HOME MEDICATIONS PROGRAM SUPPLEMENTS ABOUT US CONTACT
If
you wish to remain on Effexor but eliminate current Effexor withdrawal side
effects, click here.
If you
want to taper off the Effexor and you are not sure where to start, you can click
here and read the bestselling book, How to Get Off Psychoactive Drugs Safely or
send Jim Harper an email at
Jim@theroadback.org and he will guide you through the process of Effexor
withdrawal.
If you
are experiencing brain zaps, electrical jolts in the head,
click here
Effexor Withdrawal Symptoms
If you
are experiencing brain zaps (electrical jolt in the head) click here for the
solution. The Omega 3 Supreme is the only answer. Take 2 softgels in the morning
and 2 more at noon and the brain zaps should stop within 3 days. Most likely in
hours. Click here for Omega 3 Supreme.Part
1:
Introduction to Effexor Withdrawal.
Effexor, also known as Venlafaxine, is a medication used to treat depression and
anxiety disorders. While it can be effective in managing symptoms, many
individuals who take Effexor find that they become dependent on the medication.
This dependence can lead to withdrawal symptoms when they try to stop taking the
medication. Withdrawal from Effexor can be a challenging experience, and it's
important to understand the process in order to manage symptoms effectively.
Part
2: Common Effexor Withdrawal Symptoms.
Withdrawal from Effexor can cause a range of physical and emotional symptoms.
Some of the most common physical symptoms include headaches, dizziness, nausea,
and fatigue. Individuals may also experience flu-like symptoms, such as muscle
aches and chills. Emotional symptoms can include irritability, anxiety, and
depression. In some cases, individuals may experience suicidal thoughts or
behaviors.
Part
3: Timeline of Effexor Withdrawal.
The
timeline of Effexor withdrawal can vary from person to person, depending on
factors such as the dose and duration of medication use. Generally, withdrawal
symptoms can begin within a few hours of the last dose and can last for several
weeks or even months. The first few days of withdrawal are typically the most
intense, with symptoms peaking around day three or four. Symptoms may gradually
improve after the first week or two, but some individuals may experience
protracted withdrawal, in which symptoms persist for several months or longer.
Part
4: Managing Effexor Withdrawal Symptoms.
There
are several strategies that can help individuals manage withdrawal symptoms from
Effexor. One of the most effective is to taper off the medication slowly, under
the guidance of a healthcare provider. This allows the body to adjust gradually
to lower doses of the medication, minimizing the severity of withdrawal
symptoms. Other strategies that can help manage symptoms include getting regular
exercise, practicing relaxation techniques, and getting support from friends and
family. In 1999, The Road Back found; 50% of the people trying to withdrawal off
an antidepressant could make it through withdrawal but they still suffered
withdrawal side effects. This withdrawal was accomplished by only using a 10%
reduction of the medication every 2 weeks. Of the 50% that could make it off the
antidepressant, 40% went back on the antidepressant because the withdrawal
symptoms were too severe, and they saw no hope in ever living a normal life
again.
The
Road Back began investigating other options than a slow and gradual withdrawal.
In 2000, The Road Back began a trial using a whey protein shown to increase the
glutathione in the body. The success was immediate. We found; 90% of those that
went back on their antidepressant could now go off their antidepressant, do very
well with the taper and remain off the antidepressant.
During
the next 10 years, The Road Back continued testing other nutritional supplements
to improve the program and during the decade several changes were made to the
supplements recommended.
In
2010, a major breakthrough was accomplished. In 2010, our founder Jim Harper,
discovered a gene that becomes altered with the use of every psychotropic
medication. This gene, the JNK gene, was virtually responsible for most every
psychotropic medication withdrawal side effect. Not only during withdrawal but
also when a person is taking the full dosage of the medication as prescribed.
Part
5: Effexor Withdrawal, Where we are in 2023, and The Road Back Program?
The
Road Back Program uses formulated nutritional supplements to address; the JNK
gene, glutathione as well as aquaporins to help eliminate Effexor withdrawal.
Over 19 million people throughout the world have now used The Road Back Program
to get their life back.
Part
6: Risks of Effexor Withdrawal.
While
most individuals who withdraw from Effexor will experience only mild to moderate
symptoms, there are some risks associated with the process. In some cases,
withdrawal can lead to severe or even life-threatening symptoms, such as
seizures or suicidal thoughts. It's important to work closely with a healthcare
provider to manage withdrawal safely and effectively.
Part
7: Conclusion.
Effexor withdrawal can be a challenging experience, but it's important to
remember that symptoms are temporary and can be managed effectively with the
right strategies. By working with a healthcare provider and taking steps to
manage symptoms, individuals can successfully withdraw from Effexor and regain
control of their mental health. If you or a loved one is experiencing Effexor
withdrawal, seek help from a healthcare provider as soon as possible.
Part
8: Additional Effexor Information The majority of people attempting Effexor
withdrawal experience an antidepressant withdrawal syndrome. This is also known
as Effexor discontinuation syndrome in the United States. In Europe it is called
Effexor withdrawal side effects. The F.D.A. estimates 10% of those experiencing
Effexor withdrawal will go back up on the Effexor because the withdrawal
symptoms are too severe.
