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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 4 to 28 of 28. Go back in thread:
Posted by SLS on February 8, 2009, at 18:36:52
In reply to Re: People taking rocket fuel, posted by West on February 8, 2009, at 18:21:54
> Well the ssris fluoxetine and escitalopram, duloxetine and escitalopram + bupropion, in ascending order of effectiveness though prozac (my 1st) was dramatic intially
>
> The duloxetine fairly well ruined my sleep and made me rather dull cognitively. I had to take it with modafinil since it made me feel so out of it in the day
>
> I tried milnacipran, tianeptine, moclobemide and dosuelpin each for a month and experienced only side effects. Of these milnacipran was the best though i found it physically intolerable at 100mg a day
>
> I suppose i thought venlafaxine would be worth a shot with mirtazapine, as it at least seems to reliably allow people taking it to fall asleep.
>
> WestEffexor + Wellbutrin + Geodon might be worth putting on your list of possibilities. If Effexor + Remeron does nothing for you, maybe you can swap out the the Remeron for the Wellbutrin and add the Geodon if needed. I have seen this combination work wonders for a friend of mine. Everything came together with the addition of Geodon. She has atypical unipolar depression.
- Scott
Posted by ricker on February 8, 2009, at 18:51:34
In reply to People taking rocket fuel, posted by West on February 8, 2009, at 12:47:01
Had a good run with effex/rem for approx. 3 years until poop-out. I was taking 75 of effexor and 15 of remeron. Sleep was good throughout.
I thought the effexor would be too stimulating...increase my anxiety, but they seemed to go good together. Was taking 0.5 bid of clonazepam as well.
Posted by Phillipa on February 8, 2009, at 19:53:47
In reply to Re: People taking rocket fuel, posted by ricker on February 8, 2009, at 18:51:34
Ricker how high did you go on the effexor? And the klonopin probably helped. Know a few who did well with effexor, wellbutrin, klonopin and no trouble weaning off. Phillipa
Posted by ricker on February 8, 2009, at 20:02:54
In reply to Re: People taking rocket fuel » ricker, posted by Phillipa on February 8, 2009, at 19:53:47
> Ricker how high did you go on the effexor? And the klonopin probably helped. Know a few who did well with effexor, wellbutrin, klonopin and no trouble weaning off. Phillipa
Hi Phillipa, I went up to 150mg but did better at 75mg.
Posted by Phillipa on February 8, 2009, at 23:29:41
In reply to Re: People taking rocket fuel » Phillipa, posted by ricker on February 8, 2009, at 20:02:54
Ricker so you do better at lower doses of meds also like I do. Thanks. Love Phillipa
Posted by Neal on February 9, 2009, at 0:45:32
In reply to People taking rocket fuel, posted by West on February 8, 2009, at 12:47:01
rf worked for me on and off over the years. on and off in the sense that sometimes i was able to drop one or the other of buproprion or mirtazapine; mostly the latter because of appetite getting too healthy.
if you're having sleep problems, buproprion might aggravate them at the beginning, i mainly remember terrible problems with the common side-effect of irritability at the beginning, which seemed to go away after awhile or i got used to them.
Posted by West on February 9, 2009, at 11:50:36
In reply to Re: People taking rocket fuel, posted by Neal on February 9, 2009, at 0:45:32
> rf worked for me on and off over the years. on and off in the sense that sometimes i was able to drop one or the other of buproprion or mirtazapine; mostly the latter because of appetite getting too healthy.
So you took it with bupropion? I think i'd have trouble getting three antidepressants prescribed, and trouble enough getting bupropion since it isn't licensed for depression where i live
> if you're having sleep problems, buproprion might aggravate them at the beginning, i mainly remember terrible problems with the common side-effect of irritability at the beginning, which seemed to go away after awhile or i got used to themYes that is my experience - interesting that that went away along with the irritability
Thanks
West
Posted by West on February 9, 2009, at 11:58:23
In reply to Re: People taking rocket fuel » West, posted by SLS on February 8, 2009, at 18:36:52
>
> Effexor + Wellbutrin + Geodon might be worth putting on your list of possibilities.I am not familiar with geodon though i see you've written some stuff about it. I'll look into it.
I have read anecdotal stuff about both effexor and mirt causing anger/rage. Is this something i can expect to experience like with bupropion? Wasn't it Andrea Yates who was taking rocket fuel when she drowned her children?
Thanks
West
Posted by linkadge on February 9, 2009, at 16:47:49
In reply to Re: People taking rocket fuel, posted by ricker on February 8, 2009, at 18:51:34
I'd personally prefer venlafaxine plus low dose TCA for sleep.
