![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by PG on August 27, 2000, at 8:52:08
The 20/20 show on anti-depressant withdrawal came at a very appropriate time for me. I had been trying for four days to renew my Effexor XR prescription, but with no luck. (It takes a day for my doc's secy to get back to me, then she asks me to call the pharmacy so the pharmacy can call them back to get the prescription, but the pharmacy says they never got the message, etc. etc.). After two days off the Effexor, I started feeling most of the same symptoms that have already been described here. I won't go into it. But if it weren't for the 20/20 report, I probably never would have known for certain that it was withdrawal I was going through.
The show got me thinking and then looking for an internet site to learn what I can from other people in my situation--I'm not getting the info I need from my doc.
I am taking 450mg Effexor XR every day (for the last four months). I was on Zoloft for years until it started losing its effectiveness around January. My GP started me with 75mg and then 150mg, but because it wasn't working, he referred me to a psychiatrist, who bumped me up to 300, and then 450mg. Now he wants me to start taking 45mg Remeron in addition at bedtime. Everything I read says that the max dose for Effexor is 300mg, but the typical dose is 75 to 150. Having experienced just a few days of withdrawal symptons, I'm scared of getting any more deeply into this pharmaceutical black hole.
Does anybody have any experience with this high a dosage and/or combining the two drugs? Does a higher dose mean more severe withdrawal? How do these two drugs combine? My doc says that Remeron makes the Effexor 40x more effective (Anybody ever see that in print?).
If anyone has information or experience with this, I'd appreciate it.
I still find it hard to believe that so many of us are finding out that our miracle cures really were too good to be true.
Paul
Posted by SLS on August 27, 2000, at 14:47:37
In reply to High Dose of Effexor and Remeron?, posted by PG on August 27, 2000, at 8:52:08
Frome Medscape:
Ask the Experts on . . .
Refractory Depression--------------------------------------------------------------------------------
Question
I need some help for refractory depression in a 54-year-old physician. He has a 6-year history of unremitting depression with suicide ideation. The drugs we tried at full dose are (1) desipramine; (2) venlafaxine; (3) nefazodone, good result but discontinued; (4) amitriptyline; (5) fluoxetine up to 40 mg/day. Reasonably controlled on 60 mg of paroxetine daily, 50 mg of doxepin at night, mirtazapine 45 mg at night, 30 mg of flurazepam at night. He still has recurrences. Should I increase the mirtazapine or the paroxetine? Are there any proven unique drug combinations that may help? He has quite severe sweating from the paroxetine and mirtazapine and a 30-pound weight gain. I have put him on phentermine (30 mg twice a day) to control his appetite and help with his extreme fatigue and lack of concentration. Incidentally, he has fibromyalgia, with a peripheral neuropathy. All test results are negative, including HIV. He has refused ECT.Response
from Thomas A.M. Kramer, MD, 08/15/00
It sounds like an extremely difficult case. It also sounds like you have done a superb job with an extremely difficult patient.
One thing in your description I am curious about. You say that this patient failed venlafaxine at full dose. I am wondering what you mean by "full dose." In extremely treatment-refractory patients, often good responses have been obtained by using venlafaxine at extremely high doses, ie, at 500 mg or greater. I have seen case reports of the use of up to 1000 mg a day in these patients with good result. Obviously, blood pressure must be monitored in these patients, but in the case reports that I have read, they have tolerated this dose reasonably well.Failing that, and to answer your questions more directly, I think you can go up to at least 60 mg on the mirtazapine. Some of the greatest success in treatment-refractory patients has come from combining an SSRI with bupropion and/or mirtazapine. You may want to consider this combination if your patient deteriorates.
