Posted by bleauberry on May 26, 2008, at 16:50:44
In reply to effexor not helping but making things worse?, posted by shadowmon on May 25, 2008, at 19:00:59
Any drug can make someone worse. Roughly speaking, based on a few scattered clinical studies that looked at this topic, and some subjective anecdotal evidence, I would estimate the percentage of people who get worse on any particular med is between 5% and 15%.
I think it is a common mistake for a doctor to have some predetermined target dose in mind when in fact he has absolutely no clue how this particular person will respond to the drug. That target is based on other people and generalities. Go to askapatient.com or search archives of various forums and you will see there are a good number of people who did very well with their starting dose of 37.5mg, or 75mg tops. Sure higher doses might be needed, but why go too far and possibly ruin a good thing. Go higher when a lower dose has had a fair shot.
One doc I saw somewhere on the web said something I agree with. That is, have the patient stay at the starting dose for a month before increasing it. Each increase needs another month. The idea is to get a good true reading of what the drug is doing. Too many dose changes in a short time, or too large of dose changes in a short time, makes evaluation of side effects and efficacy inaccurate. The drawback with this approach is it takes longer, if a higher dose is in the plans.
I have discovered that meds for me have a therapeutic window. Higher than my window and I feel worse.
Nortriptyline may be an exception, as it has a verified blood level that relates to efficacy. But with any other drug, personal opinion here, I say don't try to copy drug trials, don't try to be somebody else, find the dose that you personally agree with. There should be no predetermined dose target in mind.
But that's just me. I would go back down to the previous dose and stay there a while before making another move.
poster:bleauberry
thread:831109
URL: http://www.dr-bob.org/babble/20080519/msgs/831239.html