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Suggest Treatment For Withdrawal Symptoms Of Venlafaxine
Question: Hello I need A psychiatric consultation.
Need to know the causes of sudden weakness after slow withdrawal of venlafalxine
1. Need advise on Use of pure Prozac and its dosage
2. Do you advise comibantion therapy. And if so what drugs
3. Depressive illness since 8 yrs
Used citalopeam- no use
Venlaglaxine - no use
Now doctors prescribed well butryn
Don't want to start another new drug now
Need to know the causes of sudden weakness after slow withdrawal of venlafalxine
1. Need advise on Use of pure Prozac and its dosage
2. Do you advise comibantion therapy. And if so what drugs
3. Depressive illness since 8 yrs
Used citalopeam- no use
Venlaglaxine - no use
Now doctors prescribed well butryn
Don't want to start another new drug now
Brief Answer:
I am there to help you
Detailed Answer:
Dear XXXX,
Thanks for using Healthcaremagic.
As I can see there is possibility of treatment resistant depression I need to look for possible causes of it. First we need to review the diagnosis. It is possible that there is some other component like bipolarity or element of personality traits. As we know depression responds poorly when there is comorbid disorders or when the main component is bipolarity.
Second I need to know how long and at what dose each medication was used. This is because if we use lower than required dose there is possibility of no or incomplete response
Thirdly I request you to have following profiles before hand when we consult which includes
Your weight
Your Height
BMI
Blood pressure
Thyroid profile
serum Vitamin B 12
Serum D3
Now regarding your current question the withdrawal side effect is most likely cause of sudden withdrawal of effexor. I understand that it was lowered down slowly but there is still chance of limited withdrawal symptoms and that includes sudden weakness.
I hope this helps you.
Thanks and regards.
I am there to help you
Detailed Answer:
Dear XXXX,
Thanks for using Healthcaremagic.
As I can see there is possibility of treatment resistant depression I need to look for possible causes of it. First we need to review the diagnosis. It is possible that there is some other component like bipolarity or element of personality traits. As we know depression responds poorly when there is comorbid disorders or when the main component is bipolarity.
Second I need to know how long and at what dose each medication was used. This is because if we use lower than required dose there is possibility of no or incomplete response
Thirdly I request you to have following profiles before hand when we consult which includes
Your weight
Your Height
BMI
Blood pressure
Thyroid profile
serum Vitamin B 12
Serum D3
Now regarding your current question the withdrawal side effect is most likely cause of sudden withdrawal of effexor. I understand that it was lowered down slowly but there is still chance of limited withdrawal symptoms and that includes sudden weakness.
I hope this helps you.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The following is the complete history
I feel she doesn't have a bipolar component
Pl see below
Iam a practicing physician and My daughter is aged 25 yrs
For the past 8 yrs she is suffering from moderate to severe depression and attacks of anxiety and panic
In her anxiety she is often angry, emotional, snappy and uses hurtful words to the surrounding people
These things interfere with her studies and right now she is taking a study break because of her symptoms
She had been on the following medicine sin order of sequence
2008 -2009 – citalopram – did not work and caused drowsiness
2019-2012- started fluoxitene 20mg BID worked ok for 2 yrs
2014 – stopped as it was not working and venlafaxine was added and increased to 200 mg
-absolutely no improvement till date
2016 October- reduced venla with a bssic dose of 150 mg and restarted on 20mg fluoxetine
Now has the following symptoms
Fatigue, sleepiness, lack of energy, anxiety attacks time to time, lack of interest and sleepiness
We presume these are due to venla withdrawl and wish to increase Prozac
Right now she is on following medications
1. Venlaflaxine 150 mg once daily
2. Prozac 20 mg once daily
3. Clonazepam 1mg for anxiety
4. Psychotherapy
5. Lots of family and sibling support
There were multiple advises taken from different psychiatrists during change of medications
She says she needs a stimulant medication to concentrate on studies
