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  #1  
Old 10-07-2010, 06:45
AlexaN AlexaN is offline
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Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania??

Hi All,

Has anyone experienced bad side effects during the combination of those two?

One psychiatrist told me it may cause psychosis or mania and the other one claims it's very rare and one should not be worried about it if one does not have "Schizophrenic Tendencies". That's a quote.

What do you say?

Last edited by AlexaN; 29-08-2010 at 20:06.
  #2  
Old 10-07-2010, 13:19
Amnesia Amnesia is offline
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Re: Effexor XR 225 mg + Ritalin IR= psychotic episode / mania??

Neon-Blue has no experience of combining these two medicines but she can say with confidence that the second psychiatrist is talking shite.

Methylphenidate hydrochloride (Ritalin) and venlafaxine (Effexor), and other pharmaceutical amphetamines and antidepressants, when taken individually and as prescribed, can cause mania and/or psychosis in individuals with no previous history of psychotic or bipolar symptoms – they are listed as side effects in the British National Formulary (a reference book of medicine used by British doctors). It is also worth noting that mania is predominantly a symptom of bipolar disorder (manic depression) NOT one of schizophrenia, the presence of non-drug induced mania in psychotic illness is almost always due to a form of bipolar disorder.

It is possible that combining these medicines may cause mania and/or psychosis and there is no way to tell whether this will happen to SWIY due to individual variations in physiology, chemistry etc.
Finally, venlafaxine is notorious for its association with serotonin syndrome and taking amphetamines with serotonergic antidepressants is a common cause of this potentially fatal reaction (please see this post for more information).

If SWIY is thinking of combining these medicines for mental illness, such as treatment resistant depression, it should be done under medical supervision to minimize the risks and spot any adverse reactions as quickly as possible. Neon-Blue would recommend avoiding recreational use of any amphetamines whilst SWIY is taking venlafaxine.

Neon-Blue hopes this has been helpful.

Last edited by Amnesia; 10-07-2010 at 14:25.
  #3  
Old 10-07-2010, 22:59
zeno zeno is offline
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Re: Effexor XR 225 mg + Ritalin IR= psychotic episode / mania??

SSIR's and SNRI's can also cause mania in individuals who have been incorrectly diagnosed with Major Depression instead of Bipolar Disorder. Has SWIY ever had manic or hypomanic symptoms before? Does Bipolar run in the family? Does SWIY typically take 225mg of venlafaxine daily? How much methylphenidate hydrochloride was taken? Venlafaxine does have an activating component for some folks which is why most doctors prescribe it to be taken in the morning.

There are a lot of unknowns.
  #4  
Old 10-07-2010, 23:33
AlexaN AlexaN is offline
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Re: Effexor XR 225 mg + Ritalin IR= psychotic episode / mania??

Quote:
Originally Posted by zeno View Post
SSIR's and SNRI's can also cause mania in individuals who have been incorrectly diagnosed with Major Depression instead of Bipolar Disorder. Has SWIY ever had manic or hypomanic symptoms before? Does Bipolar run in the family? Does SWIY typically take 225mg of venlafaxine daily? How much methylphenidate hydrochloride was taken? Venlafaxine does have an activating component for some folks which is why most doctors prescribe it to be taken in the morning.

There are a lot of unknowns.
Well, SWIM is diagnosed with chronic major depression. It started in the early teenage years.
Never had manic or hypomanic symptoms before, no bipolar in the family.
Used to take 150 mg of Effexor...the psychotic episode occured 3 days after the dose was increased to 225 mg...and actually, the amount of Ritalint aken on that day was quite high...higher than the 60 mg daily SWIM was prescribed.
But it was not taken all at once, it was taken in small doses within 24 hours.
Maybe that explains it...
The thing that scared SWIM the most was the thought that it might happen again even with a lower Effexor dose...
SWIM is back on 150 mg again. No more 225 mg for her.
  #5  
Old 11-07-2010, 02:32
zeno zeno is offline
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Re: Effexor XR 225 mg + Ritalin IR= psychotic episode / mania??

