Efexor has a duel effect, blocking both serotonin and noradrenaline reuptake, prolonging brighter moods.
Efexor, or Venlafaxine, is a relatively new drug with a unique group of actions that many people have found to be a highly effective as an anti-depressant.
In the brain there are numerous different chemical compounds called neurotransmitters. These act as chemical messengers between the nerve cells. There are two key neurotransmitters, serotonin and noradrenaline. Efexor increases the availability of the stimulating neurotransmitter noradrenaline and the calming neurotransmitter serotonin.
Efexor accomplishes this by preventing serotonin and noradrenaline from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood lightening effect of any released serotonin and noradrenaline. In this way, Efexor helps relieve depression and anxiety.
Depression and anxiety disorders come in many different guises but whatever form they take, they are serious medical conditions that require the same level of care, treatment and understanding that is given to more physically based illnesses.
And depression and anxiety disorders are perhaps more common than you think. The latest figures from the US National Institute of Mental Health (NIMH) make sobering reading. NIMH reported that in any given year major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population aged 18 and older, and that in 2008 major depressive disorder was the leading cause of disability in the U.S. for people aged between15-44. Chronic, mild depression that persists for at least two years (known as dysthymic disorder) affects around 1.5 percent of the U.S. population aged 18 and over each year, which translates to about 3.3 million American adults. And anxiety disorders including panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, and post traumatic stress disorder affect around 40 million adult Americans every year - which is about 18% of the population!
It’s clear then that we are dealing here with a huge health issue and it’s not surprising therefore that the pharmaceutical industry has invested millions of dollars in bringing various antidepressant medications to the market place. One of the newest is Venlafaxine, sold under the brand names Venlafaxina or Efexor, but before we look in more detail at this innovative treatment for depression and anxiety, it helps to have a clearer understanding of what exactly these illnesses are.
Depression is a very complicated debilitating medical condition that is often misunderstood by the lay person. It’s more than just feeling a little bit down and out of sorts - after all we all feel like that from time to time but we’re not all suffering from clinically diagnosed depression - and it’s not something that you can simply “snap out” of.
How a person actually experiences depression is a very individual thing and depends not only upon individual differences but also upon the type of depression that they are suffering from (we look in detail at some of the different types of depression and anxiety disorders below). However, there are a number of common symptoms that appear across all types of depressive illnesses. These common symptoms include:
Whilst we all might experience some of these symptoms from time to time, for people suffering from depression these types of feeling and symptoms are often more severe and they do not go away over time. Depression is usually diagnosed if such symptoms last for a period that goes beyond two weeks.
As we’ve already touched upon there are a number of different types of illness that have a depression as a key symptom including major depressive disorder, bipolar disorder, dysthymic disorder, seasonally affected disorder and post natal depression.
Just like we might feel a little down or sad from time to time, it’s perfectly normal to feel anxious, worried, tense or scared occasionally. We all experience these types of feelings when we’re under pressure or facing a stressful situation. Anxiety is part of our body’s natural response to danger - and occurs whenever we feel threatened.
And although it might not be a very pleasant thing to experience, anxiety is often useful. It helps to keep us alert and focused, motivates us to solve problems and spurs us into action. But for some people these feelings of anxiety become constant or can be completely overwhelming and can ultimately interfere with their ability to interact with others or carry on their daily lives. In these cases, the person is probably suffering from some sort of anxiety disorder.
And just as there are a number of different illnesses that involve depression, there are 6 major types of anxiety disorders, each with their own distinct symptom profile. They are: generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, post-traumatic stress disorder, and social anxiety disorder.
Given that depression and anxiety disorders can manifest themselves in so many different ways, getting a proper clinical diagnosis is really important. And once contact has been made with the appropriate medical professional, a treatment plan can be devised and the necessary steps taken to treat the patient with the ultimate goal of putting their condition into remission. Medication has a key role to play when it comes to treating depression and, with its proven safety record and high rate of efficacy, Venlafaxine makes an excellent choice for antidepressant therapy.
Venlafaxine is the generic name for an antidepressant medication that offers a novel approach to the treatment of depression. Bearing a unique chemical structure unlike any other form of antidepressant, Venlafaxine belongs to a class of drugs known as serotonin-norepinephrine reuptake inhibitors or SNRIs. Confusingly the acronym SNRI is often used to denote selective norepinephrine reuptake inhibitors that are prescribed primarily for Attention-Deficit / Hyperactivity Disorder (ADHD).
