Started Effexor XR

Hello, I have been gaining great assistance from this forum and you all have been extremely helpful and comforting even though this is my first real post! Similar to most of you, I have been through many Drs and finally have a seemingly concrete diagnosis of MAV/vestibular migraine. My symptoms are a constant lightheaded/imbalance feeling, some weakness/fatigue, and brain fog accompanied by odd vision (things seem very crisp and bright). I have finally been seen by Dr Young at Jefferson Headache Center. I had already done a lot of research and found Dr Hain’s website fantastic. Dr Young has started me on Effexor - I have not tried any other meds yet and I currently dont take anything else (prior to this episode that started in June, my migraines were very bland - visial aura followed by a headache that would ease with advil; got about one every month or two). Dr Young wants me to get up to 150 mg, starting at 37.5 mg. After reading your posts and Dr Hain’s website, that seems very high and I told him that I wanted to go slower - he was ok with that. In any event, to my question…I started with what I think was about 1/3 of the 37.5 mg after dinner last night. I had and continue to have pretty bad nausea since about midnight. Is that a little unusual with such a low dose - the nausea is bad enough that it kept me awake much of the night. I also seem to have a bit of a headache. I was just wondering if this was to be expected even with such a low start and how long should I expect it to last. Perhaps I should start it during the day when I can eat more regularly, although I dont feel much like eating breakfast now but I know that it may make me feel better so I will. Thank you for any thoughts and please be patient with me…I am not a good medicine taker! Ben

Whenever I had to start a new drug & was worried about it making me nauseous, I’d take it before bedtime, after eating a couple pieces of toast & drinking a nice glass of milk. I can usually sleep through the ‘minor’ nausea-producing drugs that way.

If I start getting nauseous during the day while I’m trying to ‘get started’ on a new med, I can usually nibble on crackers or toast (or cookies :slight_smile: ) & feel better.

— Begin quote from “benh”

Hello, I have been gaining great assistance from this forum and you all have been extremely helpful and comforting even though this is my first real post! Similar to most of you, I have been through many Drs and finally have a seemingly concrete diagnosis of MAV/vestibular migraine. My symptoms are a constant lightheaded/imbalance feeling, some weakness/fatigue, and brain fog accompanied by odd vision (things seem very crisp and bright). I have finally been seen by Dr Young at Jefferson Headache Center. I had already done a lot of research and found Dr Hain’s website fantastic. Dr Young has started me on Effexor - I have not tried any other meds yet and I currently dont take anything else (prior to this episode that started in June, my migraines were very bland - visial aura followed by a headache that would ease with advil; got about one every month or two). Dr Young wants me to get up to 150 mg, starting at 37.5 mg. After reading your posts and Dr Hain’s website, that seems very high and I told him that I wanted to go slower - he was ok with that. In any event, to my question…I started with what I think was about 1/3 of the 37.5 mg after dinner last night. I had and continue to have pretty bad nausea since about midnight. Is that a little unusual with such a low dose - the nausea is bad enough that it kept me awake much of the night. I also seem to have a bit of a headache. I was just wondering if this was to be expected even with such a low start and how long should I expect it to last. Perhaps I should start it during the day when I can eat more regularly, although I dont feel much like eating breakfast now but I know that it may make me feel better so I will. Thank you for any thoughts and please be patient with me…I am not a good medicine taker! Ben

— End quote

If you are med sensitive it may take a little while for some of these symptoms to subside. You may even have to start slower, you know your body and how it effects you .

If I may ask what else have you tired other than medications …

I would highly suggest getting the book “HeaL Your Headache” which really for me has been very helpful in getting this disease to a somewhat managable state.

I have not been able to take any of the meds yet.

The diet, the getting the same amount of sleep, regular exercise (walking) , drinking plenty of water, taking Vitiam D, magnesium and B12.

Keeping the sugar and simple carbohydrates to a minimum has been very important and keeping away from any other triggers.

Good luck and come here and ask questions and vent anytime as it helps to know that others are in the same boat.