Finally, there is a great deal of research that has been published recently and continues to be generated on the combination of antidepressants with atypical antipsychotics, particularly olanzapine. These recent data have suggested that there may be some synergistic effect of the combination of these drugs
Posted by JaneST on August 27, 2000, at 17:52:39
In reply to Re: High Dose of Effexor and Remeron?, posted by SLS on August 27, 2000, at 14:47:37
Scott:
Thanks for posting this info...I haven't been able to get relief for chronic depression for 2+ years despite various med trials...but it makes me think I'm never on a dose that's high enough to be beneficial. I've discussed this with my pdoc to no avail...we just skip on to the next med. I have printed this and will be taking it to my next appointment.
Thanks again,
Jane
Frome Medscape:
>
>
>
> Ask the Experts on . . .
> Refractory Depression
>
> --------------------------------------------------------------------------------
>
>
> Question
> I need some help for refractory depression in a 54-year-old physician. He has a 6-year history of unremitting depression with suicide ideation. The drugs we tried at full dose are (1) desipramine; (2) venlafaxine; (3) nefazodone, good result but discontinued; (4) amitriptyline; (5) fluoxetine up to 40 mg/day. Reasonably controlled on 60 mg of paroxetine daily, 50 mg of doxepin at night, mirtazapine 45 mg at night, 30 mg of flurazepam at night. He still has recurrences. Should I increase the mirtazapine or the paroxetine? Are there any proven unique drug combinations that may help? He has quite severe sweating from the paroxetine and mirtazapine and a 30-pound weight gain. I have put him on phentermine (30 mg twice a day) to control his appetite and help with his extreme fatigue and lack of concentration. Incidentally, he has fibromyalgia, with a peripheral neuropathy. All test results are negative, including HIV. He has refused ECT.
>
> Response
> from Thomas A.M. Kramer, MD, 08/15/00
> It sounds like an extremely difficult case. It also sounds like you have done a superb job with an extremely difficult patient.
> One thing in your description I am curious about. You say that this patient failed venlafaxine at full dose. I am wondering what you mean by "full dose." In extremely treatment-refractory patients, often good responses have been obtained by using venlafaxine at extremely high doses, ie, at 500 mg or greater. I have seen case reports of the use of up to 1000 mg a day in these patients with good result. Obviously, blood pressure must be monitored in these patients, but in the case reports that I have read, they have tolerated this dose reasonably well.
>
> Failing that, and to answer your questions more directly, I think you can go up to at least 60 mg on the mirtazapine. Some of the greatest success in treatment-refractory patients has come from combining an SSRI with bupropion and/or mirtazapine. You may want to consider this combination if your patient deteriorates.
>
> Finally, there is a great deal of research that has been published recently and continues to be generated on the combination of antidepressants with atypical antipsychotics, particularly olanzapine. These recent data have suggested that there may be some synergistic effect of the combination of these drugs
Posted by stjames on August 27, 2000, at 20:08:30
In reply to High Dose of Effexor and Remeron?, posted by PG on August 27, 2000, at 8:52:08
Effexor + remeron is well known as a "big gun"
Ive taken this combo sine 95. Very effective.
Some people need to go beyond the recomended doses.Also Psycobabble is not a good sample
of people on AD's. People who come here are the ones
that are not doing well, the ones that do well have no
reason to post here. I choose to post here because
I have been on everything except MAOI's and AP's.
It took careful research to find what works (and very well, I might add)
so I try to share what I have learned along the way.
Too bad your situation is governed by military law,
otherwise one would call this discrimination.james
Posted by JaneST on August 27, 2000, at 20:53:54
In reply to Re: High Dose of Effexor and Remeron?, posted by stjames on August 27, 2000, at 20:08:30
> Effexor + remeron is well known as a "big gun"
> Ive taken this combo sine 95. Very effective.
> Some people need to go beyond the recomended doses.
>James,
If I may ask, what are your dosage levels for effexor and remeron? I want to add this as an example for when I make my case to my pdoc.
Thanks,
Jane
Posted by stjames on August 27, 2000, at 21:56:33
In reply to Re: High Dose of Effexor and Remeron? » stjames, posted by JaneST on August 27, 2000, at 20:53:54
> James,
>
> If I may ask, what are your dosage levels for effexor and remeron? I want to add this as an example for when I make my case to my pdoc.
