Switching from Venlafaxine to Fluoxetine

Hello,

4 weeks ago I had a serious chest infection and a host of other symptoms. During the 3 week period I wasn't very consistent with my daily dose of Venlafaxine, which I had gradually upped to 115 mg a day prior to falling ill. I've been taking it since 2015.

My tinnitus has been pretty bad up until the infection, then I fell ill, then I was missing my doses days on end or taking one 35 mg tablet.

10 days ago I go back to work and start taking 75 mg again and now, 10 days on, my tinnitus is singing merry hell, it even feels like it's up an octave... a much higher pitch than originally.

I've taken Fluoxetine many years ago with no problems other than some emotional bluntness and my Doctor is switching me to that. I know it's Prozac, but if it weren't for the internet I'd never hear about any horror stories. All antidepressants come with some risk.

This is a bit of an experiment for myself to see if I can see any change in the pitch at least, but does anyone have any experience or learning to share?

I'm not tapering off, just switching straight away - Doctor's advice [which I'm pleased about because I'd probably crash and burn].

 

Venlafaxine is known to have Tinnitus as a side effect. But I'm not sure about the switching without tapering... I for myself would taper. How long have you been in Venlafaxine?

 

Since 2015, but for four weeks I've been hitty missy with taking it. I don't think I could handle the down that probably comes with tapering.

 

@Allan1967

Effexor is pretty hardcore. I was on it for a decade and stopped several years ago. Are you sure no taper is wise? When I started it again in December it doubled my tinnitus volume.

Different drugs can change the pitch. With Mirtazapine 1 dose did it for me.

I recently compared 10 different ADs on eHealth website because I also need one and surprisingly Prozac had the lowest score I could find for aggravating/causing tinnitus out of the 10.

0.6 out of over 52.192 people.

I’m sorry you’re going through this tough time, You’ll get through this bro, be strong, my tinnitus is pretty severe also.

 

Thank you @Stu1983.

I started taking Venlafaxine in 2015 after developing some imbalance problems very similar to MdBS. I just hope it doesn't come back as the Venlafaxine seemed to stop it but from what I read, Venlafaxine is out of your system inside of 1.5 days, so I'll find out soon.

Venlafaxine hasn't given me any real problems that I can tell and my doctor told me to just switch.

Mirtazapine changed my frequency too so so stopped that but in these last two weeks my tinnitus pitch has just been insane from the moment I wake up to when I go to bed and even increases as the day goes on.

I read so many stories of people bringing their tinnitus down from an 8 to a 2, or how it gets quiet for them but I'm just not getting any relief and I don't know why.

 

Tinnitus arising from antidepressants is uncommon and there are only two published cases of tinnitus from venlafaxine even though it has been prescribed to millions since the early 1990's.

Sudden withdrawal from any antidepressant can cause transient tinnitus but as depression and anxiety 'amplify' the perception of tinnitus, many more people with tinnitus benefit from the appropriate use of these medications.

 

Thank you @Dr. Ancill

I cannot figure out what is going on at the minute with my tinnitus. It seems to have increased in pitch and I have two faint noises, one in each ear.

 

For most tinnitus sufferers (like me), the tone, pitch and volume frequently change - that is quite 'normal' for tinnitus.

 

For 20 years my pitch never really changed but the volume would and my tinnitus was caused by infection/ototoxic ear drops.

Since my spike in October pitch has increased and volume is always high.

 

What are you thoughts on switching from 75mg of Venlafaxine to Fluoxetine with no tapering please @Dr. Ancill?

 

Technically, as both drugs target the same serotonin system, no withdrawal is necessary and you can switch straight across to Fluoxetine 20mg but, as always, check with your doctor first.

 

The Swedish equivalent to the FDA has Tinnitus as a "Common" side effect for Venflaxine, meaning 1% to 10%. Im sure this is based on something more than two case reports?

Venflaxine is an SNRI and Fluoxetine an SSRI. I guess there is some difference there?

 

Actually, until it reaches a dose of 225 mg, venlafaxine is a SSRI. The norepinephrine (the 'N' in SNRI) effect only occurs at higher doses. You can see a similar action with paroxetine, another SSRI.

With duloxetine (Cymbalta) the two effects occur at all doses

 

I´ll advice you to taper off Venlafaxine even when you start Fluoxetine. Venlafaxine is a much more potent AD than Fluoxetine.

It´s quite common to actually use Fluoxetine to get off Venlafaxine, but people will still feel the withdrawal.

I have 20 years experience with Venlafaxine. Tapering and updosing many times throughout those years. If you have gotten off Venlafaxine before, it´s even more important to get off gradually this time as it seems to get harder each time. Even though 75 mg is sort of a low dose, i recommend you taper. I´m in the process of getting off from 225 mg (initially 375 mg) and it´s HELL even with small drops. Been on them a long time though.

When it comes to them being the culprit of my tinnitus and hyperacusis I´m on the fence. They can make you more prone to noise damage maybe. But in itself I do not think of them as ototoxic.

Also, be ready for a spike during the Venlafaxine withdrawal.

Good luck to you!

 

@Dr. Ancill

Can I ask please if switching from Venlafaxine to Fluoxetine can be done straight away, would I be safe to assume switching back is ok?

I have a long complicated tale as to why I might need to do that that I wont go into here.

 

Thanks for the response @grate_biff.

It was actually my GP who said just switch straight away and he has known my battles with the Black Dog; Tinnitus and Anxiety for many years so I'd like to think he wouldn't put me in a position where I'd freak out.

I'm on day 3 without Venlafaxine and my understanding is it's out of your system within a day and a half.

This morning I had a thumping headache, but that may be because of other things (that I'm monitoring) plus I'm still recovering from a serious chest infection and head cold. Only other thing is I've been easily moved to tears, but once I have a bit of a blub I'm ok after that.

Feel some cold sweats and a bit unsteady at times but so far nothing catastrophic.

 

Well, your body will tell you if you´ll make it or not. I think a good marker is if nausea will appear, or not. If not, you´ll probably be OK. It´s about will too of course. If it´s important for you to CT, then do that.
How ever severe it could be, 75mg to 0mg is not gonna kill you.
As i´ve said, duration, dosage and prior withdrawal will have a lot to say in how it plays out.

3 days is still early though and if the med is in your system or not is irrelevant. What matters is it has changed your brain chemistry while on it.

 

No medication works the same for all people. It’s great if Prozac helps your Tinnitus. Forget about the horror stories because all meds have them ,
Prozac has saved a lot of lives. Sure it may dull your senses but with a lot of people that is needed.