Past history
She has severe Hashimotos thyroiditis and using 200 micrograms thyroid supplements everyday
She is overweight and weighs 100 kg
Her other blood tests are all normal including sugars, lipids and cortisol
Our questions are as follows
1. What is the cause of present increase in weakness and fatigue when she started reducing venlafaxine doses
2. We are not sure whether or not to use the following medicines
Our suggested choices are
3. a. Venlaflaxine 150 mg + 20 - 40 mg of Prozac
b. well butyrin pure
c. Prozac pure
4. or Prozac with other drugs
I feel she doesn't have a bipolar component
Pl see below
Iam a practicing physician and My daughter is aged 25 yrs
For the past 8 yrs she is suffering from moderate to severe depression and attacks of anxiety and panic
In her anxiety she is often angry, emotional, snappy and uses hurtful words to the surrounding people
These things interfere with her studies and right now she is taking a study break because of her symptoms
She had been on the following medicine sin order of sequence
2008 -2009 – citalopram – did not work and caused drowsiness
2019-2012- started fluoxitene 20mg BID worked ok for 2 yrs
2014 – stopped as it was not working and venlafaxine was added and increased to 200 mg
-absolutely no improvement till date
2016 October- reduced venla with a bssic dose of 150 mg and restarted on 20mg fluoxetine
Now has the following symptoms
Fatigue, sleepiness, lack of energy, anxiety attacks time to time, lack of interest and sleepiness
We presume these are due to venla withdrawl and wish to increase Prozac
Right now she is on following medications
1. Venlaflaxine 150 mg once daily
2. Prozac 20 mg once daily
3. Clonazepam 1mg for anxiety
4. Psychotherapy
5. Lots of family and sibling support
There were multiple advises taken from different psychiatrists during change of medications
She says she needs a stimulant medication to concentrate on studies
Past history
She has severe Hashimotos thyroiditis and using 200 micrograms thyroid supplements everyday
She is overweight and weighs 100 kg
Her other blood tests are all normal including sugars, lipids and cortisol
Our questions are as follows
1. What is the cause of present increase in weakness and fatigue when she started reducing venlafaxine doses
2. We are not sure whether or not to use the following medicines
Our suggested choices are
3. a. Venlaflaxine 150 mg + 20 - 40 mg of Prozac
b. well butyrin pure
c. Prozac pure
4. or Prozac with other drugs
Brief Answer:
Most probably it is prozac
Detailed Answer:
Hello XXXX,
Thanks for reverting back to me with relevant details.
Since you are practicing physician and closely monitoring your daughter for last eight years in regard to depression I am convinced with diagnosis. Same time there are two comorbidities which you have mention in the current query which need to be addressed.
Now regarding your question the current weakness, lethargy fatigue is most probably due to prozac. These are the common side effects even before prozac starts working. In my experience most patients come out of these side effects in few weeks if not days and there is little to worry about them.
Now regarding further course of action I feel she needs augmentation with other molecules in addition to antidepressants. Since she responded well to prozac in past this should be the first choice of antidepressant. In addition considering her weight and metabolic profile we need a medication which is weight neutral and prozac is one among them. Regarding augmentation I feel Ability 5 mg should be added to her treatment profile. This we plan to add considering treatment resistant depression. In addition clonazepam need to be continued on need basis for time being till she responds for treatment of panic attacks.
I hope this assists you further.
Thanks and regards.
Most probably it is prozac
Detailed Answer:
Hello XXXX,
Thanks for reverting back to me with relevant details.
Since you are practicing physician and closely monitoring your daughter for last eight years in regard to depression I am convinced with diagnosis. Same time there are two comorbidities which you have mention in the current query which need to be addressed.
Now regarding your question the current weakness, lethargy fatigue is most probably due to prozac. These are the common side effects even before prozac starts working. In my experience most patients come out of these side effects in few weeks if not days and there is little to worry about them.
