Effexor question

I was on 37.5 of effexor XR with good results (I am also on Nortriptyline). My specialist advise to increase to 75 mg.
Every time I attempt to increase my symptoms are stronger. I am micro dosing but sill having the same problem.

Any experience ?

If you are having good results at the 37.5 mg dosage, why does your specialist think you need to increase the dose?

because I still get bad days. It’s not bad bad but it could be better

Ahh, OK. I don’t have any experience with Effexor so I can’t answer your question. I think I’ve read that in general, most antidepressants will have stronger side effects the first few weeks that you take them.

I was reading your post on medication. I am on Nortriptyline had no side effects from it I was going up 5 mg every week. I am now at 50 mg. Unfortunately by itself is not helping much so that is why doc added the other one on top.

Increase in dosage causing more symptoms is a sign the drug is working.

I would stick to 37.5mg a little longer as I believe 100% does not exist.

Not to scare you but hain says 37.5 and less have no problems weaning off effexor. Higher doses might have weaning issues.

I wonder whether you’re having problems because you’re taking two drugs from the same group (antidepressants)?

Hain’s flow chart says to avoid two drugs from the same group ( see link): flow_chart_migraine_prevention_for_patients.pdf (12.9 KB)

See the box toward the bottom that says:

“Combinations – especially
(avoid two drugs same group)”

yes I know, this was the first question I asked the neurologist he said that in low doses it’s ok.
Today I didn’t have the courage to continue with the new dose so I went back to 37.5
thanks :slight_smile:

GetBetter. I know about the weaning problems, what do you mean 100% doesn’t exist? Doesn’t exist for us you mean?

Ahh, OK. I kind of forget that the doses prescribed are usually much lower than what these drugs are given for other things. I looked up the nortriptyline and saw that it can be dosed as high as 150mg per day. I started at 10mg and am supposed to get up to 30mg so I guess that’s still a low dose.

If you have depression … the doses of tricyclics when applied to MAV are MUCH lower … usually max 50mg but typically 20-30mg (see Hain’s flowchart), though a few neurologists seem to go much higher …

Source: Migraine associated vertigo -- Vestibular Migraine

I started with 37.5mg in early November and was increased to 75mg early this month without an issue. I’m also tapering off Gabapentin & Amitriptyline and was given Valium to take as needed. The plan is to have me on Effexor alone and Valium to use for anxiety when really needed for MAV & PPPD.

James, note that Hain has a more-recent flowchart (2013):
flow_chart_migraine_prevention_for_patients.pdf (12.9 KB)

I can’t remember where I found this on his site; I saved it to my own computer when I found it.

EDIT: I just found it on his site. It’s on this page:

But don’t look at the graphic displayed on that page (that’s the 2012 version). Instead, click the link titled “Algorithm for treatment (pdf)” which links to this:

OK, but that’s not MAV, its migraine? And the flowchart suggests 10-50 still

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The 2012 flow chart is also titled “Migraine prevention.” Aren’t migraine and MAV basically the same thing? At least in terms of the way he recommends they be treated?

This is still linked from his main page …


There is definitely a big difference between Migraine Associated Vertigo (MAV) and Migraine

MAV starts out with amongst other things dizziness 24/7 - migraine on the other hand is just episodic … afaik there are no 24/7 symptoms with migraine for most sufferers even though they can happen pretty regularly …

I suspect the ear causes the 24/7 stuff (controversial opinion) and you are in this situation very much more at risk of migraines as a result. One is co-morbid with the other.

But you are right, the treatment is extremely similar.

And the sad part of this I suspect is because the migraine bit is the most treatable part … the rest of it less so … and the less treatable bit relies on compensation and spontaneous resolution. Having said that I found my dizziness was reduced considerably when taking Amitriptyline at the right dose, but suspect that was improving my symptoms, not resolving my condition.

The amount of people who have Hydrops and MAV diagnoses (I am one) convinces me that MAV is a problem that starts in the ear, but the symptoms can really vary - some people don’t have tinnitus only get it episodically (but according to my poll, the majority get tinnitus 24/7)

Hmm. The specialist I saw in 2016 said I most likely had vestibular migraine (after doing all of the ear tests), but I’ve never had dizziness 24/7.

Just my 10 cents, but I suspect there is a whole spectrum of suffering … you may only have a relatively mild variant. There is a temptation for some docs to classify things differently whereas its all simply a spectrum of severity. Hence we have “Vestibular Migraine” as distinct from “Migraine Associated Vertigo”. Hain actually states: “vestibular migraine is a subset of migraine associated vertigo,” on that page.

From my experience on this board, most people have dizziness and imbalance 24/7, at least for the first 2-3 years. So most have “MAV”. There are plenty with Hydrops as well so I suspect the aetiology may be intimately related (controversial).

Maybe time to back up that statement with a poll …

Yes, you may recall that I just saw a new specialist who isn’t convinced that mine is true vestibular migraine. He thinks it’s neurological, though, as opposed to ear.

I’m grateful that whatever mine is, it’s fairly mild compared to what many of you have gone through. I’ve had mine a long time (23 years) but have never suffered some of the debilitating symptoms that many of you have put up with.

Yes, some people, including myself, have gone through total hell, but none of it is pleasant whatever the ferocity.