Is it safe to take velafaxine hcl for depression when suffering from bipolar disorder?
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My husband has been on risperidone for about 2 yrs now for bipolar and paranoid episodes. He suffers from on and off deppression. psyciotrist had him on wellsbutrin along with the risperidone and at first wellsbutrin seemed to work great than as the doses were raised he seemed not as good and then they split off doses and still no different. He took zolof for about a year and it did nothing but made him into a robot. Paranoia had not happened in about a year but seems to be depressed on and off with mood swings. No energy or motivation. I would love to get him off of risperidone cause I think it is causing him to be more depressed, but doctor says no. Dr. just perscribed 75 mg twice daily velafaxine hcl for depression along with the 150mg twice daily wellsbutrin and 2mg twice daily risperidone. I just read reviews on this velafaxine hcl and they were bad. They all seem to consistantly say that it was highly addictive and regret taking it. I looked into another drug called la tuda and reviews seem much better. My husband had 1 dose of the velafaxine today for first time and he has been sleeping all afternoon. I dont want him to continue taking something that could work but be highly addictive to get off of. What is your opinion of the drug? Also compared to the La tuda? Any opinion on either drug or your opinion on what drug could help him out?He does see phsyciatrist regularly but we dont have health care so we pay per visit for doctor. Doctor is nice but and he doesnt speak great english or say very much so it is hard to comunicate.
Posted Sun, 16 Feb 2014 in General Health
Answered by Dr. Preeti Parakh 10 hours later
Brief Answer: Explained below. Detailed Answer: Hi, Welcome to Healthcare Magic! Before you decide on the best treatment for your husband, we must be clear about his diagnosis. You mentioned three words, bipolar, paranoia and depression. I guess you mean that he has bipolar disorder in which there are episodes of either depression or mania. Depression is characterized by persistent low mood, fatigue, loss of interest, poor concentration and hopelessness. Mania is just the opposite, with exaggerated cheerfulness, increased energy levels, decreased need for sleep, a tendency to make plans, increased socialization, increased spending etc. By paranoia I guess you are referring to symptoms of suspiciousness and other false beliefs that may have accompanied the depressive and manic episodes. People with bipolar disorder are fine in the period between the episodes with no mania, depression or paranoia. If this is what he is suffering from, then he needs to be treated with a mood stabilizer, that prevents both mania and depression. Valproate and Lithium are two commonly used ones. However I see that your husband is not on any mood stabilizer, which makes me wonder if he has been diagnosed with some other illness and not bipolar. Venlafaxine, Wellbutrin and Zoloft are all anti-depressants. Risperidone and Latuda (lurasidone) are both anti-psychotics and also have mild mood stabilizing property. They control the symptoms of paranoia. That is why, lurasidone cannot be used in place of venlafaxine, but it can be used to replace risperidone if you wish. Secondly, venlafaxine and all other anti-depressants are not addictive drugs. Please do not go by what is said on online chat fora. If your husband is depressed now, he will need anti-depressants more than anti-psychotics. If he indeed has bipolar disorder, then he needs a mood stabilizer even more than he needs anti-depressants. Best wishes. Dr Preeti Parakh MD Psychiatry
Follow-up: Is it safe to take velafaxine hcl for depression when suffering from bipolar disorder? 11 hours later
Yes, you are pretty right on with diagnosis. From what doctor has told me it is a bipolar where he has episodes of depression and paranoia. he does not have a depression where he wants to commit suicide or anything. It is more or less no energy, no ambition, doesnt really socialize. But, it is not severe where he wont go out. We do go for dinner and out at times. But after a few hours he is agitated and wants to come home to the couch. This was not his normal personality until about 2 years ago. Also he doesnt have the urge for sex. He says he wants to, but is too tired or doesnt have the urge. In your opinion is that due to medication side effects or depression? Anything to help that? I appreciate your explanation of the medications it was very helpful. Between the risperidone and the la tuda is there one that you think is better effective? Also what mood stabalizer would you suggest that would help him that I can talk to my doctor about? When I read the reviews on the venlaxafine SEVERAL diffent people said it was addictive and terrible withdraw side effects. Why would they say that if it can't be addicting? Thank You for you time!
