Contributed by Linda Fugate, Ph.D.
My friend Pamela was one of the pioneers in trying venlafaxine for hot flashes. She started 10 years ago, before the Women's Health Initiative study of hormone therapy prompted many women and their doctors to take a closer look at non-hormonal options. Venlafaxine is the generic name for Effexor, which is FDA approved for depression and anxiety.
Pamela is a nurse with an active family. Like all of us, she wanted the most out of life in middle age. Hot flashes were in the way, so she went to see her doctor. He started her on a low dose of venlafaxine, which reduced the intensity of the hot flashes. Over the next few months, he increased her dosage to the maximum recommended, 225 mg per day. She was happy with this regimen until about a year ago, when she decided it time to move past menopause treatment. To her horror, she found that she couldn't function without the drug.
The biggest advantage to venlafaxine is its safety in terms of breast cancer risk. It is believed to have absolutely no estrogenic activity. Instead, it acts to increase concentrations of the neurotransmitters serotonin and norepinephrine.
I tried venlafaxine myself for depression after I got divorced. For me, the side effects were intolerable. I felt so nauseated, I thought I had caught a stomach bug. The usual spectrum of side effects bothers some patients: headache, dizziness, drowsiness, etc. But other patients feel fine while taking the drug.
The biggest disadvantage of venlafaxine is that after a few years, it's hard to get off. The manufacturer, Wyeth, provides a warning on its web site that after stopping the drug or decreasing the dose, “Reported symptoms include agitation, anorexia, anxiety, confusion, impaired coordination and balance, diarrhea, dizziness, dry mouth, dysphoric mood, fasciculation, fatigue, flu-like symptoms, headaches, hypomania, insomnia, nausea, nervousness, nightmares, sensory disturbances (including shock-like electrical sensations), somnolence, sweating, tremor, vertigo, and vomiting.” This is found in the Effexor XR Prescribing Information, under “Precautions, General, Discontinuation of Treatment.” The section explains that symptoms are more frequent with longer duration of treatment, but doesn't say how long you can take the drug without risking these symptoms.
Pamela is now tapering off venlafaxine very gradually. For all drugs that can be used for psychiatric conditions, the manufacturers recommend a gentle taper, regardless of whether the patient was taking the drug for psychiatric conditions or something else. Pamela hopes to be back to normal within a year.
Linda Fugate, Ph.D.
References:
Carroll DG, Nonhormonal therapies for hot flashes in menopause. Am Fam Physician, 2006 Feb 1;73(3):457-64.
Evans ML, Pritts E, Vittinghoff E, McClish K, Morgan KS, Jaffe RB, Management of postmenopausal hot flushes with venlafaxine hydrochloride: a randomized, controlled trial. Obstet Gynecol. 2005 Jan; 105(1):161-6.
http://www.wyeth.com/content/showlabeling.asp?id=100
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Anon - Venlafaxine is not a narcotic drug, it's an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). It works by restoring the balance of certain natural substances in the brain (serotonin and norepinephrine), which helps to improve specific mood problems.In addition to being used for hot flashes, as in your case, this drug is used to treat major depressive disorder, anxiety and panic disorder. It's not in a class of drugs with addictive properties.
Millions of people use anti-depressant medications on an as needed basis and then successfully stop taking them. What's important is to work with your doctor and do this in a gradual, deliberate manner.
July 15, 2010 - 5:30pmWhile I too have read isolated horror stories in the media and books about these drugs, I have known many real human beings whose lives have been improved because of these drugs and who've been able to use them to successfully treat major depressive disorders. Hope that helps! Pat
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I am 48 my oncologist prescribed Venlafaxine to reduce the hot flashes that started after I completed chemo with docetaxol.. let me tell you hot flashes have disappeared a 95% I am happy but I do not want to think i will be addicted to this pill.. what can I do? , please advise.
July 15, 2010 - 5:06pmThis Comment
After a breast biopsy and a diagnosis of atypical ductal hyperplasia a little over a year ago, I was prescribed Tamoxifen to cut my risk that this condition would develop into cancer. I have not had a period since starting Tamoxifen yet my last FSA test was 28 (I am 54). The hot flashes were terrible, so my doctor prescribed Effexor. Now, after an endometrial biopsy that indicates complex hyperplasia with atypia, I am off the Tamoxifen (may have been the cause), scheduled for a D&C but still on the Effexor. I have gained significant weight since being on this drug. I'm not sure why I still need to be on it but I have heard that the withdrawal is awful. I do not know what to do or who to talk to about this, my family doctor, my breast surgeon ( the prescriber) my endocringologist (oh, did I mention that I had a thyroidectomy 6 years ago!) or my gyn. Whenever I bring up the subject of weight gain, they all tell me that is my age, stress, etc. I do not over eat and get moderate excerise. I am so frustrated and depressed about my weight gain, I probably need an anti depressant!
May 11, 2009 - 8:44pmThis Comment
My experience has been that it takes a lot of shopping to find the right doctor, especially when you have more than one issue. I encourage you to keep trying! Also I recommend the book "Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medication" by Peter Breggin. You can read the full warnings about Effexor at http://www.wyeth.com/content/showlabeling.asp?id=100. I found psychotherapy much better than antidepressants for emotional issues (divorce, in my case). Thank you for your comment. I hope this helps.
May 12, 2009 - 5:58amThis Comment
Dr.Fugate,
April 27, 2012 - 8:45amPlease edit per your discretion.
*Please do not discontinue any medication without the assistance of your healthcare provider. Abrupt discontinuation or rapid taper can produce distressing or dangerous withdrawal symptoms*
Thank you for informed comments on this topic. I write this in 2012 and there are still very few physicians who know how to safely taper patients off of SS/NRIs and mitigate withdrawal from years of serotonin, a neurohormone with extensive effects on the endocrine, cardiometabolic and digestive systems.
Please visit www.survivingantidepressants.org for information on SAFE tapering. The information is based on Dr. Breggin's work as well as a hand full of other international researchers who take part in the group on occasion.
I have worked with psychopharmacologists in the past and find the level of knowledge on Surviving Antidepressants to be on a par or above. There are several mental health professionals on the group as well. Another excellent resources is Beyond Meds by Gianna Kali www.beyondmeds.com.
Thank you again.
Barbara
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