A garden snail thinks you should speak to your doctor - the snails first hunch is similar to Amnesia's in serotonin syndrome or the combination of too much of a stimulant plus an increase in the Effexor.

Serotonin Syndrome is a very serious deal and can be life threatening, this snail would avoid any intoxicating drugs that have the risk until you speak with SMIY doctor.


Last edited by Jatelka; 11-07-2010 at 05:08.
  #6  
Old 12-07-2010, 23:55
DextroClonazyCodone DextroClonazyCodone is offline
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

SWIM would say it is very rare. No one really knows what causes mania. Some say serotonin, some say norepinephrine, others dopamine. Still others say glutamate imbalances.
What SWIM is saying, is that, while rare, it could occur. The main culprit would be the Effexor more than the MPH, though. Effexor is a very powerful antidepressant, in fact, after Remeron, it is cited as the most effective. And, any bipolar person should know that antidepressants can cause mania. Effexor is notorious for it.
As for MPH, it would be very unlikely to induce mania. In fact, ADHD and bipolar disorder are hypothesized to have similar roots, and thus a medicine for ADHD would be unlikely to trigger mania. Also, know that Buproprion, another NDRI, is the first choice of antidepressant for bipolar folks.

SWIM's summary- go down on the Effexor. It gave SWIM troubles. He also took it with a stimulant. Now, he is almost off of Effexor and the stimulants have not caused any cycling/mania.
  #7  
Old 13-07-2010, 12:46
AlexaN AlexaN is offline
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

Quote:
Originally Posted by DextroClonazyCodone View Post
SWIM would say it is very rare. No one really knows what causes mania. Some say serotonin, some say norepinephrine, others dopamine. Still others say glutamate imbalances.
What SWIM is saying, is that, while rare, it could occur. The main culprit would be the Effexor more than the MPH, though. Effexor is a very powerful antidepressant, in fact, after Remeron, it is cited as the most effective. And, any bipolar person should know that antidepressants can cause mania. Effexor is notorious for it.
As for MPH, it would be very unlikely to induce mania. In fact, ADHD and bipolar disorder are hypothesized to have similar roots, and thus a medicine for ADHD would be unlikely to trigger mania. Also, know that Buproprion, another NDRI, is the first choice of antidepressant for bipolar folks.

SWIM's summary- go down on the Effexor. It gave SWIM troubles. He also took it with a stimulant. Now, he is almost off of Effexor and the stimulants have not caused any cycling/mania.
Thanks, I am now back on 150 mg instead of 225 mg and so far no delirium, psychosis signs etc.
Maybe 225 mg is indeed too much...

Last edited by AlexaN; 29-08-2010 at 20:07.
  #8  
Old 16-07-2010, 16:45
Amnesia Amnesia is offline
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Re: Effexor XR 225 mg + Ritalin IR= psychotic episode / mania??

A person doesn’t have to suffer from bipolar disorder to have a manic reaction to drugs/medicines. The defining factors of drug induced mania/psychosis are that the symptoms remit when the substance(s) are withdrawn, and that the symptoms do not occur organically. Manic/psychotic reactions can even occur in people with no mental health problems at all.

Without knowing exactly how much methylphenidate SWIY took, and what SWIY’s symptoms and their duration were, Neon-Blue would be inclined to believe that the main culprit was the amphetamines, especially as SWIY states:
Quote:
Originally Posted by AlexaN View Post
...and actually, the amount of Ritalint aken on that day was quite high...higher than the 60 mg daily SWIM was prescribed.
But it was not taken all at once, it was taken in small doses within 24 hours.
She saw this while reading and thought SWIY might be interested:
Quote:
Drug induced psychosis is common among individuals taking large doses of amphetamines (over 50mg per day). Such psychosis may resemble paranoid schizophrenia with persecutory delusions despite a clear sensorium. Hallucinations are common. Usually the psychosis subsides 1 or 2 weeks after use of the drug stops.

North, C.S. & S.H. Yutzy. 2010. Goodwin & Guze’s Psychiatric Diagnosis (6th Ed.)
Neon-Blue says if it had happened to her she wouldn't worry too much unless the symptoms occurred when she wasn't taking any medicines/drugs, she would just avoid mixing so much MPH with venlafaxine again.