Thank you for the replies! I actually just finished the Heal Your Headache book two weeks ago and started to implement the diet and life changes just prior to starting the Effexor. It was a great book with plenty of very useful information. I am hopeful that I can tolerate the Effexor and with the diet and lifestyle changes I can get my life back. I also was thinking about the magnesium supplements and may give that a try also. In the past, my main triggers were stress accomapnied by lack of sleep and chocolate (and maybe bananas). Given my current 24/7 issues now, it has been very difficult to pinpoint the triggers. It’s almost like I am beyond a trigger mechanism now. Thank you all again and I will keep you posted.

PS I also tried vestibular therapy for 5 weeks to no avail…my vestibular therapist was the one who started me thinking that this all could be related to migraine even though the issues were entriely different from my “normal” migraine presentation.

My doctor said effexor is great for treating MAV. If my Verapamil doesn’t work, I will try Effexor. Effexor was my doctor’s first choice for me, but I am so senstive to meds, that I chose the Verapamil. I was given Lexapro and Xanax at the same time last June, when all this started because my doctors around here thought the 24/7 dizziness was “all in my head”, anxiety only. Anyways, I felt more anxious on the lexapro and Xanax. I think the MAV was contributing to most of the anxiety and I blamed it on the meds. That is the only reason why I was reluctant to try the Effexor. My friend takes Effexor and has not had one side effect. She doesn’t have MAV, just anxiety. My doctor told me Effexor has little to no side effects. I always get nausea too, when I start a new med, then it goes away. Please keep me informed on how the Effexor works for you. I think you’ll have good results with it!

— Begin quote from “benh”

Thank you for the replies! I actually just finished the Heal Your Headache book two weeks ago and started to implement the diet and life changes just prior to starting the Effexor. It was a great book with plenty of very useful information. I am hopeful that I can tolerate the Effexor and with the diet and lifestyle changes I can get my life back. I also was thinking about the magnesium supplements and may give that a try also. In the past, my main triggers were stress accomapnied by lack of sleep and chocolate (and maybe bananas). Given my current 24/7 issues now, it has been very difficult to pinpoint the triggers. It’s almost like I am beyond a trigger mechanism now. Thank you all again and I will keep you posted.

— End quote

The magnesium will not hurt and as my doctor said if they do not work then you can stop taking them. She recomends 400mg twice a day , I take 500mg or now with the Calm which is a magnesium supplement, I take a tsp a day.

When you say it is difficult to pinpoint triggers, I had to alleviate all of them (per the book) and start adding them back in slowly to find out which ones I could tolerate. Some of the foods seem to be a given, MSG, caffeine, and others.

I do not think you may beyond the trigger mechanism it takes a while to get them out of your system so to speak , it took me almost two months before I saw improvement from the diet and lifestyle changes.

I hope the medication works for you as it is frustrating to feel this way all the time.

Quick Update: I have done 1/3 of the 37.5 mg for 4 days and 1/2 for 1 day. The first night I was very nauseous. Since then, however, I don’t have overwhelming nausea (still a little) but I do have general loss of appetite and most importantly, I feel very, very out of sorts. It is a nervous type of feeling with shaky and weak arms and legs and I feel like my usual brain fog is multiplied by 10 and is much more constant. I have been sleeping a lot yesterday and today. I want to give this med a solid shot and was intending to do 1/2 for the next 3 days then go up to the full dose but I am not sure because I have been feeling so badly. While I have had brain fog and weakness in the past as part of my “normal” symptoms, it is clearly much worse since starting Effexor and the nervousness is somewhat new for me. Has anyone else had these types of symptoms settle down after a week or so - everyone in my family is essentially telling me to stick with it and give it a fair shot (1-2 weeks). This is my first try with a med and my Dr picked this one due to my general anxiety caused by this horrible condition. Thank you for any thoughts. Ben

