Venlafaxine/ effexor hcl and Nortriptyline cross-taper

Hi everyone,

So I decide to make the switch from Nort (was up to 50 mgs at about 6 weeks on trial) to effexor . I felt maaaybe a slight improvement with nort, but barely much, and docs said at that dose they would hope I would have seen more. also, i know for sure I am dealing with real anxiety issues, and have been my whole life, just wasn’t fully treated in the past!

so figured an snri might help more.

I tapered down nort fairly quickly to 20 mgs in a weeks time, and crossed it with low dose of venlafaxine (half at 37.5 tab). honestly, i feel like i can notice dizziness, imbalance and visual symptoms (and mood) lift almost immediately on it, though i felt v weird the first time (like coming up) and also nauseous every time, though it now it passes. then it feels like it wears off within 6-7 hours.

the problem is that im super irritable, and am having major issues sleeping (and im approaching pms!). i feel almost manic at times (not euphoric - more angry mind moving a mile a minute). could this also be the nortriptaline withdrawal? since i actually feel best the few hours while venlafaxine pill has been taken, im encouraged to keep going with it as im hoping withdrawal from nort starts to dwindle along with the side effects of the new pills.

thoughts? experiences? i really need to get some better sleep soon… so im also debating the time release as worried maybe that would effect sleep more? or maybe it would help. too many options!!

also i take ativan daily (.5-1) and really want to get off that once i feel better! tried tapering several times while on nort to no avail - ultimately why i felt nort was a failure bc it seemed like it was only ativan actually helping.

I found this chart one day that explains how to switch a patient from one antidepressant drug to another.

Switching-antidepressants-A3-poster.pdf (53.1 KB)

In your case, you are switching from nortriptyline to venlaxafine. So in the left-hand column, find the row containing nortripyline and then in the top row, find the column containing venlaxafine. Where the two intersect are the instructions:

taper drug, start SNRI at low dose*

Now go to the bottom of the chart and read the notes:

  • Taper means gradual dose reduction, with lowering by increments every few days, usually over a period of 4 weeks, modified by patient experience, drug, illness and other factors.

  • *A washout period of 2–5 half‑lives (most frequently 2–5 days) between cessation of previous drug and the introduction of a new drug is the safest switching strategy from the point of view of drug interactions. In the indicated instances a washout period is not essential if switching is carried out cautiously and under close observation, and clinical considerations such as illness severity support harm–benefit considerations. Cautious cross taper (when the dose of the first drug is being reduced and the dose of the second drug is being increased at the same time so that the patient is taking both antidepressants) may be used in the indicated instances if appropriate and safe. (See Table 1 of original article for drug half‑lives.)

give more time on nort…it takes 3 months for full effect

effexor can cause mood swings…stay a little longer on the dose and you will find it settle down.

sleep is my really limiting factor. I am 14mg and cannot go up higher as it affects sleep.

I am on 15mg of Ami that helps with sleep as of now but still have problems with sleep. Try to switch from nort to Ami if sleep is a problem.

I use melatonin sometimes as a sleep aid

Do you use Ativan in the day or at night to help with sleep ?

I use ativan to help during the day - helps with dizzies and visual disturbances. doesn’t make me sleepy except at high doses. actually none of the medicines seem to make me tired exactly…

I am just going to continue to give the effexor a fair shot. i think that ill keep nortriptaline as a back up for down the road if several other trials don’t work after this one (though you’re right, I probably should have given it a longer time). but im trying to stay optimistic about this one since I started the course - will try harder to stick with it longer i hope! i seem to be past the side effects now - dealing more with pms and just withdrawal of the nort. i really should have just waited until after my time of the month to do the cross-taper!

you should really save the ativan for bad days and try to tough out the ok days. effexor is a god send if you can tolerate it…also ativan is limited in quantity and cannot get refills easily. Use them sparingly and they will continue to work , regular use means you need higher dose to garner same effect. good luck Elizabeth, pray effexor is your silver bullet.

I’m also in the process of cross tapering. I am currently taking 35mg of nortriptyline and 37.5mg of Effexor XR. My and my doctor’s plan is to get me to 25mg or lower in nortriptyline and move forward with both nortriptyline and Effexor. It seems that as I’ve increased my nortriptyline dose my anxiety and a burning/tingling in my hands and arms has increased. It is really helping my migraines though.

How are you feeling? I’m on day 5 of 35mg nort and 37.5mg Effexor XR. I’m having good and bad times. I think that I need to be reducing my nort dose as the Effexor starts to ramp up in my system. I know that when I switched doses of nortriptyline I’ve been angry at times and also had a few days of depression along with the physical stuff. I’ve been pretty shaky today, having some heart palpitations and trouble breathing. I’m going to email my doc today to see what she thinks.

