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Dr. Bob is Robert Hsiung, MD,
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Posted by bleauberry on October 16, 2010, at 5:28:22
In reply to Effexor: is it worth it?, posted by orbital on October 16, 2010, at 0:06:40
I think a good approach would be to closely inspect what meds and combos you have done thus far, and then make choices that are not close repeats of those. For example, someone who has tried several SSRIs, but none of them in combination with Nortriptyline, Desipramine, or Ritalin, I think would have much better potential by doing that instead of taking on an SNRI like Effexor. Which with very little effect on NE really is a stretch to call it a SNRI anyway.
That said, Effexor does once in a while prove to be a magical drug for some people. Even the lowest dose of 37.5mg has worked great for some.Statistically speaking, effexor has no more of a chance of getting you well than anything else. You could pretty much flip a coin blindly. Some studies show it about the same as other meds, with some studies showing it a few percentage points better....either way, in the same ballpark as all the others. It's a risk/benefit choice.
If you have not had experience with the plants of the world, I would try Rhodiola Rosea, St Johns Wort, or SAMe (all three separately) before venturing deeper into the treacherous psychiatric world. Rhodiola or SAMe work especially fast, which is something you need. So you don't need to devote as much time to trials as you do on pharmaceuticals. All three of them have a multitude of other biological benefits to them, making them healthy depression choices.
If you want an SNRI (assuming you do since you are considering effexor), then instead do Zoloft+Nortriptyline.
The plants first.
Effexor last.
IMO.
Posted by SLS on October 16, 2010, at 6:31:41
In reply to Re: Effexor: is it worth it?, posted by bleauberry on October 16, 2010, at 5:28:22
> Statistically speaking, effexor has no more of a chance of getting you well than anything else.
http://www.biopsychiatry.com/veneffex.html
http://bjp.rcpsych.org/cgi/content/full/178/3/234
There are more.
Venlafaxine is not a perfect drug, of course, but studies have indicated that it will get more people well than SSRIs, and that the quality of response is greater. Studies are not perfect either. I would want to do more research before guaranteeing somebody that all antidepressants are therapeutically equivalent.
- Scott
Posted by SLS on October 16, 2010, at 6:35:50
In reply to Effexor: is it worth it?, posted by orbital on October 16, 2010, at 0:06:40
> So I've searched for info on Effexor here at Babble, and keep pulling horror stories.
Are the horror stories related to ongoing treatment with Effexor or its withdrawal effects?
> Is this med effective or, at the very least, even worth considering?
I think Effexor is worth considering, particularly if you have exhausted alternatives.
Tricyclics? MAOIs?
- Scott
Posted by linkadge on October 16, 2010, at 8:51:25
In reply to Re: Effexor: is it worth it?, posted by SLS on October 16, 2010, at 6:31:41
Some studies have doubted whether there really is a efficacy advantage to "dual acting" agents.
I didn't mind venlafaxine, but I couln't get beyond 37.5mg. At 75mg my heart always felt overworked and I had a tight chest feeling.
Linkadge
Posted by SLS on October 16, 2010, at 9:33:23
In reply to Re: Effexor: is it worth it?, posted by linkadge on October 16, 2010, at 8:51:25
> Some studies have doubted whether there really is a efficacy advantage to "dual acting" agents.
There are a few commentaries questioning the work that was done 10 years ago.
Effexor did more for me than any SSRI. It's too bad that the potential of having severe withdrawal reactions with Effexor must complicate the decision-making process.
- Scott
Posted by orbital on October 16, 2010, at 11:14:24
In reply to Re: Effexor: is it worth it? » orbital, posted by Phillipa on October 16, 2010, at 0:38:45
Thanks for the info, Phillipa :) I did fine taking just Klonopin for a year, until my former doc talked me into adding an AD. And so it began.
> Personally when it came out four days was all I could handle. My neighbor about a year ago was on it for a while and had horrible withdrawal coming off it she is never taking an ad again. She just takes xanax. She's a teacher and very high functioning. You might babblemail dancingstar as she will answer. Just talked with her Phillipa
Posted by orbital on October 16, 2010, at 11:20:46
In reply to Re: Effexor: is it worth it? » Phillipa, posted by floatingbridge on October 16, 2010, at 2:05:13
Hi FB :) I have no real reason to believe Effexor might work for me, I've just refused it every time my doc suggested it because the withdrawal sounds pretty terrible.
