry is different obviously, I'll be taking the medication in conjunction with therapy, and I'm consulting a psychiatrist who specializes in this soon. But I'm just trying to get as much information as I can, and anecdotal evidence is helpful in this case. I'd be interested to hear about other non-SSRI drugs too, not just SNRIs.
Sample size of one: Getting off Effexor was the single worst thing that has ever happened in my life. A multi-month drawn out hellscape of constant headaches, nausea, lightheadedness, uncontrollable mood swings and pain. My doctor tapered me down over 2 weeks (!), but I had to go back on it and taper over a much longer period which still barely helped reduce withdrawal symptoms. Imagine a 4 month flu.
I would not ever recommend Effexor, and Googling "Effexor withdrawal" will clue you in to why.
Also, the half-life is incredibly low so if you miss a dose you will know.
posted by OnTheLastCastle at 8:37 AM on March 27, 2015 [3 favorites]
I would not ever recommend Effexor, and Googling "Effexor withdrawal" will clue you in to why.
Also, the half-life is incredibly low so if you miss a dose you will know.
posted by OnTheLastCastle at 8:37 AM on March 27, 2015 [3 favorites]
I couldn't get off Effexor without going onto an SSRI. Just couldn't. Brain zaps, mood swings, my arms went numb. It was the worst experience of my life.
posted by goatdog at 8:41 AM on March 27, 2015
posted by goatdog at 8:41 AM on March 27, 2015
OMG Effexor was hell. If I was even a half hour late taking it in the morning, I would get brain zaps and this awful, weird floaty feeling if I turned my head. I had hot flashes where I would suddenly drench with sweat and my face would turn bright red. I also lost all ability to orgasm, but NOT the desire. Not fun. Tapering off took me 2 months.
I'm not sure why you can't take SSRI's, but I'm on Brintellix now and it's the BEST med I've ever taken. If you are able to at all consider another SSRI, I highly recommend that one.
posted by hollygoheavy at 9:01 AM on March 27, 2015
I'm not sure why you can't take SSRI's, but I'm on Brintellix now and it's the BEST med I've ever taken. If you are able to at all consider another SSRI, I highly recommend that one.
posted by hollygoheavy at 9:01 AM on March 27, 2015
I was on Cymbalta off and on for a couple years. It worked brilliantly for me the first time, but eventually lost its effectiveness, possibly from stopping and starting multiple times, possibly from regular old antidepressant poop-out. For me, it was absolutely worth taking despite the funhouse of side effects, which were:
- My appetite completely disappeared for a few weeks. I'm typically the kind of person who can always eat if there's something tasty around, and suddenly food was the most boring thing in the universe. I only ate if I was feeling faint, and even then I had to make myself eat. I lost about twenty pounds without trying. I was overweight, so I was pretty happy about this. My appetite did eventually come back.
- I had zero interest in sex. That was fine by me, since I was single at the time anyway.
- This is the really weird one: I had vivid dreams every single night for about three or four months. Sometimes several in one night. At first this was cool as hell, but after a while it got a little tiring.
- If I went for more than 36 hours without it, and tried to sleep, I'd get terrifying sleep paralysis while drifting off. I'd hallucinate about jumping out the bedroom window, but at the same time I'd be glued to the bed, unable to move. That was far and away the worst part.
- Going too long without a dose also resulted in the discontinuation syndrome you hear so much about. For me it was strong brain zaps and my sense of balance going all weird - I felt like I was always walking on a rope bridge. These, along with the sleep paralysis, would go away quickly after I took my next dose.
I didn't have much of a problem going off Cymbalta. However, "going off" took a month of gradually tapering down the dosage. I had to get empty gelatin capsules to put half doses and quarter doses in. Even with all that, it was probably mostly luck that I was able to stop fairly easily. Some people have awful symptoms even when slowly tapering off, but I was okay.
I'm currently on Wellbutrin and have been for a few years, and aside from feeling a little speedy for a few days when I started or after upping the dose, I've had no side effects. Since starting I've discovered I have high blood pressure and a bit of anxiety, both of which can be side effects, but both also run in my family, so I have no idea if the medication is the culprit. But I'm generally very happy with it. It's not an SSRI or SNRI, so it might be a good option for you. It's also way, way cheaper than Cymbalta was, at least with my insurance.
posted by Metroid Baby at 9:04 AM on March 27, 2015
- My appetite completely disappeared for a few weeks. I'm typically the kind of person who can always eat if there's something tasty around, and suddenly food was the most boring thing in the universe. I only ate if I was feeling faint, and even then I had to make myself eat. I lost about twenty pounds without trying. I was overweight, so I was pretty happy about this. My appetite did eventually come back.
