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What are risk of serotonin syndrome while on Effexor and Lexapro?

Answered by
Dr. Ashok Kumar


Practicing since :2000

Answered : 2655 Questions

Posted on Fri, 8 Aug 2014 in Mental Health
Question: I have received a lot of advice from physicians that the Effexor shoulgradually be increased. I am also on 20 mg lexapro. At what point do I need to worry about serotonin syndrome since these are both acting on serotonin?
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
There is possibility but very minimal

Detailed Answer:
Thanks for using healthcaremagic.

Your physician is right in saying that effexor should be gradually increased in almost all persons and very particularly for those who receiving Laxapro or some SSRI group of medicines.
With the low dose of Effexor (37.5), the risk is very minimal for serotonin syndrome. If there is sudden changes in dose than the risk is much larger in compare to gradual increase in doses of these two medicines.

Generally serotonin syndrome start to appear within 48 hours of addition or dose changes and if you are feeling well after passing two days than please get assure that you are not having serotonin syndrome with current doses.

I request you to provide following details in follow up query for further clarification if any.
1. Complete symptom description for which you got this prescription
2. History of previous medication
3. What was the response with previous medication.
4, Reason for two antidepressants as it is neither a recommended strategy nor scientific one.

'Hope I have answered your query. If you have any further questions I will be happy to help".

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Ashok Kumar 49 minutes later

I had been taking lexapro at 10mg or 15mg at times for a few years and to prevent recurrences. I had my first depression 12 years ago. I took celexa for the first episode and it worked great. Every time tried to wean off the celexa it would be ok for a while but I would always end up back on it. The I switched to lexapro after cel exta seemed to lose most it's positive effects.
This spring I developed a recurrence, so my doc raised lexapro to 20. When I was still having anxiety and other symptoms 2 weeks later he added Effexor. It's been about a week and I still felt awful this morning.
Do you think it's safe to go to 75mg of Effexor? I see doctor on Thursday

Thank you!
Answered by Dr. Ashok Kumar 9 hours later
Brief Answer:
You can ask for dose increase

Detailed Answer:
Welcome back to healthcaremagic.

In that case your psychiatric took right decision to add on effexor when you had inadequate response and anxiety symptoms.

After one week of 37.5mg of effexor it is safe to increase the dose to 75mg.

At the same time I advise you to discuss other safer options with your doctor as add on therapy.

"If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health".
Dr Ashok
Above answer was peer-reviewed by : Dr. Prasad

The User accepted the expert's answer

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