I wonder if people who use Prozac to wean off other meds take too low a dose. I know someone who quit Effexor by crossing over to 60mg Prozac for a week, then tapered off that - it worked fine for her.
> Orbital, I don't know for you.
>
> When I was younger, I had a good run with it. Withdrawal is noted to be horrible, and mine was, however, some people do not withdraw properly. They cold turkey it or their doctor doesn't believe how hard it can be, though I think they are generally now more savvy due to a trickle down effect of information.
>
> Why do you think effexor might work for you?
>
Posted by orbital on October 16, 2010, at 11:30:42
In reply to Re: Effexor: is it worth it?, posted by bleauberry on October 16, 2010, at 5:28:22
Bleauberry, mirtazapine is the one med that undoubtedly worked for me, I felt amazingly well on it. The effect was short lived though, just a week or so, and I was never able to replicate it.
I'm open to trying different approaches. I'm currently on escitalopram and sulbutiamine, but would gladly switch to something else. SAMe in particular sounds interesting, can it be added to SSRIs or -eventually- SJW?
> I think a good approach would be to closely inspect what meds and combos you have done thus far, and then make choices that are not close repeats of those. For example, someone who has tried several SSRIs, but none of them in combination with Nortriptyline, Desipramine, or Ritalin, I think would have much better potential by doing that instead of taking on an SNRI like Effexor. Which with very little effect on NE really is a stretch to call it a SNRI anyway.
> That said, Effexor does once in a while prove to be a magical drug for some people. Even the lowest dose of 37.5mg has worked great for some.
>
> Statistically speaking, effexor has no more of a chance of getting you well than anything else. You could pretty much flip a coin blindly. Some studies show it about the same as other meds, with some studies showing it a few percentage points better....either way, in the same ballpark as all the others. It's a risk/benefit choice.
>
> If you have not had experience with the plants of the world, I would try Rhodiola Rosea, St Johns Wort, or SAMe (all three separately) before venturing deeper into the treacherous psychiatric world. Rhodiola or SAMe work especially fast, which is something you need. So you don't need to devote as much time to trials as you do on pharmaceuticals. All three of them have a multitude of other biological benefits to them, making them healthy depression choices.
>
> If you want an SNRI (assuming you do since you are considering effexor), then instead do Zoloft+Nortriptyline.
>
> The plants first.
>
> Effexor last.
>
> IMO.
Posted by orbital on October 16, 2010, at 11:36:34
In reply to Re: Effexor: is it worth it? » orbital, posted by SLS on October 16, 2010, at 6:35:50
Scott, I've had trouble finding Effexor success stories, most tend to center on the withdrawal thing.
My experience with TCAs is limited, as I have very low blood pressure and the tricyclics really mess with that.
Might discuss MAOIs during my next appointment, while I'm at it.
> > So I've searched for info on Effexor here at Babble, and keep pulling horror stories.
>
> Are the horror stories related to ongoing treatment with Effexor or its withdrawal effects?
>
> > Is this med effective or, at the very least, even worth considering?
>
> I think Effexor is worth considering, particularly if you have exhausted alternatives.
>
> Tricyclics? MAOIs?
>
>
> - Scott
Posted by orbital on October 16, 2010, at 11:39:55
In reply to Re: Effexor: is it worth it?, posted by linkadge on October 16, 2010, at 8:51:25
Link, did the 37.5mg dose do anything at all for you? If I do wind up trying venlafaxine, I'd try to keep the dose as low as possible.
> Some studies have doubted whether there really is a efficacy advantage to "dual acting" agents.
>
> I didn't mind venlafaxine, but I couln't get beyond 37.5mg. At 75mg my heart always felt overworked and I had a tight chest feeling.
>
> Linkadge
Posted by linkadge on October 16, 2010, at 15:06:18
In reply to Re: Effexor: is it worth it? » linkadge, posted by orbital on October 16, 2010, at 11:39:55
Orbital, I never went above 75mg. Actually 37.5mg was not too bad. I felt pretty good on a cross taper between effexor and celexa. I wonder if a low dose of both would work for me.
