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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Roslynn on April 14, 2023, at 10:36:42
Hi all,
Does anyone know of any antidepressants that can be combined with Effexor (besides Wellbutrin and Remeron)?
Thank you for any help.Roslynn
Posted by SLS on April 14, 2023, at 11:04:13
In reply to Antidepressants to combine with Effexor?, posted by Roslynn on April 14, 2023, at 10:36:42
Hi.
Answer: Lithium 300-450 mg/day.
You already tried lithium, didn't you? What dosages? What was your reaction?
Did you already try combining Wellbutrin with Effexor or Pristiq? What dosages of both drugs? What were the results?
Zoloft + Wellbutrin was popular for awhile - "Welloft".
> Hi all,
>
> Does anyone know of any antidepressants that can be combined with Effexor (besides Wellbutrin and Remeron)?
>
>
> Thank you for any help.
>
> Roslynn
- Scott
Posted by Roslynn on April 14, 2023, at 12:52:58
In reply to Re: Antidepressants to combine with Effexor? » Roslynn, posted by SLS on April 14, 2023, at 11:04:13
Hi Scott,
I developed kidney problems which continued even though I lowered my lithium dose to barely nothing.
>
I'm taking Effexor 150 right now.Wellbutrin gave me some concerning side effects so had to stop taking it.
Roslynn
Posted by SLS on April 14, 2023, at 15:45:16
In reply to Re: Antidepressants to combine with Effexor? » SLS, posted by Roslynn on April 14, 2023, at 12:52:58
> Hi Scott,
>
> I developed kidney problems which continued even though I lowered my lithium dose to barely nothing.
> >
> I'm taking Effexor 150 right now.
>
> Wellbutrin gave me some concerning side effects so had to stop taking it.
>
> Roslynn
>
There are quite a few people who need 300 mg/day of Effexor. I'm one of them. 225 mg/day was insufficient.Why are you taking Wellbutrin? Did it help at all?
If there is any history of bipolarity in your family, I would suggest taking lamotrigine 200-300 mg/day.
I forgot to ask - Did lithium help at all?
If Nardil worked, and it has been 3 months or more since you last took it, you might be responsive to it again.
Were you under any additional stress leading up to your relapse while taking Nardil?
- Scott- Scott
Posted by Jay2112 on April 14, 2023, at 15:58:00
In reply to Antidepressants to combine with Effexor?, posted by Roslynn on April 14, 2023, at 10:36:42
> Hi all,
>
> Does anyone know of any antidepressants that can be combined with Effexor (besides Wellbutrin and Remeron)?
>
>
> Thank you for any help.
>
> RoslynnHi Roslynn,
Amitriptyline and imipramine are two good sedating antidepressants you can take at bedtime with Effexor. Amitriptyline is still considered the most effective antidepressant in the world, by the WHO (World Health Organization), and is listed on the WHO's essential medication list.
For me, Prozac (fluoxetine) has also been a go-to med to combine with my Effexor. Also, if you are looking to treat anxiety, a non-antidepressant, Lyrica, has worked quite well.
Let us know how you make out. :)
Best,
Jay
Posted by SLS on April 14, 2023, at 17:12:43
In reply to Re: Antidepressants to combine with Effexor? » Roslynn, posted by Jay2112 on April 14, 2023, at 15:58:00
> > Hi all,
> >
> > Does anyone know of any antidepressants that can be combined with Effexor (besides Wellbutrin and Remeron)?
> >
> >
> > Thank you for any help.
> >
> > Roslynn
>
> Hi Roslynn,
>
> Amitriptyline and imipramine are two good sedating antidepressants you can take at bedtime with Effexor. Amitriptyline is still considered the most effective antidepressant in the world, by the WHO (World Health Organization), and is listed on the WHO's essential medication list.
>
> For me, Prozac (fluoxetine) has also been a go-to med to combine with my Effexor. Also, if you are looking to treat anxiety, a non-antidepressant, Lyrica, has worked quite well.
