Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Remedy For Severe Anxiety
Question: Hi. I am currently suffering from anxiety. I have been on sertraline, lexapro and effexor xl in the past. I was off all medication for a month and went to see a psychiatrist two weeks ago, who suggested going back on to sertraline for my anxiety. I told her I wanted to try deal with it on my own and to my detriment, two weeks later I'm suffering with severe anxiety again. I have made an appointment with my doctor but can't be seen until next Friday. I am at my wits end. I have 75mg effexor at home and was wondering if I took one of those a day, can I just change straight on to sertraline on the Friday? Thanks
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
You describe recurrence of anxiety now that you are no longer on medications. As you now know, sometimes we need to be on maintenance medications to prevent relapse of anxiety. No one likes to be on medications, of course, but it sounds like they keep you most like your true self, so I would encourage you to stay on medication in the future.
You're asking if you can use leftover Effexor to hold you over until your appointment next Friday. My answer is that you should not do this, and let me explain why. First, these medication act on brain receptors, which can take a few weeks to be modified to the point where you will see benefit. This is true even if you were on this medication before but stopped taking it. Therefore, it really won't be any benefit to you to take Effexor for a week, because you will likely not see any benefit from it. Furthermore, as you likely know, medication side effects exist and happen right away, so it's likely you would experience the side effects of Effexor without seeing any benefit. To minimize the risk of side effects, Effexor is usually started at a low dose and increased gradually. If the Effexor you have is Effexor XR, I generally start at 37.5mg, not 75mg. For all these reasons, I think you should hold off until next Friday to restart medication.
If you're having difficulty in the meanwhile, I am available for therapy on this website, and would be happy to talk you through your anxiety while you're waiting to restart medication.
My name is Dr. Sheppe, and I am a psychiatrist in New York City. If you'd ever like to become a part of my online practice, and for a personalized comprehensive evaluation, treatment recommendations, and private therapy, you can reach me at HealthCareMagic at this unique link: tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hello, and thanks for your question.
You describe recurrence of anxiety now that you are no longer on medications. As you now know, sometimes we need to be on maintenance medications to prevent relapse of anxiety. No one likes to be on medications, of course, but it sounds like they keep you most like your true self, so I would encourage you to stay on medication in the future.
You're asking if you can use leftover Effexor to hold you over until your appointment next Friday. My answer is that you should not do this, and let me explain why. First, these medication act on brain receptors, which can take a few weeks to be modified to the point where you will see benefit. This is true even if you were on this medication before but stopped taking it. Therefore, it really won't be any benefit to you to take Effexor for a week, because you will likely not see any benefit from it. Furthermore, as you likely know, medication side effects exist and happen right away, so it's likely you would experience the side effects of Effexor without seeing any benefit. To minimize the risk of side effects, Effexor is usually started at a low dose and increased gradually. If the Effexor you have is Effexor XR, I generally start at 37.5mg, not 75mg. For all these reasons, I think you should hold off until next Friday to restart medication.
If you're having difficulty in the meanwhile, I am available for therapy on this website, and would be happy to talk you through your anxiety while you're waiting to restart medication.
My name is Dr. Sheppe, and I am a psychiatrist in New York City. If you'd ever like to become a part of my online practice, and for a personalized comprehensive evaluation, treatment recommendations, and private therapy, you can reach me at HealthCareMagic at this unique link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks for your answer Dr. Sheppe. I realise, having been on SSRI's and SNRI's previously, that they have awful side effects. I found with most, I had similar side effects, mainly nausea and lethargy.
The reason I thought it might be ok to take the effexor xl 75mg before starting on sertraline was because they work on similar brain receptors. My thinking was that I might not have to wait as long to see the benefit of the sertraline if I have already been taking the effexor xl for a week previous. Would that not be the case?
I am really struggling to keep it together in work, with my family, friends and boyfriend and I really feel I need something to suppress my anxiety. I can't cope. Thanks for your help.
xxxx.
The reason I thought it might be ok to take the effexor xl 75mg before starting on sertraline was because they work on similar brain receptors. My thinking was that I might not have to wait as long to see the benefit of the sertraline if I have already been taking the effexor xl for a week previous. Would that not be the case?
I am really struggling to keep it together in work, with my family, friends and boyfriend and I really feel I need something to suppress my anxiety. I can't cope. Thanks for your help.
xxxx.
Brief Answer:
Follow-up
Detailed Answer:
It's certainly a good thought and makes sense intuitively, your idea about starting with Effexor now and moving to Zoloft later. The problem is, even if they were both SSRIs (which they are not, as you point out Effexor is an SNRI), these different drugs act in subtly different ways, and you have to titrate off one before you can start another. You can't simply jump from one to the next without risking serotonin syndrome or risking double the side effects from both drugs. Taking Effexor now would probably INCREASE the time until you will be on a therapeutic dose of Zoloft, because your doctor will first have to titrate off Effexor while raising the Zoloft dose slowly. All in all, despite the difficulties you're experiencing which I certainly empathize with, waiting until next week to start Zoloft makes the most sense to me.
Again, if you'd ever like to become a part of my online practice, and for a personalized comprehensive evaluation, treatment recommendations, and private therapy, you can reach me at HealthCareMagic at this unique link: tinyurl.com/DrSheppeAnswers
Follow-up
Detailed Answer:
It's certainly a good thought and makes sense intuitively, your idea about starting with Effexor now and moving to Zoloft later. The problem is, even if they were both SSRIs (which they are not, as you point out Effexor is an SNRI), these different drugs act in subtly different ways, and you have to titrate off one before you can start another. You can't simply jump from one to the next without risking serotonin syndrome or risking double the side effects from both drugs. Taking Effexor now would probably INCREASE the time until you will be on a therapeutic dose of Zoloft, because your doctor will first have to titrate off Effexor while raising the Zoloft dose slowly. All in all, despite the difficulties you're experiencing which I certainly empathize with, waiting until next week to start Zoloft makes the most sense to me.
Again, if you'd ever like to become a part of my online practice, and for a personalized comprehensive evaluation, treatment recommendations, and private therapy, you can reach me at HealthCareMagic at this unique link: tinyurl.com/DrSheppeAnswers
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