Linkadge
Posted by West on February 10, 2009, at 13:23:07
In reply to Re: People taking rocket fuel, posted by linkadge on February 9, 2009, at 16:47:49
> I'd personally prefer venlafaxine plus low dose TCA for sleep.
>
> LinkadgeThat's interesting, why?
Posted by linkadge on February 10, 2009, at 19:30:26
In reply to Re: People taking rocket fuel) linkadge, posted by West on February 10, 2009, at 13:23:07
I found that rocket fuel was taxing on my cardiac muscle. The remeron increases norepinephrine release and effexor inhibits its reuptake.
The combination of low dose TCA and effexor will probably give you all the benefits of a TCA (ie sleep improvement, anxiolysis, potent AD effects) without the cardiac side effects.
Remeron and effexor was just a little too weird for me. Effexor and doxapin seemed to mix more smoothly.
Linkadge
Posted by West on February 10, 2009, at 23:56:36
In reply to Re: People taking rocket fuel) linkadge, posted by linkadge on February 10, 2009, at 19:30:26
==Cool
Thanks
Posted by Dee2 on February 19, 2009, at 20:11:15
In reply to People taking rocket fuel, posted by West on February 8, 2009, at 12:47:01
Hi,
Thanks for starting this thread, this combo is very intriguing to me. Just started it today. I have topped out at 225mg. of Effexor, after taking it for 8 years. Stopped being as effective about a year ago.I can't tolerate a higher dose, the noradrenergic effects make me anxious. I also take 30mg of Buspar (15mg 2x daily)
From what I've read this combo is highly synergistic, but we shall see. One thing is for sure, Remeron is a knock-out drug. I will take it tonight and see how I feel in the morning. Was excited to start and took 7.5 mid-day, big mistake. Kind of like taking three sleeping pills at once!
One thing I did notice was a calmness and definite decrease in rumination and anxiety right off the bat. I've been lamenting a breakup and after taking the Remeron all thoughts of this negative experience dissappeared (think "The Eternal Sunshine of the Spotless Mind" movie!)
I'm hoping the sleepiness wears off by the AM, as I plan to take this at night. From what I've read it does wear off anywhere from a few days to a few weeks. Will keep you posted!
Best of luck.
Posted by Neal on February 22, 2009, at 22:09:40
In reply to Re: People taking rocket fuel, posted by Dee2 on February 19, 2009, at 20:11:15
Remeron will help most people sleep better, just watch out for too many trips to the refrigerator
__________________
Posted by Dee2 on February 23, 2009, at 23:32:27
In reply to Re: People taking rocket fuel » Dee2, posted by Neal on February 22, 2009, at 22:09:40
> "Remeron will help most people sleep better, just watch out for too many trips to the refrigerator"
Yep, I did get the odd hunger for the first few days, but it abated. Guess I'm lucky! I'm a calorie counter anyway, no way I'm putting on weight.So far loving the Remeron/Effexor combo, it's awesome. Pretty nervous from the noradrenergic spike the first few days, due to norepi re-uptake inhibition, but that leveled out. The pill puts me right to sleep at night and I wake up refreshed, not dopey at all the next day.
BTW, I figured out that since I take Effexor, Buspar and Remeron in combination, i'm hitting all of the relevant mood related serotonin receptors!!! Buspar 5ht-1a, Remeron effects 5ht 2 a-b plus 5-ht3, and Effexor hits 5-ht1 a-b plus 5ht-2a.
Norepi activity is triple affected and dopamine double affected, I believe. Nice thing about this effect is that it is receptor specific and the additional norepi load from remeron is on the good norepi feedback loop, not straight up norepi, which would cause agitation.
BTW, if you're a nerd like me you can get this info from a google book search, they have tons of full and partial psychiatry/chemistry texts online. God bless.
Posted by SLS on February 24, 2009, at 6:02:31
In reply to Re: People taking rocket fuel, posted by Dee2 on February 23, 2009, at 23:32:27
> Effexor hits 5-ht1 a-b plus 5ht-2a.
Hi.
I looked on the PDSP ligand database and it looks like Effexor hits none of these targets. Where did you get your information. Effexor, of course, is a very effective drug and surely belongs in your regime. It would be nice if it did hit those receptors, though.
You put together a nice treatment. I hope it works for you.