- I had zero interest in sex. That was fine by me, since I was single at the time anyway.
- This is the really weird one: I had vivid dreams every single night for about three or four months. Sometimes several in one night. At first this was cool as hell, but after a while it got a little tiring.
- If I went for more than 36 hours without it, and tried to sleep, I'd get terrifying sleep paralysis while drifting off. I'd hallucinate about jumping out the bedroom window, but at the same time I'd be glued to the bed, unable to move. That was far and away the worst part.
- Going too long without a dose also resulted in the discontinuation syndrome you hear so much about. For me it was strong brain zaps and my sense of balance going all weird - I felt like I was always walking on a rope bridge. These, along with the sleep paralysis, would go away quickly after I took my next dose.
I didn't have much of a problem going off Cymbalta. However, "going off" took a month of gradually tapering down the dosage. I had to get empty gelatin capsules to put half doses and quarter doses in. Even with all that, it was probably mostly luck that I was able to stop fairly easily. Some people have awful symptoms even when slowly tapering off, but I was okay.
I'm currently on Wellbutrin and have been for a few years, and aside from feeling a little speedy for a few days when I started or after upping the dose, I've had no side effects. Since starting I've discovered I have high blood pressure and a bit of anxiety, both of which can be side effects, but both also run in my family, so I have no idea if the medication is the culprit. But I'm generally very happy with it. It's not an SSRI or SNRI, so it might be a good option for you. It's also way, way cheaper than Cymbalta was, at least with my insurance.
posted by Metroid Baby at 9:04 AM on March 27, 2015
I haven't been on any SNRIs, but I do know a couple people who have taken Effexor, and they did say that the discontinuation was miserable, and even a single delayed dosage caused unpleasant side effects.
However, as noted above, it's not clear why SNRI's are okay if you can't take SSRI's, since medications like Effexor work on serotonin as well as norepinephrine. On the other hand, Wellbutrin is a norepinephrine-dopamine reuptake inhibitor, so if you're trying to avoid any serotonin reuptake inhibitors, that may be worth looking into.
I was on Wellbutrin for awhile. It was helpful, but it ramped up my anxiety, so eventually I switched over to a different med. However, I only had anxiety issues when I was at a high dose (300 mg), but going lower meant it didn't do anything for me. Still, it might be worth looking into. I know some people like it because it's less likely to cause sexual side effects and wait gain. I had no probably doing an abrupt (less than a week) taper.*
Obviously, IANAD/IANYD, YMMV, etc.
*Taper was approved my my psychiatrist.
posted by litera scripta manet at 9:28 AM on March 27, 2015
However, as noted above, it's not clear why SNRI's are okay if you can't take SSRI's, since medications like Effexor work on serotonin as well as norepinephrine. On the other hand, Wellbutrin is a norepinephrine-dopamine reuptake inhibitor, so if you're trying to avoid any serotonin reuptake inhibitors, that may be worth looking into.
I was on Wellbutrin for awhile. It was helpful, but it ramped up my anxiety, so eventually I switched over to a different med. However, I only had anxiety issues when I was at a high dose (300 mg), but going lower meant it didn't do anything for me. Still, it might be worth looking into. I know some people like it because it's less likely to cause sexual side effects and wait gain. I had no probably doing an abrupt (less than a week) taper.*
Obviously, IANAD/IANYD, YMMV, etc.
*Taper was approved my my psychiatrist.
posted by litera scripta manet at 9:28 AM on March 27, 2015
I took Cymbalta for a few years and very quickly was imprisoned by it - the brain zaps and nausea would start about an hour after a missed dose and then the fun ramped up to panic and suicidal thoughts. I tapered off over a period of 3-4 months (and cross-tapered with Prozac) with the help of my psychiatrist. The withdrawal symptoms were not as acute as they were when I straight up missed a dose, but they were still present and very unpleasant. In terms of mood, I felt exactly the same once I stopped taking it as I did while I was on it (but I've felt that way about every anti-depressant or other psychotropic I've ever taken so I'm probably not a great gauge.) I also had similar severe withdrawal symptoms with Paxil. Best of luck to you!
posted by tatiana wishbone at 9:38 AM on March 27, 2015
posted by tatiana wishbone at 9:38 AM on March 27, 2015
A user who inadvertently memailed me instead of the OP asked me to pass this along anonymously:
Hi, I'm on old phone so looking up specific threads isn't workable right now, butposted by dorque at 9:49 AM on March 27, 2015
http://www.dr-bob.org/babble/#search
should yield a lot of anecdata on effexor.
HTH!
