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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by needesp on September 7, 2005, at 20:04:37
I introduced myself earlier with concerns about my son's usage of MJ (Marijuana and antidepresants). He has been on Effexor 300mgs and Avanza (mirtazipine) 60mgs for 13 weeks and just recently (10 days ago today) been put up to Effexor 375mgs as his OCD had worsened and depression resurfaced. The mix in this equation is Marijuana which he started when he left the clinic at the 4 week mark on the higher doses.
HIs MJ use has increased over the last 10 weeks (now at 3 to 4 gms of MJ a night) and just recenty in the afternoons he has become very anxious/agitated just prior to starting his MJ at 5pm (the last couple of nights he has taken 100 mgs of Seroquel to relieve the agitation - the MJ wasn't getting him stoned - i thought that it might be due to the higher dose of Effexor). With the seroquel he was able to relax (OCD slow down) and get stoned again on the MJ!)
His mood is muted most of the time and he has lost interest in things (he gets to things he has to i.e. trainer x 2 week and his day clinic x 1 a week but his motivation is low and he isn't getting pleasure in them and afterwards i.e. when he returns (around the time of starting MJ) he is very negative/OCD running and this leads to agitation (he has had 6 bouts of intense anger in last 4 weeks)
I kept thinking that if the medication combo would work his desire for MJ would reduce. Must admit though that the increase to Effexor 375mgs (10 days now) has just today shown signs of impovement as he has woken without any depression, the first day of relief again in over 3 weeks).
Could you tell me how the MJ would work alongside of the Effexor and Avanza (I.e. neurotransmitters) and how Seroquel added to the equation works. Basically whats going on in his brain chemical scenario daily i.e.
Effexor 375mgs
Avanza 60mgs
Seroquel 100mgs
Marijuana 3gmsHe was told to use the Seroquel prn for agitation(100mgs a pop but only once a day and preferably to not use it eventually) but by the time he is agitated its all over bar the shouting (literally) as it takes about an hour to work.
I wondered if a steady dose of Seroquel in the evening would help? The time of concern is in the late arvo so I guess the seroquel would have been metabolised by then but is it like AD's and after a while the blood plasma levels stay up or would it need an am dose to keep him stable at 5pm.
Would so appreciate your knowledgeable input.
Posted by sleepygirl on September 7, 2005, at 22:40:22
In reply to To ed-uk could you help, posted by needesp on September 7, 2005, at 20:04:37
Hey, I was just thinking, there's lots of OCD sufferers on this board that may be of help to you. You might want to direct a thread to them. :-)
Posted by needesp on September 7, 2005, at 22:52:02
In reply to Re: To ed-uk could you help » needesp, posted by sleepygirl on September 7, 2005, at 22:40:22
Sleepgirls suggestion is a good one. I might be able to get my son to interact with you. OCD is sooooo specific (and individual). My son has tried Luvox at high doses (but not for the 3 mths - at the high dose of 300mgs) that is recommended. We are both realising that you need to stay on one medication (or combo)at the higher dose for 3 to 4 months to see if it gets to the OCD (it is so resistant). My son doesn't want to go on a MAOI (yet anyway) and even then their not quaranteed to work.
Just to help you understand - his OCD has latched onto the MJ usage i.e. it is now a ritual and as I said to sleepygirl it is a double bunger because he has the MJ dependence (now) and the OCD dependence on the MJ to deal with!
Posted by needesp on September 8, 2005, at 18:08:22
In reply to Re: To ed-uk could you help, posted by needesp on September 7, 2005, at 22:52:02
Can anyone tell me what is occuring in the brain chemical arena on (can keep up with some of your amazing info but need some layman definitions)
Effexor 375mgs
Avanza 60mgs
Marijuana 3gms
Plus the occasional Seroquel 100mgsHow does each drug interact with the others?
Mainly need to know if MJ negatively impacting on prescribed drugs and if Seroquel as a daily addition would counteract some negative affect (agitation from increased OCD negative rumination and pressure to tell leading to anger)
Posted by linkadge on September 8, 2005, at 19:12:45
In reply to Re: To ed-uk could you help, posted by needesp on September 7, 2005, at 22:52:02
I don't know If I can help any.
I am 22 yr old male. I have been on *many* AD's and have combined it with MJ very briefly.
My gut seriously tells me that the doc is going in the dead wrong direction.
The effexor + Remeron is an **extrordinarily** powerful combination and (my goodness) those are high doses of the two medications. Are his vital signs ok ?
--------------------------
This would by my target.
1. Replace the remeron with seroquel.
2. Lower the effexor and perhaps replace it with
a different AD, say celexa, zoloft, luvox, or
clomipramine.I don't mean to scare you, but my gut fear is that he honestly be at risk of having a seizure at those doses.
Please taper off, and try some a different med, which may be more effective at lower doses.
Please email me if you have any questions:
[xxx]
Linkadge
Posted by needesp on September 8, 2005, at 20:36:51
In reply to Re: To ed-uk could you help, posted by linkadge on September 8, 2005, at 19:12:45
> I don't know If I can help any.
>
> I am 22 yr old male. I have been on *many* AD's and have combined it with MJ very briefly.
>
> My gut seriously tells me that the doc is going in the dead wrong direction.
