Posted by SLS on March 4, 2003, at 6:53:05
In reply to EXP'NCED P'BABLRS PLS ADVISE: Parnate or Effexor? , posted by Jack Smith on March 3, 2003, at 12:32:28
Hi Jack.
> I suffer from depression/GAD with some atypical features (hypersomnia, leaden paralysis).> I experienced an almost total remission from Celexa for about a year and a half and then it pooped out.
> So the question is this: My pdoc suggests that I try Effexor but is willing to give me Parnate.
> I know the conventional wisdom is that I should probably try Effexor first since I have only really tried three drugs (Paxil--OK but total sedation, WB and Celexa).
I think Mitch (Ritch) has focused on an important point - you ARE responsive to SSRIs. Effexor (venlafaxine) is sort of a like a combination of SSRI + TCA. That you are resonsive to SSRIs leads me to believe that Effexor has a pretty good chance of working without poop-out (tachyphylaxis). A recent study of over 2000 patients demonstrated that Effexor has a somewhat higher rate of producing an antidepressant response than SSRIs, and has a much lower rate of pooping-out than SSRIs (probably similar to TCA).
> BUT I know that an MAOI would work on my symptoms.
An MAOI might work. It might not.
You may want to take into consideration the side-effects that you have experienced with Paxil and Celexa. Were of such magnitude that you would want to try another class of drugs on that basis alone? If so, pehaps now would be the time to try an MAOI.
> I think Effexor has a good shot of working and I would be willing to give it a full 3 month trial working my way up to 225 (where there is a norepinephrine effect).
You MUST try at least 300mg. This is really the sweet-spot for severe, recurrent, or chronic depression.
> I am just worried that if it doesn't work, it will take me months to get off and then I will have to suffer for quite some time before I try Parnate.
Effexor has a short half-life (5-7 hrs for venlafaxine; 11 hrs for active metabolite). In their package insert ,the manufacturer suggests waiting 7 days from the last dose before initiating a trial of MAOI. (For the reverse switch, 14 days is prudent when changing from an MAOI to Effexor - especially with Nardil). This shouldn't take any more than 3 weeks to accomplish.
> It is a crucial time now, I can wait two weeks and go to Parnate or I could try Effexor. What do people think? Any advice helpful.
I don't want to make a recommendation, but I hope this information helps you to arrive at a decision.
Good luck. I think you can look forward to achieving a remission, even though you might guess wrong for your first choice.
- Scott
poster:SLS
thread:205524
URL: http://www.dr-bob.org/babble/20030301/msgs/205765.html