Venlafaxine

How do antidepressant medicines work?

Depression is thought to be linked to low levels of naturally-occurring chemical messengers in the brain. These messengers are called neuro-transmitters. They send electrical impulses between different parts of the brain. In depression, two neuro-transmitters are known to be particularly important. These are called serotonin (pronounced seer-o-tone-in) and noradrenaline (pronounced nor-ad-ren-a-linn). Serotonin is also

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sometimes called 5HT for short.

Some antidepressants work by increasing the levels of serotonin in the brain. This type of antidepressant is called a selective serotonin re-uptake inhibitor or SSRI for short. SSRI antidepressants are the ones that are most widely used in Britain.

Some antidepressants work by increasing the levels of noradrenaline in the brain. Some antidepressants work by increasing the levels of both noradrenaline and serotonin.

It doesn’t seem to matter which neuro-transmitter is increased, all antidepressants are about equally effective.

Venlafaxine is an SSRI antidepressant and increases the levels of serotonin in the brain.

What type of medicine is Venlafaxine and what is it used for?

Venlafaxine is an antidepressant medicine. It treats the symptoms of depression.

Brief description of depression

Depression is a condition that affects both your mental and your physical health. It can cause a persistently low mood, prevent you from enjoying your life, interfere with your sleep, make it very difficult to concentrate, sap your energy, affect your appetite and cause unpleasant morbid thoughts about death and suicide. Depression affects different people in different ways: some people may have many symptoms of depression, but are able to get on with their lives; others may have few symptoms but be completely unable to cope.

Treatments for depression

Most people with depression are not able to manage without outside help. Many people are not aware that help – and choices – are available at all. For some people with depression, talking treatments like cognitive behavioural therapy (called CBT for short) are effective. Other people respond better to antidepressant medicines. Some people need both. CBT works best in milder forms of depression, while in more severe forms of depression, antidepressants work better. The important thing to know is that the majority of people with depression can be treated successfully.

Antidepressant medicines

Antidepressants are not very effective in milder forms of depression, but may be of benefit if you are suffering with anxiety. They have been shown to be effective in moderate to severe depression, and, in severe depression, can be combined with CBT.

Taking an antidepressant is not a sign of weakness, but is a positive decision to take control of your depression.

  • Click here for more information about the treatment of depression.
      • 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 increased to 150 mg/day.
      • If the response is still not good enough, the dose can be increased again up to 225 mg/day.
      • When increasing the dose, increases of up to 75 mg/day should be made at least 4 days apart.
      • It is a generally a good idea to leave enough time between dose increases to see whether the increased dose improves the response, or causes more side effects before increasing the dose again.
      • In severe depression, when being treated by a specialist, higher doses, over 300mg and up to a maximum of 375mg a day can be used.
      • For most patients, the recommended starting dose for Venlafaxine slow release capsules is 75mg.
      • Depending on side effects and how well the patient has responded to treatment, the dose may be increased to 150 mg/day.
      • If the response is still not good enough, the dose can be increased again up to 225 mg/day.
      • When increasing the dose, increases of up to 75 mg/day should be made at least 4 days apart.
      • It is a generally a good idea to leave enough time between dose increases to see whether the increased dose improves the response, or causes more side effects before increasing the dose again.
      • The maximum recommended dose of Venlafaxine slow release capsules is 225mg.
      • anxiety
      • dizziness
      • headaches
      • nausea and
      • paraesthesia (pronounced paraz-theezier)
      • No desire to continue taking the drug
      • No compulsion to increase use of the drug
      • No tolerance to the drug develops
      • No neglect of other activities / interests in order to maintain drug-taking behaviour
      • No desire to persist with taking the drug despite evidence of harmful consequences
      • Click here for information about antidepressants and drug dependence.
      • anxious
      • agitated
      • irritable
      • or cause panic attacks
      • insomnia
      • hostility
      • or restlessness like you can’t sit or stand still (called ‘akathisia’)
      • or make you act impulsively
      • or have thoughts about suicide.
    • How should treatment with Venlafaxine be started, and what is the usual dose?

      Venlafaxine tablets

      Venlafaxine slow-release capsules

      Venlafaxine is also available as slow release capsules which are taken just once a day – with food. They must be swallowed whole with a drink of water and not chewed.

      Is there anything else I should know about Venlafaxine?

      Yes, continue reading below.

      Blood pressure monitoring

      Taking Venlafaxine can increase your blood pressure. It is recommended that blood pressure is monitored regularly. If your blood pressure increases and stays high, either the dose of Venlafaxine should be reduced, or a change to a different antidepressant should be considered.

      Discontinuation symptoms with Venlafaxine

      If treatment with antidepressants is stopped suddenly, all of them can cause side-effects – these are usually called discontinuation symptoms. This is a particular problem with Venlafaxine.

      Discontinuation symptoms include:

      Discontinuation symptoms are usually mild and stop by themselves but occasionally they can be severe, particularly if the drug is stopped suddenly.

      Symptoms can emerge if a patient misses only a single dose of some antidepressants, or stops treatment without telling their doctor, or sometimes when stopping treatment has been agreed with their GP, but isn’t done slowly enough.

      Generally, planned stopping of treatment should involve the dose of antidepressant being reduced slowly over a 4-week period, although some people may require longer. This is particularly important for medicines such as Paroxetine and Venlafaxine, while for Fluoxetine, discontinuation symptoms are rare, and it can usually be stopped more quickly.

      If discontinuation symptoms are mild, brief reassurance for the patient is usually all that’s needed. If symptoms are severe, the antidepressant should be restarted at its previous dose and the dose reduced gradually while monitoring for symptoms.

      However, discontinuation symptoms are not signs of addiction. There is:

      Problems with agitation and anxiety

      In the early stages of treatment, in a small proportion of people who take it, Venlafaxine can make you feel

      If you get these symptoms and find that they are distressing you should tell your GP immediately, especially if they are severe, came on abruptly, or were not among the symptoms you went to the doctor with originally.

Click here to learn more about antidepressant side effects
    • Shortly after you have started taking Venlafaxine your doctor should check whether you are having these symptoms.

      If you feel very restless and agitated over a long period of time your doctor should consider whether you need a change of medication.

      Risk of stomach bleeds

      When combined with some painkillers called non-steroidal anti-inflammatory drugs (NSAIDs for short) or aspirin, or medicines used to prevent strokes, some antidepressants have been associated with an increased risk of bleeding in the stomach. It is recommended that if you are taking any of these medicines together with Venlafaxine, you should receive additional medication to prevent possible stomach bleeds. If you are taking Venlafaxine on its own, you won’t need this additional medication.

      If you are taking any other medicines, you should ask your pharmacist if any of them fall into these groups.

      Some of these medicines can be bought without a prescription – so always ask your pharmacist for advice before buying any non-prescription treatments for minor ailments.