Venlafaxine / Effexor – A Med of Dread?

The below is a list of symptoms that I have experienced since starting to take Venlafaxine (75mg) from 15 June.  It is redacted in places, for either personal reasons or to help the ‘flow’ of this post, but essentially this is from a list I have been maintaining with the intention of showing Dr C when I finally see her again on 8 September.

  • Significant increase in (hypo?)mania I am very much the ‘life of the party’, very confident (at times to the point of arrogance, or being very over-talkative)
  • Significant increase in mixed episodes.
  • In both of the above obviously fragmentation, pace and disorder of thoughts are of increased severity.
  • Rapid cycling between (hypo?)mania and depression at times (ie – changes once or twice a week – occasionally more often, occasionally less so).
  • Significant increase in compulsion to (and execution of) self-harm. Execution of ‘creative’ cutting reduced a little after the initial six or so weeks, but is still sometimes happening and I still feel the compulsion strongly and with great frequency.   Any lack of execution of cutting is mainly due to environmental factors or preventative measures I have previously taken (eg. hiding knife). Head-banging, hair pulling, scratching at self all still very frequent.
  • Severe restlessness – compulsion to head-bang, to pace, get up, sit down, get up, sit down – noticed usually in tandem with severe anxiety and/or mixed states, but not necessarily limited to this (this was present before Venlafaxine but it was much less frequent and much less severe).
  • Psychosis – Increased and more severe delusions (frequency – circa once a week? Though hard to say) – eg sun (watching me), signs (sending me messages), iPod (reading my mind/mood), severe paranoia (trust issues even worse – everyone is out to get me).  Some hallucinations are of similar frequency as before, but are more vivid – shapes especially clear.  Now also hearing voices/whispers which are very audible – as opposed to nebulous – at times (obviously unaccounted for).  The frequency of the voices – there are no hard and fast rules, some weeks this is frequent, some weeks there are none at all.  No specific time. Content is not ‘demanding’, it just says stuff like saying my name, asking what I’m doing – it is meaningless ‘small talk’. The shapes are there most (but not all) nights as before, same nebulous form as previously, except sometimes with greater clarity.
  • Amnesia – eg. ending up in places with no idea how I got there or forgetting long discussions usually related to being mental.  Frequency of this is hard to determine – at a guess once a week? It depends – sometimes no such amnesia one week, sometimes several instances thereof.
  • Increased mood swings, independent of mania-depression-mixed states – eg. extreme and uncontrollable irritability, anger, frustration, lethargy, anxiousness (again, these mood swings have been strongly present long since taking Venlafaxine but seem to have increased since taking it).
  • Constantly exhausted – even more so than previously – except when I’m in a ‘manic’ state during which high energy levels are present.
  • Fantasy world is still there but seems less intense than previously – not sure whether this is a result of tablets or psychotherapy though?
  • Terrible forgetfulness – I go to do something and literally five seconds later I’ve forgotten what it was or what I went to do.  As with anyone this happened the odd time in the past but  for me it is now several times daily.
  • Horrible, vivid nightmares when I do manage to sleep. Once or twice a fortnight.  I very rarely had such dreams before taking this tablet (approximately once every few years). They focus mainly around my being attacked (physically or sexually) or painfully trying to kill myself – despite suicide ideation this is not pleasant at the time!
  • Suicide ideation seems increased to others (though not necessarily to me).
  • Others say ‘default’ mood is slightly improved but not still not to extent they would have hoped.  My own view is mixed.   I still feel profoundly depressed most of the time, but perhaps the intensity of that profundity is very slightly reduced (not always – but I think in the main). Furthermore, given the substantial increase in (hypo)mania, depression occurs less frequently – but is felt very strongly when it does due to the strong divergence in mood. Mixed states, which are now very common, are probably the worst state as when I am very depressed I don’t have enough energy to self-harm or seriously consider suicide, etc – in a mixed episode I do.
  • Others describe lows / mixed states as being of considerably worse severity.