The
most common and debilitating Effexor withdrawal side effect is called "brain
zaps." Brain zaps are described by people experiencing it as a; electrical jolt
that tends to run from base of the neck up into their head. Another side effect
that tends to run with brain zaps is a shiver, a feeling as your head is
floating, dizziness, and/or a whirling sensation in the head.
These
symptoms can come in waves or even be persistent. The good news; in 2002, our
founder, Jim Harper, discovered the correct type of Omega 3 taken in the right
quantity will eliminate these devastating head symptoms quickly. Usually within
a couple of hours.
The
body in a normal state uses the oil from our diet, specifically from omega 3
found in fish, to build and replenish the end point of areas in the brain that
sends and receives electrical signals. We are using easy to understand
terminology, so it is easy to understand. Let's leave the technical jargon to
physicians. These brain zaps have nothing to do with serotonin levels or other
made-up reasons. It is simple really; our body works in a very natural way with
how it uses amino acids, proteins, fats in food and all other diet items to
maintain a balance. When you introduce any toxin that disrupts these processes
the body reacts.
The
most common Effexor Venlafaxene withdrawal symptoms reported include:
Flu
like symptomsInsomnia
Anxiety
Brain
zaps
Tremors
Diarrhea
Vomiting
Increased suicidal ideation
Nausea
Headache
Mania
Hypomania
Ringing in the ears
Aggression
Confusion
Imbalance
Mood
swings
Please
note: These are the most common Effexor withdrawal side effects but far from all
potential Effexor withdrawal side effects.
There
is a warning the FDA has put a black box warning on Effexor. WARNING: SUICIDAL
THOUGHTS AND BEHAVIORS
See
full prescribing information for complete boxed warning. Antidepressants
increased the risk of suicidal thoughts and behaviors in pediatric and young
adult patients (5.1) Closely monitor for clinical worsening and emergence of
suicidal thoughts and behaviors
You
may have been prescribed Effexor within a very short doctor visit. There was no
investigation into other life factors, lab testing, or any conversation about
what side effects might present. The failings of this approach may cause quite a
burden on the patient.
Depression, insomnia, anxiety, fibromyalgia, and other symptoms that Effexor is
often prescribed for might stem from; diminished vitamin D levels, over active
JNK gene, specific proteins that need to be silenced, dietary concerns and food
allergies, mitochondrial dysfunction, neurotoxic accumulation, and many other
reasons. A full physical from an understanding physician is ideal, before
prescribing Effexor.
Do
Your Symptoms Require Effexor?
The
Road Back Program uses nutritional supplements to help with the Effexor
withdrawal. Most people feel a very fast relief from the Effexor withdrawal once
they begin taking the supplements and we feel the odds are high; if would have
taken nutritional supplements like these before starting the Effexor you would
have been prescribed the Effexor in the first place.
In
2007, Jim Harper was giving a speech to a group of psychiatrists in Ireland and
during his talk he mentioned his mother just passed away 30 days ago. He went on
to describe how he made sure to take his JNK Formula each day to help the body
cope with the stress being put on it do to his loss. He went on to say, "The JNK
Formula will not remove the emotional loss and how I feel but it will keep the
body strong during my time to grieve.
"How
Do You Survive Effexor Withdrawal?
Surviving Effexor withdrawal depends on what you do at this very moment. If you
keep doing the same thing you have been doing and you are in a heavy Effexor
withdrawal, nothing will change for the positive, That is a given.
If you
decide to do the Effexor withdrawal as an inpatient in a drug rehab center DO
NOT DO THE 9 DAY PLAN BECAUSE THAT WHAT INSURANCE ALLOWS. Over the past 22 years
I have worked with far too many people who were sold on a rehab facility, stayed
the 9 days because insurance would only pay for that amount of time. The
unscrupulous facility took them off the Effexor in 9 days as they promised and
by the time the person got off the airplane after their return home they were in
full withdrawal. You can't do an Effexor withdrawal in 9 days.
The
Road Back Program can normally help you get back on your feet again but the
rehab facility approach of this type is not worth the price you will pay
mentally and physically.
You
will find a few other outpatient Effexor withdrawal programs on the internet now
and Jim Harper is not aware of one that will cause you harm like the rehab
facilities mentioned. However, every other program on the internet was trained
by Jim Harper years ago and they are doing what Jim Harper and The Road Back did
during that time frame. Almost 2 decades ago Jim Harper trained several
physicians and good intentioned people how to get a patient off Effexor. Jim
went into detail of the process and what nutritional supplements were used and
why they were used. At that time of The Road Back the success rate was not as
high as desired and over the following years Jim changed the formulas used with
the supplements several times to use new information with DNA testing.
Long
story short; you will likely wind up using an Effexor withdrawal approach The
Road Back used in 2003, that was scrapped for something more successful. If you
are currently in Effexor withdrawal, send Jim Harper an email and he will
personally guide you through the process so you can get back on your feet
quickly and have a very successful Effexor withdrawal. It does not matter if you
have been on Effexor for 1 month or 20 years. Recovery can happen and the good
part is it does not take more time because you have been taking Effexor for
years. When Do Effexor Withdrawal Symptoms Start When Discontinuing / Quitting
Effexor?
