Hello, I think it might help for someone to go over the ins-and-outs of blood pressure, so s you can see where the various opinions are coming from. The blood pressure is the fluid pressure in the arteries, it isn t the fluid pressure inside the heart. Even though it s the heart that generates the pressure by pumping out blood. The first pressure, your 140/ , is the pressure in the arteries a fraction of a second after the heart pumps. It s often said that this first pressure should be your age +100, so on the basis that you are 26, a first pressure of over 100+26 = 126 is too high. This second pressure, your /90, is actually more important in diagnosing high blood pressure than the first reading. The second pressure, is the pressure inside the arteries in between heart-beats, whilst the heart is refilling. If the heart were a rotary pump, there would only be one blood pressure, but in fact clearly the heart is an intermittent pump, - - it pumps, refills, pumps, refills, pumps, refills, etc. The second arterial pressure depends not so much on the heart end of the circulation, it depends on the other end or far end of the circulation, where the arteries are emptying out at the far end into the tissues and veins. A high second pressure expresses a blockage, an obstruction, or an arterial spasm at the far end of the circulation,so that blood already in the arteries can t get out and backs up. It s this arterial spasm that anti- high blood pressure tablets treat: they relax the spasm, so blood can exit the arteries as easily as it gets in at the heart end. There is debate about the normal second pressure. 75 is normal, 80 is normal, 85 is normal, 90 is equivocal, 95 is too high. So you are on the edge of what people consider normal. In about 8 cases out of 10, doctors don t know why someone should have a raised blood pressure. In the other 2 cases, there is a find-able and treat-able cause, like being on the Pill, having a kidney infection, having over-active adrenal glands, that sort of thing. That s why you needed the blood-work, to rule out the 20% of known causes. I have looked up Efexor in my British National Formulary (September 2007 edition), and hypertension (high blood pressure) is listed as a side-effect in black-and-white, page 210. Efexor is a dual-action anti- depressant. It works by being not only a Serotonin re-uptake inhibitor, (as they all are), but also a nor-adrenaline re-uptake inhibitor. In other words, the effect of adrenaline is being boosted in the brain, and the effect is similar to having an adrenal problem, which we know can cause high blood pressure. Why your doctor and Psychiatrist should be denying what is presumably in American drug-reference books as well as in English ones, is not clear to me. Probably they don t want you to stop the Efexor at any cost, because your depression has been so bad? I don t think you should be getting ankle swelling, especially as it raises the possibility of the right side of your heart not coping very well, i.e. that could be related to the blood pressure problem. The last time I posted an opinion that a Questioner s treatment wasn t right, the Moderators took it off, but admittedly I phrased it less tactfully that time. I would be very disappointed if they took this post off. Yes, I think it could be the Efexor, and yes, I think you should try one of the single-action antidepressants. If your dose of Efexor, (a dual-action antidepressant), really is so low, - - then you should be able to manage on a single-action antidepressant, shouldn t you? I hope this is of some help. Best wishes, Belliger (retired uk gp)