>
> Thanks,
> JaneJames here....
At present Remeron, 15 mg (just enough for sleep) and Effexor XR 300 mgs.
I have taken as little as 150 effexor and as much as 450 mgs. Most of the time I am on 300 mgs.
We have been holding the Remeron dose at a lower level for now
and plan to up it if I have another breakthru depression. As I am due for
on anytime now we may raise it to avoid a breakthru.James
Posted by bethesdabob on May 19, 2004, at 18:34:53
In reply to Re: High Dose of Effexor and Remeron?, posted by stjames on August 27, 2000, at 21:56:33
I wish that this were a more recent thread, would love to get some info about how this combination worked for you.
My wife died on 12/16/03. Her psych had her taking 600 mgs of effexor xr and 90 mgs of remeron, wife was also an epileptic, pathologist ruled that my wife died from a seizure disorder, have read that these meds in combo are proconvulsant.
How did they work for you, are you still alive ?
Posted by Sinnielou on May 19, 2004, at 21:34:09
In reply to High Dose of Effexor and Remeron?, posted by PG on August 27, 2000, at 8:52:08
> The 20/20 show on anti-depressant withdrawal came at a very appropriate time for me. I had been trying for four days to renew my Effexor XR prescription, but with no luck. (It takes a day for my doc's secy to get back to me, then she asks me to call the pharmacy so the pharmacy can call them back to get the prescription, but the pharmacy says they never got the message, etc. etc.). After two days off the Effexor, I started feeling most of the same symptoms that have already been described here. I won't go into it. But if it weren't for the 20/20 report, I probably never would have known for certain that it was withdrawal I was going through.
>
> The show got me thinking and then looking for an internet site to learn what I can from other people in my situation--I'm not getting the info I need from my doc.
>
> I am taking 450mg Effexor XR every day (for the last four months). I was on Zoloft for years until it started losing its effectiveness around January. My GP started me with 75mg and then 150mg, but because it wasn't working, he referred me to a psychiatrist, who bumped me up to 300, and then 450mg. Now he wants me to start taking 45mg Remeron in addition at bedtime. Everything I read says that the max dose for Effexor is 300mg, but the typical dose is 75 to 150. Having experienced just a few days of withdrawal symptons, I'm scared of getting any more deeply into this pharmaceutical black hole.
>
> Does anybody have any experience with this high a dosage and/or combining the two drugs? Does a higher dose mean more severe withdrawal? How do these two drugs combine? My doc says that Remeron makes the Effexor 40x more effective (Anybody ever see that in print?).
>
> If anyone has information or experience with this, I'd appreciate it.
>
> I still find it hard to believe that so many of us are finding out that our miracle cures really were too good to be true.
>
> PaulI'm not sure if I'm going to be of any help to you because I'm not an expert, but I take 225 mg of Effexor and 30 mg of Remeron at night. I've been taking the Remeron for only a month and the Effexor for almost a year I have had no troubles with the combination. My doctor actually did the research for me before she added the Remeron. I was taking Zopiclone to sleep, but anxiety kept me awake even with the sleep aid. I'm not sure if I've helped any, but the combo works for me. Good luck.
Shannon
Posted by Molybdenum on March 3, 2008, at 14:56:02
In reply to Re: High Dose of Effexor and Remeron?, posted by Sinnielou on May 19, 2004, at 21:34:09
I'm taking 600mg Effexor & 225mg Remeron. I take them both at night because the Remeron makes me drowsy & helps me sleep.
:)
Posted by Molybdenum on March 4, 2008, at 15:49:48
In reply to High Dose of Effexor and Remeron?, posted by PG on August 27, 2000, at 8:52:08
There's another thread on this topic. Try here:
http://www.dr-bob.org/babble/neuro/20080114/msgs/809756.html
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.