Symptoms with No Change Since Taking It

  • Still feel depressed though as stated others comment that I seem to them to be less depressed during ‘normal’ periods and own view is that it may be very marginally improved at times.
  • Insomnia in a similar state, though general exhaustion and lethargy increased. Difficulty falling asleep – if and when I do, wake up frequently, even with medication (without sleep is usually non-existent beyond maybe half an hour or so).
  • Dependency / abandonment issues unchanged.
  • Narcissism, entitlement – though self-hate has definitely manifested more significantly since onset of psychotherapy (apparently unrelated to medication).
  • Misanthropy.  Mistrust of people.  Abject terror of work, work-related issues, going to unfamiliar places – I fall about in a mess even thinking about this stuff. This is all the same as before.  Despite all this, I experience a lot of paradoxical loneliness.
  • General levels and frequency of inappropriate anger is similar to before, though outbursts seem to be increased (as stated above).
  • Self-analysis, overthinking.
  • Dissociative symptoms – depersonalisation and derealisation seem mostly unchanged (apart from the development of amnesiac occurrences – presume this is related to dissassociation in some way?).
  • Continued personification of inanimate objects, feeling sorry for such things – no such sympathy or empathy for people (in general).
  • Fixation with death (as distinct from specific suicidal thoughts) is ‘stable’.
  • Complete and utter lack of motivation – no interest in everyday activities eg tidying, dressing,cooking etc.  Same as before.
  • Utter inability to concentrate or focus for anything more than a few minutes, except when mood is strongly elevated (and certainly not always then either). Very easily distracted, little ever gets done (applicable at all times).Memory rubbish too. Need to sit and plan things to have any grasp on them.
  • Eating problems similar to before.
  • Obsessional behaviour continues.
  • Black and white thinking and behaviour.
  • Post-morteming behaviour.
  • Other issues that I can’t think of.

In short, I think Venlafaxine could, potentially, help me with my depression – but the dosage would have to be increased, as the small improvements made in that regard are simply not sufficient to keep me sane.  More importantly, though, Venlafaxine is not only not helping all my other symptoms, but either it is making no difference or, more commonly, it is in fact increasing them.  I have described some of the horrors elsewhere on this blog.  The past few months have been fucking horrendous, by and large.  This is particularly the case, of course, as regards the bipolar symptoms.

As you can see from the link at the top of the page, Dr C refused to give me mood stabilisers when I last saw her as she believes that BPD is my primary diagnosis, and NICE advise against the use of them and anti-psychotics in BPD (though this seems to be the mainstay of treatment for borderline in other countries!).  That’s all well and good, but of course Venlafaxine is notorious for increasing or inducing manias and mixed states to those predisposed to them.  Given that circumstance, you would have thought that she would either have had the decency to listen to my plea for mood stabilisers at the time, or at the very least had her SHO keep the fucking July appointment that they cancelled.  If I, a complete psychiatric novice beyond my explorations on the internet, am aware of Venlfafaxine’s notoriety in this regard, surely a consultant psychiatrist, who herself diagnosed me with an illness on the bipolar spectrum, should have taken some bloody consideration of this?

In any case, I have forgotten to bring all my medications, including the bloody Venlafaxine, with me to an overnight visit to my mother’s house.  I am well aware of how hardcore missing doses of Venlafaxine can be, plus I also don’t have my sleeping pill so no doubt insomnia calls.  I’m sure, ergo, that tomorrow morning’s session with C will prove interesting…
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20 Responses to “Venlafaxine / Effexor – A Med of Dread?”

  1. Wow. Given your psychotic symptoms, I can’t believe they’re not giving you anti psychotics. Sure, the side effects suck, but they’re better than the psychosis IMHO.

    I’m rather shocked that the UK doesn’t want to treat BPD. Why is that?

    • Grr – don’t get me started. According to my psychiatrist the National Institute of Clinical Excellence have said that patients presenting with BPD should be treated with anti-depressants and psychotherapy. NICE claim that anti-psychotics and mood stabilisers are not proven to be effective in the treatment of BPD.