Effexor withdrawal usually begins between day 1 and day 3 of adjusting the
Effexor. For some people this is not the case but eventually most everyone hits
some dosage of the Effexor when reducing that jars them. Effexor withdrawal
begins and they have no idea what they should do. Their physician does not know
what to do. They wind up in a spiral downward and wind up on a new medication to
try and stop the Effexor withdrawal. The best case is the additional drug does
that, but you are now on 2 drugs instead of only Effexor.
What
is Effexor?
Effexor is an antidepressant medication developed in the 1970s with FDA approval
granted in 1991. This SSRI drug is prescribed in treating adult depressive
disorders (MDD), panic disorder, obsessive compulsory disorders (OCD), social
anxiety (SAD), post-traumatic stress disorders (PTSD), and premenstrual
dysphoric disorder (PMDD).If you have anxiety before taking Effexor, or anxiety
begins while taking Effexor, odds are the anxiety will continue to get worse.
Effexor alters dopamine much like the antidepressant Effexor and anxiety is a
byproduct of these two drugs.
What
Is Effexor Used For?
Effexor is an antidepressant medication approved to treat adult MDD (major
depressive disorder). The Black Box warning on the drug’s packaging mentions
that the drug should not be prescribed to anyone under the age of 25, due to
heightened risk of suicide. There is an exception to this for patients under the
age of 25 who have been diagnosed with OCD (obsessive-compulsive
disorder).Potential suicidality is associated with all Effexor and may be a
concern leading to consider Effexor withdrawal, which is recommended to be done
always under medical or caregiver monitoring.
Adult-only approved uses for the drug provided in a clinical or treatment
setting include:
MDD:
Major Depressive Disorder
PTSD:
Post-traumatic stress disorder
PD:
Panic disorder
SAD:
Social anxiety disorder
OCD:
Obsessive-compulsive disorder
PMDD:
Premenstrual dysphoric disorder
Effexor Side Effects
The
full list of Effexor side effects is quite staggering. In 2004, Jim Harper used
the Freedom of Information Act to get the full list of Effexor side effects. Jim
received the information, and it is 500 sheets of letter size paper, single
space, a number 10 font size, 3 columns per page. In other words, thousands of
known potential Effexor side effects were disclosed. Some of the other Effexor
and Effexor withdrawal side effects:
Serotonin syndrome: A life-threatening condition requiring immediate medical
care in a hospital emergency clinic or ICU. Symptoms to watch for include sudden
fever, losing consciousness, inability to move or speak, copious sweating,
dilated pupils, chills, tremors, convulsions, diarrhea, agitation, restlessness,
racing heart, etc.
Suicidal thoughts (common) Suicide attempt (common)Hyperkinesis (muscle spasms,
movement disorder)Worsened depression
Aggression
Paranoia (rare)
Anxiety
Mania
(common)
Convulsions
Unconsciousness
Coma
Teeth
grinding
Akathisia (relentless internal restlessness and discomfort marked by repeated
motions, pacing, rocking, etc., that can lead to suicidal thoughts as a means of
relief)Tachycardia (racing heart, even when the body is at rest)
Rash
Itching
Burning, crawling feeling in the skin
Fever
Tics,
sudden jerky movements, myoclonus
Emotional blunting
Behavioral apathy, SSRI-induced-indifference
Pain
on urination or difficulty urinating
Cloudy
urine
Headache
Sexual
impairments, i.e., anorgasmia, inability to ejaculate, lowered libido Mood
swings
Pain
around the eyes or eye sockets
Sleepiness
Bladder pain
Prickling skin sensation
Numbness
Sensory disturbances
Insomnia
Depersonalization (common)
Nervousness
Nightmares (paroniria)
Hostility
Nausea
Diarrhea
Weight
gain
Some
documented Effexor birth defects and injuries include:
PPHN
or persistent pulmonary hypertension of the newborn, a heart and lung condition
which can result in respiratory failure, decreased oxygen to the brain, and
multiple organ injuries.
Congenital Heart Defects connected to Effexor and other SSRIs include
ventricular septal defects and atrial septal defects, also referred to as “holes
in the heart”, related to heart murmurs, suppressed appetite, breathing
difficulties, tiredness, inadequate growth, etc.
Increased Risk of Autism has been extensively reported but evidence has not yet
been considered conclusive enough for regulatory bodies to ban prescribing to
pregnant women.
Increased Risk of Clubfoot connected to SSRIs during pregnancy as reported by
NIMH, where exposure had the highest increase in clubfoot of all SSRIs.
Increased risk of atrial/ventricular defects and craniosynostosis was reported
in a Canadian study from 1998 to 2010 and published in the June 2015 issue of
the American Journal of Gynecology & Obstetrics.
