Adam:
I am 95% on Zoloft 100 mg and Verpamil 360 mg … I had some initial side effects but like you has totally killed the migraine. I get as high as no symptoms. One thing that helped me get back into a sleep cycle was a mild amounts of a benzo Klonopin … just my experience. All prescribed by my headache specialist.
Hi Howie,
I tried to PM this but was unsuccessful…I may be following your rx footsteps. I am on Verapamil now, getting up to 240 then 360 but feel like I need an antianxiety also so will suggest Zoloft. My question relates to Klonopin - my Dr just prescribed it for me because I told him about trouble sleeping and waking up with anxiety almost every day and I think I am beginning to have some panic attacks. Did you use the generic brand or get the name brand Klonopin? I am always a little leery of generics but that may be unfounded.
Thank you and you have been a great success story.
Ben
I got your PM and sent you one back
best of luck
Hi Ben,
I am always a little leery of generics but that may be unfounded.
This is a legitimate concern. When I was taking Cipramil I was best on the actual name brand. Any time I tried generics, I would get gut disturbances or anxiety. A pharmacist told me that the drug is the same but the packing agents differ and can cause adverse reactions (although not common).
Scott 8)
I have not had issues with generics. I take a generic for all three drugs… I used to worry and sometimes think it was Placebo with me.
I am on generic Klonopin with no problems (.5 a day/ half am half pm). There are some meds that you do want to stay away from in the generic form. I can’t recall them now, but ironically, at my first appointment with my neurologist, my dad (who came with me) was reading an article about that topic in Prevention magazine.
Has anyone who has tried Effexor taken it at night rather than the morning? I am on day three at 37.5 mg. So far it has been an okay experience with no serious side effects. I am however finding myself to be extremely tired several hours after taking it. The funny thing is, I am also experiencing some insomnia at night. So, I don’t know whether to keep taking it in the morning and hope the fatigue fades away or to try taking it at night.
Any thoughts?
So it’s day 12 off the drug. Still lightheaded as all hell but the vertigo let up a lot after my period started. It got really, really rough for a couple of days there.
I am hoping I am seeing slight improvement, periods where my cognition is somewhat clearer, but boy is it slow, slow going. I get the impression this latest bout of dizzy hell isn’t going anywhere fast. It’s so frustrating as aside from major light sensitivity I was doing ok before I took this. It’s ironic that I didn’t just want to just stick with the propanolol because of the photophobia and the relapses I still got, but this has triggered the worst relapse I have had in a long, long time.
I am starting to think that along with the withdrawal (although that has been a big part of it), I am one of the people in whom this drug also triggered migraine. Instead of curing my migraine it ramped it up and I am dealing with the on-going attack. That would explain why I also felt so bad on the drug. My symptoms just all got worse. For people without MAV that might just have meant a few initial headaches whilst getting on to it, for me it meant a full scale MAV attack.
It’s really difficult to say as it’s a drug that can cause dizziness and vertigo both on it and withdrawing from it. So it’s impossible to differentiate between withdrawal and what might be just my usual MAV symptoms which have got really bad because of the reaction to the drug.
H
— Begin quote from “MarciM”
Has anyone who has tried Effexor taken it at night rather than the morning? I am on day three at 37.5 mg. So far it has been an okay experience with no serious side effects. I am however finding myself to be extremely tired several hours after taking it. The funny thing is, I am also experiencing some insomnia at night. So, I don’t know whether to keep taking it in the morning and hope the fatigue fades away or to try taking it at night.
Any thoughts?
— End quote
Hi Marci,
I’m day 16 at 37.5mg. The first few days I was taking it at lunch time about 1pm everyday, and every night I would wake up, wide awake, at 3am, and it would take me about an hour to get back to sleep. I take it at night now right after dinner, for me which is about 8pm. I’ve been sleeping through the night and awaking regularly between 7-8am.
I can’t comment on the fatigue as I’m am always tired and have been since I’ve been ill. I don’t think the effexor is making me feel more fatigued than usual.
C.
Crystal,
Thanks for your response. I slept better last night and the fatigue was better today, but I still may try switching to a nighttime dose to see how my body reacts. Now would be the time to do it before my body is set on a schedule and on a weekend when I don’t have to work the next morning.
How are you doing on Effexor? Have you had any side effects? Are you feeling any better?