>
> The effexor + Remeron is an **extrordinarily** powerful combination and (my goodness) those are high doses of the two medications. Are his vital signs ok ?
>
> --------------------------
>
> This would by my target.
>
> 1. Replace the remeron with seroquel.
> 2. Lower the effexor and perhaps replace it with
> a different AD, say celexa, zoloft, luvox, or
> clomipramine.
>
> I don't mean to scare you, but my gut fear is that he honestly be at risk of having a seizure at those doses.
>
> Please taper off, and try some a different med, which may be more effective at lower doses.
>
> Please email me if you have any questions:
>
> [xxx]
>
> Linkadge
>
> Hi,I remember a poster from way back "st james" and he was on this powerful combo (hope he is still alive!!!) and he was very comfortable with the combo.
And yes my sons vital signs are good - though I must admit that i can't wait to see his gorgeos face in the mornings!!
He has tried Luvox and Zoloft (at very high doses also - no go there although we were pretty new at this medication thing back then and side effects were off putting - he is more tolerant of side effects and has pushed through them with this new combo!)
I do worry about the dosages but he is under constant care (me - qualified nursing sister and psychology student 3rd year (the last one is probably more dangerous than good - LOL); psychiatrist (external) every 3 weeks and every week he goes to the day clinic - the in-house psychiatrist there (who put him on the high doses) is also available. The p-docs think he is very healthy physically speaking but the OCD is severe and all literature points to the need for higher dosages.
THE GOOD NEWS - yesterday was day 10 on 375mgs Effexor and he woke without depression; then last night he said he didn't feel like doing AS MUCH (!) MJ. He said that his OCD will tell him to keep getting up and doing more (anxiety wise) and last night he felt no OCD anxiety push and just went to sleep (no Seroquel). This am he woke without depression again, more motivated and pretty happy about what went down yesterday........fingers crossed
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Posted by needesp on September 8, 2005, at 22:11:32
In reply to To ed-uk could you help, posted by needesp on September 7, 2005, at 20:04:37
Meant to say "Geogeous" face in the morning gorgeos sounds like a gorgon head!! - I might be biased (no never) but my sons looks are better than Brad Pitt!!
Posted by SLS on September 9, 2005, at 1:07:05
In reply to linkage, SLS, Curt ,brainy people, posted by needesp on September 8, 2005, at 18:08:22
It is encouraging that your son has described an improvement in mood and OCD symptoms. If, after optimizing the antidepressants, there is still some residual anxiety that causes him to want to self-medicate with MJ, I would look to add Klonopin (clonazepam) as an anxiolytic (anti-anxiety).
- Scott
Posted by linkadge on September 9, 2005, at 7:24:25
In reply to Re: linkage, SLS, Curt ,brainy people, posted by SLS on September 9, 2005, at 1:07:05
The only problem I see, is that effexor is not approved for OCD, neither is remeron or seroquel.
Mixed results have been noted for OCD and this SNRI. I would think that a pure SSRI would be much more efficatious.
I also think that remeron may worsen OCD symptomology.
"He said that his OCD will tell him to keep getting up and doing more (anxiety wise)"This could be related to the strong noradrenergic effect of the combination. In OCD serotonin seems to be the key chemical, boosting noradrenaline to such an extent could lead to anxiety, insomnia, anger, etc.
I think that replacing the remeron with trazedone would be a positive change.
Linkadge
Posted by linkadge on September 9, 2005, at 7:42:29
In reply to Re: linkage, SLS, Curt ,brainy people, posted by linkadge on September 9, 2005, at 7:24:25
The literature may point to high doses, but it does *not* point to high doses of mirtazapine or venlafaxine and certainly not in combination.
I think this combination could cause a strong responces of anger due to strong NE overfolw. Which could theoretically also worsen OCD.
Any anger that he is experiencing I would attribute directly to this combination.
This combination (dubbed california rocked fuel because it can be extrememly stimulating) has recieved attention since the case of Andrea Yates and the drowning death of her 5 children.
Geeze, I hate to be one of these people, but this is a "shot in the dark" combo.
Linkadge
Posted by needesp on September 9, 2005, at 18:42:16
In reply to Re: linkage, SLS, Curt ,brainy people, posted by linkadge on September 9, 2005, at 7:42:29
He also had very resistant depression (he is not as bad now) and the anger outburts (negative rumination that boils over) were present before this combo. That may be why he is on Effexor at high doses (he had been using 15mgs Avanza to help him sleep at night and that may be why (always wonder what pdocs are thinking) the in-patient pdoc ramped that up as well).
Maybe your suggestion of Seroquel at night with the Effexor is how we should go (it will help him sleep and may be calming for some of the next day)....he gets really nervous changing his med regimne (OCD symptom). He doesn't have any obvious side effects (like when he first started) but maybe the MJ (late arvo thru evening) was to quieten him, as you say the norepinephrine would have been very stimulating and maybe it was a reaction to this.
Posted by linkadge on September 11, 2005, at 10:02:40
In reply to Re: linkage, SLS, Curt ,brainy people, posted by needesp on September 9, 2005, at 18:42:16
I didn't mean to sound harsh, I just was shocked by the doses.
Please keep us posted, and if he can ever try to give a description of the kind of emotions he feels please post them as they could be integrel to knowing whats wrong.
Linkadge
This is the end of the thread.
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