Hsiao, 2008 Successful duloxetine use to prevent venlafaxine withdrawal symptoms.

[Altostrata]

One frying pan into the other. All this demonstrates is that one SNRI, Cymbalta, may be swapped for another, Effexor. This paper does not address the difficulties reported by patients who attempt to discontinue Cymbalta.

 

Prog Neuropsychopharmacol Biol Psychiatry. 2008 Feb 15;32(2):576. Epub 2007 Aug 31.

Successful duloxetine use to prevent venlafaxine withdrawal symptoms.

Hsiao MC, Liu CY.

 

No abstract. Citation at http://www.ncbi.nlm.nih.gov/pubmed/17889418

 

Full text:

 

Successful duloxetine use to prevent venlafaxine withdrawal symptoms

 

Mei-Chun Hsiao, Corresponding Author, and Chia-Yih Liua

 

Department of Psychiatry, Chang-Gung Memorial Hospital and Chang Gung University School of Medicine #5 Fu-Shin Street, Kweishang, Taoyuan, 333, Taiwan

 

Antidepressants with a dual action of inhibiting the reuptake of noradrenaline and serotonin (SNRI) e.g. venlafaxine have been reported to have risks of withdrawal symptoms on stoppage of venlafaxine (Fava et al., 1997 M. Fava, R. Mulroy, J. Alpert, A.A. Nierenberg and J.F. Rosenbaum, Emergence of adverse events following discontinuation of treatment with extended-release Venlafaxine, Am J Psychiatry 154 (1997), pp. 1760–1762. Fava et al., 1997), even under low dosage (Hsiao and Liu, 2004).

 

This is a report of a woman with remitted major depressive disorder who had developed severe withdrawal symptoms after discontinuation of venlafaxine. We used another SNRI, duloxetine, to prevent venlafaxine withdrawal symptoms successfully.

 

A 41 year-old career woman was successfully treated with 150 mg daily dosage of venlafaxine for her major depressive disorder at our clinic. She had used venlafaxine for over one year and eight months and she wished but could not discontinue the drug due to previous severe intolerable withdrawal symptoms. The symptoms included graving anxiety, palpitations, restlessness, fine tremors, excessive sweating, increased frequency of bowel movements, nausea, vomiting, headache, diarrhea, easy fatigability, general somatic pain and electric shock-like sensations if she did not take the last dosage of venlafaxine 75 mg for 48 to 36 h. These complaints were associated with significant socio-occupational dysfunction.

 

We had tried to reduce her venlafaxine to 37.5 mg t.i.d. over a period of 2 weeks, but this woman complained severe headache and dizziness and she took 75 mg b.i.d. again by herself. Then we tried to use fluoxetine to replace venlafaxine with cosss-taper switching strategy (Edlinger et al., 2005) with failures. She is still afraid to taper off venlafaxine due to those dysphoric and awful experiences although severe sexual dysfunction was also complained under taking venlafaxine.

 

We started to give her another SNRI (Stahl et al., 2005), duloxetine 30 mg, and venlafaxine 150 mg daily for one week, then duloxetine 60 mg and venlafaxine 75 mg in the second week. No any discontinue symptoms were reported. In the third week, duloxetine 60 mg and venlafaxine 37.5 mg were used, and then she only took duloxetine 60 mg in the forth week. She showed good tolerance with duloxetine and she discontinued duloxetine 60 mg daily in the end of the fifth week without any antidepressant discontinue syndrome.

 

To our best knowledge, it's the first report to use duloxetine, another SNRI, to prevent venlafaxine withdrawal. We then tried another 8 cases that had severe venlafaxine withdrawal history and also got similar good response.

 

In summary, duloxetine shows better tolerance and it may be another good choice to taper venlafaxine with significant withdrawal history or even prevent venlafaxine withdrawal symptoms. No significant side effects or serotonin syndrome were noted in our 9 cases during the combination use of duloxetine and venlafaxine. But further larger sample clinical trial is warranted to prove our successful clinical experiences.

References

 

Edlinger et al., 2005 M. Edlinger, S. Baumgartner, N. Eltanaihi-Furtmuller, M. Hummer and W.W. Fleischhacker, Switching between second-generation antipsychotics: why and how?, CNS Drugs 19 (2005), pp. 27–42. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (15)

 

Fava et al., 1997 M. Fava, R. Mulroy, J. Alpert, A.A. Nierenberg and J.F. Rosenbaum, Emergence of adverse events following discontinuation of treatment with extended-release Venlafaxine, Am J Psychiatry 154 (1997), pp. 1760–1762. View Record in Scopus | Cited By in Scopus (64)

 

Hsiao and Liu, 2004 M.C. Hsiao and C.Y. Liu, Withdrawal reactions associated with low-dose venlafaxine treatment in a patient with premenstrual dysphoric disorde, J Clin Psychiatry 65 (2004), pp. 1147–1148. View Record in Scopus | Cited By in Scopus (2)

 

Stahl et al., 2005 S.M. Stahl, M.M. Grady, C. Moret and M. Briley, SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants, CNS Spectr 10 (2005), pp. 732–747. View Record in Scopus | Cited By in Scopus (66)

[Barbarannamated]

Just the title made ne cringe.

[bubbles]

So, does this just mean that one of these drugs has more pronounced discontinuation problems than the other? At least they called it withdrawal...

[Altostrata]

They don't seem to address problems with duloxetine withdrawal, which seem to be as bad or worse than venlafaxine.

 

I would not call this a good way to go off venlafaxine.

[Nikki]

Okay so this poor woman got off Effexor safely and is now on Cymbalta which is another horror to get off of.

 

And the point of this is?

 

So now how does she get off of Cymbalta?

 

:o