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Ask Dr. Ed Wilfong Your Own Question

Dr. Ed Wilfong
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience:  Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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I have been on Effexor XR for 8 years. About 6 months ago I

Customer Question

I have been on Effexor XR for 8 years. About 6 months ago I came off of it to suddenly relapse and I had to be put back on it plus 7.5mg Restoril for sleep. I have always taken Effexor XR at night and it never bothered me but now my doctor once me to go on it in the morning. I am trying to taper of the Restoril after being on it for 1 week and really want to know if my restlessness is associated to when I'm taking the Effexor. I'm trying to get my sleep back to normal and last night I didn't take the restirol and had trouble sleeping. Is the Effexor XR interfering?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Ed Wilfong replied 2 years ago.

Dr. Ed Wilfong :

First, often a certain drug, such as effexor, will lose effectiveness after many years of working well. You may need to switch to different medication IF it doesn't work after 2-3 weeks. Sometimes until it builds back up in system, it can cause insomnia and jitteriness. I would give it 2-3 weeks before deciding if a change is warrented (I am assuming you started back on it a week ago). Don't worry about tapering restoril yet. It is very low dose and a month is a reasonable amount of time to be on it. Solve the antidepressant problem first, then d/c restoril. If you can skip restoril once or twice a week it will help prevent tolerence, but I don't see a problem staying on it longer.

Customer:

Should I continue taking the Effexor at night? I never felt like it lost effectiveness. It always seemed to work well. And I'm fine if i get a good night sleep.

Dr. Ed Wilfong :

You can take morning or night-whichever works best for you. It really doesn't matter therapeutically (I usually recommend nite).

Dr. Ed Wilfong :

How long have you been back on it and current dose? Previous dose?

Customer:

Ok I'll continue night. Do you think the sudden stopping of hte Restoril last night just mentally made me awake?

Customer:

I've been back on it for 1 month at 75mg

Customer:

Never had insomnia before

Customer:

That's why I think it's the Restoril

Dr. Ed Wilfong :

What was your previous dose before you quit.

Customer:

75

Customer:

And my anxiety was always controlled

Customer:

I tried other meds and they didn't work

Dr. Ed Wilfong :

Try the effexor at night again. You can take the restoril as needed - don't have to every night - so you can use trial and error to see what works best. Also, you were young when started effexor and 75 is low dose, so you may need higher dose if changing time doesn't work. Usual dose is 150-225.

Dr. Ed Wilfong :

you still are young :-)

Customer:

hahaa thanks

Dr. Ed Wilfong :

no need to "taper" restoril. you can stop when you want at this dose or skip nites. you may get a night of "rebound insomnia" so skipping it a few nights in a row may be more telling. ry to change only one thing at a time, so you can tell what works.

Customer:

My cousin is on the same dose and had sleeping problems so she started taking Effexor in the morning so I thought maybe that was my problem

Customer:

So should I try the Effexor in the morning first or the Restoril

Dr. Ed Wilfong :

Effexor is complex, and she is too far removed genetically to think her experience is the same reason. I would try effexor at night first with restoril then skip restoril for a couple of nites after a week of pm effexor. If that is ineffective, I would talk to MD about incresing effexor dose. Quitting for six months may have changed system, requiring higher dose. It is not uncommon.

Dr. Ed Wilfong :

Restoril is good sleep med., so it should not be contributing to insomnia other than when you skip or quit it, then just for a few nites.

Customer:

Would it be uncommon for Effexor to all of a sudden cause insomnia in me?

Dr. Ed Wilfong :

It may change how it effects you after being off it for 6 months. I would guess it is more the low dose now or other outside sources of anxiety. The effexor may cause insomnia in first few weeks, so you are on borderline of that time. Once it settles in at proper dose, it should not cause insomnia. If it does, I would really suspect you need to try higher dose.

Customer:

Thakns so much for your help. I've only been on the 7.5 for 2 days so I'll give that another week or so and then try coming off.

Customer:

I definately feel the residual anxiety so once that is settled I should be ok

Customer:

After some good sleep

Dr. Ed Wilfong :

sounds good.

Customer:

You're awesome

Customer:

Best answer EVER

Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience: Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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