When starting a new medication like Effexor (venlafaxine), it's normal to feel anxious about how your body may react. The prospect of experiencing side effects can be daunting, especially concerning depression and the medications used to treat it, which can affect your appetite and body weight in unwanted ways. This article reviews Effexor, the relationship between this medication and weight changes, and other common side effects.
What is Effexor?
Effexor (venlafaxine) is an antidepressant commonly prescribed to treat symptoms associated with depression and anxiety. It helps relieve symptoms like sadness, hopelessness, guilt, and lack of interest in things that once brought you joy. Effexor is used to treat anxiety disorders, panic disorders, and social phobia disorder, as well as major depressive disorder. Other studies show that venlafaxine is effective in treating nerve pain, migraines, and tension headaches. It has also been prescribed to treat hot flashes resulting from menopause or chemotherapy.
How Effexor Works
Antidepressants work by affecting the chemicals in the brain known as neurotransmitters, including managing available levels of serotonin, norepinephrine, and dopamine. Effexor is part of a class of drugs known as SNRIs (serotonin-norepinephrine reuptake inhibitor), which regulate the amount of serotonin and norepinephrine molecules in the brain by blocking the reabsorption or reuptake of such chemicals.
Effexor and Weight Gain: What the Studies Say
Many antidepressant and anxiety medications list weight gain as a potential side effect. Studies show that newer antidepressant drugs may be associated with weight gain. In one such study, venlafaxine was associated with significant weight gain alongside citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil).
Individual Variability
Weight gain is a possible side effect accompanied by taking venlafaxine, but side effects vary depending on the patient. There is no way to know whether you will experience such a side effect. Some patients in one study found it difficult to lose weight during and after taking venlafaxine; this is not a universal experience and will differ from patient to patient. If you’re having trouble losing weight on venlafaxine, seek the help of a registered dietitian.
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Appetite Changes and Effexor
Decreased appetite is one of the possible and common side effects of Effexor. This may affect your weight but will likely resolve as your body adjusts to the medication.
Other Potential Side Effects of Effexor
Like many medications, there are a variety of side effects that may occur when taking Effexor. These side effects are often mild, and a doctor will usually prescribe a low dose to start and build up slowly to a higher daily dose to avoid significant side effects.
Signs of Depression to Monitor
A common sign of depression to look out for is appetite changes, which may include a noticeable weight gain or loss. Those who are depressed may be less likely to make healthy eating choices, which may affect one’s weight more than a medication itself. Depression also affects energy levels and your desire to do things that you once enjoyed.
Dosage and Administration
Effexor is often taken daily with a starting dose of 37.5 mg per day, which is increased over time to 75 mg daily, a common dosage to treat depression, generalized anxiety, panic disorders, and social anxiety disorder. Before starting Effexor, tell your doctor about all medications and supplements you take, as some can interact with the medication and cause serious side effects. Before stopping Effexor, consult your doctor, and they will help you wean off the medication. Sudden and immediate stopping can cause withdrawal side effects like nausea, vomiting, headache, and irritability.
Serotonin Syndrome
With drugs that affect the serotonin levels in your brain, there is a risk of serotonin syndrome. This is when your body has too much serotonin and requires immediate medical attention.
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Important Precautions
- Do not take venlafaxine with a monoamine oxidase (MAO) inhibitor (e.g., isocarboxazid (Marplan®), phenelzine (Nardil®)], selegiline (Eldepryl®), tranylcypromine (Parnate®)).
- Do not start taking venlafaxine during the 14 days after you stop a MAO inhibitor, and wait 7 days after stopping venlafaxine before you start taking a MAO inhibitor.
- Venlafaxine may cause a serious condition called serotonin syndrome if taken together with certain medicines like buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), linezolid (Zyvox®), lithium (Eskalith®, Lithobid®), methylene blue injection, tryptophan, St John's wort, amphetamines, or some pain or migraine medicines.
- This medicine may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed.
- Do not suddenly stop taking this medicine without checking first with your doctor.
- This medicine may cause hyponatremia (low sodium in the blood).
- Venlafaxine may increase your risk for bleeding problems.
- Venlafaxine may cause some people to become drowsy or have blurred vision.
- It is best to avoid alcohol with venlafaxine.
- Do not take other medicines unless they have been discussed with your doctor.
Effexor and Weight Loss: Is it Possible?
Side effects vary from patient to patient, but neither weight loss nor weight gain is guaranteed when taking antidepressants. Effexor is not amongst the list of antidepressants that have been connected to weight loss, which include bupropion (Wellbutrin), fluoxetine (Prozac), and duloxetine (Cymbalta). The best way to lose weight is to make healthy lifestyle and eating choices, which can include managing caloric intake.
Long-Term Effects of Effexor
Effexor (venlafaxine) belongs to a class of medications called serotonin-norepinephrine reuptake inhibitors (SNRIs). While these medications can provide significant relief for depression, anxiety, and other mental health conditions, understanding their long-term effects becomes crucial as treatment duration extends beyond the initial months of use.
Cardiovascular Impact
One of the most significant long-term effects of Effexor involves cardiovascular changes, particularly sustained increases in blood pressure. Clinical trials demonstrate that Effexor treatment is associated with dose-dependent increases in both diastolic and systolic blood pressure. Healthcare providers typically recommend regular blood pressure monitoring for patients on long-term Effexor therapy. Long-term Effexor use is also associated with clinically relevant increases in serum cholesterol levels. Regular lipid monitoring becomes an important component of long-term care for patients taking Effexor, especially those with existing cardiovascular risk factors.