Hi Heather,

It’s good to hear from someone who is going through exactly what I am at the same time (or close to it!). It’s interesting to hear that you’re stopping nort for same reasons as me - didn’t feel it was helping anxiety - but did help with head pain. that said, i don’t get classic migraines - and never thought of myself as a migrainer until i got diagnosed with mav. everything fit into place though. for me i start to get a ton of head pressure that builds with dizziness and imbalance and visual disturbance to a point where I feel like i will implode - or something like that…

Anyhoo - can’t say it’s been a good week. I can’t tell if it’s the effects of withdrawing from the nort, or the side effects of effexor. OR that i’m in the midst of my cycle which always makes my symptoms awful.

i’m currently at 20 mgs nort at night, and 37.5 venlafaxine in the morning, and today will start a second half of that tab in the later afternoon. may drop down to 10 mgs of nort later this week. I am sort of winging it - my doc’s wanted me to just stop nort and then start venlfaxine. i did research and found the char that Manatee spoke of earlier and figured that would work better (I also talked to my psychiatrist about it who has also been advising during this process).

anyway, lots of increased imbalance and visual disturbance . i also feel energized and then tired, and i was emotional though that seems to have passed (perhaps, again, pms?). but i think i may have dropped down on the nort too quickly.

I am going to try to toughen it out, and try to be at 75 mgs effexor (37.5 twice a day) by the end of the week.

Also, I do take ativan as mentioned. those have helped with the heart palps and anxiety which i think increase with all the medical changes. I do know it’s not ideal, and that I am dependent on it now, but my hope is that I will get stabalized on a different medication and can then taper off the benzo and use just as needed…

Keep me updated and let me know how it goes this week with the doctor… I hope your symptoms calm down. I assume they will though - it always seems the worst right after the changes and right now we’re dealing with two sides of changes if that makes any sense!!

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I heard from the doctor this morning - she wants me to increase to 75mg of Effexor and drop to 30mg of nortriptyline and see how I do. Had a lot of stomach issues today. No sweating or hot flashes though so I think my body is adapting to the Effexor. I’m going to start the 30mg tonight and the 75mg tomorrow morning.

I was on Effexor 3 years ago and was up to 225mg before it really helped my migraines. Unfortunately it also gave me really high blood pressure and I gained 30lbs. I’m hoping that the combination of nortriptyline (which gives me no appetite) and lower dose of Effexor will be more effective.

How is it going for you?

I did the whole cross - taper, not on Nort anymore. I actually had a great week there at week 3 of Effexor - taking 75 mgs, but now that I am headed into my pms week symptoms start to be coming back a bit. I am staying hopeful that the effexor will be my golden ticket, as I am not having any side effects now, and really felt the best I have since this whole thing started back in January!

I’m picking up on your previous thread as it looks like I will be doing the same change—nortriptyline (currently 50mg and doing a little though not enough) to Effexor XR. If you’re open to updating on how the Effexor is going for you and what it was like switching, I’d be grateful for any insight—Lorissa

Hi Lorissa,

Happy to update!

I’m currently on 100 mgs venlafaxine (50 x 2 a day).

The switch seemed easy at first - a bit difficult to kick the last 10 mgs of nort but not awful.

I’m honestly doing a lot better. Living life like normal except I still deal w some symptoms daily. Always feel them the worst during ovulation and period. I think the venlafxine helps w my reaction to the symptoms - I get less freaked out by them and am able to just deal. I tried going up to 125 and higher bc my psychiatrist wants my anxiety to be more under control but I started to get headaches from it.

I do remember every time I went up in dose I would get a bit nauseous and occasional head aches - but nothing has bad as when I tried to go above 100. I may try to go up again in the future or might try bringing in low 10 mg dose of nort.

I will say I’ve also found Advil tends to help a lot w symptoms - starting to think inflammation may be an issue so need to work on a better diet!!

Hope this helps - overall I have liked the medication.

Thank you so much. That is wonderful to hear that you are living a generally normal life—really it’s only what everyone deserves, but not easy to achieve with this disorder. I have no doubt it was a long road to this point and not easy.

I am on day 1 of Effexor XR 18.75mg. This week 25mg Nort (down from 50mg), next week down to 10mg Nort, and the following 37.5mg Effexor and no Nort. A pretty quick transition but I’m going to try to roll with it. Today has felt pretty good and I don’t know if it’s the Effexor or just a hopeful outlook. It seems the dosages range quite a bit: I’d love to have acceptable results at 37.5mg, but it seems like there is room to go much higher.

Hoping that your good results continue and improve further. Very grateful for your reply! Lorissa