Posted by linkadge on May 28, 2008, at 20:30:34
In reply to Re: The best Tricyclic for anxiety...., posted by SLS on May 28, 2008, at 19:42:29
>Effexor is effective when treating generalized >anxiety disorder (GAD). That's what you should >focus on. It works better than the SSRIs, >including Paxil.
Yes and no. Wyeth did a number of head to head trials that favored their drug, but some of the SSRI companies fired back with trials that supported their drug. The SSRIs also appear to be more tollerable than venlafaxine.
>Take some time to look over the literature on >the Web regarding Effexor and GAD. At this point >in time, I think empirical observation must take >precedence over prediction based on theory.
But the "empirical" evidence is a little flawed.
I think if an indivudal is not gaining adequate relief with venlafaxine alone then it is not unreasonable to suggest something to augment it. There is good evidence that AP's can augment uptake inhibitors. Looking to drug mechanisms is may not work all the time, but the combination of a uptake inhibitor with some form of 5-ht receptor blocker does appear to have supporting literature in both human and animal models of anxiety.
>What is the rationale for using Remeron in >combination with Effexor?
I would not recomend this combination on account of significant noradrenergic stimulation.
>I would not give up on Effexor until you reach >300mg.
I would. Especially if you are experiencing unhealthy side effects like BP increase or a significant increase in anxiety.
I didn't sleep much at all on 150mg of effexor. I felt much better when I lowered it to 75mg and added 25mg of seroquel. I was also feeling much more suicidal as we went up on effexor. Effexor also causes dose dependant increases in cortisol (again probably a 5-ht2 related mechanism). 5-ht2 antagonists are strong anticortisol agents.
Doxapine, amitrpytaline, remeron, cyproheptadine, trimipramine, seroquel, risperidal, zyprexa and many more 5-ht2 antagonits have documented anticortisol effects. In contrast most pure uptake inhibitors (ie SSRI's etc) increase cortisol, sometimes even after prolonged adminstration. They may also ameliorate disrupted sleep profiles.
Many of the above 5-ht2 antagonists also increase slow wave sleep (a stage of sleep often lacking in depression). There is good evidence of this. If sleep is significantly disturbed sometimes a low dose of a 5-ht2 blocking drug would be very helpful.
Linkadge
poster:linkadge
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/831767.html