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Venlafaxine - add on for anxiety?

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Hi all,

First, I just want to send support to all of those who struggle with their mental health. Depression & anxiety are damn beasts, but hopefully we can all find things to help ease the pain.

I’ve been on Venlafaxine/Effexor for ~4 months now. My current dose is 225mg, which was boosted ~2 weeks ago from my previous 150mg after changing from Cymbalta/Duloxetine 60mg. I was on Cymbalta for ~5 years with good results, but found my mental health declining over the past 2 years since COVID. This led to a few hospital admissions, and my psychiatrist switched me to Venlafaxine/Effexor. 

I’ve found the 225mg dose fairly good for alleviating my depressive symptoms and increasing motivation, but I still seem to constantly have issues with anxiety. It goes from just a general sense of dread/feeling my heart in the absence of physical activity, to occasional full panic attacks. I have benzos as a PRN for these times, but doctors are VERY hesitant to prescribe them for long-term use (potentially rightly so). 

The psychiatrist tried adding mirtazapine to the mix for a while for the “California Rocket Fuel” combo. I seemed okay for a while on 30mg, but had a fairly severe mental breakdown that put me back in the hospital. I’ve had had 30 TMS sessions on the right side during this stay - unsure of whether it’s helped as yet. I also had gene testing done which showed I have reduced effect to mirtazapine, so the doc boosted me to 45mg. This didn’t go so well - ended up in a huge depressive spiral which lasted 4 days starting almost immediately after I increased my dose. Doc immediately dropped me back to 15mg, and I’m slowly decreasing the dose to nothing. She’s added 50mg extended release seroquel/qutiapine to aid sleep while I taper the mirtazapine down.

I guess what I’m looking for are opinions/experiences on adding medications alongside Effexor for decreased baseline anxiety. The seroquel seems to maybe?? help, but I was on 25mg instant release previously with Cymbalta and Effexor up until I started the mirtazapine, and don’t think it did much then. I’ve come across a few potential options by doing some research - Abilify, Lamictal, Gabapentin, Preglabin/Lyrica. My other option is to boost the Seroquel XR to 100mg. Also, despite the good things I’ve read, my doc is hesitant to prescribe Gabapentin or Preglabin for her own reasons (something regarding me being quite young and foetal abnormalities - which seems pretty bullshit as I’m not intending to have children any time soon, if ever).

Has anyone ever had a good experience while on Effexor or another anti-d/SNRI and adding things like Abilify, Gabapentin, Preglabin, Lamictal to help aid anxiety symptoms? Any help would be much appreciated! 

Apologies for the lengthy post, but wanted to provide some background 🙂

Edited by AnxiousAmber
Adding some more info.
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hey, Im on 75mg Effexor and 15mg mirtazapine, its going ok, though Im still feeling a lot of depression and anxiety, my doc is going to push me up slowly to 150mg of effexor but keep me on 15mg mirt because that does helps me sleep. Shes recently given me 1mg lorazapem for anxiety. Si I cant really answer your question, maybe when my dose increases of effexor ill feel the "California rocket fuel" effect i've read about too. Idk, but youre not alone in this battle 🙂


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