I have heard of these antidepressant drugs - Effexor actually making one feel worse at first then after a week or two on them they start to work. I had the same “nervousness” happen to me when I took one over the summer. I felt weak, shakey, out of sorts, just plain out of it. I didn’t wait it out. I hated the way it made me feel. Now, my friend is complete opposite, she has tolerated it so well. It has calmed her down, mellowed her out, she can do anything and go anywhere. I’m sure your anxiety will lighten up once you start to feel better. Did you ever think about trying Verapamil, if you don’t like the way the Effexor makes you feel? You probably should try to give the Effexor a longer try or call your doctor and ask their opinion. Dr. Hain has me on Verapamil and started me out really low and worked me up on the dosage. It seems to be helping me. It’s a calcium channel blocker (high blood pressure medicine). I still am dealing with the anxiety from this mav but it lessens as I start to feel better. It’s been a long, hard road for me. This forum has been a great source of comfort and support. I truly hope you feel better and the Effexor works for you. Try to stay positive throughout this ordeal. You will find the right medicine that works for you, it may just take some time. Keep us posted.

You’re in my thoughts -

Nance

Nance, thank you so much for the support. I am going to try to stick it out for another week. I had seen some of the success that you and others have had with Verapamil and I think I will ask my Dr about it if I don’t make it on Effexor. He mentioned only Effexor, Nortriptoline, and Topamax as his preferred meds. My only hesitation would be its potential impact on my blood pressure. I am already a little low (110/60) but based on what I have read, it doesn’t look like at the dose levels as a preventative it would impact that too much. Interestingly, I checked my blood pressure today and it was high (for me) 140/90…then I read that Effexor can increase it. I guess I don’t have to worry about it but I will keep an eye on it and try to tough out another week to see if Effexor is going to give me any relief. Thank you again and I will post another update soon. Ben

Hi Ben,

Why don’t you slow down the titration for a while longer? There’s definitely no rush when throwing meds at a “migraine brain”. I think if I were you, I’d stay at 1/3 for a week (possibly longer) and then move up to 1/2, then 2/3 and so on. Hain has said that some people get relief on just 1/3 in some cases. Of course it can takes weeks (up to 6) to see the full benefit of Effexor. I agree that 150 mg really sounds hugely excessive. Those doses are for people with intractable depression. I’d hold on a max dose of 37.5 mg for 6-8 weeks before going any higher. Effexor is apparently tougher to get free of when the dose is higher than 37.5 mg. It also starts having effects on noradrenalin and dopamine at higher doses (which could be a good thing if you’re getting no effect at 37.5 mg).

Cheers … Scott 8)

Scott, re: the dopamine, that’s only at really high doses (I think you need http://www.crazymeds.us/effexor.html). According to that page (Jerod is pretty trustworthy about these things) it’s mostly serotonin-only up to 200mg.

Hi Tranquility,

Yup, you’re right. Here’s what they say at crazymeds:

“And the way Effexor XR (venlafaxine hydrochloride) works on neurotransmitters is very complicated. Your doctor may or may not explain this to you. First it starts to work on your serotonin. Then somewhere around 200 mg a day it starts to work on norepinephrine. Then around 300 mg a day it starts to work on your dopamine. Mileage will vary for each individual, and there’s no guarantee on getting all that much dopamine action.”

This is rather scary! I thought Paxil was the absolute worst one of all because of its high affinity for serotonin receptors… but no, it’s Effexor apparently:

“Few, if any doctors, will discuss the possibility that Effexor XR (venlafaxine hydrochloride) could become a permanent part of your life, whether you like the results of Effexor XR (venlafaxine hydrochloride) or not. Granted that is a very rare adverse effect, but it does happen. It’s hard enough to get them to discuss SSRI discontinuation syndrome, let alone get them to admit that Effexor’s symptoms are the absolute worst and the longest lasting of all serotonergic drugs. The discontinuation from Paxil (paroxetine) is bad enough; it’s much, much worse with Effexor (venlafaxine hydrochloride).”

Hain does say though that discontinuation is apparently not so bad or is absent when the dose remains ≤ 37.5 mg daily. I guess it differs with everyone though. Knowing my luck I’d be climbing the walls for weeks. It is worth knowing, however, that 5HTP (from Jarrow) is something that can be thrown in while trying to come off any AD if necessary.