Effexor Withdrawal, What to Expect
If
using The Road Back Program, you should expect to feel a lot better within the
first couple days of the program. If you do nothing, expect to continue to feel
as you do now. Possibly worse as time goes on. The chance of feeling better if
you do nothing is nil.
In
1999, The Road Back only had people taper the Effexor gradually and slowly. They
still suffered. Around 50% could get off the Effexor but most went back on the
Effexor because they continual Effexor withdrawal side effects would not
diminish or go away.
We
wish there was a better answer for you than the above but with working with over
19 million people over the last 22 years, the truth is the truth. No way to
water it down to make it sound better.
Some
may think it is just their depression returning but who would not feel depressed
if they were still going through Effexor withdrawal months after stopping the
Effexor. We can't stress enough; what you do or do not do at this moment in time
is critical for your future. Take your time if possible. If you have brain zaps
go buy any omega 3 fish oil, even the wrong omega 3 fish oil will help somewhat.
While you read this you may want to pause and go take a walk. Look at the trees,
the sky or anything off in the distance. Getting your attention off your mind
and body may do wonders. Keep this close to your heart; There is Hope and There
is a Solution. We are speaking directly to YOU.A 30-day supply of the
nutritional supplements will cost you around $80. If you feel it is worth around
$80 to take a chance that all of this can go away in a couple of days, then take
that chance. Over the past 22 years many have sent an email to Jim Harper and
said they were not sure what to do about the Effexor withdrawal. Even after
reading this information. The people that tried something else generally came
back within a few months and were in worse shape than before. We do not want
this to happen to you. But if so; Jim will still be here to assist.
Can
Effexor Make Depression Worse?
Common
sense answers this question. If depression is one side effect of taking Effexor,
then Effexor can cause depression. You do stand a greater chance of Effexor
causing depression during withdrawal than while simply taking the Effexor as
prescribed. The depression during Effexor withdrawal can be due to the other
Effexor withdrawal side effects you are experiencing. Who will not start to get
depressed if you have anxiety from morning to night, can't sleep and your head
feels like it is on fire.
Effexor Aggression in Children
Children are more prone to aggression when taking Effexor than adults. It occurs
in 10-20% of children taking any SSRI antidepressant. Two clinical trials
performed by Pfizer, aggression was the most common reason noted for Effexor
discontinuation.
Can
You Get Addicted to Effexor?
Yes
and no. This is where Effexor dependence is a matter of wording. Medically
speaking in the United States Effexor is not addicting. In Europe it is viewed
as addicting. The bottom line is; Once you take Effexor for 7 days the Effexor
has made its way through your body. If your body no longer has the Effexor in
its system, your body will react to the Effexor being gone. Much like a person
that eats a lot a sweets every day. Your body will react when the sweet
substance is not present. Call it addicting, as we would, call it a dependence
as United States physicians will, it is what it is. If you do not provide the
substance the body reacts, and you also have mental feelings that are not
positive. We can get into the insulin discussion etc., but we are only talking
about a substance being present and then not and the body and mind reacting in a
negative manner.
What
is the difference between Effexor and a Benzodiazepine?
Effexor is an SSRI medication, an antidepressant, used to treat depression and
anxiety. Benzodiazepines are prescribed mainly for the treatment of anxiety and
panic disorders but also prescribed off-label to treat depression.
These
two types of drug have different chemical components and were designed to work
on different brain receptors and neurotransmitters, but some of their effects
can be seen to overlap. Benzodiazepines are thought to mainly affect GABA
transmission, which can slow the central nervous system to reduce anxiety, while
Effexor is designed to block the reuptake of serotonin.
Benzodiazepines are known to be more prone to dependence/addiction than Effexor.
While the withdrawal symptoms are similar between both drugs, Effexor’s
half-life is 22-36 hours, and Benzodiazepines half-life is much lower.
Benzodiazepines can have more severe complications if abruptly stopped,
including seizures. For safe Benzodiazepine or Effexor withdrawal, either of
these drugs must be slowly tapered to allow the central nervous system and
neurochemistry to safely normalize.
Choosing to withdrawal from the Effexor first or the benzodiazepine first needs
to be evaluated. Use Chapter 23, The Science to decide is part of that equation.
Depending on the benzodiazepine you may be taking with the Effexor, if you
reduce the Effexor first it may make you go into withdrawal on the
benzodiazepine, even if you did not reduce the benzodiazepine.
How
long does Effexor stay in your system after the last dosage?
Our
founder, Jim Harper, made great strides with determining this question. Using
his DNA testing company in 2004-2005, Jim conducted hundreds of DNA tests to
determine how fast or slow medications took to metabolize. In roughly 34 percent
of the population the Effexor can take as long as 48 hours to clear the body. In
others, as little as 8 hours can occur for the Effexor to clear the body.
Depending on other habits you may have, Effexor could clear faster or even take
more time than the 48 hours. If you smoke cigarettes and stop smoking while
taking Effexor, the Effexor dosage you are taking will decrease by 15%. On the
other side of this, if you start smoking while taking Effexor, the Effexor
dosage will act as though it is 15% higher than you think it is. This is because
cigarettes induce an enzyme used to metabolize Effexor and anything using that
same pathway will shoot though much faster. Caffeine restricts that same enzyme,
so if you start or stop drinking coffee while taking Effexor you will either go
into withdrawal or feel an overdose, even though you have not changed the
Effexor dosage.
