Help! Effexor start up questions!

Hello all, I suffer from basilar or brainstem migraines and MAV, that has fortunately been episodic. My neck/face pain has progressively worsened, and an MRI showed I have a pinched nerve at C5/C6 as well as severe facet arthritis, all on the same side (left). I take propranolol, but it’s not doing much. Tried a cervical epidural- helped for 3 days only. Have done phys therapy and chiro. They want me to try meds before resorting to neck surgery.
They’ve put me on Effexor ER. I just started 4 days ago, using Hain’s recommendation of 1/3 of the 37.5mg capsule to start. Well, last night it must’ve really kicked in. While my body was very relaxed, I could not sleep! My mind was racing with random thoughts. I finally would doze off, only to have the most disturbing, violent dreams. I think I only had 3-4 hrs sleep. Also hot flashes/sweats. This is after 3 doses of 12mg!! I guess the good news is that my dizzies already feel better.
My question is- do I stick with it? Does this effect go away? Or is this a sign that it is not for me? I work and commute so I do need sleep. I also take a small dose of klonopin, but it seemed no match for this effexor!

Hi. I recognise yr username from archived posts I’ve read ages back before I started posting. Sorry to hear you are still having problems. I, like you, take Propranolol so not an Effexor expert but from what I’ve read and from others on here your experience is pretty typical I’d have to say. It seems to take 4/5 days to start to kick in and insomnia and vivid dreams are the way it goes and they do seem to persist. Vivid dreams seem to occur commonly with alot of the preventatives used. I’ve had them with Propranolol. In fact I had them every night for several years but either I’m currently having a lull in them or they have recently stopped. I think hot flushes/flashes are also quite common with Effexor which seems strange as my GP here in UK tells me she uses Effexor to treat hot flushes regularly with great success. It’s possible changing the time you take the meds might help with the insomnia but I’m sure @nin and/or @jojo65 who both take it may input on that. Glad that it is beginning to work for you though. That’s great. Hopefully you will be able to make peace with the side effects soon. Helen

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Effexor is said to be an “activating” medication and it’s recommended that one take it in the morning.

I would say to stay with it—especially if you have noticed improvement with the dizziness; sometimes it’s weeks or months before improvements occur. Many side effects subside substantially after a little while.

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Hey napa girl, I’m on 112mg of effexor. I found getting up to 37.5mg bit challenging, like you first few tablets I took at night kept me awake at night so I changed to early am with breakfast, and sleep great. In terms of night sweats, it’s very common side effect and I still have them. I also have very vivid dreams too nightly. I’ve made significant progress on this and its a med that keeps on giving, am only few weeks on this dose. In terms of side effects it’s a decent trade off, you might find they settle in a few weeks. If I were you I’d stick with another while. Reach out if you have any questions. One final thing, it’s been a game changer in terms of my pain, had daily nerve pain around eye, temple and forehead and its now gone, only comes back if I’ve pushed it to max and have period.

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Yes, I’m back! The Neuro thinks my neck is triggering these migraines/MAV, and I agree. But I’m told surgery is always a risk to make things worse, so I’m up for meds before that last resort.

I do take effexor in the AM. I was using like 11-12 pellets (1/3 capsule) the last 3 days. I wasn’t going to take it this morning, but decided to lower it to 6 pellets and see what happens. I’m prone to insomnia, so this is a concern. I am waiting to see my rheumatologist right at this moment, and hopefully she might have some advice even tho the Neuro prescribed it. I will update on that. In the meantime, any advice on getting sleep?

Perhaps tirating up six beads a time will prove the answer to your sleeping. More time for your body to adjust to the drug should reduce side effects. Helen

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Rheumatologist thinks I should try to stick with it since my nerve pain is improved and dizziness improved. I took 6 pellets at 9am. Now I am feeling spacey and nauseous, like I’m stoned or something (yes I took with food). I will never understand why people take recreational drugs- I hate this feeling! I will try to stick with it. Rheumy said to try some benadryl tonight. I could totally commit to this much better if I didn’t have to commute/work!

Perhaps you need to take some time out to give the drugs a fair chance to work. Particularly if this is last resort before surgery. Just so you know you have given it a good try. Helen

I would LOVE to! Unfortunately beteween my Dr visits and various procedures, I’m low on sick leave. More importantly, my manager is losing patience with the state of my health (he is not a very understanding person and is never ill himself- I suspect he thinks I’m exaggerating my issues). I’m so close to retirement (I can go out early in a few years), I don’t want to risk my job right now. If it gets super horrible, I will be forced to see if one of my Dr’s can put me on short term disability. I’m not sure how it is in other places, but here in SF bay area, Dr’s seem hesitant to put you off work for a few weeks unless you are injured or having surgery.

One additional question: by taking the pellets on their own vs in the capsule, does it hit our system harder- more at once?

Im thinking of titrating up to 75mg to see if my morning dizzies will improve so your advice on what to expect side effect wise may be required at some point.

I don’t think so—my doctors and pharmacists have never mentioned anything on that score.

