How To Avoid Mania While On Effexor For Severe Depression?

Posted on Tue, 24 Oct 2017

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 24 Oct 2017 Answered on

Wed, 22 Nov 2017 Last reviewed on

Question : My 26 yr old son was depressed at the beginning of th year and was prescribed prozac. This precipitated manic episode from mar-jun, during which he was taken off prozac, put on lithium (450) mg, then fell into a severe depression. He was then put on wellbutrin (past 4 weeks) but depression seems to be worsening. altho he has a psychiatrist and a therapist, he is low-functioning and desperate. I am bipolar II myself and have been trying to help him through this but he seems stuck. My question is what else can we do to help him? We are both afraid. XXXXXXX

10/24/2017

Wow, thank you for the follow-up, Dr. XXXXXXX After 6 weeks on Wellbutrin with no response, my son's psychiatrist changed his med to effexor, but with no anti-manic component. She would not prescribe an OFC, because she felt the health risks were too great for a healthy 26 yr old (?). He's been taking the effexor for about 10 days, one week 37.5 mg, then increased to 75 mg daily. I think I see a little bit of improvement but without some kind of mood regulation I'm afraid he might shoot through to mania again. I hate this this wait-and-see mode and the attitude that the most effective treatment should be the treatment of last resort. It's like treating someone with cancer with vitamins and acupuncture instead of chemo because they have "less side effects." Anyway, if you have any more to add, I'd appreciate hearing from you.

Best Regards,
XXXXXX
YYYY@YYYY

Answered by Dr. Dr. Ashok Kumar Choudhary (49 minutes later)

Brief Answer:
What about the lithium

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

I completely agree that in severe depression wait and watch must be the last resort rather than the first one. I also agree that OFC have its side effect but they are never universal. However being a online psychiatrist I have no authority to guide the treating psychiatrist and will prefer not to intervene in his mode of treatment. At the same time I like to state that the guidelines never recommend antidepressant without mood stabiliser once the diagnosis of bipolar disorder is established as it increases risk of rapid cycling.

Now regarding the further course of action if the lithium is still the part of treatment there is nothing to worry as it acts as anti manic medication. Truly speaking lithium is gold standard among anti manic medications.

In case lithium is not the part of treatment close observation at your end and regular visit to his psychiatrist can supplement the need of anti manic medication to some extent.

For a 26 year young man irritability is most important sign of mood switch provided it starts after the starting or increasing the dose of venlafaxine. This should be observed and if you see significant changes in irritability please discuss with his psychiatrist without much delay.

I hope this helps you.
Thanks again.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar