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Dr. Bob is Robert Hsiung, MD,
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Posted by joe schmoe on October 31, 2011, at 15:02:35
In reply to Re: Viibrid Treatment - Increase to 60 mg » SLS, posted by SLS on October 31, 2011, at 13:39:08
> I saw my doctor today. He wants me to increase the dosage of Viibryd to 60 mg.
>
> Thinking positive...
>
>
> - Scott
Good luck.I have noticed with Viibryd that there seems to be an unusually long series of side effect periods at each dosage. For example after going from 10 to 20 I might have loose stools for a week, then tiredness for a week, then dizziness for two weeks, etc. It seemed to take a VERY long time to figure out what a dose really would feel like in the long run, as it took weeks and weeks to "shake out" the side effects, which often manifested in a series one at a time instead of all at once. Very strange.
The social-anxiety-inducing effects seem to have finally calmed down for me at 20 mg. I underwent the ultimate stress test for me (a job interview) and, thanks to clonazepam, had no difficulty despite some anxiety problems in the past with Viibryd. I was at 40 for awhile (months I think) but it still felt "trippy" and activating so I think I am better off at 20. At 40 mg I don't even like going shopping in a store.
If it is making you anxious, I would be surprised if increasing the dosage will help, but this is a peculiar medicine, for sure, so who knows.
Posted by SLS on October 31, 2011, at 15:23:19
In reply to Re: Viibrid Treatment - Increase to 60 mg » SLS, posted by floatingbridge on October 31, 2011, at 14:52:19
> Fingers crossed. Did you not go to 80mg yet?
No. I had thought to, but decided to wait.
Patience can be a real pain in the derrière.
> Good luck.Thanks. I could use some.
- Scott
Posted by SLS on October 31, 2011, at 15:25:16
In reply to Re: Viibrid Treatment - Increase to 60 mg, posted by joe schmoe on October 31, 2011, at 15:02:35
Hey, Joe.
Thanks for sharing your experience and insight. It really helps.
- Scott> I have noticed with Viibryd that there seems to be an unusually long series of side effect periods at each dosage. For example after going from 10 to 20 I might have loose stools for a week, then tiredness for a week, then dizziness for two weeks, etc. It seemed to take a VERY long time to figure out what a dose really would feel like in the long run, as it took weeks and weeks to "shake out" the side effects, which often manifested in a series one at a time instead of all at once. Very strange.
>
> The social-anxiety-inducing effects seem to have finally calmed down for me at 20 mg. I underwent the ultimate stress test for me (a job interview) and, thanks to clonazepam, had no difficulty despite some anxiety problems in the past with Viibryd. I was at 40 for awhile (months I think) but it still felt "trippy" and activating so I think I am better off at 20. At 40 mg I don't even like going shopping in a store.
>
> If it is making you anxious, I would be surprised if increasing the dosage will help, but this is a peculiar medicine, for sure, so who knows.
Posted by floatingbridge on October 31, 2011, at 16:31:28
In reply to Re: Viibrid Treatment - Increase to 60 mg » floatingbridge, posted by SLS on October 31, 2011, at 15:23:19
>Patience can be a real pain in the derrière.
I've noticed it can make time pass very slowly....
Posted by Phillipa on October 31, 2011, at 19:39:31
In reply to Re: Viibrid Treatment - Increase to 60 mg, posted by floatingbridge on October 31, 2011, at 16:31:28
Scott hope this works well at the lower dose. What was his rationale at dropping the dose? Seems so many docs are using lower doses of meds today. Phillipa
Posted by Phillipa on October 31, 2011, at 19:55:29
In reply to Re: Viibrid Treatment - Increase to 60 mg, posted by Phillipa on October 31, 2011, at 19:39:31
Looking at post title above was thinking you already were at 80mg so it's increased to 60mg? Hoping this works well. Phillipa
Posted by Chairman_MAO on October 31, 2011, at 21:29:16
In reply to Re: Viibrid Treatment » Chairman_MAO, posted by SLS on October 25, 2011, at 19:07:42
> I tried memantine once. I still have some left. It didn't help at 20mg when combined with Parnate, but it didn't hurt, either. I was reluctant to push it to 40mg because I felt drunk the first day I added an extra 20mg dose.I fear you may have titrated up too quickly.