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The decision to drop to 6 pellets is a good call I think, you may need to stay on this for about 10 to 14 days to allow the brain to adjust. If I look back on my journey, I only had trouble tirating up when I rushed it and didn’t allow my brain to adjust. When I started it was on 9mg only and was wrecked for days in terms of tiredness but it did pass. In terms of sleep, I go to bed just after I get kids up and simply read a few pages and mug of camomile tea, it’s a strict routine I’ve followed for almost 3 years and when I had days where I couldn’t read I did some simple tai chi exercises to unwind. Insomnia is awful, sorry to hear you are prone to that also. I hope the next few days go well for you, the fact that it’s helping the dizzies and nerve pain so soon is very positive, in terms of side effect profile it has one of the lowest compared to other meds so if you want to really test this, this would be the one too. Best of luck

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Of course Jo. Overall I found the move up to 75mg really good, I had gotten my brain use to the 37.5mg so found it easier. The only side effect I experienced in moving up was more night sweats but I lived with it and still do and just went and bought a few extra cotton pyjamas :blush:. Reach out with any questions as you move up anytime x

No, I was told that the only thing that can affect the release mechanism is to cut the tablet or pellets.
However, in the spirit of experimentation you could put 6 pellets in a capsule tomorrow. Then you’d know its the release mechanism so after a time it should settle, the body would adjust.

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@nin @Jojo65 and anyone else who can advise!

I’m wondering if I should give up on effexor. I had started with 11 pellets, had sleep issues, night sweats, and vivid dreams. But felt better in the neck pain dept and somewhat with dizziness. So I went down to 6 pellets abt 2wks ago. I’ve slowly increased, and was at 10 measley pellets as of Thursday and the awful side effects returned. I had only 3-4 hours of sleep each night, with horrible nightmares, waking up 10+ times. Lack of sleep is a major trigger for me, so I ended up actually WORSENING the MAV/neck pain all weekend. I am back down to 8 pellets now, and can sleep. Is this typical? I mean, I’m barely taking anything! Another symptom I was getting on the 10-11 pellets is major brain fog or lack of attention- worse than the MAV. Like I’d be driving my normal route home and think, where am I again?? Like my mind just drifts away.

When is it determined that a drug just isn’t for you or is BAD for you? I know with these SNRIs and SSRIs, genetics can be a factor in their success. My sister was given Wellbutrin several years ago to stop smoking. She took one dose, and thought she was dying! 0 hrs of real sleep that night, and horrible half awake/half asleep hallucinations. Almost called 911. I’m wondering if SNRIs are not for me? Help!

mmhh seems you are very sensitive. The sleep will get better but takes a while and every time I increased it took 3-4 days for me to be able to sleep. Now, I dont sleep super deep, according to my sleep tracker I am always between light and REM sleep, never con deep. Seems to be common with ssris and snris, since it changes the sleep structure.

Thanks, dizzy3. I’ve taken SSRI before for fibromyalgia- I had taken Prozac at that time. It did NOT do this to me… As a matter of fact, it was the best sleep I ever had. It’s too bad Prozac doesn’t work for MAV.

What sleep tracker do you use… Apple watch?

When you reach the point you cannot cope with the side effects I’d say. My doctor prescribed me Citalopram (SSRI) initially for my dizziness because she thought it was Anxiety. She told me to expect to feel worse, probably much worse (I was 24/7 dizzy at that time), for three weeks before I should start feeling better and if not to go back to her, presumably for a change. As I knew it wasn’t Anxiety, I never started the Citalopram but I’ve always remembered being surprised at her statement.

I’ve no idea of your MAV journey med-wise and what ‘you have left’ in the box to try but I know you and struggling trying to keep drug trialling and working/commuting. I’m wondering if being so med sensitive, it’s a feasible scenario. Helen

So, I am taking/have taken since the beginning of this- propranolol. It helps my anxiety and I no longer get “regular” migraine, but I don’t think it’s really helped the MAV/dizziness much. I still take it because it does calm me.

The drug before effexor that I tried was gabapentin- low dose 100mg. Since the Dr’s think this is all coming from my pinched nerve/damaged discs in my neck, they are wanting me to try drugs that would work for nerve pain- hence the gabapentin and effexor. My first gabapentin dose immediately stopped my neck pain and tinnitus. It was quite amazing. I was a little loopy the next day, but I think I could eventually come to deal with that. I took it for a few days and it seemed to work well. I don’t know abt dizziness though, because I wasn’t having the dizziness at that time. Anyway, i stopped it after a few days because I had to get up early and drive. Within a day or 2, it seemed the neck pain/tinnitus came back WORSE than before. So I guess I’m a bit paranoid that taking gabapentin might “sensitize” my condition. I’ve read of people having to take more and more, and I don’t want caught up in that. So I had suggested the effexor based on Hain, and the fact that it is given for nerve pain as well. I suppose with my sleep problems if I stop effexor, amitriptyline in the eve may be what I suggest next. Nortriptyline was the first drug I ever tried, and I felt so horrible on it. I have taken 10mg of amitriptyline in the past for sleep, and didn’t seem to have any side effects. Funny, I wonder what the difference is between norti and ami…