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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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Is akathisia a relatively common side effect of Efexor XR,

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Is akathisia a relatively common side effect of Efexor XR, and, if so, when will it disappear? I've been taking 37.5mg for a week and 75mg for the last 4 days and this restlessness is worrisome as I've always been reasonably "laid back."
Akathesia does sometimes occur with effexor. It will typically disappear a couple weeks after you reach you final dosage.

  • If you have not been on an antidepressant before, you may want to talk to MD about changing medications. It can be done without losing ground fairly easily at this point.
  • You should let MD know regardless.
  • Often they will give you a low dosage of a anti-anxiety medication just for a few weeks until you adjust.
  • If it hasn't disappeared after 3-4 weeks after reaching your final dose, you may want to ask MD about changing medication.
Although harmless, I know how uncomfortable it is. Not what you need while trying to get better.

Dr. Ed
Customer: replied 7 years ago.
Prior to Efexor XR, I spent a few months on Lexapro, with nothing but terrible side effects. In addition, since taking Efexor XR I feel "choked up", like I want to cry (but can't). I'm trying Efexor because my sister has been successfully taking it for many years. You should also know that my 25 year old daughter died in an accident about 1 year ago.
I am so sorry for your loss of daughter. How are you doing with the grief? Had you ever been on antidepressants prior to this last year?
Sometimes that "choked up" is also an effect of the medication. I have heard many people (not a high %) say they feel constricted emotionally on antidepressant and they complain specifically of not being able to cry. Is it that you can't cry or that or you are feeling like crying more now? Did you have akathesia with Lexapro? Do the effexor and Lexapro have similar side effects (please elaborate)? Have you seen anyone professional for grief counseling.

I hope you reply. I would really like to help you sort this out and come up with good options for you.

Customer: replied 7 years ago.
I've been in couselling for the last few months and have been helped a bit vis a vis anti-depressant choices from a psychiatrist friend as well as two family doctors. Unfortunately, they contradict each other, leaving me to seek your opinion. I'd never taken any anti-depressants before this episode, which started "out of the blue" (no pun intended) 6 months after she died. I feel like I want to, even need to cry, but just can't.
Both had similar emotional side effects, but Lexapro was much worse (so far) in terms of headaches and nausea. It should also be noted that I don't have all the classic depression/anxiety symptoms as I'm fully "operational" socially, at work, and with my family,save for libido issues.
My best guess is you have a delayed grief reaction, and a reactive depression. (just means you are depressed because of what happened).
There are many medications to choose from, so if they are disagreeing over which one, it is understandable.
Over observing many years, I have often thought that people who don't need anti-depressants seem to have more side effects. Now this is purely speculation on my part and I have never seen any research to support it.
As you mentioned you also do not have all the symptoms of a clinical (need meds) depression. Your age is also unusual for a first depressive episode.
Obviously I cannot decide for you and I only have what we can do on the net to assess the situation.
My gut is to quit the medications. Common practice is to taper off effexor 37.5 for a 3-4 days and then you may be able to just quit. Run it by your MD.
I would continue counseling, which may be painful, but unless you start developing those symptom of depression you don't have (especially the physical one like inability to concentrate, waking quickly after 4 hrs sleep and not able to fall asleep, no appetite - the meds may or may not be the cause of loss of libido - it is one of most common side effects and you seem to be getting them all)

Even if you stay on medication, I would talk to MD about switching to to an SSRI. Still kills libido, but people tend to tolerate better. Examples are celexa, prozac, zoloft. Unlikely to get akathesia (might).Personally, I don't like to recommend Paxil because of weight gain.

I hope this gives you some options and enough information to aid in decision making. If so, I appreciate you accepting answer, if not, keep asking until I get it right.

Customer: replied 7 years ago.
How is Lexapro, which is an SSRI and didn't work, different from, say, Zoloft? Also, forgot to mention that I have depression in my family, not severe, but there. Finally, I can tolerate the side effects if they go when the Efexor "kicks in" in the publishd 2-4 weeks, it's the not knowing that's making me even more anxious.

Many thanks
Tom, there is no way to predict if side effects will go away. Even tho' they are both SSRI's, one one guide says "it is classified as an ssri, but it is not just and ssri" (it doesn't elaborate. Zoloft is though to have a minor effect on dopamine. There are several (many) subtypes of serotin receptors, same with noepinephrine and dopamine. Current research trends are more geared toward looking at "circuits" in the brain and how different medication effect neurotransmitters at different sites in the brain. Every time they move a molecule, it changes something. There also more to SSRI's than re-uptake inhibition. The can sensitize receptor, or de-sensitze them. It can change how they are metabolized. Honestly, I don't know all the details, butthe state of the art for practice is we just know they are different. In essence, SSRI's have more in common than SNRI's. So the groups are "most similar meds", no the same stuff, different name. In practice , we don't know enough to predict how a particular drug (or class of drug) will affect a given individual. Trial and error with educated guesses is the best we can do.

As for you, I can promise what will happen when you dose stabilizes. Many people get over most of them, some don't. Not much way to predict. Handgernades and Horseshoes is the best we can do.

It really is up to you whether to stay on the effexor and see what happens or not. I just can promise akethesia will go away. Being on medication plus psychotherapy, according extensive and consistant research, has better outcome than either one alone. Alone, they tend to be very similar in results. I actually hope medication is effective for you. As long as you stick with couseling. If the emotional effects were on the right track with lexapro and effexor, it bodes well for medication being successful.

I am not sure I know much more than I have told you, but let me know if any more questions.

I wish you luck whatever you decide. There is more than one way to reach your goals here andonly you can decide which one(s) to try.

If you want to follow up with me in the future, I would welcome it. You can just select me as your expert and ask directly (I don't know logistics. I assume JA tells you how. I work the other side of the street).

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