Recent Feedback
I recenty asked about Venlafaxine & I have another question for you. Since they increased my dosage to 75mg I have experienced a severe migraine. My pharmacist suggested dropping back to 37.5mg. I take it at bedtime & about 3 AM I woke up with another headache. The reason my Dr prescribed this med is because I have been on hydromorphone for over 4 yrs due to chronic pain & I am in the process of decreasing my dose. I was on 16mg 4 X a Dy. I have now dropped to 12 Mg a day. I split that dose up throughout the day.My Dr. explained that my serotonin levels have been depressed for along time & that Venlafaxine will help with that. Is that accurate? I will admit that this last period of poor health has been difficult but I think that anyone would feel have some depressed moods. I am concerned about adding another drug that may cause long term problems. Can you give me some info & is the info that I have been given accurate information? Can you suggest if I should look at alternate med that would not give me a headache?
Optional Information: Person's Gender: Female Person's Age: 55
I will be glad to help you find an answer. Please give me a minute to research your question.
Venlafaxine (Effexor) is a Serotonin/Norepinephrine Reuptake Inhibitor (SNRI), that works by decreasing reuptake of both serotonin and norepinephrine. Serotonin and norepinephrine are neurotransmitters that are released then taken "reabsorbed". There action comes when they are released. By preventing reuptake, these neurotransmitters stay around longer.
Essentially, your physician is using this a bridge type therapy. Can you please remind me, is your physician a neurologist, psychiatrist, general internist, etc.?
I am not following the reasoning with respect to the association between prolonged use of hydromorphone and depression of serotonin levels. Is your understanding from speaking with your physician these are related or are they separate phenomena?
I will check some additional reference sources.
Let me state this in a different way. While venlafaxine would be appropriate for increasing serotonin levels, I do not see the link between long standing hydromorphone and decreased serotonin levels.
Hydromorphone is an analgesic opioid that binds to specific receptors in the central nervous system called mu-opioid receptors. This results in a decreasing pain. It does not effect serotonin or dopamine as far as I am aware.
Venlafaxine, like most medications has both FDA approved indicated uses and what is called off-label uses. FDA approved indicated uses include management of anxiety, depression, and/or panic disorder. "Off-label" uses are many and include management of migraines. As such, this medication should actually alleviate rather than contribute to headaches.
Other "off-label" uses of this medication include ADHA, OCD, PST, hot-flashes, neuropathic pain, etc.
When dealing with antidepressants, some work better with some individuals than others and visa-versa. It is really a trial and error approach. Venlafaxine is a reasonable choice to begin treating the above mentioned indications.
I actually am inclined to suspect the tapered decrease in pain medication may be playing a contributioning role to the headaches you are experiencing. To what extent, I am uncertain.
I am not a big advocate of adding one medication to treat a condition of another, however, in this case adding something to treat the headache may be appropriate. I would discuss this with your physician. Options include acetaminophen. You would not be a candidate for aspirin, NSAIDs, or sumatripan (Imitrex) due to interactions these medications have with venlafaxine.
I hope this helps answer your question. If you have other questions, please let me know and I will be more than happy to answer. If satisfied, I would appreciate a favorable rating of "satisified/excellent customer service".
Almost forgot, if the above does alleviate the headaches, your physician may wish to try you on another antidepressant. There are many classes to choose from and like was mentioned previously, what works best for one person may not work well for another. Venlafaxine is an S/NRI. There are also selective SRIs such as citalopram (Celexa) and others; selective NRIs such as atomoxetine (Strattera); DRIs such as bupropion (Wellbutrin), many Tricyclic antidepressants, MAOIs, etc.
Thanks so much for the info. I needed this info to try & make some decisions based on info than following down the garden path so to speak. My Dr is a GP & I have had him for many years. In the past he has made wrong decisions but I have remained due to my complicated health history. I'm not trying to Dr. bash but I do not have faith in his decisions so I guess it is time to find a Dr. that I can trust & feel safe with. One other ? if you dont mind? I am hoping to add some of my history so u can better understand my circumstances...
The server has just started to act up again. I am seeing you rapidly enter and the exit chat. This has been an issue today and nothing to do with you.
Let me provide you some links to help you locate board certified physicians in your area. Even if you don't use them at this point, they are helpful to have.