You could try acamprosate--it seems quite benign on paper.>
> I might ask my doctor again about buprenorphine. He was not at all interested the first time I brought up the subject. I would prefer to try a few more things before heading down that road.
>
>
I'm sure he wasn't interested. ;-)The only thing I can tell you for sure is that the phenelzine + amphetamine + buprenorphine combination (and 2mg lorazepam qhs plus hctz for water retention) was the best cocktail I have ever taken. Just amazing.
Posted by hyperfocus on November 1, 2011, at 12:07:44
In reply to Re: Viibrid Treatment » SLS, posted by Chairman_MAO on October 31, 2011, at 21:29:16
It feels amazing but is that sustainable? Wouldn't your receptors burn out or something, and/or you become chemically dependent on the cocktail? Not the bupe but the lorazepam and amphetamine.
Posted by Conundrum on November 1, 2011, at 16:40:39
In reply to Re: Viibrid Treatment » Chairman_MAO, posted by hyperfocus on November 1, 2011, at 12:07:44
> It feels amazing but is that sustainable? Wouldn't your receptors burn out or something, and/or you become chemically dependent on the cocktail? Not the bupe but the lorazepam and amphetamine.
Technically someone who takes an antidepressant their whole life is chemically dependent on it right? I'd be more concerned about the burning out part than being dependent unless it requires constant dose increases.
Posted by Chairman_MAO on November 3, 2011, at 19:49:23
In reply to Re: Viibrid Treatment » Chairman_MAO, posted by hyperfocus on November 1, 2011, at 12:07:44
> It feels amazing but is that sustainable? Wouldn't your receptors burn out or something, and/or you become chemically dependent on the cocktail? Not the bupe but the lorazepam and amphetamine.
If by "sustainable" you mean felt the same way for over two years, then yes, it was sustainable. Receptors don't necessarily automagically "burn out". The lorazepam I was not dependent on because I was only taking it for sleep. I stopped it with one night of insomnia.
Coming off of Nardil was worse than coming off of buprenorphine. There is virtually no withdrawal with the dose of amphetamine (60mg/day) that I take. I recently had to stop it to start Marplan, and I didn't even have to alter my daily routine.
Anyone taking any drug for a prolonged period of time is to some extent physiologically dependent on it; doesn't matter if it's Prozac, Nardil, Oxycontin, whatever.
Posted by Conundrum on November 3, 2011, at 22:39:19
In reply to Re: Viibrid Treatment » hyperfocus, posted by Chairman_MAO on November 3, 2011, at 19:49:23
> > It feels amazing but is that sustainable? Wouldn't your receptors burn out or something, and/or you become chemically dependent on the cocktail? Not the bupe but the lorazepam and amphetamine.
>
> If by "sustainable" you mean felt the same way for over two years, then yes, it was sustainable. Receptors don't necessarily automagically "burn out". The lorazepam I was not dependent on because I was only taking it for sleep. I stopped it with one night of insomnia.
>
> Coming off of Nardil was worse than coming off of buprenorphine. There is virtually no withdrawal with the dose of amphetamine (60mg/day) that I take. I recently had to stop it to start Marplan, and I didn't even have to alter my daily routine.
>
> Anyone taking any drug for a prolonged period of time is to some extent physiologically dependent on it; doesn't matter if it's Prozac, Nardil, Oxycontin, whatever.I'm decreasing Nardil now and the withdrawal effects are pretty weird. I keep getting twitches that are mainly in my head but sometimes my whole body jerks.
Posted by Phillipa on November 3, 2011, at 23:48:00
In reply to Re: Viibrid Treatment » Chairman_MAO, posted by Conundrum on November 3, 2011, at 22:39:19
That sounds scarey hope they go away. Phillipa
Posted by Conundrum on November 4, 2011, at 12:32:03
In reply to Re: Viibrid Treatment » Conundrum, posted by Phillipa on November 3, 2011, at 23:48:00
> That sounds scarey hope they go away. Phillipa
I've discovered that they seem to come maybe -5 hours after the previous dose. It seems to be an immediate effect of the drug being metabolized rather than a long term change in neurotransmitter levels and cell firing that one might expect to feel a few weeks later.