Since OP asked about other meds:
Modafinil, in low doses, was brilliant. It's an atypical stimulant, not a SNRI.
I took a low dose of Cymbalta for off-label reasons (migraine and neuropathy). I gained about 20 pounds in 6 months while eating a very clean diet. It did help my chronic pain and my mood quite a lot, and aside from dry mouth and weight gain, the other side effects were not noticeable for me. I had to go off of it when I become pregnant, and my doctor basically made me go cold turkey; the withdrawal was excruciating -- serious nausea, brain zaps, cold sweats, etc. It definitely felt like I imagine kicking a major drug addiction would feel, and I had only taken a low dose for six months. I later lost the pregnancy (which I'm not blaming on Cymbalta, to be clear), and I still have not managed to take off the excess weight I put on despite sticking fairly closely to a strict diet. Anyway, that's just my experience. Overall, I would avoid going on it again, even though it helped tremendously with my condition.
posted by katie at 10:06 AM on March 27, 2015
posted by katie at 10:06 AM on March 27, 2015
I'm guessing "exploding liver" refers to Serzone (nefazodone). Here's what the NIH has to say. (Spoiler: It's still approved for use in the US.)
Anecdata: I've taken Effexor (venlafaxine) and Pristiq (desvenlafaxine). They both worked for me, and I stopped taking them for reasons other than "stopped working." Tapering off Effexor's not fun, but I wouldn't dissuade someone from taking it on the basis of that alone. Pristiq was easier, and my understanding is that it's now often prescribed before Effexor for that reason.
If there's a possibility you might also have ADHD, which is often comorbid with depression, that opens some possibilities as well. (ADHDers sometimes report responding better to SNRIs than SSRIs, which is why I mention it at all.)
posted by gnomeloaf at 10:49 AM on March 27, 2015
Anecdata: I've taken Effexor (venlafaxine) and Pristiq (desvenlafaxine). They both worked for me, and I stopped taking them for reasons other than "stopped working." Tapering off Effexor's not fun, but I wouldn't dissuade someone from taking it on the basis of that alone. Pristiq was easier, and my understanding is that it's now often prescribed before Effexor for that reason.
If there's a possibility you might also have ADHD, which is often comorbid with depression, that opens some possibilities as well. (ADHDers sometimes report responding better to SNRIs than SSRIs, which is why I mention it at all.)
posted by gnomeloaf at 10:49 AM on March 27, 2015
SNRI success story here. Cymbalta has been literally (and yes I do mean literally) a life-saver for me. That said, if I forget a single dose, by the end of the day I'm getting brain zaps, feel like a weepy zombie, and have sleep paralysis + insomnia. I imagine withdrawal would be hell.
I spent years trying various SSRIs and they either didn't work well for my mood, or gave me weird/unbearable side-effects. I did try a different SNRI years ago (Effexor), which made me agitated, angry, and hypersexual. Withdrawal wasn't a problem, probably bcs my doc started me on (yet another) SSRI while I weaned off the Effexor. And I only took Effexor for a few weeks.
No liver problems at all, and as far as I know it isn't a concern with most SNRIs.
The moral of the story is that people are highly idiosyncratic in how they respond to antidepressant meds. And even if one SNRI doesn't work for you, another might work beautifully. I was super reluctant to try Cymbalta after my bad experience with Effexor, but it turned out to be my miracle drug. You just have to try different things -- it's impossible to predict how your brain will respond.
posted by phoenix_rising at 12:04 PM on March 27, 2015
I spent years trying various SSRIs and they either didn't work well for my mood, or gave me weird/unbearable side-effects. I did try a different SNRI years ago (Effexor), which made me agitated, angry, and hypersexual. Withdrawal wasn't a problem, probably bcs my doc started me on (yet another) SSRI while I weaned off the Effexor. And I only took Effexor for a few weeks.
No liver problems at all, and as far as I know it isn't a concern with most SNRIs.
The moral of the story is that people are highly idiosyncratic in how they respond to antidepressant meds. And even if one SNRI doesn't work for you, another might work beautifully. I was super reluctant to try Cymbalta after my bad experience with Effexor, but it turned out to be my miracle drug. You just have to try different things -- it's impossible to predict how your brain will respond.
posted by phoenix_rising at 12:04 PM on March 27, 2015
Everyone is different. I took Effexor for about 10 years. It was a life-saver. I had no serious side effects, just dry mouth. I heard all the stories people told about brain zaps so I was nervous about discontinuing it, but I had no problems at all. You won't know until you try.
posted by islandeady at 1:52 PM on March 27, 2015 [1 favorite]
posted by islandeady at 1:52 PM on March 27, 2015 [1 favorite]
If you are asking for anecdotal information here, you might also like the information available at crazymeds
If you are really concerned about your liver, you might consider genetic testing to see if you are a likely to have problems metabolizing certain medications. The doctor I know uses genomind for this.
posted by metahawk at 4:10 PM on March 27, 2015
If you are really concerned about your liver, you might consider genetic testing to see if you are a likely to have problems metabolizing certain medications. The doctor I know uses genomind for this.
posted by metahawk at 4:10 PM on March 27, 2015
There was a really good article linked from here a couple of years ago about how psych drugs behave at different dosages, I can't remember enough to find it again, but maybe someone else does.