This
is why The Road Back Program wants you to not change smoking habits or caffeine
habits during the Effexor taper.
Can
you overdose on Effexor?
Yes,
it is definitely possible for Effexor poisoning to occur. A substantial Effexor
overdose requires emergency medical intervention to prevent major health
problems. This list of Effexor overdose symptoms would be the same as those
Effexor side effects listed above, but more severe.
According to the National Institute of Health (NIH), the use of intravenous
benzodiazepines is sometimes required during Effexor overdose to prevent
seizures. Extra cooling measures must be used to reduce hyperthermia, always
under the direction of EMT or other medical staff attending to the patient.
Treatment for Effexor Withdrawal
Effexor has become one of the most frequently prescribed antidepressants in the
US. Of equal importance is that depressive disorders have become one of the most
frequently diagnosed conditions. These two facts together underscore two
important steps toward improved health:
Providing safe treatment programs for those who have decided on Effexor
withdrawal and offering drug-free options to regain natural mental health
without the need for prescription medications.
The
Road Back Program was described by Dr. Hyla Cass M.D. in this way:
Here's
an essential handbook on how to safely and more easily wean yourself (under
medical supervision) off the heavily over-prescribed psychotropic medications. I
have used the program with my patients and it works! "Hyla Cass M.D. Author of
Supplement Your Prescription
Send
an email to Jim Harper by using the Contact link on the top of this page or read
How to Get Off Psychoactive Drugs Safely by Jim Harper and follow the program
for Effexor withdrawal.
Why
Jim put his entire book on our website for free is so you can instantly read the
material and start this process if you are ready now.
One
last thing Jim asked us to provide at the bottom of each page of Effexor
descriptions:
There
is Hope and There is a Solution
1. Acute and
Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic
Medications
Studies on psychotropic medications decrease, discontinuation, or switch have
uncovered withdrawal syndromes. The present overview aimed at analyzing the
literature to illustrate withdrawal after decrease, discontinuation, or switch
of psychotropic medications based on the drug class (i.e., benzodiazepines,
nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine,
antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria
of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63-71], which
encompass new withdrawal symptoms, rebound symptoms, and persistent
post-withdrawal disorders. All these drugs may induce withdrawal syndromes and
rebound upon discontinuation, even with slow tapering. However, only selective
serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and
antipsychotics were consistently also associated with persistent post-withdrawal
disorders and potential high severity of symptoms, including alterations of
clinical course, whereas the distress associated with benzodiazepines
discontinuation appears to be short-lived. As a result, the common belief that
benzodiazepines should be substituted by medications that cause less dependence
such as antidepressants and antipsychotics runs counter the available
literature. Ketamine, and probably its derivatives, may be classified as at high
risk for dependence and addiction. Because of the lag phase that has taken place
between the introduction of a drug into the market and the description of
withdrawal symptoms, caution is needed with the use of newer antidepressants and
antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam,
paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine
are more likely to induce withdrawal. The likelihood of withdrawal
manifestations that may be severe and persistent should thus be taken into
account in clinical practice and also in children and adolescents.
Keywords: Antidepressant; Antipsychotic; Benzodiazepine; Discontinuation;
Lithium; Mood stabilizers; Selective serotonin reuptake inhibitor; Serotonin
noradrenaline reuptake inhibitor; Tolerance; Withdrawal.
2.
Antidepressant Withdrawal and Rebound Phenomena
Background: Antidepressants are among the most commonly prescribed drugs
worldwide. They are often discontinued, frequently without the knowledge of the
prescribing physician. It is, therefore, important for physicians to be aware of
the withdrawal and rebound phenomena that may arise, in order to prevent these
phenomena, treat them when necessary, and counsel patients appropriately.
Methods: This review is based on a comprehensive, structured literature search
on antidepressant withdrawal phenomena that we carried out in the CENTRAL,
PubMed (Medline), and Embase databases. We classified the relevant publications
and reports by their methodological quality.
Results: Out of a total of 2287 hits, there were 40 controlled trials, 38 cohort
studies and retrospective analyses, and 271 case reports that met the inclusion
criteria. Withdrawal manifestations are usually mild and self-limiting; common
ones include dizziness, headache, sleep disturbances, and mood swings. More
serious or pro- longed manifestations rarely arise. There is an increased risk
with MAO inhibitors, tricyclic antidepressants, venlafaxine, and paroxetine; on
the other hand, for agome- latine and fluoxetine, abrupt discontinuation seems
to be unproblematic. There is also some evidence of rebound phenomena, i.e., of
higher relapse rates or especially severe relapses of depression after the
discontinuation of an anti- depressant.
Conclusion: A robust evidence base now indicates that there can be acute with-
drawal phenomena when antidepressants are discontinued. Putative rebound
phenomena have not been adequately studied to date. It is recommended that
antidepressants should be tapered off over a period of more than four weeks.