@ DextroClonazyCodone

Although Neon-Blue is inclined towards the spectrum theory of mental illness she believes it is incorrect to state that, because manic depression and ADHD may share similar roots, mania is unlikely to be triggered by amphetamine use. Amphetamine use is known to trigger manic episodes:
Quote:
An underlying bipolar illness may be precipitated by alcohol or drug use. For example a first manic episode in a biologically vulnerable individual may be triggered by hallucinogen or stimulant abuse.
* * * * * * * *
A number of case reports suggest stimulants can induce manic and hypomanic states. In one open case series, when methylphenidate was added to an existing mood stabilizer.... 20% of patients dropped out because of hypomania or anxiety/agitation.

Goodwin, F.K. & K.R. Jamison. 2007. Manic Depressive Illness: Bipolar Disorders and Recurrent Depression.


Post Quality Evaluations:
excellent, helpful, well-researched (& sourced!) posts in this thread for the OP. well done!
  #9  
Old 16-07-2010, 20:26
DextroClonazyCodone DextroClonazyCodone is offline
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

Amnesia: SWIM's psychiatrist (probably the most respected in the county he lives in) told him that it is complex using stimulants for bipolar. They work very well if the patient is monitered in their symptoms. For bipolar depression they are essentially a cure-all and will not cause mania. However, if a person is IN a mania, stimulants just amplify the behavior. For mixed states, they may be beneficial, as they reduce aggression and lack of focus. So, the key to using stimulants in BP people is to use other options first, but if needed, use them with a mood stabilizer in high doses (like Lithium, lamotrigine, etc.).

It works for SWIM.
  #10  
Old 15-08-2010, 08:29
Amnesia Amnesia is offline
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

Neon-Blue says she doesn’t claim that pharmaceutical amphetamines have no place in the treatment of depression; the evidence shows that they can be helpful for those suffering from treatment-resistant depressions.

Quote:
Originally Posted by DextroClonazyCodone View Post
For bipolar depression they are essentially a cure-all and will not cause mania.
This statement, however, is contradicted by the evidence from clinical studies. The study she previously quoted, with a switch rate of up to 20%, was performed on bipolar patients suffering from a depressive episode. She says, if she remembers correctly, all of the studies performed on the adjunctive use of MPH for bipolar disorder were performed on patients suffering from a depressive episode –after all, no sane doctor would give an amphetamine to a manic person unless they wanted them to die from manic exhaustion.

The studies that have been performed on the use of pharmaceutical amphetamines in treating bipolar disorder have, to date, been of limited size and often have no controls, so it is far too early to make any conclusions regarding their use. Large scale, controlled trials are needed, and certainly before such a claim could be made.

Last edited by Amnesia; 15-08-2010 at 10:32. Reason: typos
  #11  
Old 29-08-2010, 19:57
C.D.rose C.D.rose is offline
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

just to add to the experiences of venlafaxine plus methylphenidate, in an individual with unipolar, non-psychotic, treatment-resistant depression..
SWIM is on 600mg/d of venlafaxine and has been taking methylphenidate for the past two weeks, starting at 5mg/d, he now is at 25mg/d, and he doesn't notice anything.. no change in mood, no improvement in mood, certainly no mania and no psychosis.. he will probably increase it up to 40mg/d, and if it won't do anything, the stimulant option appears to have failed to..
  #12  
Old 29-08-2010, 20:02
AlexaN AlexaN is offline
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

Quote:
Originally Posted by C.D.rose View Post
just to add to the experiences of venlafaxine plus methylphenidate, in an individual with unipolar, non-psychotic, treatment-resistant depression..
SWIM is on 600mg/d of venlafaxine and has been taking methylphenidate for the past two weeks, starting at 5mg/d, he now is at 25mg/d, and he doesn't notice anything.. no change in mood, no improvement in mood, certainly no mania and no psychosis.. he will probably increase it up to 40mg/d, and if it won't do anything, the stimulant option appears to have failed to..
SWIM's dose of Ritalin is much higher than yours...and she is extra sensitive to meds.

