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Doctors Lounge - Psychiatry Answers
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- Wed Jan 25, 2006 5:37 pm |
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i began taking effexor xr five years ago. i was put on 75mg a day. About a year ago i went down to 37.5 mg a day. i have been trying to wean myself off, following my doctors advice. take one every second day for a few weeks, then every third day for a few weeks and continue weaning until i'm off the drug. i am finding it impossible to get off this drug! i've been taking it every three days now for the last two months and by the third day i am so sick that i can't function. the fuzzy head,fatigue, nausea, emotions etc are so unbearable. Will it get better? should i be doing anything different? i truely feel addicted and it is awful.
i am a 31 yr. old woman.
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| Dr. Tamer Fouad
- Fri Jan 27, 2006 8:37 am |
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 Hello,
Effexor (Venlafaxine) is a serotonin-norepinephrine reuptake inhibitor.
Discontinuation symptoms (withdrawal) are recognized with tricyclic antidepressants, MAOIs, SSRIs, and various other antidepressants, including venlafaxine (Effexor) and mirtazapine.[1] The World Health Organization asserts that SSRI and SSRNI antidepressants cause dependence and that discontinuation symptoms can be troublesome and persist not withstanding taper therapy.[2]
General strategies to prevent and manage symptoms associated with the discontinuation of SSRIs include a gradual tapering of the dose when discontinuing treatment with any SSRI except for fluoxetine (Prozac).[3] If withdrawal reactions occur while tapering or at the end of treatment, it may be necessary to increase the dose and initiate a slower rate of taper.[2]
Some authors suggest switching to fluoxetine (Prozac) if symptoms are severe and the patient is unable to discontinue the SSRI despite tapering.[2,3,4] For paroxetine (Paxil), some suggest reducing the dose by 5 mg/d at weekly intervals to below the initial minimum therapeutic dose.[5]
References
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1. Haddad PM. Antidepressant discontinuation syndromes. Drug Saf 2001;24:183-97.
2. Selective serotonin re-uptake inhibitors and withdrawal reactions. WHO Drug Information. 1998;12:3, 136.
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. Taman L, Ozpoyraz N. Selective serotonin reuptake inhibitor discontinuation syndrome: a review. Adv Ther 2002;19(1):17-26.
5. 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.
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