Scott 8)

What does it mean when the quote say it can become a permanent part of your life? Does it act upon the serotonin-receptors in such a way that it can irreversibly change them?

— Begin quote from “MikaelHS”

What does it mean when the quote say it can become a permanent part of your life? Does it act upon the serotonin-receptors in such a way that it can irreversibly change them?

— End quote

No, just that the discontinuation is so goddamn harsh that people simply won’t quit it.
I can’t fathom what would have happened if I picked up my Effexor RX about a month before my MAV crash. It MIGHT have helped prevent this… but given how hard it is for me to quit “easy” meds, coming off Effexor… that just wouldn’t happen.

Well, I have completed my trial with Effexor and have decided to come off of it. I got up to about 50 mg (one 37.5 mg pill and 1/2 of another one). It was a little difficult getting on it (brain fogginess and tired) but it didn’t help at all and actually seemed to make me dizzier. I am weaning down and my dizziness seems to be much worse…I am hoping it is only a mild withdrawal symptom and will ease quickly! I am pouring out about 20 granuals a day, which will get me off within a week. My next choices are either Verapamil or Nortriptyline. My BP is a little on the lower side (110/60) and I have some constipation issues already, so Nortriptyline may be the better option. I did some searching and didn’t really see anyone with great success on Nortriptyline so I am a bit hesitant. Thank you all for the continued support, it is a bit of a let down that Effexor didn’t do anything but I realize that was my first try at any medication. Ben

Sorry to hear the Effexor didn’t help. I wasn’t happy with it either.

I tried Verapamil. It helped the dizzies tremendously but made me have a week-long headache so I had to stop it. I think - if I remember right - Joseph uses Verapamil. It also didn’t get along with Zocor so my primary doc didn’t want me on it. (I had the choice of experiencing MAV symptoms or having a stroke/heart-attack because of my high cholesterol.)

I tried Nortriptyline - the very first med I took - & it made me too jittery. I’m on Amitriptyline now … my neurologist said it’s a cousin of Nort … maybe I’ll have better luck with it. So far it’s not been too bad … groggy in the mornings but headaches are less. Dizzy is about the same though.

Don’t be discouraged by our results from Nort … it might be your ‘wonder’ drug!

Hi Ben,

I notice you started Effexor around the 21st of Jan which means you’ve been titrating up the dose for about 6 weeks. I’m wondering if you may need to tough this out a little longer if you want to be certain you’ve given the drug a proper full trial and can then definitely rule it out. There are others who did not see a really good effect until nearly 3 months had passed and they had levelled off at around 50–75 mg for a period of time. You might even consider Pristiq which may be even more effective than Effexor. One of the other members here felt very well after approximately 10-12 weeks on 50 mg Pristiq. I don’t even know if it’s available where you are … not sure if it’s even available in Australia either. I’m sticking in two slides that might help from a presentation Hain gave in May 2008.

You’ll notice Hain says it can take “weeks-months” for the full effect to be realised and that it may require up to 75 mg of Effexor (note: 50 mg Pristiq is equivalent to 100 mg Effexor). I doubt I could personally handle that much SNRI flowing through my veins but maybe you can. Have you had any good effects at all?

Anyway, let me know what you think.

Best … Scott 8)

Joy and Scott, thank you for the replies and thoughts. Scott, you make a very good point about the length of time. I didn’t want to pull the plug early but it seemed to be making my dizziness worse - I began to feel dizzy in bed at night when that was never an issue before. I also was grinding/clenching my teeth at night and that was causing me to loose sleep, even with a mouthguard. I tried switching to taking it in the am but that seemed to make me a little anxious during the day. It was a tough call stopping but I also was a little concerned about how to eventually get off of it. Maybe I was expecting too much too soon. I spoke with Dr Hain and he wants to try Verapamil next and my local neurologist had suggested I try Nortriptyline if the Effexor didn’t help. Dr Hain did note that Pristiq could be an option down the road if Verapamil didn’t work. I plan top start the Verapamil this week - I wanted to give my body a few days off Effexor before starting. Ben