Any medical types out there who can tell me whether the prescibing guidelines for Venlafaxine have changed in the last 18 months or so.

I saw a GP last night who was probably a locum and was advised that in order to re-start on Venlafaxine I would need a secondary referral as the guidelines had changed probably not long after I first started taking the nasty stuff a couple of years back.

The odd thing is that originally my GP had told me that the NICE guidelines had been slackened – but now they appear to have tightened.

Is it a case of that the locum was a young GP with perhaps no “special interest in metal health” and therefore needed to refer whereas if I had seen my own GP he would have been able to prescribe or would any GP now also need to refer.

I have tried google but most articles seem perhaps now out of date.

Not a rivetting subject for most STWers but I know there are some docs out there somewhere 😯

The answer is probably in here somewhere:

http://www.nice.org.uk/search/guidancesearchresults.jsp?keywords=Venlafaxine&searchType=guidance

The label has changed requiring closer monitoring especially regarding suicidality. A locum GP is not going to be able to offer that level of supervision.

I thought the changes were also related to people who had cardiovascular problems. If that is the case for you, you may need an ECG etc prior to re-starting. If you haven’t had cardiovascular problems in the past, it may be worth making another appointment with your regular GP to see what they think about the advice you were given. Most importantly, if you feel you need to re start medication, don’t be put off by the confusing visit.

Thanks guys

I searched through the “amended NICE guidelines” for “venla” but all that seems to have changed is some sections have been deleted and others are now in italics. I couldn’t find anything on who can and cannot prescribe.

The issue as I understand it is with increased risk of cardiac arrhythmias but that doesn’t help me to ascertain whether all primary care physicans are now unable to initiate treatment or not.

Milsonwheels – unfortunately my own GP seems to have gone AWOL. It took me two weeks to get an appointment in the first place and when I turned up I was told he was not available for an unspecified amount of time. So I am guessing he is sick or some other problem.

GJP – as you’ll have seen, the guidance on antidepressant prescribing changed in 2007. Venlafaxine isn’t recommended as a first line drug because of the higher risk of side effects and it’s more dangerous in overdose, and there are safer options. Unless you have severe depression, when it’s a possibility. As you say, it’s not for you if you have arrhythmias or high blood pressure.
That guidance applies in England and Wales; it isn’t compulsory but drs tend to follow it. There may also be local prescribing polices in place that tell GPs what they should or shouldn’t prescribe.If you’ve had venlafaxine before and it worked and you were OK, there’s probably a case for having it again.
Good luck.

aw, mrs julian beat me to it (see above).

if you found it ‘nasty stuff’, why not mention this to gp and ask if there is an alternative? It depends what you have tried before and what sort of problems you are having but there are quite a few other antidepressants out there. Escitalopram (trade name Cipralex) has a particularly ok side effect profile (it works as well as ‘old’ citalopram but with less downsides) but not usually first line of treatment as it is expensive to the prescriber ie your GP surgery. (you of course just pay your prescription whatever they prescribe).

It may be an anti-depressant but doesn’t mean it is used for it.

Can be used for constipation and diarrhea too by acting on the colon.
(I have diagrams!)

Anyway – Hope you get better GJP :-).

Zaskar – diagrams or not, venlafaxine is not licensed for constipation and it would be astonishing if a GP prescribed it in that way.

slight tangent: one of the ssri’s (paroxetine/seroxat iirc) also stops your, ahem, gelignite stick from detonating too early and i heard anecdotes several years ago of it being prtescribed for this.

and yes venlafaxine has also been used to treat anxiety, post traumatic stress disorder and obsessive compulsive disorder too.

I reccommend the royal college of psychiatrists website here for information withou the adverts or crystals in your bellybutton type suggestions. Considering they are all doctors its very well balanced between medicinbes, psychiological therapies and lifestyle changes.

Thanks everybody.

My understanding is that the majority of medications that work on the serotonin system, or at least the SSRI type ADs affect the ability to orgasm easily. I have read that paroxetine is one of the worst in that respect and it also has one of the worst discontuation syndromes.

Although there are other ADs that are rarely used at least as first line or sole agents that can enhance orgasm (e.g. Trazodone and perhaps even Mirtazapine although perhaps with the later the effect is just neutral)

From personal experience I have unfortunately developed a deep distrust of Psychiatrists whose approach has been nothing more than prescribe high dosages of very potent ADs (like Venlafaxine) to make one as “High as a Kite” (ie. bordering on Mania – Hypomania) and then going on to prescribe a cocktail of drugs (e.g. adding in a mood stabiliser or two) to smooth out the rough edges caused by the first line of treatment in the first place.

I am not in too bad a place at the moment and would prefer not to go back on the meds (especially a pure SSRI after previous very bad experiences) but am loathe to go back to a shrink – but I am finding it very very hard to get out of bed and motivate myself and it is clearly affecting both my work and personal life (ie biking). I am hoping come spring and the longer days things will pick up but April still seems a long way off.