Marci
— Begin quote from “MarciM”
Crystal,
Thanks for your response. I slept better last night and the fatigue was better today, but I still may try switching to a nighttime dose to see how my body reacts. Now would be the time to do it before my body is set on a schedule and on a weekend when I don’t have to work the next morning.
How are you doing on Effexor? Have you had any side effects? Are you feeling any better?
Marci
— End quote
Hi Marci,
So far I am not noticing any improvements with the Effexor. I had a false alarm on Tuesday, I was feeling less awful than usual, but the following day I was back on the couch completely useless for most of the day…
My side effects have been pretty mild, I had stomach upset the first week. I’ve been grinding my teeth at night so my jaw is always sore now. My appetite seems to have decreased a bit. I feel a little more spacey in the head than usual. I suppose I’ll just keep at it and see what happens.
Crystal
Sixteen days off the drug now. I wish I could say things were vastly improved, but any improvement is very slow. The bouts of actual vertigo seem to have lessened, although my tinnitus is still perpetually louder and there is a constant sensation of pressure through my head. I am still perpetually lightheaded although that is somewhat better than it was. The brain fog is bad. Brain fog and dizziness always go hand in hand with me, so it would be unlikely I could sustain this amount of dizziness and vertigo without being fairly fogged up.
I am freelance but have been having to attend meetings on and off throughout the last two weeks. This has been very challenging, especially as no one I work with knows I am ill. It’s been miserable frankly and scary. There is a lot of anecdotal evidence that omega 3 fish oil and drinking lots of water helps, who knows if it is true but I’ve been doing it anyway as it can’t do me any harm. Apparently people get a lot of relief from anti histamine type medications like benadryl and also ant emetics like meclizine and cinnarizine. I have been too scared to try those as I have such a violent reaction to drugs and fear making an already bad situation worse.
I have now read every thing I can get my hands on, on the net about this drug. As ever, people’s experiences vary. For the most part the experiences I have been reading are those people who experience severe withdrawal, but of course the net is skewed towards those who are having a bad time as people who have no problems withdrawing are much less likely to write about it. That said, some do and say they have had no problems at all. A doctor quoted the statistic of 75% of people experiencing withdrawal with effexor, however within that 75% there is a subset that experiences severe withdrawal, in some people it is moderate. It seems that IF people do experience withdrawal it is more severe than from other anti-depressants. It also seems to make little difference if you take a very high dose or a low dose or how long you have been on it. There are people who have taken very little and like me, end up in a mess and those who have taken huge doses for years who do fine.
With hindsight I wouldn’t have taken this. I simply couldn’t get my head round the idea that such a small amount of a drug could cause such long lasting issues. However, I have such a violent reaction to drugs if I’d thought about it I should have guessed this was likely to happen to me. It’s a bit of a bitter blow to realise I was driven by the desperation to get well and have merely succeeded in making myself very ill. I think I have got unluckly in that a number of people do report increased migraine as part of the withdrawal. I think I have been hit from two sides, my brain is attempting to adjust to the loss of the drug and this adjustment is also causing a major resurgence of migraine.
Once again I was unsure whether I should write about this as I am aware people will be considering this drug. However, I do wish I had been better informed when taking it. Even if I still chose to take it, it would have helped to really grasp that there can be a discontinuation syndrome and that it can be harsh. Part of what is making this so bad is how naive I was. As I said before - if you are fore warned, it also means you can carefully pick your moment to try it, particulary when you choose to withdraw from it. Those people who are able to take time off work, or who might be at home looking after children, but are able to hand over childcare to someone else, seem to be less distressed by the severe SE’s.
I picked just about the worst time to do this. If I was at home and able to take sick leave, this would be miserable but bearable, having to work through this has been a special kind of dreadful.
Anyway, the range of time it seems for this to pass varies from a week to 2 to a number of weeks to months. I just hope I might be one of the three week people, but the fact is there is no way of knowing, particularly with the added complication of vestibular migraine. Many people take this for depression so a resurgence of a migraine condition isn’t a factor.
H
Hannah, have you taken an SSRI before trying the effexor, which I believe is an SNRI?
If so, how did you get on with that? I am curious because I tried an SSRI before and from the day I took it I had unrelenting constant migraine until the day I stopped which incidently was only 4 days (the migraine was unbearable).