      Now I’m not a shrink, but it seems like horseshit to me. A number of people on the other side of the pond I’ve spoken to whose primary diagnoses are also BPD couldn’t live without mood stabilisers and/or anti-psychotics. I tried to argue with Dr C about the mood stabilisers at least, but she wasn’t having it. To be fair, she did say she’d consider it if Venlafaxine increased the bipolar symptoms or there was no improvement in general, but then the stupid cow’s SHO (her junior doctor) who was meant to see me at the end of July canceled the appointment and it’s still another fortnight until I see them.

      I suspect when they’re presented with this list, they’ll not have much choice!

      Thanks for your thoughts again 🙂

  2. Did a bit of research:

    Your pretty much screwed on the med’s front. You might be able to get something like a pack of zyprexia for emergencies, but it’s pretty much DON’T TREAT BPD WITH MOOD STABILISERS. NO NO NO! Have a look for yourself. http://www.nice.org.uk/nicemedia/pdf/CG78NICEGuideline.pdf

    However, I looked through the literature, and I think these will interest you.
    http://www.thieme-connect.com/DOI/DOI?10.1055/s-2005-837767
    http://themadandwild.wordpress.com/files/2009/08/understanding_bpd.pdf
    http://themadandwild.wordpress.com/files/2009/08/167.pdf
    http://themadandwild.wordpress.com/files/2009/08/1221.pdf
    http://themadandwild.wordpress.com/files/2009/08/fulltext.pdf

    Just read through the introductions and conclusions.

  3. I had so many similar symptoms when I was taking Effexor (I started listing them, but it would be like repeating you post!). I had requested Effexor because a long time ago when it first came out it helped me with depression. My pdoc was hesitant because he said it’s not a good med for people with bipolar disorder, but I was insistent (delusions of grandeur?). But when the symptoms started getting bad, he had me get off of it slowly (this is an insidious drug and withdrawal is a bitch), and then did a little bit of “I told you so.”

    • God, I hate it when they do that. Smug pricks! I’m glad you managed to get off it eventually though; I am actually terrified of her trying to take it off me. OK, so all this shit is very bad, but I’m mildly encouraged by the slight reduction in depression. I just want her to give me extra medication.

      I’m scared of anti-psychotics, I have to say, and would rather do without them (though as NiroZ I suppose it’s better to have their side effects than endure some of the above). But I do want mood stabilisers. I recognise that they can be dangerous and need to be closely monitored, but I don’t see any other viable solution at present, as I need treatment for strong depression too.

      Anyway, Sheri, thanks for sharing your experience with me. Hope things are a little easier for you at the minute. Take care x

      • Hmm. You do realise that the only thing non anti psychotic medication would do is to get rid of the hypomania/mixed states and perhaps the mood swings.

        I suggest you look up the various meds on http://www.crazymeds.us/, but I think you’ll find that they’re all as bad as each other when it comes to risks.

        I’ve on read the abstracts of the articles, so which paper was that?

        • It was NICE’s own paper. It was about half way down the document.

          I’ve just read through the introductions and conclusions of the other documents you linked to – very interesting indeed. Thank you so much for taking the time to link to them – I’ll be referring back to them.

          I’d already checked Crazy Meds in terms of mood stabilisers, but will look up the anti-psychotics too. Someone on Twitter referred me to Geodon; she said it controlled both her mania and some of her psychotic features.

          I don’t know; psychiatry is educated guesswork as far as I can see. I’ll keep reading up anyway and see what she says – still two weeks to go.

          Thanks again!

  4. Good you have kept “evidence” of what’s been happening with your list. Doc’s love the evidence and should never ignore it.
    SSNRI’s are notorious for triggering mania in bipolar patients.
    As you said, it’s all a combo of treatments, moodstabilisers, anti depressants, sometimes antipsychotics and antiepileptics. and most importantly TALKING TO YOUR DOCTOR REGULARLY.
    Good luck AND
    thank you for your comments on my blog, you were spot on….i was dissociated. I’m ok now…

    • I’m glad you’re feeling a good bit better now. Disassociation sucks – I’d written here that I felt my symptoms thereof were unchanged but in conversation with C this morning he thinks the instances of amnesia are exactly that. Still nearly two weeks until the psychiatrist though.

      Anyway, thanks Lissy; it’s all trial and error, educated guesswork, but hopefully we’ll get somewhere sooner or later. I’m glad that the Lamictal has been helpful to you and hope that you will see much progress in the next few months. Good luck and hugs.

  5. I’d like to weigh in on this subject… It is a FACT that antidepressants have been proven to have the reverse effect in many bipolar patients. In fact, they can actually cause rapid cycling.

    My symptoms were fairly easy to deal with before my primary care physician prescribed Wellbutrin to help me quit smoking.

    Long story short: Fiasco! The Wellbutrin was the originator of what is now my ultra rapid cycling (ultradian).

    Also, regarding your BPD diagnosis… I’m no shrink, but that sounds fishy. BPD does not cause auditory OR visual hallucinations, psychosis, mania or the majority of other symptoms you mentioned.

    Have you thought about getting another opinion? I could be way off base, but your diagnosis & prescribed treatment sounds like a stretch to me. JMHO… Kim

    • Hi Kim 🙂

      I do believe that the BPD diagnosis is, in the main, accurate. Most of my symptoms before the medication would have chimed with it. One or two of the general diagnostic criteria don’t apply, but I would have six or seven of them, and I believe after five or more such a diagnosis is applicable. As far as I understand it, one thing often seen in BPD is co-morbidity, so that’s where the bipolar II diagnosis comes in.

      However, I can’t attribute the psychotic features to that as, as I understand it anyway, in the bipolar spectrum psychosis is only seen in BPI.

      I agree that this does make things sound a bit weird. Dr C said that it was not uncommon to “not fit neatly” into one diagnosis or another, so she seemed to justify the psychotic features I present on those grounds. I can understand that, but it does seem a bit like a get-out clause.

      I’d love to seek a second opinion, but I’m not sure how I’d go about that. The NHS is an odd organisation, and I’m fairly sure I couldn’t afford private treatment at the minute. Nevertheless, thanks for the suggestion – I could maybe enquire as to the situation vis a vis the NHS with one of the mental health charities here.

      I’m blaming the increase in psychosis plus a lot of the other stuff simply on the medication, which may be naive or misguided, I don’t know. From what I’ve read, a lot of these symptoms are seen in Venlafaxine, but then that perspective can’t explain why it has only increased them, rather than caused them.

      I’m seeing her (or at least one of her team) on 8 September, which is a week on Tuesday. I’ll have it out with her then, but if there isn’t a satisfactory outcome between C and a charity I’ll try and see how I can proceed.

      Your humble opinion is always welcome here 🙂 Thanks for your comments – what you’ve said is food for thought.

      Take care x

  6. I said to Kim there that she had provided me food for thought, and she certainly has. Can I just add that everyone contributing to this thread has done so – this has been a really interesting and enlightening discussion. Thank you all.

    • OK, thanks – interesting reading. The relationship between the two disorders seems debated…that it is uncertain seems the only certainty!

      From the second article:

      In BPD, mood changes are often more short-lived — they may last for a few hours at a time. Also, mood shifts in BPD are usually in reaction to an environmental stressor (such as an argument with a loved one)

      I would say this is generally true of me, or at least it was more so before taking Effexor. I certainly do shift moods for no reason as in bipolar at times, but there are often situational causes, and they have tended to be changable several times daily. Nevertheless, that could be explained by ultradian cycling. The thing is, before I took this drug, the article’s assertion that your ‘best’ mood swing as a BPD sufferer would be from miserable to OK would have been mire true of me than a shift from miserable to manic. But the latter was certainly not unknown. Since taking Effecor, as stated in the main post, that type of swing has become more common.

      I’m not sure what I think now. I still think I clearly meet the diagnostic criteria for BPD, but I don’t think it’s just as simple as that unfortunately; you’re certainly correct to assert that the kind of symptoms described here don’t correlate well with BPD at all.

