Nowadays, more and more people feel depressed, burnt out and hopeless – depression has become a common disease. The antidepressant venlafaxine helps combat the aforementioned symptoms by having a mood-lifting effect.
Venlafaxine for depression with anxiety
Venlafaxine is especially useful for people whose depression is accompanied by anxiety, because the drug is also used to treat panic attacks and other anxiety disorders. Just as with other antidepressants, side effects may occur when taking venlafaxine. Side effects can be particularly severe when stopping venlafaxine.
Venlafaxine: how the antidepressant works
Just like duloxetine, venlafaxine belongs to the serotonin–norepinephrine reuptake inhibitors (SNRIs). This distinguishes these antidepressants from agents such as fluoxetine or citalopram, which belong to the group of selective serotonin reuptake inhibitors (SSRIs). In contrast to them, venlafaxine inhibits the reuptake not only of serotonin but also of norepinephrine and dopamine. However, the reuptake of norepinephrine and dopamine is only inhibited when venlafaxine is taken in a higher dosage. Decreased levels of the substances serotonin, norepinephrine, and dopamine are thought to trigger depression. Due to the blocking effect of venlafaxine, the substances can remain longer in the synaptic cleft and their concentration increases. This can lead to an improvement in mood in depressed people. In addition, the substance is also helpful in anxiety disorders, as it relieves anxiety. The correct dosage of venlafaxine should always be discussed with the attending physician.
Typical side effects of venlafaxine
Many sufferers experience more or less severe side effects in the first few days and weeks after starting to take an antidepressant. However, in the case of venlafaxine, the experience so far has been quite positive. The most common side effects of venlafaxine include nausea and headache. Constipation, nervousness and insomnia, impotence, and loss of appetite and weight loss are also common. Occasionally, however, venlafaxine may cause weight gain. Occasionally, cardiac arrhythmias, skin bleeding, or hair loss may also occur. In contrast, side effects such as seizures or hot flashes are rare. Recent studies have also shown that long-term use of certain SSRIs or SNRIs can interfere with the work of the cells that break down and build up bone. This can lead to increased bone fractures and an increased risk of osteoporosis. However, it is still unclear for which agents these side effects apply in detail. For a complete list of venlafaxine side effects, please refer to the package insert of the respective drug.
Increased risk of suicide as a result of taking the drug
Similar to other antidepressants such as fluoxetine, taking venlafaxine increases the risk of suicide during the first few weeks of therapy. Suicide risk may also increase after a change in dosage. Patients should monitor themselves closely especially during this time, but should also be monitored by friends, relatives as well as the treating physician. The highest risk of suicide is observed in adolescents and young adults under 30 years of age. From a medical point of view, the increased suicide risk is due to the drive-increasing effect of venlafaxine. In particular, patients who have already thought about suicide are more likely to actually carry out their plans due to the effect of the antidepressant.
Side effects of discontinuing venlafaxine
Although side effects tend to be mild while taking venlafaxine, unpleasant experiences can occur when discontinuing venlafaxine. To avoid these as much as possible, venlafaxine should not be discontinued suddenly, but the dose of the antidepressant should be reduced step by step. Nevertheless, discomfort often occurs during discontinuation (SSRI discontinuation syndrome). Which symptoms occur, and to what extent, depends on the one hand on the duration of treatment and the dosage of the active substance, but also varies from patient to patient. The most common side effects after discontinuation of venlafaxine include:
- Fatigue and drowsiness,
- Insomnia and other sleep disturbances,
- Nervousness and anxiety,
- Loss of appetite,
- Tremor as well as
- Diarrhea and vomiting
Generally, symptoms should subside within two weeks, but sometimes the listed side effects are still noticeable two or three months after discontinuation.
Venlafaxine: contraindications
The antidepressant venlafaxine must not be taken if there is hypersensitivity to the active substance. Likewise, the active ingredient must not be used together with monoamine oxidase (MAO) inhibitors, which also have an antidepressant effect. If switching from one antidepressant to the other, there should be at least a two-week drug-free period in between. In addition, venlafaxine should not be taken together with other substances that also have a serotonergic effect. These include all SSRI agents, but also lithium, St. John’s wort, and triptans. In combination of venlafaxine with one of these drugs, the so-called serotonin syndrome can occur, which in the worst case can be fatal.
Drug interactions with venlafaxine
Patients who have kidney or liver disease should seek specific advice from their treating physician before taking venlafaxine. The same applies to patients who receive electric shock treatments or who suffer from seizures. In each case, a cost-benefit calculation must be made by the treating physician. Regular monitoring of blood pressure is also recommended during use, as venlafaxine can lead to an increase in blood pressure depending on the dose taken. In addition, it should be noted that the ability to react is reduced by the active substance. This effect of venlafaxine is further enhanced in conjunction with alcohol.
Venlafaxine in pregnant women and children
During pregnancy, venlafaxine should be used only in particularly urgent cases and explicitly discussed with a doctor. This is because the active ingredient can lead to increased blood pressure, breathing difficulties, or vomiting in the newborn. Venlafaxine should also be avoided during breastfeeding, as the active substance also passes into breast milk. If it is absolutely necessary to take the drug, the child should not be breastfed. In children under 18 years of age, the side effects on development have not yet been fully researched, but it is considered certain that taking venlafaxine increases the aggressiveness of children.