I am reading your posts with horror as I am about to start on effexor, having been to the GP, then waited to see the neurologist to prescribe it for me, now waiting for the letter to get back to the GPs which has taken 4 weeks so far. There is also a choice of cymbalta (which I believe is very similar to effexor) and verapamil which I asked to try again but that gave me terrible dizziness for the two weeks I took it years ago. Were you on the effexor XR or the ordinary one?
Having said this, I have had horrendous migraines and vertigo lately, I am in the throws of a two day one now which started with bad nausea and bad dizziness and I havent been on anything different so I am desperate to try something.
Are you sure that you are experiencing withdrawal or is there anything else that could have thrown a spanner in the works. I too have read some of the stories of people coming off effexor but noted that it was mostly at 75 mg and over. Haine says that people dont usually have trouble on coming off at 75mg or less, thats why he doesnt like to go over that.
Thanks
Christine
Hey Christine,
There’s no way of knowing how you will personally react to Effexor. It could be great, terrible or have no effect. Both Emma and myself have been coming off Effexor with only some trouble but definitely manageable – in fact the comedown on Effexor has been orders of magnitude easier than any SSRI I’ve tried previously including St John’s Wort. I think most of my current problems right now are because of Paxil (emotionally numb, nervous, headache). Jenny is doing really great on Effexor and of course it was not good for Hannah unfortunately. Marci is trialling it now and (I think) is pretty much fine. It’s like trying to shoot a duck with a blind fold on. We have to turn over every stone. I personally take internet reports with a grain of salt because they never match my experience. But, as Hannah said, we need to be aware that it may not necesarily be a cake walk trialling these meds.
Good luck … Scott 
Hi Christine,
Scott is right, it’s impossible to know how this would go for you. We are all so different.
I did take an SSRI once before since getting MAV. I lasted one day as I almost immediately became lightheaded and then developed a visual aura of the like I have never had before - a ball of light dancing around in one of my eyes. It was fairly obvious the effects weren’t positive so I came off it. I realise now I simply don’t react well to drugs that manipulate serotonin. I have taken pizotifen, a serotonin antagonist, and it caused severe anxiety. I also took 5HTP and that caused vertigo. I was taking the XR version of effexor.
It’s fairly undeniable that it’s the drug that has done this to me. I was actually doing ok before I took it. I went for it to combat the severe photophobia I was having, which I have had for years. My dizziness was under control, I wasn’t in a relapse. The drug disagreed with me straight away - then things got really bad when I came off it. I know that some of what is going on is withdrawal as the quality of what is happening is so different from my usual relapses. I have had this for years, relapsed many times and it has never looked like this. Severe vertigo is not a usual part of a relapse for me, and it is too much of a coincidence that lots of people talk of vertigo on withdrawal. Nausea is also something I haven’t experienced in years and on withdrawal it hit me pretty hard.
I don’t agree with Hain that this doesn’t cause withdrawal at low doses. I have read so many accounts of people withdrawing at 37.5 mg who do suffer withdrawal. I think that is wishful thinking on his part. It is fairly usual for me to have a big reaction to very little drug, so I shouldn’t really be surprised that withdrawal hit me hard even at a low dose. I think these things are very individual and it is impossible to generalise.
I can’t really advise you what to do. I can only tell you what I wish I had done. The drug disagreed with me straight away. It caused clenching, sleeplessness and anxiety plus increased visual and motion provoked dizziness and brainfog. I hung in there for 3 wks telling myself that SE’s can pass. But clenching, anxiety and sleeplessness are all migraine triggers for me. And I think all this did was stir up the migraine rather than help it. In retrospect what I should have done, having noticed that, was get off it fast instead of giving it a chance to really cause trouble.
I am making very slow progress recovery wise, although much slower than I would like.
As I said before I did think long and hard before deciding to write about this. I have taken many drugs which have disagreed with me and never written about it. The reason being that when I stopped the drug the problems stopped. Even if people choose to take effexor, I think it is wrong that they aren’t properly informed that withdrawal can happen and that it can be severe even at low doses. I honestly wish someone had told me as I might have still chosen to take the drug but I would never have taken it now. I would have picked my moment carefully.
