Expert: Nigel Simmons - 5/16/2007

Question
QUESTION: Hi, I have been taking novo venlafaxine xr: 37.5 mg a day (for anxiety) for the last 3 days and I am wondering what happens if I suddenly decide to stop taking the pills? I am also curious to know if it is normal to be feeling somewhat lightheaded in the beginning. Thank you.
ANSWER: Julie

It sounds as though you are experiencing common side effects of Venlafaxine (see www.drugs.com/mtm/venlafaxine.html). These will often settle as you become more established with the medication. As you are taking the sustained release formulation, these problems should be lower, but not necessarily nil.

If however you find these symptoms intolerable, it should be quite safe to stop the drug at this stage. However, once established it is often necessary to slowly withdraw the medication to prevent other symptoms. Regrettably most of the newer anti-depressant and anti-anxiety medication are associated with withdrawal problems.

My suggestion would be to consider whether the side effects are making you more anxious and if so it may be better to discontinue. Many anxety states respond to motivational change and you may consider that the potential for side effects is not comfortable and that you may find that with a positive outlook your anxiety could  be reduced. If you can achieve this, the recognition that you feel better and more positive is the starting point for the next step along the road.

I hope this helps.

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QUESTION: Dr.,
How long until the meds become "established" as you say? If I choose to 'wait and see' for a few more days, I don't want to run the risk of allowing them to establish and then have to deal with withdrawal. On the other hand, I don't want to stop without giving this a fair shot, especially if it will help me in the end. Thank you again.
ANSWER: Julie

As you are taking a sustained release (long acting) formulation, it will usually take 7-10 days before a static blood level is reached. Full therapeutic effect will typically be within two to three weeks. Hopefully as the drug becomes more effective your side effects will decrease because you feel better in yourself and your body adjusts to the medication.

If however the side effects worsen, then it would be advisible to stop and discuss an alternative product. Although Venlafaxine is one of a class of drugs which have a common mechanism of action, side effects can vary between patients and between products. You may find that you tolerate an alternative product better.


If you find your symptoms of anxiety improving, then that is a positive move forward.

---------- FOLLOW-UP ----------

QUESTION: Thank you again. Last question: Any alternative medication you can suggest for anxiety? (vitamin supplements? acupuncture?)

Answer
Julie

I'm afraid I can't really recommend any vitamin or herbal type products to treat anxiety. As far as I am aware none will have been properly researched and any claims for effect are more likely to be marketing hype than real science.

You may however wish to explore support therapies such as psychotherapy or cognitive behaviour therapy which can be very helpful to some people.