Posted by Ron Hill on January 5, 2002, at 16:14:18
In reply to Effexor Ex and Nicotine Patch HELP, posted by NatA on January 3, 2002, at 19:19:51
Nat A,
I also recently used the patch to quit smoking and I take medication (600 mg/day Lithobid) to treat bipolar disorder. The rage I experienced during this time was very scary. My poor wife!
Here is my layman's partial interpretation of what might have caused my foul mood: As I understand it, nicotine affects the level of norepinephine in the brain (perhaps the main reason people continue to smoke). As changes in nicotine blood levels occur due to smoking cessation activities, norepinephine levels are also affected (at least temporarily).
As an aside, even if nicotine blood levels are held constant, the particular type of nicotine delivery system (i.e. patch vs. smoke inhalation) also seems to influence the nicotine/norepinephine biochemical interaction. I might be wrong on this one but it sure seemed like it to me?
Getting back on topic, I personally think my rage mood was a function of the serotonin/norepinephine balance in my brain rather than just the raw quantity of norepinephrine.
My pdoc and I successfully treated this rage condition by adding a small amount of an SSRI (25 mg Zoloft). As I had fully anticipated, based on my prior experiences with other SSRI's (Prozac and Paxil), my rage mood disappeared on the first day of the low dose Zoloft trial. However, even at this extremely low dose, Zoloft rendered me totally unmotivated, void of enthusiasm, and emotionless after just one week of the trial.
This also did not surprise me since Paxil and Prozac had the same effect. SSRI's turn me into what my wife affectionately refers to as her "do nothing boy". In my "SSRI brain chemistry state" I'm content and peaceful with no hint of rage, but the most I can motivate myself to do is veg out on TV 24/7.
So I took myself off the Zoloft and within a day was experiencing SSRI withdrawal which, for me, includes what I call a "one-quart-low serotonin depression" lasting about a week this time. The reason I mention all this is because I fully expected the rage to return after going off the SSRI. But it did not! By the time the one week Zoloft trial and one week SSRI withdrawal time periods had elapsed, I had weaned myself off the nicotine patch. (I use scissors to cut full strength patches into progressively smaller and smaller pieces so as to taper the nicotine dose, and I use athletic tape to secure the properly sized patches to my wrist). In the absence of a nicotine addiction and/or nicotine intake, the rage mood disappeared.
I've rambled here, but the bottom line is that, for me, once the nicotine was out of my system, the rage was gone as well. I wish you success with your nicotine withdrawal and your mood!
-- Ron
PS As you probably know, Effexor is a Selective Norepinephrine Reuptake Inhibitor (SNRI). The smoking cessation medication Zyban (identical to the AD Wellbutrin) is a reuptake inhibitor of dopamine and Norepinephrine and is thought to be effective because it offsets the decline in brain levels of Norepinephrine caused by nicotine withdrawal. Although this mechanism may be overly simplistic, if increasing Norepinephrine does indeed aid smoking cessation then Effexor should also help smokers quit. At the same time, increasing Norepinephrine will almost certainly not reduce rage but instead may very well cause rage to escalate. Having said all this, everyone one is different and, therefore, your mileage may vary.
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Hello,
> I have been taking effexor ex for the past 4 months with nice results. Lately life has not been so nice and added a ton of stress and crisis to my life. I also quit smoking with the help of the nicotine patch. YIKES!! The patch says that it can cause panic attacks and anxiety for people who take meds for depression.. Bingo, that would be me.. I also have gad. Since I have never "really" tried to quit smoking before for more than a day.. I am on day 12 right now, I don't know what I am feeling is normal or not. I feel like a raging mad woman. I wake up with my insides so wound up that I feel as though I might explode, very anxious, nervous, full of rage, .. basically like a bitch on wheels. I am not sure if it is the stopping smoking, the effexor and the patch or what!! Anyone with any help or ideas or stories.. I would be greatful. I have resulted in taking some adivan durring the day just to survive. I hate this feeling and need any thoughts you guys have for me. Thanks so much!!
> Nat
poster:Ron Hill
thread:13781
URL: http://www.dr-bob.org/babble/20020103/msgs/88889.html