Posted by hyperfocus on November 4, 2011, at 21:18:29
In reply to Re: Viibrid Treatment » hyperfocus, posted by Chairman_MAO on November 3, 2011, at 19:49:23
> If by "sustainable" you mean felt the same way for over two years, then yes, it was sustainable. Receptors don't necessarily automagically "burn out". The lorazepam I was not dependent on because I was only taking it for sleep. I stopped it with one night of insomnia.
>
Oh ok, cool. It was more euthymia-like for you I guess? I've felt like crap for so long I mixup euphoria with just feeling normal.> Coming off of Nardil was worse than coming off of buprenorphine. There is virtually no withdrawal with the dose of amphetamine (60mg/day) that I take. I recently had to stop it to start Marplan, and I didn't even have to alter my daily routine.
>
> Anyone taking any drug for a prolonged period of time is to some extent physiologically dependent on it; doesn't matter if it's Prozac, Nardil, Oxycontin, whatever.
Yeah you're right. I guess I was thinking more about people who don't have depression or SP taking drugs that target the dopamine or GABA receptors. It's an interesting point - specialists have said for years that people with SP or any type of major anxiety cannot become psychologically dependent on benzos. I suppose the same might be the case with amphetamines or opiates for people with depression?
Posted by SLS on November 6, 2011, at 11:30:57
In reply to Re: Viibrid Treatment » Phillipa, posted by Conundrum on November 4, 2011, at 12:32:03
Well, I have decided to stop taking Viibryd. Increasing the dosage did not help at all, and I feel no better than I did before.
Tinnitus appeared after I raised the dosage of Viibryd above 40 mg. I am guessing that this is a side effect.
- Scott
Posted by Phillipa on November 6, 2011, at 20:33:13
In reply to Re: Viibrid Treatment, posted by SLS on November 6, 2011, at 11:30:57
Scott tinnitis not a good side effect at all. Sorry it didn't work.When will you start pristiq? Phillipa
Posted by Conundrum on November 6, 2011, at 20:56:40
In reply to Viibrid Treatment, posted by SLS on September 28, 2011, at 9:13:28
Scott while it is very well possible the improvement you felt could have been from the discontinuation of nardil, perhaps the higher doses are too much for you. Look at how good you felt when taking just 20mg.
If the binding data on wikipedia are accurate, you probably don't need a high dose of this drug to block transporters/receptors. Too much might make it just like another numbing SSRI. I wonder if you can take 10mg?
> Hi All.
>
> I am experiencing an unexpected improvement in depression. It would be difficult not to attribute this to Viibryd. The only other thing I can think of is that it might be the result of discontinuing the Nardil with a resultant withdrawal rebound improvement. I believe that it is more likely to be due to Viibryd. You know that I respond to certain drugs for three days, only to relapse afterwards. Today is the third day of improvement. Viibryd differs from the other drugs I have taken in that the improvement began on the very first day. However, this might be the result of having had my 5-HT1a autoreceptors be downregulated by Nardil.
>
> Viibryd works. It doesn't have to be novel on paper (it actually is novel, though) in order to be effective for people who previously were TRD. Viibryd only has to be different to be worthy of consideration as a treatment. Different is different. As proof of this, there are people who respond to Pristiq whom do not respond to Effexor, regardless of dosage. I like what this drug does on paper and in real life. My doctor has had several TRD patients respond to Viibryd. It is his feeling that it will work as a prophylactic against relapse. You know, I am thinking that Viibryd might act to potentiate the therapeutic effects of standard antidepressants. You can probably add Viibryd to anything except MAOIs. I hope I continue to improve and achieve remission with the addition of Viibryd. Ill keep you informed as to how I do with this drug. Lithium might be an important component to my Viibryd treatment. Both drugs act to release serotonin, albeit via different mechanisms.
>
> I am currently taking:
>
> Viibryd 20mg (target dosage is 40mg)
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 10mg
> lithium 300mg
>
> I have a good feeling about Viibryd. Wish me luck.
>
>
> - Scott
>
Posted by SLS on November 7, 2011, at 7:47:00
In reply to Re: Viibrid Treatment - 20mgs » SLS, posted by Conundrum on November 6, 2011, at 20:56:40
> Scott while it is very well possible the improvement you felt could have been from the discontinuation of nardil, perhaps the higher doses are too much for you. Look at how good you felt when taking just 20mg.