Venlafaxine affects naturally occurring chemicals in the brain called neurotransmitters. Neurotransmitters are specialized chemicals that allow neurons (cells of the nervous system) to communicate with one another. Neurons are separated by tiny gaps known as synaptic gaps. When one neuron wants to pass on an impulse to the next neuron, it does so by releasing neurotransmitters that effectively transport the impulse across the gap and on to the next neuron. Here they bind with the appropriate receptors (proteins on the surface of the neuron). The receiving neuron then either passes the impulse on further or that is where the impulse’s journey ends. The neurotransmitters themselves are either destroyed or reabsorbed by the nerve endings in which they were produced.
Neurotransmitters are central to memory, learning, mood, behaviour, sleep, pain perception and libido. Different neurotransmitters operate at different parts of the nervous system, and have different effects. Whilst some promote the transmission of impulses, others inhibit it. The three main neurotransmitters that are involved in depression are dopamine, norepinephrine (also called noradrenaline in the UK) and serotonin (also known as 5-HT). When brain levels of one or more of these neurotransmitters falls too low or when an imbalance occurs, depression can occur.
As yet, the exact mechanism of Venlafaxine and its impact upon these neurotransmitters is not fully understood but it is thought to work by strongly inhibiting the reuptake of norepinephrine and serotonin. Venlafaxine may also weakly inhibit the reuptake of dopamine. By preventing reuptake, levels of these neurotransmitters are increased - especially serotonin and norepinephrine (hence the name selective serotonin and norepinephrine reuptake inhibitors or SNRIs).
By increasing levels of these neurotransmitters and by correcting any imbalances of these two chemicals that may have occurred, Venlafaxine can help to relieve symptoms. Although low levels of serotonin and norepinephrine are associated with depression, serotonin is thought to be more involved in influencing mood whereas norepinephrine is believed to have a greater influence over alertness and energy. This means that Venlafaxine is able to work on different aspects of depression and anxiety disorders.
As we have discussed above, there are a broad range of illnesses that feature depression and there are also six major forms of anxiety disorder. Venlafaxine does not pretend to be a panacea for all these different ills but it has been successfully proven to treat the symptoms of depression and three anxiety disorders , namely generalized anxiety disorder (GAD), panic disorder (PD) (with or without agoraphobia), and social anxiety disorder (SAD).
Just as depression and anxiety conditions do not suddenly develop overnight, they also take a long time to treat. And as is the case with other antidepressants, Venlafaxine is not a quick fix. It may take 4 to 8 weeks before the benefits of the treatment are felt. This can be particularly frustrating for the patient during this time because the symptoms continue even though medication is been taken. It is vital therefore to get support and to keep in contact with your health care professional during this time. Even when you are beginning to feel better it’s extremely important that you continue taking Venlafaxine and you should not change your dose without first consulting you health care professional (see below in particular with regard to discontinuation syndrome).
Many people have found that the ability of Venlafaxine to alter levels of both serotonin and norepinephrine has provided them with a very effective treatment with which to combat their illness. The dual actions do not simply lift your mood, they also provide you more energy and alertness and once the symptoms of your depression have improved you will then be able to deal more effectively with whatever issues may have contributed to your illness occurring in the first place.
But the fact that Venlafaxine works does not just come from anecdotal evidence. For example in 2009 results of a meta-analysis of all the available trials of Venlafaxine and its use as a treatment for major depressive disorders, including treatment resistant depression and long-term relapse prevention, were published(1). The researchers concluded that not only is Venlafaxine clinically effective in the treatment of major depression, but that it is actually more effective than SSRIs (selective serotonin reuptake inhibitors such as Prozac (fluoxetine) and Zoloft (sertraline)) , and at least as effective as tricyclic antidepressants (such as Elavil (amitriptyline) and Norpramin (desipramine)). It also appeared to be more effective than SSRIs and tricyclic antidepressants in the treatment of resistant depression. In addition, Venlafaxine was found to be effective in reducing relapse if it was used as a long term treatment after a major depressive episode.