Anyway, one of the take home lessons was that up to a medium dosage, an SNRI targets exactly the same receptors and only those, as an SSRI. It's only once those are overloaded that it "spills over" (metaphorically) to the other receptors. So many people on relatively low dosages of SNRIs are unlikely to see any benefit over an SSRI. I don't know if that's true of side effects too, but it's worth considering. It's maybe good news for you, if you really would rather be taking an SSRI but can't for some reason.
This article I have in mind was by a psychiatrist and he said that most psychiatrists don't know this either, so don't necessarily rely on your doctor being able to explain this to you further, sorry.
(My own personal experience is only with SNRIs (Pristiq) and getting on and off was pretty nasty, but I was too depressed to care much at the getting on stage. There was a lot of nausea and dizziness. Brain zaps coming off. But the effect it had on my depression was worth it, and I freely chose to go back on it again a few years later despite those side effects, because I knew it was effective for my particular brain chemistry issues. The side effects for me last about 10 days when starting the meds and about 2 weeks when coming off.)
posted by lollusc at 4:58 PM on March 27, 2015 [2 favorites]
Anyway, one of the take home lessons was that up to a medium dosage, an SNRI targets exactly the same receptors and only those, as an SSRI. It's only once those are overloaded that it "spills over" (metaphorically) to the other receptors. So many people on relatively low dosages of SNRIs are unlikely to see any benefit over an SSRI. I don't know if that's true of side effects too, but it's worth considering. It's maybe good news for you, if you really would rather be taking an SSRI but can't for some reason.
This article I have in mind was by a psychiatrist and he said that most psychiatrists don't know this either, so don't necessarily rely on your doctor being able to explain this to you further, sorry.
(My own personal experience is only with SNRIs (Pristiq) and getting on and off was pretty nasty, but I was too depressed to care much at the getting on stage. There was a lot of nausea and dizziness. Brain zaps coming off. But the effect it had on my depression was worth it, and I freely chose to go back on it again a few years later despite those side effects, because I knew it was effective for my particular brain chemistry issues. The side effects for me last about 10 days when starting the meds and about 2 weeks when coming off.)
posted by lollusc at 4:58 PM on March 27, 2015 [2 favorites]
Ooh, I found it. The preliminary article, which you have to read first to understand the other, is about Seroquel. Then there is the one about SSRIs and SNRIs here.
posted by lollusc at 5:31 AM on March 28, 2015
posted by lollusc at 5:31 AM on March 28, 2015
If one of your reasons for avoiding SSRIs had to do with a bipolar or suspected bipolar diagnosis, be aware that SNRIs may cause similar side effects (without a mood stabilizer). That's what I was told by a pdoc who was incredulous that Effexor was recommended by a previous doctor.
posted by casualinference at 8:02 AM on March 28, 2015
posted by casualinference at 8:02 AM on March 28, 2015
I took Cymbalta for one week to deal with my chronic joint pain. And I was a completely different person. I felt like I was floating through life, no libido, incredible nausea, insane dreams, no appetite, excruciating migraines. I was, however, happier and pain free, but also feeling super off. Like my head weighted 30 pounds and my limbs were tingly. I stopped cold turkey and felt extremely dizzy, dehydrated, irritable and depressed. ONE WEEK! My doctor (rheumatologist) did not tell me that it was an SNRI and did not educate me at all about the mood changes/effects. I do not see her anymore, obviously, for suggesting such an all-encompassing solution for something that was clearly just physical.
I'm tempted to try it again sometimes when my pain gets bad, but I am too scared. Tread carefully!
posted by doctordrey at 5:05 PM on April 1, 2015
I'm tempted to try it again sometimes when my pain gets bad, but I am too scared. Tread carefully!
posted by doctordrey at 5:05 PM on April 1, 2015
This thread is closed to new comments.
That said, if you can't take SSRI's, it's not obvious that SNRI's would help -- they also affect serotonin levels (the first S in SSRI is for "selective", but in SNRI it's for "serotonin").
posted by dorque at 8:31 AM on March 27, 2015