Answered by Dr. Preeti Parakh 2 hours later
Brief Answer: Explained below. Detailed Answer: Hi, You have mentioned that he has episodes of depression and "paranoia". In bipolar, there are episodes of depression and "mania" as I described earlier and the person is completely well for months in between the episodes. If your husband is having episodes of suspiciousness, fear of being persecuted by others, hearing voices and other such false beliefs without having any increased cheerfulness then I am not convinced that he has bipolar. The symptoms you describe as depression, that is not having any energy, no ambition, no socialization etc could well be something called "negative symptoms" that are seen in psychotic (paranoia in lay man's terms) illnesses. The reason I am harping so much on the diagnosis is that medicines won't work well if the diagnosis is wrong. Anti-depressants will have no benefit in negative symptoms. A correct diagnosis would require a detailed history and mental status examination. I would suggest that you read up on two illnesses, bipolar disorder ( WWW.WWWW.WW and schizophrenia ( WWW.WWWW.WW . I have included one link each for your convenience, but there is a lot of material on the internet. Once you read up on the different symptoms, you will be in a better position to identify what is wrong with your husband and you can communicate better with the doctor. Regarding loss of libido, it can be due to both the illness itself and the side effects of medicines. A correct diagnosis is therefore important as it prevents the use of needless medication. Between Latuda and Risperidone, I would prefer risperidone as it has been there for longer and there is a lot of research on risperidone as compared to the newer latuda. Having used it in thousands of patients, I know it is effective and safe. It perhaps will also be cheaper. I do not expect latuda to be more effective. Regarding mood stabilizer, lithium and valproate are two commonly used medicines. The choice would depend on your husband's physical condition, blood tests and the types of symptoms he has. I have no answer to why people give out such false information on the internet. All antidepressants are associated with withdrawal symptoms, which are actually discontinuation symptoms, when stopped abruptly and venlafaxine is not an exception. But that doesn't mean that anti-depressants are addictive. It simply means that anti-depressants should be tapered off rather than abruptly stopped. Best wishes. Dr Preeti Parakh MD Psychiatry
Follow-up: Is it safe to take velafaxine hcl for depression when suffering from bipolar disorder? 1 hour later
doctor thought he was not schizophrenic. He felt like he didnt fit certain criteia for schizophrenia. He was treating him for bipolar. I asked the docter a few times if you can have paranod epsodes from bipolar and he told me yes. He has been hospitalized 3 times for paranoia. yes, he feels people are after him and he is afraid. They raise the risperdone to 6mg daily and after about 4 days it seems to go away. The episodes come on from severe stress the doctor said. As I said before he has not has a paranoid episode since last christmas so just over a year. I have done alot of research already on bipolar and schizophrenia and I am aware of the difference. I was just trusting the doctor that after getting to know him for about a year he didnt think he was schizophrenic. The risperidone has been brought down to 3 mg daily and then doctor brought it up in November to 6 mg because he was having some small paranoid symptoms but he didnt have an episode. Doctor just dropped it last month to 4 mg daily. I understand the risperidone is helping with the paranoia, but my fear is it is also makng him worse by making him depressed and lethargic. In your opinion is it possible to stop taking risperidone or cut down to very little but if he has another paranoid episode he would ge back on it? He took one dose of venlafaxne yesterday and had a terrible headache and stomach ache and slept ALL DAY!! What is your experience with this medication and is that normal for a first dose? My husband works full time as a carpentar and cant go around feeling sleepy all day! Thanks for your advice.
Answered by Dr. Preeti Parakh 5 hours later
Brief Answer: Explained below. Detailed Answer: Hi, Your doctor is right in saying that there can be psychotic symptoms in bipolar disorder, but these occur only when the manic or depressive episode is severe. Psychotic symptoms do not arise independent of mania and depression in bipolar disorder. If they do, then the diagnosis is likely to be schizo-affective disorder. For both bipolar and schizo-affective, he will need to be on an a mood stabilizer. It is also possible for people to have brief psychotic episodes which may be followed by depressive episodes which are called post-psychotic depressive episodes. For this he will need to be on an anti-psychotic initially and if there is post-psychotic depression, an antidepressant may be added. Since your husband is having a psychotic episode once a year or so, I feel your doctor is doing right in continuing the risperidone as a prophylaxis. I would not suggest that risperidone should be tapered off and started only when there are psychotic symptoms. This will not only increase the frequency of episodes, but also make them more severe and difficult to manage. I think your doctor has started on too high a dose of venlafaxine. The recommended starting dose is 37.5mg, taken twice a day with food, so that the total daily dose is 75mg. Depending on side effects and how well the patient has responded to treatment, the dose may be later increased to 150 mg/day. Your husband was however directly started on 150 mg per day, which is perhaps why he is unable to tolerate it. I have never seen such a reaction to venlafaxine as you describe, but then I have never started it this dose. I think you should call up his doctor and tell him about the adverse effects. I am sure he will either ask you to stop it or lower the dose. Sedation can be a problem with all anti-depressants and if so, the antidepressant should be taken at night. With venlafaxine, this is not possible if you are using the immediate release formulation. But if you use the extended release formulation, the total daily dose may be taken as a single dose at night time. Best wishes. Dr Preeti Parakh MD Psychiatry
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