>
> Let us know how you make out. :)
>
> Best,
> Jay
Over the years, I have come to the conclusion that clomipramine is the most effective tricyclic in the world to treat depression, even though the drug company wanted it to be approved for only Obsessive-Compulsive Disorder. I believe that this was just a marketing strategy. It is supposed to be more effective than amitriptyline for depression.In the 1980s, doctors used to prescribe clomipramine (Anafranil) to their patients who were treatment-resistant. It hadn't been approved in the U.S., but Baron Shopsin hooked me up with a pharmacy in Canada. For me, clomipramine was no more effective than any of the other TCAs I had tried. However, I don't respond well to any drug treatment that doesn't include a MAOI. I did notice a moderate reduction of my sex-drive, presumably due to the ability of clomipramine to potently inhibit the reuptake of serotonin (5-HT). However, at age 25, I seemed to have plenty left. Clomipramine is perhaps the "dirtiest" of the TCAs. I did not like the way I felt on it, mostly because of side effects. It's a pretty strong anticholinergic.
I don't doubt that amitriptyline is the most effective TCA that is FDA-approved to treat depression. However, it is approved for treating depression in other countries.
https://www.psychotropical.com/clomipramine-potent-snri-anti-depressant/
At the moment, I consider clorgyline to be most effective antidepressant in the world - although it is no longer available for human consumption. For me, it was much more potent than any of the other MAOIs I have tried. At the time, I was a research patient at the National Institutes of Health. They reserved clorgyline for people who responded to nothing else. Mark Schmidt called it their "ace-in-the-hole". Clorgyline is an irreversible and specific (as opposed to selective) inhibitor of MAO-A. It is a great biological probe that is still used on rats. Lucky rats.
- Scott
Posted by Roslynn on April 15, 2023, at 12:02:36
In reply to Re: Antidepressants to combine with Effexor? » Roslynn, posted by SLS on April 14, 2023, at 15:45:16
> > Hi Scott,
> >
> There are quite a few people who need 300 mg/day of Effexor. I'm one of them. 225 mg/day was insufficient.I've taken up to 300 in the past, actually combined with remeron, and it didn't do anything...
>
I am not currently on Wellbutrin, it gave me EPS.
>
Lamotrigine gives me major cognitive problems even at the lowest dose.
>
> I forgot to ask - Did lithium help at all?
>
Yes, it did, it was hard to see what it was doing but when I went off it, it was hell.
>
I couldn't tolerate nardil due to major dizziness at the lowest doses.
I don't really have discrete episodes of depression--just one continuous one for many years.Thanks Scott.
Roslynn
>
>
Posted by Roslynn on April 15, 2023, at 14:20:13
In reply to Re: Antidepressants to combine with Effexor? » Roslynn, posted by Jay2112 on April 14, 2023, at 15:58:00
Jay,
Thank you so much for your message. Do you mind telling me how much Prozac and Effexor you are taking?
Thank you,
Roslynn
> Hi Roslynn,
>
> Amitriptyline and imipramine are two good sedating antidepressants you can take at bedtime with Effexor. Amitriptyline is still considered the most effective antidepressant in the world, by the WHO (World Health Organization), and is listed on the WHO's essential medication list.
>
> For me, Prozac (fluoxetine) has also been a go-to med to combine with my Effexor. Also, if you are looking to treat anxiety, a non-antidepressant, Lyrica, has worked quite well.
>
> Let us know how you make out. :)
>
> Best,
> Jay
Posted by SLS on April 15, 2023, at 15:49:14
In reply to Re: Antidepressants to combine with Effexor? » SLS, posted by Roslynn on April 15, 2023, at 12:02:36
Hi, Roslynn.
> > There are quite a few people who need 300 mg/day of Effexor. I'm one of them. 225 mg/day was insufficient.
>
> I've taken up to 300 in the past, actually combined with remeron, and it didn't do anything...
> >
> I am not currently on Wellbutrin, it gave me EPS.
Wellbutrin gave you EPS? What were the EPS symptoms you experienced with Wellbutrin? I have never heard of this occurring with Wellbutrin. Perhaps others have. It's a critically important question. Using Wellbutrin by itself is not the best antidepressant. It does work, though. However, the true worth of Wellbutrin is that it augments serotonin reuptake inhibitors. It works well with Zoloft, Effexor, and Pristiq.
> >
> Lamotrigine gives me major cognitive problems even at the lowest dose.
> >
> > I forgot to ask - Did lithium help at all?
> >
> Yes, it did, it was hard to see what it was doing but when I went off it, it was hell.You came off of lithium for kidney abnormalities? What about thyroid?
