Venlafaxine history

Alternatives to estrogen for hot flushes are shown in Table 31-6. Progesterone alone may be an option in women with a history of breast cancer or venous thrombosis, but side effects limit their use. For women with contraindications to hormone therapy, selective serotonin reuptake inhibitors and venlafaxine are considered by some to be first-line therapy, but efficacy of venlafaxine beyond 12 weeks has not been shown. 

Serotonin-boosting antidepressants or longer-acting benzodiazepines are also both suitable first-line treatments for APD. For APD patients who are also troubled by depression, an antidepressant is obviously preferable. We also prefer to use antidepressants rather than benzodiazepines to treat APD patients who have a history of substance abuse. The current data suggests that any of the SSRls as well as nefazodone, mirtazapine, and venlafaxine may be helpful. When these do not work, a MAOI is a reasonable alternative provided the patient is willing to commit to the dietary regimen. 

AppetiteAA/eight changes Anorexia was reported for venlafaxine-treated patients. A dose-dependent weight loss often was noted in patients treated for several weeks. Manla/Hypomania During clinical trials, hypomania or mania occurred in 0.5% of patients treated with venlafaxine. As with all antidepressants, use venlafaxine cautiously in patients with a history of mania. 

Cardiac patients Venlafaxine has not been evaluated in patients with a recent history of Ml or unstable heart disease. 

Drug abuse and dependence Carefully evaluate patients for history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse of venlafaxine. 

E. Nefazodone,fluoxetine,mirtazapine, and venlafaxine have minimal effects on seizure threshold. Bupropion in its original formulation caused seizures in 4 in 1000 patients. Although this has been reduced with the slow release form of the medication (Wellbutrin SR), it remains a contraindication to prescribe this medication to patients with a history of seizures. 

Rudolph R, Entsuah R, Derivan A Early clinical response in depression to venlafaxine hydrochloride [abstract). Biol Psychiatry 29 6308, 1991 Rudorfer MV, Hau HG, Clayton PJ Dexamethasone suppression test in primary depression significance of family history and psychosis. Biol Psychiatry 17 41-48, 1982... 

SNRIs have many of the serotonergic adverse effects associated with SSRIs. In addition, SNRIs may also have noradrenergic effects, including increased blood pressure and heart rate, and CNS activation, such as insomnia, anxiety, and agitation. The hemodynamic effects of SNRIs tend not to be problematic in most patients. A dose-related increase in blood pressure has been seen more commonly with the immediate-release form of venlafaxine than with other SNRIs. Likewise, there are more reports of cardiac toxicity with venlafaxine overdose than with either the other SNRIs or SSRIs. Duloxetine is rarely associated with hepatic toxicity in patients with a history of liver damage. All the SNRIs have been associated with a discontinuation syndrome resembling that seen with SSRI discontinuation. 

The death of a 36-year-old patient with a history of alcohol dependence who was taking tramadol, venlafaxine, trazodone, and quetiapine has highlighted the increased risk of seizures with concomitant use of tramadol and selective serotonin re-uptake inhibitors (125). 

A 39-year-old woman with a history of treatment-resistant depression developed delusions that her medical attendants were in love with her on two separate occasions when taking venlafaxine in doses of 225 mg and more (17). There was no evidence of mania and no other psychotic symptoms. On both occasions the delusional beliefs subsided when venlafaxine was withdrawn. She was subsequently treated with another antidepressant and made a good recovery. 

The absence of a history of psychosis and the re-emer-gence of delusional thinking when venlafaxine was prescribed again suggest that venlafaxine played a role in producing this psychotic state. At high doses venlafaxine... 

A 38-year-old man without a previous history of substance misuse took up to 3600 mg of venlafaxine daily (about 10 times the maximum therapeutic dose) because it caused a subjective high (26). He maintained his high doses by obtaining illicit supplies of venlafaxine until a dose of 4050 mg produced acute central chest pain. He was then admitted to be treated for depression and substance misuse. 

A 47-year-old man with a long history of depression had been stable on a combination of venlafaxine 300 mg/day and mirtazapine 30 mg/day for 3 months. He started to take tramadol for a chronic pain syndrome and the dose was titrated up to 300 mg/day over the next 4 weeks. The dose was then increased to 400 mg/day, and 8 days later he developed shivering, sweating, myoclonus, hyper-reflexia, and mydriasis. His medications were withdrawn, but over the next 4 hours he developed a fever (39.2°C) and a tachycardia. He was given intravenous hydration and closely monitored, and the symptoms resolved over the next 36 hours. Venlafaxine and mirtazapine were restarted and he remained symptom free. 

Worsening of psychosis could have been an adverse event of topiramate in a 50-year-old woman with a long history of a schizoaffective disorder treated with risperidone 4 mg/day, venlafaxine 300 mg/day, and topiramate 200 mg/day (652). Her behavior worsened after topiramate was introduced. After it was withdrawn her mood, spontaneous speech, and psychomotor activity improved. 

A 45-year-old woman had a long history of dysthymia and depression. She had taken many antidepressants, including tricyclics, SSRIs, amfebutamone, and venlafaxine. She had no history of mania or hypomania. She took sertraline 250 mg/day, with only a transient response, and mirtazapine 15 mg/day was added. Within 4 days she developed clear symptoms of hypomania, with euphoric mood, mild grandiosity, pressure of speech, increased energy, and a reduced need for sleep. Mirtazapine was withdrawn and sertraline continued within 3 days the hypomanic symptoms had remitted. The depressive disorder then re-emerged (3). 

A case of neuroleptic malignant syndrome is reported in a 36-year-old male receiving methadone, venlafaxine and quetiapine IR (50 mg daily) with history of hepatitis C and hypothyroidism [215 ]. Another case of neuroleptic malignant syndrome in a 48-year-old female occurring 1 montix after initiating quetiapine XR is reported [216 ]. 

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