3.
Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor
Discontinuation: Systematic Review
Background: Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used
in medical practice. Their discontinuation has been associated with a wide range
of symptoms. The aim of this paper is to identify the occurrence, frequency, and
features of withdrawal symptoms after SNRI discontinuation.
Methods: PRISMA guidelines were followed to conduct a systematic review.
Electronic databases included PubMed, the Cochrane Library, Web of Science, and
MEDLINE from the inception of each database to June 2017. Titles, abstracts, and
topics were searched using a combination of the following terms: "duloxetine" OR
"venlafaxine" OR "desvenlafaxine" OR "milnacipran" OR "levomilnacipran" OR
"SNRI" OR "second generation antidepressant" OR "serotonin norepinephrine
reuptake inhibitor" AND "discontinuation" OR "withdrawal" OR "rebound." Only
published trials in the English language were included.
Results: Sixty-one reports met the criteria for inclusion. There were 22
double-blind randomized controlled trials, 6 studies where patients were treated
in an open fashion and then randomized to a double-blind controlled phase, 8
open trials, 1 prospective naturalistic study, 1 retrospective study, and 23
case reports. Withdrawal symptoms occurred after discontinuation of any type of
SNRI. The prevalence of withdrawal symptoms varied across reports and appeared
to be higher with venlafaxine. Symptoms typically ensued within a few days from
discontinuation and lasted a few weeks, also with gradual tapering. Late onset
and/or a longer persistence of disturbances occurred as well.
Conclusions: Clinicians need to add SNRI to the list of drugs potentially
inducing withdrawal symptoms upon discontinuation, together with other types of
psychotropic drugs. The results of this study challenge the use of SNRI as
first-line treatment for mood and anxiety disorders.
Keywords: Adverse events; Antidepressant drugs; Desvenlafaxine; Discontinuation
syndrome; Duloxetine; Levomilnacipran; Milnacipran; Serotonin-noradrenaline
reuptake inhibitors; Venlafaxine; Withdrawal symptoms.
4.
Withdrawal Syndrome Following Discontinuation of 28 Antidepressants:
Pharmacovigilance Analysis of 31,688 Reports from the WHO Spontaneous Reporting
Database
Introduction: Evidence is lacking on withdrawal syndrome related to individual
antidepressants and relevant risk factors for severe reactions.
Objective: To ascertain whether antidepressants are associated with an increased
reporting of withdrawal syndrome as compared with other medications, and to
investigate risk factors for severe reactions.
Methods: This is a case/non-case pharmacovigilance study, based on the
VigiBase®, the WHO global database of individual case safety reports of
suspected adverse drug reactions. We performed a disproportionality analysis of
reports of antidepressant-related withdrawal syndrome (calculating reporting
odds ratio [ROR] and Bayesian information component [IC]). We compared
antidepressants to all other drugs, to buprenorphine (positive control), and to
each other within each class of antidepressants (selective serotonin reuptake
inhibitors [SSRIs], tricyclics and other antidepressants). Antidepressants with
significant disproportionate reporting were ranked in terms of clinical
priority. Serious versus non-serious reactions were compared.
Results: There were 31,688 reports of antidepressant-related withdrawal syndrome
were found. A disproportionate reporting was detected for 23 antidepressants.
The estimated ROR for antidepressants altogether, compared to all other drugs,
was 14.26 (95% CI 14.08-14.45), 17.01 for other antidepressants (95% CI
16.73-17.29), 13.65 for SSRIs (95% CI 13.41-13.90) and 2.8 for tricyclics (95%
CI 2.59-3.02). Based on clinical priority ranking, the strongest
disproportionate reporting was found for paroxetine, duloxetine, venlafaxine and
desvenlafaxine, being comparable to buprenorphine. Withdrawal syndrome was
reported as severe more often in males, adolescents, persons in polypharmacy,
and with a longer antidepressant treatment duration (p < 0.05).
Conclusions: Antidepressants are associated with an increased reporting of
withdrawal syndrome compared with other drug classes. When prescribing and
discontinuing antidepressants, clinicians should be aware of the potentially
different proclivity of withdrawal syndrome across individual antidepressants,
and the liability to experience more severe withdrawal symptoms in relation to
specific patient characteristics.
5.
Antidepressant withdrawal reactions
Antidepressants can cause a variety of withdrawal reactions, starting within a
few days to a few weeks of ceasing the drug and persisting for days to weeks.
Both tricyclic antidepressants and selective serotonin reuptake inhibitors cause
similar syndromes, most commonly characterized by gastrointestinal or somatic
distress, sleep disturbances, mood fluctuations and movement disorders. Most
symptoms related to tricyclic antidepressant withdrawal are believed to be
caused by rebound excess of cholinergic activity after prolonged anticholinergic
effect on cholinergic receptors. (This situation is analogous to the adrenergic
rebound that occurs after beta-blocker withdrawal.) Treatment involves
restarting the antidepressant and tapering it more slowly. Alternatively,
tricyclic antidepressant withdrawal symptoms often respond to anticholinergics,
such as atropine or benztropine mesylate. Three case reports of antidepressant
withdrawal are presented, including one featuring akathisia (motor restlessness)
related to withdrawal of venlafaxine.