Also, FYI I didn't have much withdrawl from effexor. I switched from 75mg of effexor to 50mg of zoloft in one swoop, no withdrawl, infact I felt better as my heart started to slow down over the next few days.
Linkadge
Posted by floatingbridge on October 16, 2010, at 15:17:29
In reply to Effexor: is it worth it?, posted by orbital on October 16, 2010, at 0:06:40
Orbital, I wanted to add some anecdotal info. I do know a few (maybe about 5) that do well on effexor. Side effects are intolerable for some--I did not experience them myself. Because I had done well on effexor in the past, we chose pristiq to which my response is less robust :(.
When I've considered trying an maoi, the pristiq withdrawal (really as bad as
effexor, though some docs don't know or acknowledge) has made the decision difficult. My doctor feels confident enough about doing it (prozac cross taper) but is concerned about my destabilization. It can be a lengthy taper done his way by the book. There may be other, faster ways. I don't know.
Posted by orbital on October 16, 2010, at 16:31:34
In reply to Re: Effexor: is it worth it?, posted by linkadge on October 16, 2010, at 15:06:18
Link, was the heart thing anxiety related?
I can usually handle side effects pretty well - GI problems don't bother me too much, ditto headaches, sexual stuff (couldn't care less!) fatigue, etc. But, along with emotional numbness, the one I simply can't tolerate is anxiety/insomnia. I do take clonazepam daily, but I'm trying to lower my dose, not up it.
I appreciate your reply :)
> Orbital, I never went above 75mg. Actually 37.5mg was not too bad. I felt pretty good on a cross taper between effexor and celexa. I wonder if a low dose of both would work for me.
>
> Also, FYI I didn't have much withdrawl from effexor. I switched from 75mg of effexor to 50mg of zoloft in one swoop, no withdrawl, infact I felt better as my heart started to slow down over the next few days.
>
> Linkadge
>
>
Posted by orbital on October 16, 2010, at 16:40:31
In reply to Re: Effexor: is it worth it? » orbital, posted by floatingbridge on October 16, 2010, at 15:17:29
FB, thanks for the info :)
I do know people who did well on Effexor, and came off it with little problems.
If you're going to do a Prozac taper, how will that affect your MAOI schedule? Will you have to wait for 6 weeks?
Personally, I think that docs aren't aggressive enough when using the Prozac taper method. For instance, I doubt that one 20mg dose will help much... Prozac is so weak to begin with, and its famed long half life only begins to occur after repeated doses (but not norfluoxetine's).
When I quit Paxil and.. Zoloft?... my doc gave me a good high dose of Prozac for several days.
Not sure if there's anything else involved in (des)venlafaxine's discontinuation that needs to be addressed, though.
> Orbital, I wanted to add some anecdotal info. I do know a few (maybe about 5) that do well on effexor. Side effects are intolerable for some--I did not experience them myself. Because I had done well on effexor in the past, we chose pristiq to which my response is less robust :(.
>
> When I've considered trying an maoi, the pristiq withdrawal (really as bad as
> effexor, though some docs don't know or acknowledge) has made the decision difficult. My doctor feels confident enough about doing it (prozac cross taper) but is concerned about my destabilization. It can be a lengthy taper done his way by the book. There may be other, faster ways. I don't know.
Posted by Lil'Deb on October 16, 2010, at 18:29:25
In reply to Effexor: is it worth it?, posted by orbital on October 16, 2010, at 0:06:40
Effexor did wonders for my depression for the first couple of years, then the effects decreased. I did try to go off the medication, but my anxiety and irritability increased, so I started taking it again. Starting the med was not easy - weird sensations and little sleep for the first 6 days after start, then after increase, which eased considerably. Only troublesome side effect has been increased sweating. Stopping the medication is difficult, but easier when weaned off slowly. Missing a dose can also cause mild *withdrawal* effect. Good luck~
Posted by floatingbridge on October 16, 2010, at 19:13:47
In reply to Effexor: is it worth it?, posted by orbital on October 16, 2010, at 0:06:40
Insomnia is/was exacerbated by effexor; a good concern to address.
