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Forum Name: Antidepressants

Question: Starting Effexor XR Have questions


 Pvault - Wed Nov 30, 2005 1:48 pm

Hi all. Today I am starting effexor, I was previously on Lexapro (She's taking me off due to the side effects, i.e. Night Sweats, Mania, unable to orgasm etc.) My doctor has me taking half of my lexapro while starting the "Starter Pack" Effexor. I am feeling pretty normal today, what should I expect in the upcoming days? Any suggestions on taking it at night or in the morning? Thank you!
 Dr. Tamer Fouad - Wed Dec 07, 2005 7:02 am

User avatar Hello,
I hope your therapy is going well for you now. Please let us know.
To answer your question: Sometimes stopping an antidepressant leads to what is known as a discontinuation (withdrawal) syndrome.
Discontinuation symptoms (withdrawal) are recognized with tricyclic antidepressants, MAOIs, SSRIs, and various other antidepressants, including venlafaxine and mirtazapine.[1]

The symptoms observed following SSRI discontinuation can either be physical or psychological and are often grouped into the following categories:
1. Disequilibrium (e.g., dizziness, vertigo, ataxia)
2. Gastrointestinal disturbances (e.g., nausea, vomiting)
3. Influenza-like symptoms (e.g., fatigue, lethargy, myalgia)
4. Sensory disturbance (e.g., paresthesia)
5. Sleep disorder (e.g., insomnia, vivid dreams)
6. Psychiatric disturbance (e.g., anxiety, agitation, confusion).[2,3]

Most withdrawal reactions are mild and transient, usually occurring within 1–3 days (up to 1 week) after stopping the medication and lasting 7–14 days, but occasionally the symptoms last for several weeks.[1,2] However, some reactions can be severe and may require acute treatment.[2]

All antidepressants do not have the same type or severity of withdrawal symptoms. In studies comparing fluoxetine, sertraline, paroxetine, and citalopram, withdrawal from paroxetine was shown to cause more severe symptoms that may occur more quickly, even after the second missed dose [4-7]. Because of its long half-life, fluoxetine may have the least severe symptoms.[1,8]

Let me add to this by saying that the half life of Lexapro is within the range of 27-32 hours, so you may experience some of these symptoms.
It is not known how many people experience withdrawal syndrome as clinical trials examining this issue are lacking and limited to only trials of short duration or to anecdotal reports. Some people do well and do not experience any symptoms, hopefully that will include you.

Regarding Effexor XR the most common side effects include nausea, dizziness, insomnia, somnolence, and dry mouth. Anticholinergic side effects are significantly less severe. Sexual side effects are similar to side effects caused by SSRIs.

Effexor XR should be administered in a single dose with food either in the morning or in the evening at approximately the same time each day. Each capsule should be swallowed whole with fluid and not divided, crushed, chewed, or placed in water, or it may be administered by carefully opening the capsule and sprinkling the entire contents on a spoonful of applesauce. This drug/food mixture should be swallowed immediately without chewing and followed with a glass of water to ensure complete swallowing of the pellets.

References:
1. Haddad PM. Antidepressant discontinuation syndromes. Drug Saf 2001;24:183-97.
2. Schatzberg AF, Haddad P, Kaplan EM, Lejoyeux M, Rosenbaum JF, Young AH, et al. Serotonin reuptake inhibitor discontinuation syndrome: a hypothetical definition. J Clin Psychiatry 1997;58(Suppl 7):5-10.
3. Macdonald L. Discontinuation reactions associated with SSRIs. Can Adverse Drug Reaction Newsl 1998;8(4):2-3. Also in CMAJ 1998;159(7):846-7.
4. Committee on Safety of Medicines and the Medicines Control Agency. Selective serotonin reuptake inhibitors (SSRIs). Curr Probl Pharmacovigilance 2000;26:11-2.
5. Stahl MMS, Lindquist M, Pettersson M, Edwards IR, Sanderson JH, Taylor NFA, et al. Withdrawal reactions with selective serotonin re-uptake inhibitors as reported to the WHO system. Eur J Clin Pharmacol 1997;53:163-9.
6. Adverse Drug Reactions Advisory Committee (ADRAC). SSRIs and withdrawal syndrome. Aust Adverse Drug React Bull 1996;15(1):3.
7. Trenque T, Piednoir D, Frances C, Millart H, Germain ML. et al. Reports of withdrawal syndrome with the use of SSRIs: a case/non-case study in French Pharmacovigilance database. Pharmacoepidemiol Drug Saf 2002;11:281-3.
8. Michelson D, Fava M, Amsterdam J, Apter J, Londborg P, Tamura R, et al. Interruption of selective serotonin reuptake inhibitor treatment: double-blind, placebo-controlled trial. Br J Psychiatry 2000;176:363-8.

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