      I don’t know Kim. I’ll have it out with her; it does all seem rather fucked up, and after deserting me for three months the old bitch owes me a number of answers. I’ll raise the concerns addressed in the articles with her, not to mention the stuff NiroZ linked to as well. One way or another, whatever’s going on, I don’t feel that this situation should, or even can, continue. I’m worried that I’m going to either end up in the bin or dead, depending on circumstance :-/

      Sorry, that’s a bit of a morbid way to end! Hopefully between A and my mother I won’t actually end up in either position! Fingers crossed it can be sorted in any event. Anyhow, thanks for taking the time to look into those articles for me – I do appreciate it 🙂 x

  7. I was only on 75mg for about a week before they upped it to 150mg (was done by the crisis team psych) so I don’t really know what I’d be like on it. I don’t have the bipolar part of things to contend with so I don’t have the extremes of mood but certainly things didn’t seem great on venlafaxine until I got put on the risperidone in June. On’y on a minimal dose of that but its definately been a good thing although difficult to get my head round the antipsychotic idea.

    I hope things weren’t too rough when you missed a dose. I find the day I miss it I’m ok, it’s the next day when things feel weird until the next dose kicks in. Feels like electric shocks in my brain and very dizzy.

    Some really interesting links here thanks people.

    Take care sweetie hugs x

    • Even 150mg seems tame – I know someone in a much less serious situation than either of us that takes 225mg a day! I guess it all depends on the medic you see and how understanding they may be about the conditions they’re prescribing them for. Annoying.

      My concern is, although I do think an increased dose of the stuff would help me with the depressive side of things, that she’ll be reluctant to increase the dosage because of all the side effects. If she could prescribe a higher dose in conjunction with mood stabilisers and/or anti-psychotics, I would (at this stage anyway) be happy – but you know what she’s like; she’s obviously dealt with enough mentals in her time that she knows how to control us and you feel her professional boundaries as soon as you walk into the room – I’m a bit scared of her and reluctant to argue or press my point :-/

      As a matter of curiosity, do you know the specific reason that Dr O gave you the Risperidone? I’m so glad it’s helped a little 🙂

      Re: missing a dose, I was basically fine yesterday until I was leaving my mother’s house about 7pm when I burst into tears for essentially no reason. I cried all the way home in the car, and at various points in the evening, even when I wasn’t feeling that upset! I also experienced that entire tiggly, shaky, dizzy sensation that you mentioned. Back to ‘normal’ again today though, thankfully.

      Anyway, pet, thanks and you take care – *big hugs* xxx

  8. SSRIs trigger ‘manic’ stuff even in people who are not bipolar. Sometimes the diagnosis is based on drug reactions, which I think is stupid. I don’t understand why the shrink would add another med to fix the fact that the other one is messing you up. Common sense would dictate the removal of the drug that is causing the problems. Especially since you say the benefit is so small compared to the bad effects.

    • I had thought about this, but am still terrified of her taking it away. Not since I was taking Prozac years ago have I felt that an anti-depressant had any positive effects, so the fact that it does, however slight, make me want to cling to it (Prozac ultimately lost its effectiveness and because I was fairly young at the time, they refused to increase my dosage further, and changed it to Mirtazapine, which was shit, which was then changed in January to Citalopram, which was even worse).

      Additionally, Venlafaxine is an insidious drug – I understand that the discontinuation syndrome with it is especially nasty. The flip side of that is that I’ll potentially have to experience it sooner or later, and that the longer it’s left the more the damn thing has got you in its clutches, but I’d rather come off it – if I ever need to or can – when my head is less fucked and I feel more mentally capable. Plus if I’m brought off it, that will be the third change in anti-depressants within a year. Per se, that is not a big issue, but when you consider that it takes about six weeks for the transition to be remotely effective, there’s about four months out of 12 characterised by hardcore madness.

      For what it’s worth, I’d wanted her to give me mood stabilisers before she prescribed this; the symptoms raised in this post were already there, they’ve just been made worse.

      Nevertheless, I expect her to make this point herself so the ‘common sense’ approach may win out this time, because I’m too scared of the woman to press my point.

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