Has anyone has any success with the serotonin reuptake treatment option?. As you know i am trialing sodium channel blockers and seeing subtle changes especially in cramps. As the 2 are compatible I have decided to also start SNRI therapy taking Venlafaxine(Effexor) at 75 mg day increasing up to 375 mg day.
Be interesting to hear your experiences or views.
Lets keep sharing and moving forward
Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs increase serotonin and norepinephrine in the nervous system and provide substantial benefit for some EM patients. Effexor (venlafaxine) has been reported many times in medical journals to help EM, but it fails sometimes too. Cymbalta (duloxetine) has also provided benefit for many.
Serotonin Reuptake Inhibitors (SSRIs)
This group increases serotonin in the nervous system. There are a handful of case reports of benefit with sertraline (Zoloft), fluoxetine (Prozac), or paroxetine (Paxil). For Tramadol (Ultram), which increases serotonin by the different mechanism, there is one report of benefit.
Article from Dermatology Times.USA.
By: Cheryl Guttman
Venlafaxine improves primary erythromelalgia
New Orleans - Results from an open pilot study indicate venlafaxine
(Effexor), a combined norepinephrine and serotonin reuptake
inhibitor, may be a safe and effective treatment for primary
erythromelalgia, Ali Moiin, M.D., and Sharam S. Yashar, M.D., said at
the annual meeting of the American Academy of Dermatology.
They presented their experience using venlafaxine 37.5 mg BID to
treat 10 subjects. A diagnosis of primary erythromelalgia was
established after investigations to rule out other causes for the
patients' signs and symptoms, and all existing medications being used
for their condition were withdrawn.
At one week after starting treatment with venlafaxine, marked
improvement, in the range of 30 percent to 40 percent, was noted by
the investigators in the severity and extent of skin warmth and
erythema, and the patients reported reduction of symptoms of pain and
burning as well. Further benefit was gained with continued treatment,
and by two months, some patients were rated as improved 80 percent
These favorable responses occurred with minimal side effects. Two
patients developed nausea and one patient discontinued treatment due
to drowsiness. Currently, six patients are being followed on chronic
treatment that ranges from six months to four years in duration and
they are continuing to derive benefit and are very satisfied as well,
said Dr. Moiin, clinical assistant professor of dermatology, Wayne
State University, Detroit, and president, Comprehensive Dermatology
"A variety of medications can be used to treat primary
erythromelalgia, including aspirin, gabapentin, opiates,
benzodiazepines, and amitriptyline. The response to those agents is
variable and importantly, they are associated with significant side
effects. Venlafaxine appears to perform well relative to those
options in terms of efficacy, but it has the advantage of offering a
more favorable safety profile with long-term use,"said Dr. Moiin. "No
conclusions can be drawn from this small, open-label trial, and we
cannot rule out the possibility of a placebo effect. However, based
on venlafaxine's promising potential for efficacy and safety, we plan
to conduct a randomized, double-blind, placebo-controlled study with
more objective measurements to document clinical improvement. The
limiting factor in conducting that trial will be our ability to
recruit patients with this relatively rare disorder."
Venlafaxine is approved for the treatment of depression, and has been
used as well for the management of obsessive-compulsive disorder and
anxiety. The 75 mg/day dose that has been effective in the patients
with erythromelalgia represents the recommended starting dose for
antidepressant treatment with venlafaxine. Its maximum recommended
dose is 375 mg/day.
Dr. Moiin noted he was prompted to try venlafaxine to manage
erythromelalgia based on a published report describing success in two
patients. Previously, he had prescribed serotoninergic
antidepressants, including paroxetine (Paxil) and fluoxetine
(Prozac), for some patients with erythromelalgia, but found those
agents were ineffective. Based on that experience, Dr. Moiin and Dr.
Yashar postulate the noradrenergic activity of venlafaxine is
important in its efficacy.
"The pathogenesis of primary erythromelalgia is not known for
certain, but histologic studies of affected skin show evidence of
decreased sympathetic innervation and deficient sympathetic
regulation. By inhibiting norepinephrine reuptake, venlafaxine may
address those defects," said Dr. Yashar, dermatology resident at
Henry Ford Hospital, Detroit.
Via its serotoninergic effects, venlafaxine could alter platelet
function and reduce platelet plug formation that might contribute to
symptoms of erythromelalgia.
Anticoagulant effects pull trigger
"There is thought that erythromelalgia-associated pain might arise
from clumping and coagulation of platelets in the small vessels of
the extremities. In fact, it is believed that the benefit associated
with aspirin treatment is due at least in part to its anticoagulant
effects. Studies with venlafaxine and selective serotonin reuptake
inhibitors show they can affect platelets, and perhaps the activity
of venlafaxine is mediated at that level as well," Dr. Yashar said.
Dr. Moiin proposed that the mechanism of venlafaxine's efficacy might
also be secondary to some effects at the level of the central nervous
system and not due wholly to peripheral activity.
"Recent studies report a role of venlafaxine in treating hot flashes
in postmenopausal women and in men receiving hormonal ablation
therapy for prostate cancer. Those findings would suggest venlafaxine
can affect the peripheral vasculature through a central mechanism,"
Dr. Moiin said.
Effexor is a product of Wyeth-Ayerst. Neither Dr. Moiin nor Dr.
Yashar has any financial interest in the product. DT