Metabolic and Physical Changes
Effexor produces dose-dependent weight loss effects that can persist throughout long-term treatment. Clinical studies show that 6% of patients experienced a loss of 5% or more of their body weight during treatment, compared to only 1% of placebo-treated patients. The appetite suppression effects can sometimes lead to nutritional concerns, particularly in patients who begin treatment with lower body weight or those with a history of eating disorders. Long-term Effexor use increases the risk of bleeding events through its effects on serotonin in blood platelets. Healthcare providers typically advise patients about this bleeding risk and may recommend avoiding certain over-the-counter medications, such as aspirin or ibuprofen, that could further increase bleeding risk when combined with Effexor.
The Challenge of Effexor Withdrawal
Effexor has gained recognition as one of the most challenging antidepressants to discontinue, earning classification as a "high-risk" medication for withdrawal effects. The difficulty of Effexor withdrawal stems largely from its relatively short half-life. Research comparing different antidepressants consistently places Effexor in the highest risk category for withdrawal effects.
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Factors Increasing Withdrawal Risk
The most significant factor influencing withdrawal severity is the duration of treatment. Dose also plays a role in withdrawal risk, though duration appears to be more influential. Individual factors can also influence withdrawal risk and severity.
Understanding Withdrawal Duration and Severity
Research now demonstrates that Effexor withdrawal can persist for months or even years in some individuals. It's crucial to understand that just because Effexor has been eliminated from the body doesn't mean the brain changes caused by chronic use have reversed.
Common Withdrawal Symptoms
Effexor withdrawal encompasses a wide range of physical and emotional symptoms. The most characteristic physical symptoms include "brain zaps" or electric shock-like sensations, dizziness, nausea, fatigue, headaches, and flu-like symptoms. Emotional withdrawal symptoms can include mood swings, irritability, anxiety, and sometimes symptoms that are more severe than the original condition being treated.
Post-SSRI Sexual Dysfunction (PSSD)
A concerning long-term effect that can persist even after discontinuing Effexor is post-SSRI sexual dysfunction (PSSD). This condition involves persistent sexual side effects that continue after stopping the medication, including decreased libido, genital numbness, erectile dysfunction, and difficulty achieving orgasm.
Emotional Blunting and Cognitive Changes
Long-term Effexor use can lead to emotional blunting, where patients experience a reduced range of both positive and negative emotions. Cognitive effects may include difficulties with memory, concentration, or mental clarity.
Making Informed Decisions About Long-Term Use
Understanding the long-term effects of Effexor is essential for making informed decisions about continued treatment. Regular medical monitoring becomes increasingly important with long-term use. Planning for eventual discontinuation, even if not immediately, can be valuable. The decision to discontinue Effexor therapy should always be made in collaboration with qualified healthcare providers.
Case Report: Prolonged Discontinuation Syndrome
This case report describes a 26-year-old female with a history of childhood depression who experienced severe gastrointestinal symptoms and significant weight loss following the discontinuation of venlafaxine. After tapering off the medication, days after cessation, she developed early satiety, nausea, bloating, and vomiting, leading to severe malnutrition with a body mass index (BMI) of 14. Her symptoms improved with the initiation of mirtazapine.
Management Strategies
Effective management strategies include adhering to structured tapering protocols recommended in clinical guidelines. These protocols advocate for gradual dose reduction over weeks to months, tailored to individual patient needs and treatment duration. Close monitoring and proactive symptom management are crucial to mitigate withdrawal effects and ensure patient safety during antidepressant discontinuation.
Alternative Antidepressants and Weight
When it comes to managing depression, finding the right antidepressant can be a complex process. Although weight gain is common with many types of antidepressants, there are some options available that have been shown to be less likely to cause this outcome. Generally speaking, older antidepressants such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are most notorious for causing weight gain. Some of the newer antidepressants that work through serotonin, norepinephrine, and dopamine modulation are known to have a lower risk of weight gain and may even contribute to weight loss.
Antidepressants Associated with Weight Loss
- Fluoxetine: An SSRI that has been linked to weight loss by increasing serotonin levels in the brain, which may help improve mood and regulate appetite.
- Bupropion: A norepinephrine-dopamine reuptake inhibitor (NDRI) has the most studies connecting it to weight loss among antidepressants.
- Venlafaxine: An SNRI that has been associated with weight loss in some cases, generally when first starting treatment.
- Duloxetine: Another SNRI that has been linked to both weight loss and weight gain in individuals.
Lifestyle Changes to Manage Weight
- Regular exercise with an active lifestyle may help support weight loss efforts in those taking antidepressants.
- You may be able to manage weight while on antidepressants with a balanced diet, paying attention to portion sizes and choosing nutrient-dense foods.
- Reducing stress may be helpful in managing weight while taking antidepressants.
Weight-Neutral Antidepressants
Weight-neutral antidepressants are not known to cause significant changes in body weight. These medications may be a better option for individuals concerned about unwanted weight changes and may include Trintellix (vortioxetine), Lexapro (escitalopram), and Pristiq (desvenlafaxine).