H
I found this and thought it had enough interesting information to post. It gives a little insight into the way effexor works. I am concerned about having more noradrenaline as I am already jittery before I go to sleep. Also it seems that this can cause insomnia which I suffer badly from already. The other point of interest is that although Cymbalta works at low amounts as an SNRI, it seems that effexor works as an SSRI at low amounts and you have to increase it to get the SNRI effect. Does that mean that at low doses we just get the serotonin effects and not the noradrenaline?
Christine
eMedExpert Home > Compare Drugs > Antidepressants Effexor vs. Cymbalta
Antidepressants Comparison: Effexor versus Cymbalta
Serotonin norepinephrine reuptake inhibitors (SNRIs) - new class of antidepressants
Mechanism of action
Absorption
Indications and uses
Off-label (investigational) uses
Adverse reactions and side effects
Brief comparison table
References
SNRIs - new class of antidepressants
Serotonin norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant used to treat depression and other affective disorders. SNRIs were developed more recently than SSRIs and currently there are only two medications in this class approved by the FDA for use: venlafaxine (brand name: Effexor) and duloxetine (brand name Cymbalta). These new drugs, because of their specificity for the serotonin and norepinephrine reuptake proteins, lack most of the adverse side effects of tricyclic antidepressants and monoamine oxidase inhibitors.
Venlafaxine HCl is the first and most commonly used SNRI. Venlafaxine was first introduced by Wyeth Pharmaceuticals in 1993, and marketed under the trade name Effexor.
Duloxetine HCl, manufactured by Eli Lilly, is the newest antidepressant on the market. It was approved by the FDA and released on the market in August 2004.
SNRIs have the ability to affect two neurotransmitters - serotonin and norepinephrine. Clinical studies have shown that the SNRIs are generally quicker acting and more effective in treating severe major depressive disorder, treatment-resistant depression, and depressive symptom remission than SSRI antidepressants, and tricyclic antidepressants.
Comparative studies with SNRIs antidepressants are limited. Currently there is not enough information to firmly recommend any one of these antidepressants over another and selection of antidepressant therapy should be done on an individual basis. Drugs may work differently for different people. What is effective for some may not be effective for others. This article provide some comparative data based on the analysis of medication prescribing information and studies.
Mechanism of action
When serotonin and noradrenaline are released from nerve cells in the brain they act to lighten mood. When they are reabsorbed into the nerve cells, they no longer have an effect on mood. It is thought that when depression occurs, there may be a decreased amount of serotonin and noradrenaline released from nerve cells in the brain.
SNRI antidepressants work by preventing serotonin and noradrenaline from being reabsorbed back into the nerve cells in the brain. This helps prolong the “mood lightening” effect of any released serotonin and noradrenaline. In this way SNRIs help relieve depression. It may take between two to four weeks for the benefits of these medicines.
Effexor XR has the flexibility of being an SSRI at lower doses and an SNRI at higher doses. Cymbalta differs from Effexor in that it is comparatively more noradrenergic.
Cymbalta is also used to treat nerve pain in the feet, legs or hands that is due to nerve damage caused by poorly controlled diabetes. Cymbalta is thought to enhance the nerve signals within the central nervous sytem that naturally inhibit pain.
Absorption
Food does not affect the bioavailability of Effexor or its active metabolite, ODV (O-desmethylvenlafaxine). Time of administration (AM vs PM) did not affect the pharmacokinetics of venlafaxine and ODV from the 75 mg Effexor XR capsule.
Food does not affect the maximal plasma concentrations of Cymbalta, but delays the time to reach peak concentration by approximately 4 hours (from 6 to 10 hours) and it marginally decreases the extent of absorption by about 10%. There is a 3-hour delay in absorption and a one-third increase in apparent clearance of duloxetine after an evening dose as compared to a morning dose.
The bioavailability of Cymbalta appears to be reduced by about one-third in smokers. However, dosage modifications are not considered necessary. The bioavailability of Effexor is not affected by smoking.
