Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.
Amitriptyline is an older tricyclic antidepressant and Effexor is an SNRI anti depressant. Propranolol is a sympatholitic non-selective beta blocker.
The use of amitriptyline with Effexor (venlafaxine)
should be closely monitored because the use of these two serotonergic agents (SNRIs and tricyclics) may cause what is called serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome. The symptoms may include changes in mental status, such as irritability, altered consciousness, confusion, hallucination, and coma; It can also induce autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis. Furthermore it can induce neuromuscular problems such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia. Finally it can cause gastrointestinal symptoms such as abdominal cramping, vomiting, nausea, and diarrhea.
The use of propranolol with EITHER amitriptyline or venlafaxine (Effexor) should also be monitored, but it the reactions are not as potentially threatening as those mentioned above. It can, however, further lower the blood pressure resulting in dizziness
, lightheadedness, syncope, orthostasis, or tachycardia.
Her physician and pharmacist should be able to confirm this and probably eliminate one of the antidepressants to lower her risk of the above described symptoms.
Elliott Sewell, LPCC, NCC, CCMHC