6.
Antidepressants for people with epilepsy and depression
Background: Depressive disorders are the most common psychiatric comorbidity in
people with epilepsy, affecting around one-third, with a significant negative
impact on quality of life. There is concern that people may not be receiving
appropriate treatment for their depression because of uncertainty regarding
which antidepressant or class works best, and the perceived risk of exacerbating
seizures. This review aimed to address these issues, and inform clinical
practice and future research. This is an updated version of the original
Cochrane Review published in Issue 12, 2014.
Objectives: To evaluate the efficacy and safety of antidepressants in treating
depressive symptoms and the effect on seizure recurrence, in people with
epilepsy and depression.
Search methods: For this update, we searched CRS Web, MEDLINE, SCOPUS, PsycINFO,
and ClinicalTrials.gov (February 2021). We searched the World Health
Organization Clinical Trials Registry in October 2019, but were unable to update
it because it was inaccessible. There were no language restrictions.
Selection criteria: We included randomised controlled trials (RCTs) and
prospective non-randomised studies of interventions (NRSIs), investigating
children or adults with epilepsy, who were treated with an antidepressant and
compared to placebo, comparative antidepressant, psychotherapy, or no treatment
for depressive symptoms. DATA COLLECTION AND ANALYSIS: The primary outcomes were
changes in depression scores (proportion with a greater than 50% improvement,
mean difference, and proportion who achieved complete remission) and change in
seizure frequency (mean difference, proportion with a seizure recurrence, or
episode of status epilepticus). Secondary outcomes included the number of
participants who withdrew from the study and reasons for withdrawal, quality of
life, cognitive functioning, and adverse events. Two review authors
independently extracted data for each included study. We then cross-checked the
data extraction. We assessed risk of bias using the Cochrane tool for RCTs, and
the ROBINS-I for NRSIs. We presented binary outcomes as risk ratios (RRs) with
95% confidence intervals (CIs) or 99% CIs for specific adverse events. We
presented continuous outcomes as standardised mean differences (SMDs) with 95%
CIs, and mean differences (MDs) with 95% CIs. MAIN RESULTS: We included 10
studies in the review (four RCTs and six NRSIs), with 626 participants with
epilepsy and depression, examining the effects of antidepressants. One RCT was a
multi-centre study comparing an antidepressant with cognitive behavioural
therapy (CBT). The other three RCTs were single-centre studies comparing an
antidepressant with an active control, placebo, or no treatment. The NRSIs
reported on outcomes mainly in participants with focal epilepsy before and after
treatment for depression with a selective serotonin reuptake inhibitor (SSRI);
one NRSI compared SSRIs to CBT. We rated one RCT at low risk of bias, three RCTs
at unclear risk of bias, and all six NRSIs at serious risk of bias. We were
unable to conduct any meta-analysis of RCT data due to heterogeneity of
treatment comparisons. We judged the certainty of evidence to be moderate to
very low across comparisons, because single studies contributed limited outcome
data, and because of risk of bias, particularly for NRSIs, which did not adjust
for confounding variables. More than 50% improvement in depressive symptoms
ranged from 43% to 82% in RCTs, and from 24% to 97% in NRSIs, depending on the
antidepressant given. Venlafaxine improved depressive symptoms by more than 50%
compared to no treatment (mean difference (MD) -7.59 (95% confidence interval
(CI) -11.52 to -3.66; 1 study, 64 participants; low-certainty evidence); the
results between other comparisons were inconclusive. Two studies comparing SSRIs
to CBT reported inconclusive results for the proportion of participants who
achieved complete remission of depressive symptoms. Seizure frequency data did
not suggest an increased risk of seizures with antidepressants compared to
control treatments or baseline. Two studies measured quality of life;
antidepressants did not appear to improve quality of life over control. No
studies reported on cognitive functioning. Two RCTs and one NRSI reported
comparative data on adverse events; antidepressants did not appear to increase
the severity or number of adverse events compared to controls. The NSRIs
reported higher rates of withdrawals due to adverse events than lack of
efficacy. Reported adverse events for antidepressants included nausea,
dizziness, sedation, headache, gastrointestinal disturbance, insomnia, and
sexual dysfunction. AUTHORS' CONCLUSIONS: Existing evidence on the effectiveness
of antidepressants in treating depressive symptoms associated with epilepsy is
still very limited. Rates of response to antidepressants were highly variable.
There is low certainty evidence from one small RCT (64 participants) that
venlafaxine may improve depressive symptoms more than no treatment; this
evidence is limited to treatment between 8 and 16 weeks, and does not inform
longer-term effects. Moderate to low evidence suggests neither an increase nor
exacerbation of seizures with SSRIs. There are no available comparative data to
inform the choice of antidepressant drug or classes of drug for efficacy or
safety for treating people with epilepsy and depression. RCTs of antidepressants
utilising interventions from other treatment classes besides SSRIs, in large
samples of patients with epilepsy and depression, are needed to better inform
treatment policy. Future studies should assess interventions across a longer
treatment duration to account for delayed onset of action, sustainability of
treatment responses, and to provide a better understanding of the impact on
seizure control.