Yes. That is true. Unfortunately, I believe one other person on PB reported a similar pattern of improvement followed by relapse while taking Viibryd. I also developed ringing in the ears (tinnitus) since increasing the dosage from 40 mg to 60 mg. I skipped yesterday's dose. Already, the tinnitus has abated. I have also deteriorated further. I am having a hard time justifying the continuation of my Viibryd trial. I am going to see my doctor today.
> If the binding data on wikipedia are accurate, you probably don't need a high dose of this drug to block transporters/receptors. Too much might make it just like another numbing SSRI. I wonder if you can take 10mg?
Thanks. That's great information.
- Scott
Posted by floatingbridge on November 7, 2011, at 8:07:00
In reply to Re: Viibrid Treatment - 20mgs » Conundrum, posted by SLS on November 7, 2011, at 7:47:00
Good luck at the doc's today.
Posted by joe schmoe on November 7, 2011, at 13:29:28
In reply to Re: Viibrid Treatment - 20mgs » Conundrum, posted by SLS on November 7, 2011, at 7:47:00
> > If the binding data on wikipedia are accurate, you probably don't need a high dose of this drug to block transporters/receptors. Too much might make it just like another numbing SSRI. I wonder if you can take 10mg?
>
> Thanks. That's great information.
Scott did you ever read this post I made, referencing a discussion on another board about the drug's mechanism of action?http://www.dr-bob.org/babble/20101107/msgs/970202.html
I'll reproduce the relevant part below.
---
Here is something interesting I ran across on another forum:
"To clarify for those that don't really understand (as I didn't fully up until just a few days ago), these 5-HT1A partial agonists aren't actually enhancing 5-HT1A receptor activity at all, they're decreasing it by blocking/competing with serotonin -- a full agonist --, exclusvely at inhibitory 5-HT1A somatodendritic autoreceptors. This results in increased serotonin release and enhanced activity at 5-HT1A postsynaptic receptors. Note that these drugs have significantly higher affinity for somatodendritic autoreceptors over postsynaptic receptors, as receptors on the cell body and dendrites are much more accessible than those in synapses. Hence, at the low doses in which they're used, they inhibit autoreceptors with little actual action on postsynaptic receptors at all, resulting in therapeutic benefits."
http://www.socialanxietysupport.com/forum/f30/vilazodone-82779/#post1256448
---
It seems that the reason Vilazodone was not recognized at first as an antidepressant was because too high of a dose was being used, and the drug was "spilling over" into the synapse instead of just being active at the more accessible inhibitory autoreceptors on the dendritic body. If this is true, larger and larger doses would just reduce effectiveness. The sweet spot would be quite a low dose.
My pdoc told me the studies were started with 20mg and later changed to 40mg because it got a better response with some people. I suspect the real therapeutic dosage is 20mg or less. I had to drop back to 20mg when 40mg continued to be too trippy and activating (after taking it for months, the effects weren't going away). Now I wonder if 10 or 15 might be even better.
Note this drug's absorption decreases radically if not taken with food, so I suspect all kinds of doses are being used out there unintentionally depending on how closely people are following the "with food" recommendation. "According to the product labeling, vilazodone blood concentrations in the fasted state can be decreased by approximately 50% compared to the fed state." I wonder if the 40mg dose is really a way to get the right dose (20 mg) to patients who are not always compliant about taking it with food.
Posted by Conundrum on November 7, 2011, at 13:50:57
In reply to Re: Viibrid Treatment - 20mgs » SLS, posted by joe schmoe on November 7, 2011, at 13:29:28
Good points. I wonder what the effects of activating those serotonergic post synaptic receptors are. I thought the antidepressant response of most SSRIs were in some way mediated through that receptor.
The food thing is interesting as well, there are probably many drugs where taking with or without food makes a big impact on drug availability.
> > > If the binding data on wikipedia are accurate, you probably don't need a high dose of this drug to block transporters/receptors. Too much might make it just like another numbing SSRI. I wonder if you can take 10mg?
> >
> > Thanks. That's great information.
>
>
> Scott did you ever read this post I made, referencing a discussion on another board about the drug's mechanism of action?
>
> http://www.dr-bob.org/babble/20101107/msgs/970202.html
>
> I'll reproduce the relevant part below.