The first is from the American Medical Association. The link is: https://extapps.ama-assn.org/doctorfinder/recaptcha.jsp
The second, which I prefer, requires registration. It is from the American Board of Medical Specialties (ABMS). The link is: https://www.certificationmatters.org/is-your-doctor-board-certified/search-now.aspx. For this one, you do not need to know the name of a particular physician - just enter the city and state and specialty (i.e. internal medicine, pain medicine, etc.) into the field then register.
I have a long history of poor health. When I was 4 yr old developed crohns disease. At the age of 16 I had a total colectomy & I now have an ileostomy. I have had several revisions usually due to bowel obstructions. When I was about 22 I had endermetrosis and ended up having a hysterectomy, a year later they had to remove my ovaries. I also have had kidney stone which resulted in surgery. Later on my right kidney would drop every time I sat or stood up. The Dr. then had to stitch my kidney up as my ureter would become blocked. I am still dealing with crohns usually on my stoma. I am now diagnosed with Interstitial Cystitis and experiencing a lot of pain.In 2008 I was in hospital for my stoma flair up, on a lot of cortisone IV when I ate a ham sandwich from Maple Leaf, which was loaded with listeria. The listeria made its way to my brain & I ended up having surgery for lesions on my brain. I am a fighter & I usually dont let things get me down. The lesions were mostly in my cerebellum & one that they could not reach so I was on a huge dose of antibiotics IV. I spent close to 7 mo, in hospital. With all of these surgeries I had complications, nothing has ever been an easy fix. I must admit that this last round has left me with no energy & my mood is down. The last 4 yrs I have been on hydromorphine. 8mg - 4XDay.In the last 4 wks I have dropped it down to approx. 12mg, day.I have requested to go to pan management but the wait list is about 1 yr. 3 wks ago my Dr. prescribed 37.5mg of Venlafaxine & now I am on 75Mg. Is this a feasible thing to take? I have been experiencing a nasty migraine since the increase? How do I deal with the pain once I get off the morphine. I think all my life I have been on some type of pain killers. I am a Life skill coach & I do use deep breathing, visualization. At present I am pretty much bed ridden & I am still going through withdrawls. Any info, ideas would be apppreciated, Thank you. Arlene
I live in northern BC, Canada. Fort St. John, BC
Thank you for sharing that with me. Based on your medical conditions, I would recommend seeking out a gastroenterologist at a teaching hospital. You may also try the links provided though I am not certain then first will be of much use. The hardcopy text for the second, which might be found at at medical library (I'd call first) at one time did have physicians practicing outside the United States. If memory serves me correctly, Canada. In any event, I'd call and inquire of a reference librarian first to make sure to ave a trip. I am not sure whether the online version contains this information. The Mayo Clinic in the U.S. is world renowned for gastroenterology. It is in Minnesota. If nothing else, they have a website and newsletters with excellent information.
This is the link to information on Chron Disease provided by the Mayo Clinic. The heading are on the left in blue or you may click the bottom of each section to progress to the next. The link is: http://www.mayoclinic.com/health/crohns-disease/DS00104
sorry, misspelled Crohn above
You have been so sweet & informative. I appreciate the info, I hate being in the dark. Sometimes physicians do not take kindly to me looking for answers.I have had bad decisions over the years & its nice to discuss things without the Dr. ego being hurt. Due to our small community and lack of Dr. they all tend to stick together. Its great receiving feedback & I thank you for the links & info.
All the best. Good night.
Experience: Educator with hospital and retail experience.
Thank you for requesting me on your subsequent question regarding Oxybutynin.Due to the late hour, I am sorry I was unavailable to answer your question. I am glad njpharmacist was able to help you. The answer he provided was excellent. In reviewing my previous answer, I notice a typo. I mentioned venlafaxine decreasing reuptake of serotonin and norepinephrine and explained what this meant. Then, I went on to say, "Hydromorphone is an analgesic opioid that binds to specific receptors in the central nervous system called mu-opioid receptors. This results in a decreasing pain. It does not effect serotonin or dopamine as far as I am aware." For the last sentence, rather than stating dopamine, norepinephrine was intended. I mention this because in njpharmacist's response he touches on hydromorphone and dopamine and is correct and I did not want there to be any confusion. Again, thank you for providing me the opportunity to answer your questions.