What dosage of lithium worked best for you? It affected your kidneys? How was this ascertained, creatinine?
> I couldn't tolerate nardil due to major dizziness at the lowest doses.
I always experienced dizziness with Nardil over the course of 40 years. This time, I played a hunch. I thought that if I could prevent the *triggering* of side effects, perhaps they would never emerge in the first place. I began at 7.5 mg/day (1/2 tablet) for a week and increased the dosage very gradually afterwards.7.5 mg/day = 1 week
15 mg/day = 1 week
30 mg/day = 2 weeks
45 mg/day = 3 weeks
60 mg/day = 6 weeks
75 mg/day = 6 weeks
90 mg/day = MaximumMost people respond to 60-75 mg/day
> I don't really have discrete episodes of depression--just one continuous one for many years.Didn't you respond well to Nardil for an extended period of time?
- Scott
Posted by SLS on April 15, 2023, at 15:53:09
In reply to Re: Antidepressants to combine with Effexor? » Jay2112, posted by Roslynn on April 15, 2023, at 14:20:13
Hi, Jay.
> > For me, Prozac (fluoxetine) has also been a go-to med to combine with my Effexor.Wow. I don't recall seeing anyone else try that combination. How did you come upon it?
- Scott
Posted by Roslynn on April 15, 2023, at 16:40:29
In reply to Re: Antidepressants to combine with Effexor?, posted by SLS on April 15, 2023, at 15:49:14
>
> Wellbutrin gave you EPS? What were the EPS symptoms you experienced with Wellbutrin? I have never heard of this occurring with Wellbutrin. Perhaps others have. It's a critically important question. Using Wellbutrin by itself is not the best antidepressant. It does work, though. However, the true worth of Wellbutrin is that it augments serotonin reuptake inhibitors. It works well with Zoloft, Effexor, and Pristiq.
>
> Not sure if it was classified as EPS at the time but I was also on seroquel which could have contributed as it also causes me those issues. Both of them together gave me more issues.
> > >
>> > >
>
> You came off of lithium for kidney abnormalities? Yes
>
It affected your kidneys? How was this ascertained, creatininCreatinine/egfr
>
>I wasn't able to tolerate even the smallest smidge of nardil
>
>
>
>
>
>
>
> Didn't you respond well to Nardil for an extended period of time?
>
> No
> - Scott
>
>
Posted by Jay2112 on April 15, 2023, at 18:11:55
In reply to Re: Antidepressants to combine with Effexor? » Jay2112, posted by Roslynn on April 15, 2023, at 14:20:13
> Jay,
>
> Thank you so much for your message. Do you mind telling me how much Prozac and Effexor you are taking?
>
> Thank you,
> Roslynn
>Hi Roslynn,
Right now I take 150 of Effexor and 20mg of Prozac. I often adjust those, more if needed, but it is pretty stimulating, so I often come back down. It's been my rock, helping with my depression and anxiety. I also tke 2mg of Risperidone a day.
Any further questions...please let me know.
Best,
Jay
>
>
>
>
> > Hi Roslynn,
> >
> > Amitriptyline and imipramine are two good sedating antidepressants you can take at bedtime with Effexor. Amitriptyline is still considered the most effective antidepressant in the world, by the WHO (World Health Organization), and is listed on the WHO's essential medication list.
> >
> > For me, Prozac (fluoxetine) has also been a go-to med to combine with my Effexor. Also, if you are looking to treat anxiety, a non-antidepressant, Lyrica, has worked quite well.
> >
> > Let us know how you make out. :)
> >
> > Best,
> > Jay
>
>
Posted by Roslynn on April 15, 2023, at 18:20:03
In reply to Re: Antidepressants to combine with Effexor? » Roslynn, posted by Jay2112 on April 15, 2023, at 18:11:55
Jay--thank you for the information. I didn't mean to message the same question to you twice :)
Roslynn
Posted by SLS on April 15, 2023, at 18:38:46
In reply to Re: Antidepressants to combine with Effexor? » SLS, posted by Roslynn on April 15, 2023, at 16:40:29
>
> >
> > Wellbutrin gave you EPS? What were the EPS symptoms you experienced with Wellbutrin? I have never heard of this occurring with Wellbutrin. Perhaps others have. It's a critically important question. Using Wellbutrin by itself is not the best antidepressant. It does work, though. However, the true worth of Wellbutrin is that it augments serotonin reuptake inhibitors. It works well with Zoloft, Effexor, and Pristiq.