>
> ---
>
> Here is something interesting I ran across on another forum:
>
> "To clarify for those that don't really understand (as I didn't fully up until just a few days ago), these 5-HT1A partial agonists aren't actually enhancing 5-HT1A receptor activity at all, they're decreasing it by blocking/competing with serotonin -- a full agonist --, exclusvely at inhibitory 5-HT1A somatodendritic autoreceptors. This results in increased serotonin release and enhanced activity at 5-HT1A postsynaptic receptors. Note that these drugs have significantly higher affinity for somatodendritic autoreceptors over postsynaptic receptors, as receptors on the cell body and dendrites are much more accessible than those in synapses. Hence, at the low doses in which they're used, they inhibit autoreceptors with little actual action on postsynaptic receptors at all, resulting in therapeutic benefits."
>
> http://www.socialanxietysupport.com/forum/f30/vilazodone-82779/#post1256448
>
> ---
>
> It seems that the reason Vilazodone was not recognized at first as an antidepressant was because too high of a dose was being used, and the drug was "spilling over" into the synapse instead of just being active at the more accessible inhibitory autoreceptors on the dendritic body. If this is true, larger and larger doses would just reduce effectiveness. The sweet spot would be quite a low dose.
>
> My pdoc told me the studies were started with 20mg and later changed to 40mg because it got a better response with some people. I suspect the real therapeutic dosage is 20mg or less. I had to drop back to 20mg when 40mg continued to be too trippy and activating (after taking it for months, the effects weren't going away). Now I wonder if 10 or 15 might be even better.
>
> Note this drug's absorption decreases radically if not taken with food, so I suspect all kinds of doses are being used out there unintentionally depending on how closely people are following the "with food" recommendation. "According to the product labeling, vilazodone blood concentrations in the fasted state can be decreased by approximately 50% compared to the fed state." I wonder if the 40mg dose is really a way to get the right dose (20 mg) to patients who are not always compliant about taking it with food.
Posted by joe schmoe on November 7, 2011, at 14:07:09
In reply to Re: Viibrid Treatment - 20mgs » joe schmoe, posted by Conundrum on November 7, 2011, at 13:50:57
> Good points. I wonder what the effects of activating those serotonergic post synaptic receptors are. I thought the antidepressant response of most SSRIs were in some way mediated through that receptor.
If I understand it correctly, excess serotonin "crawling" up out of the synapse onto the pre-synaptic dendrite will activate the inhibitory autoreceptors, which will reduce serotonin production in a feedback loop. The serotonin in the synapse, on the other hand, is activating the post-synaptic receptors which result in signals being carried across the synapse, which is what you want - easier transmission. If the viibryd gets in the synapse (due to an overly high concentration), it competes with the serotonin at these "transmission" receptors on the post-synaptic neuron, and interferes with signal transmission, effectively resulting in less serotonin activity in the synapse. I could be mistaken of course.
Posted by SLS on November 7, 2011, at 14:46:01
In reply to Re: Viibrid Treatment - 20mgs » SLS, posted by joe schmoe on November 7, 2011, at 13:29:28
Hi JS.
> My pdoc told me the studies were started with 20mg and later changed to 40mg because it got a better response with some people. I suspect the real therapeutic dosage is 20mg or less. I had to drop back to 20mg when 40mg continued to be too trippy and activating (after taking it for months, the effects weren't going away). Now I wonder if 10 or 15 might be even better.
How would you describe your current state of improvement?I understand that you felt overly activated with Viibryd at a dosage of 40 mg. To what degree were you depressed at that dosage?
Thanks for all of the excellent information.
- Scott
Posted by Phillipa on November 7, 2011, at 17:53:05
In reply to Re: Viibrid Treatment - 20mgs » joe schmoe, posted by SLS on November 7, 2011, at 14:46:01
Scott how did you make out at the docs switching meds or no? Phillipa
Posted by SLS on November 7, 2011, at 18:25:37
In reply to Re: Viibrid Treatment - 20mgs » SLS, posted by Phillipa on November 7, 2011, at 17:53:05
> Scott how did you make out at the docs switching meds or no? Phillipa
My doctor doesn't understand why my brain rejects therapeutic drug effects. It is almost like the body's rejection of a new organ.
We agreed that it is worth trying Pristiq rather than to return to Effexor. I have a feeling that I will need dosages of 200-300 mg. I took my first dose today. I am starting at 50 mg and moving to 100 mg next week.
- Scott
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