Now regarding further course of action I feel she needs augmentation with other molecules in addition to antidepressants. Since she responded well to prozac in past this should be the first choice of antidepressant. In addition considering her weight and metabolic profile we need a medication which is weight neutral and prozac is one among them. Regarding augmentation I feel Ability 5 mg should be added to her treatment profile. This we plan to add considering treatment resistant depression. In addition clonazepam need to be continued on need basis for time being till she responds for treatment of panic attacks.
I hope this assists you further.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can Prozac cause drowsiness and
Sleepiness also ?
Some
More information please
As follows:
What all symptoms she has I told you
But regarding snappyness and anger
The following are the examples
I ask her normally ' why are you not talking To me?'
She says: because you are a brat
I talk to her Normally and if she doesn't like what I say ' she flatly says ' stop it stop it I say'
Usually she is Abvery respectable Good and kind girl
But during those episodes she angrily says ' you are a a looser '
And she sometimes cries and says ' Iam not mean'
But most of the times
She is soft and very helpful
Docile girl
We have a family history of depression
my younger sisters and and my mother and my maternal Uncles are aggressive angry as well as have severe depression unfortunately
And we also have familial hashimotos thyroiditis as well
Sleepiness also ?
Some
More information please
As follows:
What all symptoms she has I told you
But regarding snappyness and anger
The following are the examples
I ask her normally ' why are you not talking To me?'
She says: because you are a brat
I talk to her Normally and if she doesn't like what I say ' she flatly says ' stop it stop it I say'
Usually she is Abvery respectable Good and kind girl
But during those episodes she angrily says ' you are a a looser '
And she sometimes cries and says ' Iam not mean'
But most of the times
She is soft and very helpful
Docile girl
We have a family history of depression
my younger sisters and and my mother and my maternal Uncles are aggressive angry as well as have severe depression unfortunately
And we also have familial hashimotos thyroiditis as well
Brief Answer:
Yes it is possible
Detailed Answer:
Dear XXXX,
Thanks for reverting back to me.
The both side effects are well described with prozac and are possible;e at the same time.
Sleepiness although uncommon but reported in around 5-10 % of patients.
Thanks and regards.
Pl see my other mail also
Yes it is possible
Detailed Answer:
Dear XXXX,
Thanks for reverting back to me.
The both side effects are well described with prozac and are possible;e at the same time.
Sleepiness although uncommon but reported in around 5-10 % of patients.
Thanks and regards.
Pl see my other mail also
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Pl see my other mail also
Brief Answer:
I think there is need to augment
Detailed Answer:
Hello,
Thanks for reverting back to me.
I respect your opinion about the single medication for treatment of depression but I think she definitely needs augmentation with atypical antipsychotics such as ability because
1. There is poor response to single medication from both SSRI and SNRI group
2. Strong biological component
3. early onset
4. Irritability overshadowing mood component
Although the possibility of bipolar is low but still I request you to ask her to fill this questionnaire (mood disorder questionnaire) which is freely averrable over the internet (http://www.sadag.org/images/pdf/mdq.pdf)
In case you find anything abnormal with this questionnaire or have any more questions revert back to me using my url as this thread can be closed after this follow up.
My url is http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
I think there is need to augment
Detailed Answer:
Hello,
Thanks for reverting back to me.
I respect your opinion about the single medication for treatment of depression but I think she definitely needs augmentation with atypical antipsychotics such as ability because
1. There is poor response to single medication from both SSRI and SNRI group
2. Strong biological component
3. early onset
4. Irritability overshadowing mood component
Although the possibility of bipolar is low but still I request you to ask her to fill this questionnaire (mood disorder questionnaire) which is freely averrable over the internet (http://www.sadag.org/images/pdf/mdq.pdf)
In case you find anything abnormal with this questionnaire or have any more questions revert back to me using my url as this thread can be closed after this follow up.
My url is http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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