> >
> > Not sure if it was classified as EPS at the time but I was also on seroquel which could have contributed as it also causes me those issues. Both of them together gave me more issues.
> > > >
> >
>
> > > >
> >
> > You came off of lithium for kidney abnormalities? Yes
> >
>
>
> It affected your kidneys? How was this ascertained, creatinin
>
> Creatinine/egfr
> >
> >I wasn't able to tolerate even the smallest smidge of nardil
> >
> >
> >
> >
> >
> >
> >
> > Didn't you respond well to Nardil for an extended period of time?
> No.I apologize. It's hard for me to keep up sometimes.
Perhaps you need to include an anticonvulsant mood stabilizer to fill the role that lithium did.Which ones do you think might help? For depression, I usually think of lamotrigine. I forget whether or not you tried it. I also like Trileptal. If Wellbutrin is more tolerable when you abstain from antipsychotics, I would do everything possible in order to keep taking it.
Can you list the tricyclics you have tried?
Just an idea:
- Effexor or Pristiq
- Wellbutrin
- Nortriptyline
- Lamotrigine- Scott
Posted by SLS on April 15, 2023, at 21:06:03
In reply to Re: Antidepressants to combine with Effexor? » Roslynn, posted by Jay2112 on April 15, 2023, at 18:11:55
> > Jay,
> >
> > Thank you so much for your message. Do you mind telling me how much Prozac and Effexor you are taking?
> >
> > Thank you,
> > Roslynn
> >
>
> Hi Roslynn,
>
> Right now I take 150 of Effexor and 20mg of Prozac. I often adjust those, more if needed, but it is pretty stimulating, so I often come back down. It's been my rock, helping with my depression and anxiety. I also tke 2mg of Risperidone a day.
Jay,I wish you would throw away the idea that you can perpetually change the drugs and dosages of the antidepressants you take. I'm sure that Linkadge started his own bulletin board by now. He was the brightest person on Psycho-Babble, but the absolute worst role model for the clinical application of psychotropics.
Jay - The key to a stable, high-quality, and long-lasting remission is *homeostasis*. People never get well without it. People on Psycho-Babble have neglected this simple concept for years. I'm glad I chased some people away. I may have sounded the death-knell for Psycho-Babble, but it was worse than dead before I did it. Some people were unwittingly preventing others from getting well. Psycho-Babble didn't start out that way. In essence, people on Psycho-Babble unwittingly encourage each other to become reckless, and thus remain ill. This was a gradual transformation. I understand that thinking outside the box is necessary for people to respond to treatment. For many, it is the key success. However, the tools inside the box have to be used the right way for them to have any value.
The following is critical for you to understand if you want to attain the goal of reducing depression and perhaps attain remission.Prozac by itself doesn't make you feel better. Inhibiting the reuptake of serotonin begins within 30 minutes of your taking the very first dose. Yet, it takes weeks to see results. Why?
First, I'm going to let *you* figure out the answer to that question. I bet you will. I just want to give you the opportunity to go through the thought process for yourself. For the moment, I recommend that you throw out everything that you know or think you know about psychopharmacology and neuroscience.
Common sense is all you need. It isn't rocket surgery.
I'm serious. Why does it take a minimum of 2 weeks to respond to an antidepressant when its pharmacological effects takes only 30 minutes to begin acting? It's the concept that is important, not the details regarding physiology.
Right now, I know no other way to help people but through bluntness. This has gone on for too long. There's too little of my time left to exercise gentle tact. There is too little of your time left to find an effective treatment. Don't let anyone tell you otherwise - depression is an altered state of consciousness. It is no less so than being drunk on alcohol, stoned on weed, or tripping on psilocybin. We both deserve to leave the altered state of consciousness called depression behind.
* Interestingly, when I began to come out of depression, I did not feel that I had changed at all. The world changed.
Read the package labels/inserts of available antidepressants. They will all say two things:1. The mechanisms by which antidepressants work are unknown.
2. It takes weeks to see an improvement.Homeostasis.
Be well and stay well!