7.
Venlafaxine
Infants receive venlafaxine and its active metabolite in breastmilk, and the
metabolite of the drug can be found in the plasma of most breastfed infants;
however, concurrent side effects have rarely been reported. Some experts feel
that venlafaxine is not recommended during nursing,[1] but a safety scoring
system finds venlafaxine use to be possible during breastfeeding.[2] Breastfed
infants, especially newborn or preterm infants, should be monitored for
excessive sedation and adequate weight gain if this drug is used during
lactation, possibly including measurement of serum levels of desvenlafaxine
(O-desmethylvenlafaxine), to rule out toxicity if there is a concern. Bruxism
has also been reported in one infant. However, newborn infants of mothers who
took the drug during pregnancy may experience poor neonatal adaptation syndrome
as seen with other antidepressants such as SSRIs or SNRIs. Use of venlafaxine
during breastfeeding has been proposed as a method of mitigating infant
venlafaxine withdrawal symptoms,[3,4] but this has not been rigorously
demonstrated.
8.
Venlafaxine
withdrawal syndrome
Dual-action antidepressants serotonin-norepinephrine reuptake inhibitors (SRNIs)
are widely used to treat depression. Owing to its efficiency and safety,
venlafaxine holds a prominent place in this group of depressants. Abrupt
venlafaxine discontinuation involves a high risk of withdrawal syndrome.
Mechanism of its development is similar to that of selective serotonin reuptake
inhibitors (SSRIs), but of higher intensity. Venlafaxine withdrawal symptoms may
include several somatic symptoms as well as several psychiatric symptoms. In
some cases, symptoms may look like a stroke. A treatment option is re-inclusion
of venlafaxine or a SSRI antidepressant. The paper presents the case of a
70-year-old patient who discontinued of her own accord to take venlafaxine,
which she had been taking regularly at a daily dose of 225 mg for more than a
year. A few hours after taking the last dose, withdrawal syndrome occurred with
severe symptoms resembling a stroke. The patient was examined by a neurologist
and the CT and laboratory parameters showed no irregularities. Diagnosis was
made after psychiatric observation. Venlafaxine, 150 mg per day, was prescribed,
the symptoms disappeared relatively quickly, and the patient fully recovered.
Withdrawal syndrome is a real risk for each venlafaxine treated patient. The
possibility of its occurrence should be always kept in mind and patients should
be timely informed about it. In this way, the risk of venlafaxine withdraw
syndrome could be reduced, unnecessary stress to patients prevented and the
costs of medical treatment lowered.
9.
Withdrawal
symptoms of antidepressants
Withdrawal symptoms are encountered with both the classical anti-depressants,
i.e. the tricyclic antidepressants and monoamineoxidase inhibitors, the modern
antidepressants, i.e. the selective serotonin re-uptake inhibitors, and the new
antidepressants such as venlafaxine and mirtazapine. The symptoms that are
reported following the withdrawal of these drugs can be classified into 8
groups: influenza-like symptoms, psychic symptoms, gastrointestinal symptoms,
sleep disorders, equilibrium disorders, sensory disturbances, extrapyramidal
symptoms and other symptoms. It is characteristic of these symptoms that they
appear 1-4 days after reduction of the dose or the last administration of the
drug. They may also appear in the infants of mothers who used an antidepressant
during the last phase of the pregnancy. It is important that the patient be
informed accurately and carefully at the start and termination of any treatment
with an antidepressant. In order to prevent withdrawal symptoms, it is advisable
to reduce the dosage slowly if possible when the treatment is to be terminated.
10.
Serotonergic
anti-depressants and ethanol withdrawal syndrome: a review
Aim: To review laboratory findings on the effects of anti-depressant agents that
interact with the serotonergic system on signs of ethanol withdrawal syndrome in
rats.
Method: Adult Wistar rats received a modified liquid diet to produce ethanol
dependence. Signs of ethanol withdrawal, locomotor hyperactivity, stereotyped
behaviour, tremor, wet dog shakes, agitation, and audiogenic seizures, were
evaluated for the first 6 h of ethanol withdrawal. The effects of the
anti-depressants fluoxetine, venlafaxine, escitalopram, tianeptine, and extract
of Hypericum perforatum (St. John's wort) (HPE) were examined.
Results: Some beneficial effects of fluoxetine, tianeptine, HPE, escitalopram
and venlafaxine on ethanol withdrawal signs were observed, ranked as follows:
fluoxetine = tianeptine > HPE > escitalopram > venlafaxine.
Conclusions: Tianeptine and fluoxetine seem to be potent pharmacologically
active agents on ethanol withdrawal syndrome in rats. Thus, these
anti-depressants may be useful in treatment of ethanol withdrawal syndrome in
patients with alcoholism. In addition to serotonergic effects, interactions with
nitrergic, glutamatergic, and adenosinergic systems may also provide a
significant contribution to the beneficial effects of these drugs on ethanol
withdrawal syndrome.