High Blood Pressure with Effexor

The following comment/question brings up a number of issues that are important.  I reprint the following without editing . . .   

I have been on effexor xr for a long time. it’s the only thing that works.

I recently spiked a high BP. I thought I might be going through perimenpausal symtoms. I think my BP went up because I took an herg to clear my skin called seabuckthorn. Well, I thought I researched it good. It is abundant in 5HTP. So i mixed the two not knowing it. never the less , My dr took me off effexor xr, my dose was 300mg. Now I am on Celexa, it is terrible. I have migrianes, chest pain, tired . dizzy , want to sleep .I am on 80mg. still have signs of depression. Migrianes. Effexor never did this. can he up the dose anymore and try it at night. We just went to 80mg 4 days ago. Does Celexa take a longer time to work? I hate it. I am on BP medication toprol XL . not helping with angina or migrianes either. also take clonzepam. 3 mg a day . I have under alot of stress lately with my 15 yr old daughter who has attempted suicide 3 times. She is always keeping me going. I take fish oil , vitamins, trying to eat better.feel like it wears off. and them I am up getting a loritab for the pain. half of a 5/5 to sleep. tranq don’t work anymore have to go for higher dose. with effexor only a little tranq. I think the stress made my blood pressure go up. I have OCD and PTSD. This celexa stinks . I was told I should have tried lexapro. it is newer. But the same effects? never had to many effects with effexor. Worked quick. Boy I suffered after mixing 5htp with effexor. I was on smaller dose of effexor . was trying to get off.rihgt now it not a good time. Would like to try 5htp . felt good for about 4 days and then went into seratonin syndrome with effexor. Which probably made bp go up to. plus seabuck has high level of vit E. I noticed that my left foot started to blow up. I gues there are some people who can only take dry E. I know you have to introduce E slowly. Take 200 mg right now. hope to get up to 400mg a day. I am a mess. thanks for the help. miss the effexor. it worked.  –LA

First and most important, what is with the chest pains? You and your doctor must be 100 % certain sure they are not cardiac pains.  If that is not the case, you need to go to have a full cardiac work-up to make sure.  I’ll proceed from here assuming the chest pain is non-cardiac.  For me, the answer here lies in the first sentance . . . “the only thing that worked was Effexor”.  So many times we try to re-invent the wheel.  If you did well on the Effexor for a long time and only got significant side effects when the herbal preparation was added, you deserve a new trial of the Effexor.  You should be free of confounding factors (no more herbals for now) and you should have your BP checked at regular intervals.  The dose of Celexa that you are taking is too high for my comfort (40 mg is the typical top dose) and, anyway, isn’t doing a thing for you.  You sound like you are a mess.  You mentioned Lexapro.  It is doubtful that switching from the high dose of Celexa to Lexapro is likely to do anything more for you than Celexa.  Think receptors . . . high doses of Effexor hits two receptors (serotonin and norepinephrine).  Celexa and Lexapro only hit serotonin, no matter what the dose.  An option might be Cymbalta (also a dual-acting agent), but, again, why try to reinvent the wheel.  If Effexor worked really really well in the past, I would try that first.  While Effexor can increase blood pressure, anti-hypertensives are protective against that.  If your BP is currently controlled, you are still a candidate for Effexor. 

Another observation, I would suggest that EVERYONE let their doctors know about herbal preparations that they are considering trying.  Just because they are “natural” does not mean they are safe, especially when taken with other pharmaceuticals.  If the doctor does not know what to tell you, then you need to do more homework and educate your doctor.  Chances are, you may still get a blank stare (we are not taught about herbal preparations at all in medical school) but at least you educate yourself and the doctor, and you might (maybe) avoid a situtation like this in the future.

–Dan Hartman, MD

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