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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Magevro on March 25, 2013, at 20:35:31
Its difficult to find not only an exact answer to this particular question, but the question being asked(atleast recently) as well.
I have Panic Disorder, Anxiety Disorder, and..mild depression(although the Panic Disorder seems to feed into it and vice versa).
I have been taking Effexor for 7 years, but recently I talked to my doctor and told him I wanted to get off of it and switch to a trycyclic. Mainly, most SSRIs give me insomnia and also increase my addictive tendencies(I.E. smoking). My dad has been on Imipramine for 30 years and doesn't have these problems.
My doctor..approved it but didn't really give me any exact instructions(usually that's fine because I have about 16 years of on hand experience with psychiatric drugs), but in this case I don't know what to do. I've asked two pharmacists, none can give me a straight answer, and told me to call him, which I will, if I can get through..but in the mean time..
The question:
Can I cross medicate while tapering off of the Venlafaxine, or do I need a buffer period between my last dose and first of Imipramine? I am down to about 15 mgs a day from 75 mgs in two weeks of weaning, but the withdrawal is now constantly present and all of my symptoms have rebounded, to the point where I am losing the ability to function. I need to make the switch like..tomorrow.. If I can, but noone can tell me whether or not it is dangerous with any authority. Is it or isn't it? Thank you.
Posted by SLS on March 25, 2013, at 21:17:22
In reply to Switching from Venlafaxine(not XR) to Imipramine, posted by Magevro on March 25, 2013, at 20:35:31
I don't represent any kind of authority. However, I can tell you with certitude that I have combined Effexor and nortriptyline (a TCA) without adverse effect. Compared to nortriptyline, imipramine is a more potent inhibitor of serotonin reuptake. Some people might be concerned about the development of serotonin syndrome. If I were in your position, I would begin taking the imipramine now. I don't believe you have much to worry about, especially since you are taking such a low dose of Effexor. I don't think a washout is necessary. Others might disagree, of course.
- Scott
Posted by jono_in_adelaide on March 25, 2013, at 21:26:43
In reply to Switching from Venlafaxine(not XR) to Imipramine, posted by Magevro on March 25, 2013, at 20:35:31
I'd be inclined to slowly taper the venlafaxine over 2 weeks, than start the imipramine.
During the taper period, a benzo would be very helpfull to help control any anxiety and also lessen any withdrawl symptoms (say Xanax 0.5,g three times a day, or Valium 5mg three times a day, for 2 weeks)
Its possible that you could do a cross taper, but there is some risk of seretonin syndrome, so you'd need to do it under medical supervision.
Posted by jono_in_adelaide on March 25, 2013, at 21:29:06
In reply to Switching from Venlafaxine(not XR) to Imipramine, posted by Magevro on March 25, 2013, at 20:35:31
Actualy, given your low dose of venlafaxine, I'd start imipramine and just stop the venlafaxine - again, a benzo would be good to have on hand during the switch over period if your doctor will give you one
Posted by Phillipa on March 25, 2013, at 23:11:19
In reply to Re: Switching from Venlafaxine(not XR) to Imipramine, posted by jono_in_adelaide on March 25, 2013, at 21:29:06
If you combined a long acting with effexor would those addictive tendencies still be with you? Also if the med is still working for you I'd be hesitant to switch meds. Could you enter a form of AA for addictive tendencies or stop smoking classes. Just suggestions. But definitely talk to your doc. Phillipa
Posted by tensor on March 26, 2013, at 15:21:31
In reply to Switching from Venlafaxine(not XR) to Imipramine, posted by Magevro on March 25, 2013, at 20:35:31
> Its difficult to find not only an exact answer to this particular question, but the question being asked(atleast recently) as well.
>
> I have Panic Disorder, Anxiety Disorder, and..mild depression(although the Panic Disorder seems to feed into it and vice versa).
>
> I have been taking Effexor for 7 years, but recently I talked to my doctor and told him I wanted to get off of it and switch to a trycyclic. Mainly, most SSRIs give me insomnia and also increase my addictive tendencies(I.E. smoking). My dad has been on Imipramine for 30 years and doesn't have these problems.
>
> My doctor..approved it but didn't really give me any exact instructions(usually that's fine because I have about 16 years of on hand experience with psychiatric drugs), but in this case I don't know what to do. I've asked two pharmacists, none can give me a straight answer, and told me to call him, which I will, if I can get through..but in the mean time..
>
> The question:
> Can I cross medicate while tapering off of the Venlafaxine, or do I need a buffer period between my last dose and first of Imipramine? I am down to about 15 mgs a day from 75 mgs in two weeks of weaning, but the withdrawal is now constantly present and all of my symptoms have rebounded, to the point where I am losing the ability to function. I need to make the switch like..tomorrow.. If I can, but noone can tell me whether or not it is dangerous with any authority. Is it or isn't it? Thank you.With authority? No. But I have switched meds alot and your plan to initiate imipramine tomorrow sounds rational. You're on a low dose of venlafaxine and it has a short halflife, you will also start on a low dose of imipramine. If it was me I would allow a 24hr window between the two.
/tensor
Posted by Magevro on March 27, 2013, at 7:43:04
In reply to Re: Switching from Venlafaxine(not XR) to Imipramine, posted by jono_in_adelaide on March 25, 2013, at 21:29:06
Thanks for all the replies. I called my doctor's office yesterday and left a message with the nurse, but missed the call back from them due to work..heh
@jono_in_adelaide
I do take a benzo..1mg/2x day of lorazepam, but my panic disorder can be so acute that, without the help of other meds it will do almost nothing for me, and I do not want to take more than that(I actually would be happy not taking it at all)@Philipa
I've been clean and sober in AA for 3 1/2 years :) But I am an alcoholic, with or without the effexor. With the smoking though, it is impossible for me to quit while on it, because it makes me feel like I need a cigarette constantly. For instance, I quit once years ago when I wasn't on any meds, and the ease with which I did it was almost a joke, but after a few months I got on Effexor, and even though I didn't smoke for almost three years, the two years I was on Effexor it felt like I needed a cigarette everyday as if I was still smoking. Obviously, I finally broke down under the strain(and the being drunk at a bar) :P@SLS, and tensor
By authority, I meant someone with experience. I know I can't really rely on the internet for a "professional" response, but I do give alot of credence to those who have definitive experience.I imagine my doctor('s nurse?) will say the same as you two, so I probably will just end up toughing out a 24-30 hour period after my last dose and making the switch. But with the "medical supervision" as I've read elsewhere, and as Jono said, I don't have insurance or any kind of network of attentive doctors, so it would be me watching myself and trying to discern if I am having adverse effects or if my brain is making it up.
I suppose it comes down to fear mostly...thus the Panic disorder :)
Thanks again.
This is the end of the thread.
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