Your health care professional will be able to determine what dose is right for you. However, as a guide, the usual starting dose for Venlafaxine is 75mg for depression, generalized anxiety disorder (GAD), and social anxiety disorder (SAD) and 37.5mg for panic disorder (PD).
Also, you should be aware of the fact that your dose may need to be adjusted over time. For example, if you are taking Venlafaxine for depression, your health care professional may decide that you should start on a dose of 37.5mg for the first few days to give your body chance to get used to the medication.
Venlafaxine should be taken as a single dose with food at around the same time every day, either in the morning or in the evening. The capsule should be swallowed whole and it should not be crushed, chewed, divided or put in water. If necessary the capsule can be carefully opened and its contents sprinkled onto a spoonful of apple-sauce. This should be swallowed immediately and followed by drinking a glass of water. You must not chew this mixture before swallowing.
As with all medications, you may experience some side effects when taking Venlafaxine. However, simply because we list a side effect here does not mean that it will necessarily happen to you. If you do experience any side effects you should discuss them with your health care professional. It is extremely important that you do this prior to changing your dose or stopping treatment altogether. A sudden change in dose or cessation of treatment altogether can lead to discontinuation symptoms which we discuss further below.
Studies have revealed that the most common side effects of Venlafaxine include:
In some cases you may find that your libido is lessened by Venlafaxine although this not a very common side effect. A very small percentage of men may also find that they experience delayed ejaculation.
Venlafaxine may also cause changes in body weight (either up or down) but again in clinical trials only a very small percentage of people taking Venlafaxine noticed such a side effect.
In some patients taking Venlafaxine may lead to increased blood pressure and / or cholesterol. Therefore it’s important to tell your doctor if you have or have had high blood pressure or high cholesterol before you start taking Venlafaxine. Your blood pressure should be under control before you start taking the medication and it is recommended it is checked by your doctor on a regular basis. Your doctor may also want to do blood tests to check your cholesterol level periodically.
Also, it’s important to let your health care professional know before you start taking Venlafaxine if you have a history of glaucoma or increased eye pressure before you start taking Venlafaxine because Venlafaxine treatment can lead to mydriasis (prolonged dilation of the pupil of the eye) in some cases.
If you do experience any side effects you should discuss them with your health care professional particularly if they are causing you distress. You should also be aware that any side effects experienced may lessen as your body adjusts to Venlafaxine. You should be reassured by the fact that studies have also shown that only about 10% of people stop taking Venlafaxine due to side effects.
As mentioned above, it is extremely important that you do not suddenly stop taking Venlafaxine or quickly reduce your daily dose. If you do, you risk experiencing discontinuation symptoms. These can include physical symptoms as well as changes in mood and sensory disturbances and may occur after only missing a few doses.
To avoid discontinuation symptoms, your daily dose of Venlafaxine should be lowered gradually by your health care professional. This is known as tapering the dose. Venlafaxine is not addictive.
All patients taking antidepressants of any sort should be watched closely to make sure that their condition does not worsen or that they are becoming suicidal especially when they first start on medication or their dose is altered. Children, teens and young adults are particularly at risk of experiencing increased suicidal thinking and behaviour when taking antidepressants and as such Venlafaxine is not approved for use in children and teens.
Venlafaxine should not be taken by pregnant or nursing mothers without consulting their doctor first.
Until you know how Venlafaxine affects you, you should exercise care when undertaking such activities as driving a car or operating machinery. Do not drink alcohol whilst you are undergoing treatment with Venlafaxine.
Do not take Venlafaxine if you are allergic to Venlafaxine or any of the other ingredients contained within the medication.
It is extremely important that you tell your doctor about any medications that you are taking including over-the-counter drugs, vitamins, and herbal and nutritional supplements. This is because some medicines can interact with Venlafaxine and affect how it works. In particular:
Bauer M, Tharmanathan P, Volz HP, Moeller HJ, Freemantle N. The effect of Venlafaxine compared with other antidepressants and placebo in the treatment of major depression: a meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2009 Apr;259(3):172-85. Epub 2009 Jan 22.
Like most anti-depressants, this drug could interfere with other anti-depressants, particularly MAO inhibitors (including Gerovital-H3) and also with noradrenaline enhancers, such as Adrafinil and Modafinil, and therefore any combined use must only take place under the guidance of a physician.