Taking Effexor Yet Having Withdrawal Symptoms?
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Q:  Taking Effexor Yet Having Withdrawal Symptoms?

I have been on Effexor for Bi-Polar for about 7 years.  Doing fine on XR 150 mg. for the past year.    I am visiting my mom for two weeks and it's kinda stressful... Although, I am mostly happy and feel like I'm on vacation.

Suddenly one morning, after being here for 4 days, I started having withdrawl symptoms as if I was cutting my Effexor back too quickly!  And I am taking my usual dosage every day as always.  I am feeling sick, dizzy (have the helecopter going above my head when I look to the side, mood swings, depressed, etc.

In all the years I have been taking Effexor, this has never happened.  What is going on???

FYI: I also take 6mg. (that's right... 6mg.) of Topomax per day.  works good as mood stabalizer and I can remember my name at the same time!

Thank You for your help.

Dear Chris -- 
By the time you receive this, things may have sorted out a bit, or (I hope not) become worse in some way that will shed more light on the situation.  But just going on what you report here, uh, sorry, I do not have a good explanation.  We could guess that somehow one of your liver enzymes started working faster, chewing up the Effexor faster, lowering your blood levels.  This can happen when some other medications are added.  A whole bunch of medications taken together can sometimes get this to happen even when none of them is specifically known to do it.  There's one famous one for this, carbamazepine, but you're not taking that.  Topomax has been shown to do this "enzyme induction" just a little bit, for one specific enzyme called 3A4.
Benedetti   Since Effexor inhibits 3A4, it's conceivable that when you added the Topomax, perhaps even at this teeny dose, you "un-did" that inhibition and that's why Effexor levels went down, seemingly. 

Of course, that's a lot of "what if's", a lot of theorizing.  I also assumed  that perhaps the addition of the Topomax was recent.  Obviously if it wasn't, the first paragraph here is worthless.  We'd have to look for something else that changed by being at your mom's.  There aren't too many things you could do to your diet to account for this (grapefruit is famous for affecting 3A4, but in the wrong direction to account for this; it inhibits 3A4 activity...).  

How about a whole bunch of alcohol, which might interact with Effexor and Topomax to produce this set of symptoms? (it was Thanksgiving, after all, or somewhere around there, right?)  Maybe it wasn't really Effexor going down, just seemed like it?  I can easily imagine alcohol doing something like this.  

Did you call your doc'?  Did she recommend moving your Effexor dose up slightly?  (don't do that on your own; as you probably know, getting away with Effexor alone if you really have bipolar disorder is uncommon and the last thing I'd want you to do is just move the dose up on your own...)

When you boil it down, all this theorizing won't matter that much, of course (good literature search exercise tho'...).  What matters is "what do I do now?!", right?  For that, I'd have to defer to your doctor -- and what you may already have done!  If you were coming to me with this I'd be hoping there would be additional clues to go on, perhaps by that time.  Otherwise, I'd have to presume, as a friend says, "medications are guilty until proven innocent" and start approaching it with that assumption.  

Dr. Phelps

Published February, 2004


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