Psych

[surferdude123]

What is the general consensus on the use of Effexor?

There was a debate in psych regarding it's use today......



It was this.


Good - because dual SNRI, as compared to SSRIs, works when other's have failed. Pretty tolerable.


Bad - some side effects can be unpleasant, and there is discussion of memory loss.


What are your thoughts on this? This isn't offering medical advice, it's just posing a debate question. Does anyone know of Effexor causing memory loss and confusion?

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[OncoCaP]

What is the general consensus on the use of Effexor?

There was a debate in psych regarding it's use today......



It was this.


Good - because dual SNRI, as compared to SSRIs, works when other's have failed. Pretty tolerable.


Bad - some side effects can be unpleasant, and there is discussion of memory loss.


What are your thoughts on this? This isn't offering medical advice, it's just posing a debate question. Does anyone know of Effexor causing memory loss and confusion?

Lots of people complain about the SSRI's and memory loss. Here is an Effexor list:

http://depression.about.com/b/2006/06/06/effexor-xr-and-memory-loss.htm

I know Effexor has been a huge help to a lot of people in restoring quality of life. Personally, I have only observed one case of this drug's "before/after" and nothing long-term. What little I have seen has been very positive ... few side effects and complete recovery and overall improvement of the patient's life as far as treatment of depression symptoms. My guess is that in many cases the positives far outweigh the negatives. Because there are so many SSRIs and other antidepressants available, a competent psychiatrist should be able to work with patients to pick medicines that are effective and minimize undesirable side effects.

Unfortunately, in the real world, a fair number of patients with depression abuse alcohol and other drugs, take poor care of themselves, or have other serious medical conditions ... and take their medication inconsistently. On the physician side of the equation, it might take 4 to 6 weeks to get an outpatient appointment with a particular psychiatrist who may not have the time, energy, or competence to optimize the medication. Many patients can afford very little psychiatric care and insurance coverage can be very limited. Such real world limitations prevent appropriate care.

Searching pubmed pulls up a lot of studies that suggest that antidepressants tend to improve memory rather than harm it like untreated depression does. This is an active area of research and, for now, as is often the case, clinicians will need to use their best judgment as to what to do for a particular patient, weighing the benefits of treatment against the known negatives.

 

[Anasazi23]

I wouldn't say this is a major factor at all in prescribing the medication, or any SSRI/SNRI for that matter.

It's a great medicine, for the right patient and at the right dose. I like the fact that I can control whether it involves primarily the serotonergic or norepi component. I've had very good results with it.

 

[josehernandez94]

i've heard that one of the primary problems with effexor is that it's notoriously difficult to wean patients off of it due to a pretty intense withdrawal syndrome.

 

[Anasazi23]

You just taper it properly. This is one of those overblown issues in psychiatry, in my opinion. I've had dozens stop it suddenly (more in a non-compliance fashion) and had no effects. In the worst case scenario, it's uncomfortable for a few days. There are case reports of it lasting longer, and being more severe (flu-like). It's not life threatening, and in most cases, isn't a huge issue.

 

[whopper]

Clnically, here the the issues I have with Effexor, good & bad.

The good:
+its a very clean antidepressant. Not the lowest level of metabolic activity imposed on the liver, but very low compared to the other antidepressants.
+Because of its dual mechanism, it can be considered a good alternative should an SSRI not work
+its going generic-hopefully its price will drop sooner vs later
+the NRI effect, although there is no FDA approval for this, may create pain benefits. This has been documented in studies, and why several docs also give it for pain benefits & fibromyalgia (though I know of no head to head study vs duloxetine).
+It has some benefit with ADHD.

The BAD
-can increase BP (which may be a good thing if the patient has hypotension)
-its short half life highly increases its risk for discontinuation syndrome (DCS). I've only had patients have DCS with 2 antidepressants--Paxil or Effexor, both of which have the shortest half lives, even when slowly weaning them off. I had one patient who was switched to Effexor XR & I still couldn't get her off of the med despite weaning her to the smallest dose without discontinuation syndrome which she claimed she couldn't bear & then would still take the smallest dose. Unfortunately because its a capsule, I couldn't have her split it in half.

Edit-just read Anasazi's post. I guess my experience with it differs from his. I also got to add that this patient did seem a bit, ahem, med seeking which may have contributed her not wanting to stop Effexor XR. However still, the only meds where patients strongly complained about the wean off were Paxil & Effexor, and the half lives correlate to give a good explanation as to why.

I've heard of no memory problems with this med, though this could due to ignorance on my part. I figure if anything memory should improve because concentration & memory often times suffer from depression, depression inhibits the release of Brain Derived Neurotrophic Factor (antidepressants restore the release of this) which studies show causes hippocampal atrophy & degradation of long term memory & it improves sx of ADHD.

I've also had no problems with patients mentioning memory problems with effexor.

Edit--I just double checked my Epocrates & memory problems is not on its complaint list for the med. Also take into consideration that Epocrates mentions adverse reactions that are extremely rare. It could be that patients with memory problems are still suffering from memory problems caused by depression & not the effexor. I will though keep an open mind on this & if I see anything with Effexor & memory I'll post it.