600 mg of Effexor???
Have never heard of such monsterous dose.
Doc told SWIM he never recommends more than 375 mg daily.

Which Ritalin is SWIY trying? IR?
There is always the option to try Ritalin LA or Concerta.
Works better for some people.
SWIM tried all of them.
  #13  
Old 01-09-2010, 09:57
C.D.rose C.D.rose is offline
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

yeah, of course, SWIM wasn't going to question your experience, or that it is due to methylphenidate.. he just wanted to add that the combination is not necessarily dangerous per se, in case other people might search for information on this combination, so that they won't be too scared to give it a try if that's what their doctor suggests.

as for the 600mg of venlafaxine:
yeah, 375mg/d is the maximum dose as indicated by the manufacturer (wyeth). there are a number of case reports where patients with treatment-resistant depression actually achieved remission with higher doses (up to 600). this is obviously not possible for many, because side effects are too strong at or even below 375mg, but if this is not the case, going above 375mg can be considered. of course, attention must be paid to blood pressure development, as well as liver functioning due to its hepatotoxicity.

it does not work for SWIM though, and he will soon reduce it to try something else instead: possibly clomipramine, or an MAOI (tranylcypromine).

Post Quality Evaluations:
Good explanation of just what was meant. Informative especially about dosage of venafaxine.
  #14  
Old 06-09-2010, 03:16
zeno zeno is offline
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

Quote:
Originally Posted by AlexaN View Post
SWIM's dose of Ritalin is much higher than yours...and she is extra sensitive to meds.

600 mg of Effexor???
Have never heard of such monsterous dose.
Doc told SWIM he never recommends more than 375 mg daily.

Which Ritalin is SWIY trying? IR?
There is always the option to try Ritalin LA or Concerta.
Works better for some people.
SWIM tried all of them.
Most family physicians will not go above 300mg of effexor. This is why psychiatrists have higher liability insurance because they are willing to push the envelope.
  #15  
Old 08-10-2010, 06:02
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Re: Effexor XR (Venlafaxine) + Ritalin (Methylphenidate) = psychotic episode / mania?

One of if not THE worst experience SWIM has ever had was taking 3 unknown mg Effexor pill with lingering amphetamine from adderal the previous day. Basically come up was happy then it all hit while doing bongloads on the side of SWIMs house and SWIM had a full blown salvia flashback and left reality according to SWIMs friends the only things SWIM was saying was "I'm on salvia! I freak out when im on salvia" then SWIM blacked out of reality and came to mid-sentence screaming "take me to the hospital!" (very trippy coming to mid-sentence) after another 15 minutes SEVERE derealization started hitting and SWIM began thinkin he would unthink his own existence and that nothing else was real anymore. Almost suicidal at this point SWIM thought his only chance was to get the the hospital so leaving his friends inside his room and front door wide open music blasting just started walking to the hospital SWIMs friends trying to stop him (probably watching their own asses some friends). Also I must mention the hospital was a block away and about half-way there SWIM completely blacks out of reality again and come to with his friends standing around him and not knowing who they were. VERY scary. somehow SWIM knew he needed to get to the hospital and from there SWIMs memory gets fuzzt but I guess SWIM ran across the street hit his face on the window of a car and had a full blown seizure for over a minute. during which was the most intense psychedelic experience of SWIMs life where complete synesthesia happens where not just two senses blended (like on acid) but EVERY sense blended along with all sorts of SWIMs past memories all going very fast and much more that is beyond words. but yeah basically SWIM almost died, ended up in the hospital, scared the shit out of himself his family and his friends and didnt have a very good time. NOT recommended.

anarchyangel added 4 Minutes and 11 Seconds later...

oh and SWIM realizes it was adderal that caused this but they are both psycho-stimulants so i figured id share my input

Last edited by anarchyangel; 08-10-2010 at 06:02. Reason: Automerged Doublepost

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depressive disorder, drug-resistant depression, refractory depression, snri, snri interactions, treatment-resistant depression

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