- Scott
Posted by Dee2 on February 24, 2009, at 10:22:03
In reply to Re: People taking rocket fuel » Dee2, posted by SLS on February 24, 2009, at 6:02:31
ok, just came up with the same info...from the source DrugBank, here's a blurb from their home page:
The DrugBank database is a unique bioinformatics and cheminformatics resource that combines detailed drug (i.e. chemical, pharmacological and pharmaceutical) data with comprehensive drug target (i.e. sequence, structure, and pathway) information. The database contains nearly 4800 drug entries including >1,350 FDA-approved small molecule drugs, 123 FDA-approved biotech (protein/peptide) drugs, 71 nutraceuticals and >3,243 experimental drugs. Additionally, more than 2,500 non-redundant protein (i.e. drug target) sequences are linked to these FDA approved drug entries. Each DrugCard entry contains more than 100 data fields with half of the information being devoted to drug/chemical data and the other half devoted to drug target or protein data.
This source states that Effexor has direct affinity with 5HT-1a,b and 5HT-2a.
Posted by SLS on February 24, 2009, at 11:18:32
In reply to Re: People taking rocket fuel, posted by Dee2 on February 24, 2009, at 10:22:03
> ok, just came up with the same info...from the source DrugBank
> This source states that Effexor has direct affinity with 5HT-1a,b and 5HT-2a.
It seems that DrugBank has more up to date information than PDSP.
Does Effexor act as an antagonist at all of these receptors? I would be particularly interested to know about its activity at the 5-HT1a autoreceptor.
Thanks.
- Scott
Posted by SLS on February 24, 2009, at 11:22:38
In reply to Re: People taking rocket fuel, posted by SLS on February 24, 2009, at 11:18:32
You know, this just goes to show you how little we understand about what these drugs do in the body - both microscopically and macroscopically. It would be difficult to put together a complete theory as to the etiology and treatment of mental illness without knowing what has yet to be discovered.
- Scott
Posted by theo on February 24, 2009, at 20:40:09
In reply to Re: People taking rocket fuel, posted by Dee2 on February 23, 2009, at 23:32:27
Are you taking name brand Remeron or generic? Are you staying at 7.5mg?
Posted by Dee2 on February 24, 2009, at 22:28:55
In reply to Re: People taking rocket fuel » Dee2, posted by theo on February 24, 2009, at 20:40:09
> Are you taking name brand Remeron or generic? Are you staying at 7.5mg?
Hi, I bumped up to 15 pretty quickly (mirtazaping-generic). Read that 7.5 dose can be counterproductive as it doesn't act strongly enough on norepinephrine to override the histamine receptor response (sedation)that happens with this drug.
Posted by SLS on February 25, 2009, at 7:20:25
In reply to Re: People taking rocket fuel, posted by Dee2 on February 24, 2009, at 22:28:55
> > Are you taking name brand Remeron or generic? Are you staying at 7.5mg?
>
> Hi, I bumped up to 15 pretty quickly (mirtazaping-generic). Read that 7.5 dose can be counterproductive as it doesn't act strongly enough on norepinephrine to override the histamine receptor response (sedation)that happens with this drug.If it were me, I would consider the therapeutic to range to target 45-60mg.
- Scott
Posted by desolationrower on February 27, 2009, at 3:26:24
In reply to Re: People taking rocket fuel, posted by SLS on February 25, 2009, at 7:20:25
its likely drugbank meant venlafaxine is an indirect agonist at those receptors. if it was a direct ligand its the sort of thing that woudl get published somehwere.
-d/r
Posted by metric on March 24, 2009, at 16:03:41
In reply to People taking rocket fuel, posted by West on February 8, 2009, at 12:47:01
> Basically i would like to hear from anyone taking venlafaxine with mirtazapine. Do you like how you feel and function on it? Would you say it was preferable other combinations like an SSRI + Bupropion for example?
>
> I've just started escitalopram again after an unsuccessful trial of about 5 (mainly atypical) antidepressants but plan on changing as it's sort of a stopgap for me, not a long term solution (as I experience too much flatness from it and have continued trouble sleeping).
>
> Ta,
>
> WestI noticed that no one really answered your question, particularly in relation to _function_. I would expect the combination to produce at least an added impairment of intellectual function compared with either agent alone.
Posted by desolationrower on March 27, 2009, at 2:20:47
In reply to Re: People taking rocket fuel » West, posted by metric on March 24, 2009, at 16:03:41
i don't know you can be sure about that, it would involve just what level of NA you end up with, and with all the interacting mechanisms it could either be good or bad for cognitive function, no way to know
-d/r
This is the end of the thread.
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