- Scott
Posted by SLS on April 16, 2023, at 8:30:08
In reply to Re: Antidepressants to combine with Effexor? » Roslynn, posted by Jay2112 on April 15, 2023, at 18:11:55
Hi, Jay and Roselynn.
> Right now I take 150 of Effexor and 20mg of Prozac. I often adjust those, more if needed, but it is pretty stimulating, so I often come back down.
No comment by me is necessary if you answered properly the question I posed to you in a previous post.Hint: HOMEOSTASIS and *new* EQUILIBRIUMS.
> Amitriptyline and imipramine are two good sedating antidepressants you can take at bedtime with Effexor.
I didn't find imipramine to be at all sedating. If anything, it was somewhat energizing - especially in the beginning. Different strokes...
Amitriptyline is probably the best TCA indicated for the treatment of depression and insomnia. It is also at the top of the list of tricyclics that are approved by the FDA to treat depression. Doxepin is good, too, but probably has the weakest antidepressant properties. Doxepin is actually a stronger antihistamine than Benadryl (diphenhydramine) or Seroquel (quetiapine). Doxepin is the antihistaminic effects of doxepin that make it a sleep aid in a way similar to Seroquel (quetiapine) and Remeron (mirtazapine), but without the risk of EPS. If you decide to go with amitriptyline, you might as well use it at clinically effective doages to treat depression. It often retains it sedating/hypnotic properties. Amitriptyline would serve as a replacement for nortriptyline in the combination (polypharmaceutical) treatment that I recommended to Linkadge. Amitriptyline would fill the role of nortriptyline, which has the mildest anticholinergic side effects among tricyclics. Nortriptyline is a bit tricky to find the best dosage, though. It has a true "therapeutic window".Nortriptyline dosage versus clinical antidepressant potency:
Too low = No response
Bullseye = Remission.
Too high = RelapseSome people are low-dose responders (25-75 mg/day). Others are high-dosage responders (100-200 mg/day. Having blood tests to assay blood levels of nortriptyline are helpful as a guide to establish an individual's dosage window.
1) Nortriptyline (less sedating) OR amitripyline (more sedating) or trimipramine (normalizes sleep architecture).2) Effexor
3) Wellbutrin
4) Lamictal
This combo covers a lot of ground. It is the one I recommended to Linkadge. He didn't bite, despite never having tried it. Yet, he asserts that nortriptyline gave him a 75% improvement. Why did he elect to discontinue taking nortriptyline instead of building a combination around it the most effective drug ? He exercises poor judgment in order to play with his toys. He has a poor understanding of how to use psychotropics effectively. He simply has not been exposed to doctors and researchers that have earned the reputation of being experts in treating cases of TRD. I have been treated by some of the best doctors and university research programs in Manhattan. I had many brains to pick and many a difficult drug-trial to endure while adhering to a treatment protocol. Some drugs made me feel hideously worse. Others produced side-effects that would be deal-breakers if they didn't dissipate over time. Unfortunately, there is only one way to know the clinical worth of a drug and the acceptability of its side effects.* Low dosages of mirtazapine (7.5-30 mg/day) are also used for sleep. Again, EPS with mirtazapine is not generally not a problem. The *true* dosage range of mirtazapine to treat depression is 45-90 mg/day. Anything less is bound to result in failure. At these higher dosages, the energizing effects of mirtazapine emerge and predominate over the sedation produced by histamine receptor blockade.
> > Amitriptyline is still considered the most effective antidepressant in the world, by the WHO (World Health Organization), and is listed on the WHO's essential medication list.
That is an unfortunate representation. Clomipramine is the TCA that succeeds most often in treating depression. It is also considered the best drug of any class to treat Obsessive Compulsive Disorder. For the sake of marketing, my guess is that having the FDA approve clomipramine for OCD exclusively makes it an OCD drug in the minds of both patients and clinicians. It is the drug most capable of treating severe or treatment-resistant cases. Clomipramine is a genuine SNRI. It was the go-to TCA when imipramine or amitriptyline failed to produce an adequate clinical response.
> > > For me, Prozac (fluoxetine) has also been a go-to med to combine with my Effexor. Also, if you are looking to treat anxiety, a non-antidepressant, Lyrica, has worked quite well.
I am still fascinated with your combining Prozac with Effexor. Can you add any further comments? You may have discovered an important new weapon. Is there any reason why you would not recommend it to others?
- Scott
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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