Indications and uses
Effexor XR is indicated for the treatment of:
Major Depressive Disorder
Generalized Anxiety Disorder
Social Anxiety Disorder
Cymbalta is indicated for the treatment of:
Major Depressive Disorder
Diabetic Peripheral Neuropathic Pain
The extended-release formulation of Effexor has been approved for the treatment of generalized anxiety disorder and social anxiety disorder; however, these are not labeled indications for Cymbalta. Shortly after duloxetine was approved for the treatment of depression, FDA approved its use for the management of neuropathic pain associated with diabetic peripheral neuropathy. It is the first drug to be approved for this indication, although tricyclic antidepressants (e.g., amitriptyline) and gabapentin have been used off-label for this problem. Duloxetine is also being evaluated in the treatment of stress urinary incontinence (officially approved in Europe for this problem), generalized anxiety disorder, and fibromyalgia, but these are not labeled indications at the present time.
Off-label (investigational) uses
Many doctors are starting to prescribe Effexor “off-label” for the treatment of diabetic neuropathy (in a similar manner to Cymbalta) and migraine prophylaxis (in some people, however, Effexor can exacerbate or cause migraines). Studies have shown Effexor effectiveness for these conditions. It has also been found to reduce the severity of ‘hot-flashes’ in menopausal women. Effexor is also prescribed for off-label uses such as chronic fatigue syndrome, and obsessive-compulsive disorder (OCD).
At present, Cymbalta is not approved for treating bipolar depression, but is being prescribed to people with bipolar disorder as an off-label use. Patients who have experienced mania should be monitored carefully when taking this medication.
There are more controlled studies with Cymbalta showing benefit for all kinds of pain than any other antidepressant. In clinical trials, Cymbalta 60 mg once daily demonstrated efficacy in painful physical symptoms associated with depression. Cymbalta is being studied for the treatment of stress urinary incontinence, which may also respond to treatment with both serotonin and norepinephrine.
Cymbalta is also showing promise for the treatment of fibromyalgia symptoms. In randomized, controlled, 12-week trial, duloxetine was an effective and safe treatment for many of the symptoms associated with fibromyalgia in subjects with or without major depressive disorder, particularly for women, who had significant improvement across most outcome measures.
Hi Christine,
Thanks for that. Was very interested to read that it actually says effexor can cause or increase migraines in some. My guess is that I was hit very hard on that front and from the get go it increased my migraine activity and then withdrawing, which can also cause migraine, was the icing on the cake and threw me a mile.
The very brief experience I had with the SSRI probably indicates that anti - depressants are not good drugs for me.
I just hope that I can crawl out of the severe attack it has set off.
I think the theory is that it effexor only effects serotonin at a low level and then noradrenaline at a higher level. I think that is why there is the theory that it is harder to withdraw from at higher levels, although obviously it has been brutal in my case and I was on miniscule amounts.
H
Hi Hannah,
What dose were you on for 3 weeks? I have just found this. Now I am wondering if effexor is just working as any other SSRI at the low doses we take. I certainly wouldnt go up to the higher doses anyway.
37,.5 mg of venlafaxine. Higher doses seem to be required for disorders where depression is more predominant than anxiety, and it is at these higher doses that venlafaxine appears to perform better than SSRI medications. Mbaya (2002), for instance, noted that venlafaxine has shown greater efficacy for treatment-resistant depression than SSRIs at doses of 150 mg and above. It is above this range that venlafaxine seems to start working on the norepinephrine pathways, responsible for arousal. According to Lee & Keltner (2006), dual-action antidepressants such as venlafaxine uniquely blocks the reuptake of serotonin, norepinephrine, and dopamine; unique because uptake blockade depends on drug dosage. The SNRIs apparently block serotonin at lower doses, serotonin and norepinephrine at medium to high doses, and serotonin, norepinephrine and dopamine at the highest doses (Lee & Keltner 2006).
Hi,
I took 5mg for a week, 10 mg for another week and then a few days on 15mg. The 15 mg was when things became intolerable and I titrated down fast and then stopped.
H
To Jen if you are there. Just noted you are on verapamil as well, can I ask how long you have been on the verapamil and at what dose? Did you start to see an improvement on that before you added the effexor? It is interesting that dothiapen worked a bit for you, as it did for me as well years ago. Years ago I got up to 150 mg. Tried it more recently and couldnt tolerate something like 20.
Hannah, you sound as sensitive to drugs as I am. Its really difficult. I wouldnt give up on the anti depressents entirely. Dont know whether you have tried any others, besides the SSRIs but I found those more tolerable. I see you are on propanalol, I also tolerated propanalol up to 40 mg, which helped with the daily heads but not dizziness, couldnt get above that as got insomnia and bowel probs.
Christine