Yeah, so my doc's would take about six weeks. That alone is enough to cause a mood destabilization :)
One *good* doc said it could be done more quickly. If I do decide, as much as I adore my personal pdoc, I'd have the other supervise.
Would you let us know what you decide and how it is going? Good luck to you :)
Posted by linkadge on October 16, 2010, at 20:31:37
In reply to Re: Effexor: is it worth it? » linkadge, posted by orbital on October 16, 2010, at 16:31:34
Effexor just made my heart beat faster. I was less anxious, generally, but there were still those cardiac effects.
Linkadge
Posted by Phillipa on October 16, 2010, at 22:08:11
In reply to Re: Effexor: is it worth it?, posted by orbital on October 16, 2010, at 11:14:24
Sorry late answer just home. But if you did well on klonopin for a year why did he add an ad as mine did the same only years later? Phillipa ps relief was what I felt when I stopped the 37.5 after four days. Just was glad to be off an ad again
Posted by Maxime on October 17, 2010, at 20:43:20
In reply to Effexor: is it worth it?, posted by orbital on October 16, 2010, at 0:06:40
I was on Effexor for a while in the 1990s. It stopped working for me and I had to change. No brain zaps coming off the med. I don't even know what a brain zap feels like but apparently they are the rage here on PB.
You have hit the bottom and you need to get out of that hole. You should try anything that might help you.
Bottom line ... YES, IT's WORTH IT.
Posted by orbital on October 18, 2010, at 6:56:19
In reply to Re: Effexor: is it worth it? » orbital, posted by floatingbridge on October 16, 2010, at 19:13:47
Okay, so my doc cancelled my weekly appointment. I'll have to wait it out, still have time to decide whether to switch to venlafaxine or not.
In the meantime, I'm doing okay with Lexapro (25mg), Arcalion (400mg), and a hefty dose of lecithin.
Thanks for your advice, I really appreciate it :)
Posted by floatingbridge on October 18, 2010, at 12:33:38
In reply to Re: Effexor: is it worth it?, posted by orbital on October 18, 2010, at 6:56:19
Oh, argggh. I hate that. Post if it helps. Someone will be here... :)
Posted by floatingbridge on October 18, 2010, at 12:39:02
In reply to Re: Effexor: is it worth it? » orbital, posted by Maxime on October 17, 2010, at 20:43:20
Wow Maxime. I've heard of those painless withdrawals. Sigh. I was on in the late 90's and all the docs I saw denied 'discontinuation syndrome' from AD's. I'm trying to explain how I feel w/o any vocabulary. Brain zaps.
I'm glad you and others are spared.
Posted by ed_uk2010 on October 18, 2010, at 14:44:53
In reply to Effexor: is it worth it?, posted by orbital on October 16, 2010, at 0:06:40
> I'm considering asking my doc for the dreaded Effexor. My depression has gotten so completely out of hand, I simply cannot function anymore. Right now I can barely get out of bed, never mind show up for work.
Some people have awful withdrawal symptoms from Effexor. For me, withdrawal symptoms were tolerable and lasted about two weeks. I went from 150mg to 0mg without tapering.
Posted by SLS on October 18, 2010, at 15:42:01
In reply to Re: Effexor: is it worth it?, posted by ed_uk2010 on October 18, 2010, at 14:44:53
> > I'm considering asking my doc for the dreaded Effexor. My depression has gotten so completely out of hand, I simply cannot function anymore. Right now I can barely get out of bed, never mind show up for work.
>
> Some people have awful withdrawal symptoms from Effexor. For me, withdrawal symptoms were tolerable and lasted about two weeks. I went from 150mg to 0mg without tapering.You silly boy.
- Scott
Posted by Maxime on October 18, 2010, at 21:07:01
In reply to Re: Effexor: is it worth it? » Maxime, posted by floatingbridge on October 18, 2010, at 12:39:02
> Wow Maxime. I've heard of those painless withdrawals. Sigh. I was on in the late 90's and all the docs I saw denied 'discontinuation syndrome' from AD's. I'm trying to explain how I feel w/o any vocabulary. Brain zaps.
>
> I'm glad you and others are spared.I guess I am lucky in that respect. I have never had any bad withdrawal symptoms coming any med (knock wood)
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