Posted by Molybdenum on June 24, 2008, at 23:19:10
In reply to Re: ok what to add to the cocktail effexor*Trazodo, posted by shadowmon on June 24, 2008, at 2:39:10
> I am wondering though they keep on telling me that when you go up on the higher dosage of effexor, it starts to affect norepheneprhine and dopamine?
Hi shadowmon,
Venlafaxine (Effexor) is thought of as a potent serotonin-norepinephrine reuptake inhibitor (SNRI). Apparently it does have a very slight ability to inhibit the reuptake of dopamine too, but it's not significant. And I can't find ANY references in the data I have to indicate that it affects one neurotransmitter more than the other at different doses. Some ADs DO have this trait - but I don't believe venlafaxine is one of them.
If you want to kick your dopamine up, I think Bupropion (Wellbutrin) is a popular choice. It's classed as a norepinephrine and dopamine reuptake inhibitor.
I believe that it is a widely accepted idea that serotonin, norepinephrine (aka noradrenaline) and dopamine are the main neurotransmitters that seem to be involved in depression. (BTW, my pdoc believes that these 3 are just the tip of the iceberg.)
So in general, taking drugs that (one way or another), increase the amount of these neurotransmitters in your head, is thought to be an appropriate angle of attack in the battle against depression. Anecdotally, many people also find stimulants and opiates help them overcome depression too. Western doctors are a bit squeamish when it comes to controversial matters, so it's less often you'll hear of them using these - especially opiates. Maybe that's unfair. Truth is that these drugs can easily cause you more harm than good. Hippocrates is credited with the saying "...make a habit of two things to help, or at least to do no harm." And I appreciate doctors who respect this idea.
I don't think anybody yet knows why some people respond to one AD & not to another. The best you can hope for from your doc is that he/she chooses one that they believe is most likely to work. If it doesn't start to relieve your depression in "x weeks", the doc may want to wait a little longer, increase the dose, switch to another type in the same class, switch to an entirely different class or augment your current med with a second one.
Therefore there's an almost infinite number of "treatments" available. So a good doc will try you on ones that they have commonly seen working for more people than not. Each drug comes with it's own mix of side effects, some of which will pass in a week or two, some of which you may find intolerable, some you are prepared to tolerate and some you might like! So your feedback to the doc will influence their choice too.
So my point (here it comes) is that there's no clear right & wrong treatments within the mainstream approaches. And once you get on a drug or a combination that subjectively makes YOU feel better, that's the place to stop - or at least it's an important milestone & somewhere from which to rest and maybe "fine tune" your treatment further. And I am sure that although venlafaxine & mirtazapine is working very well for me, there's probably numerous other combos that would work just as well. It's just impractical to try them all - we won't live long enough...! Plus it's pointless too. If you feel OK, then that's what matters. And given that my combo is working for me, it would be stupid to make any major changes when basically the only direction for me to go is "worse"..!
My depression made me feel very suicidal, and I didn't like that at all. So I was thinking "damn the side effects, just give me a big dose of something that works well for more people than not". That's why I'm on the rocket fuel.Man....sorry for typing such a huge blob. Hope somebody gets something out of it.
Take Care & good luck.
Mr. Molybdenum
poster:Molybdenum
thread:836131
URL: http://www.dr-bob.org/babble/20080617/msgs/836323.html