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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on December 5, 2011, at 16:01:41
In reply to Re: Effexor 450 mg? » Phidippus, posted by SLS on December 5, 2011, at 7:33:09
>My guess is that I have become less responsive over time as my brain has been continuously exposed to a wide variety of drugs. What choice do I have?
Perhaps to taper off all or most of your medication over a period of a few months?? It really could be the best option at this stage. Any rebound worsening of depression could be avoided by gradual tapering. You may be resensitised to the effects of ADs after a medication-free interval, or you may discover that you actually feel better without certain meds. At present, you appear to be tolerant to almost all medications. Although tapering off could be difficult in the short-term, if it could help you in the long-term it could be very worthwhile. You may also feel better on less medication in some ways. As an example, you might lose a lot of weight and your physical fitness may improve as a result.
Posted by ed_uk2010 on December 5, 2011, at 16:16:27
In reply to Re: Effexor 450 mg? » jono_in_adelaide, posted by SLS on December 5, 2011, at 7:05:45
I'm not sure how useful very high doses of venlafaxine actually are. Fatigue seems to be a major problem. Sometimes, less is more.... or if a drug is not helping, it is best to stop taking it.
I think there is very often a tendency for people to keep taking medication because of the fear that things may be even worse without it. Although things may be temporarily worse due to withdrawal or rebound, some symptoms may improve once an ineffective med has been stopped. ADs are not free of adverse effects by any means.
Tolerability of high-dose venlafaxine in depressed patients.
Harrison CL, Ferrier N, Young AH.
SourceSchool of Neurology, Neurobiology and Psychiatry, Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
AbstractHigh doses of antidepressants are often used for treatment-resistant depression. Venlafaxine, a dual serotonin and noradrenaline reuptake inhibitor, has been shown to have a tolerable side-effect profile in previous studies using doses of up to 375 mg/day. We investigated the tolerability of higher than currently recommended doses of venlafaxine using the UKU side-effect rating scale. Seventy outpatients fulfilling DSM-IV criteria for major depressive disorder were recruited into two demographically matched groups according to their daily dosage of venlafaxine: high dose n = 35 (> or = 375 mg/day, range 375-600 mg, average 437 mg/day) or standard dose n = 35 (< 375 mg/day, range 75-300 mg, average 195 mg/day. Clinical characteristics were noted and the UKU side-effect rating scale was administered to a subsample of patients. The most frequently reported complaints in both groups were increased fatigue (48%), concentration difficulties (48%), sleepiness/sedation (37%), failing memory (44.4%) and weight gain (29.6%). Apart from weight gain, the complaints were found to be experienced significantly more severely by the high-dose group. Six patients discontinued venlafaxine due to intolerable side-effects but only two of these patients were on a high dose. There was a tendency for mildly raised blood pressure in 10% of patients on an average dose of 342 mg/day. However, no difference between the two groups was found. This preliminary open study demonstrates that venlafaxine is tolerated at higher than British National Formulary recommended doses (i.e. up to 600 mg daily). However, increased frequency and severity of reported side-effects in the high-dose group are not associated with increased rates of discontinuation.
Posted by jono_in_adelaide on December 5, 2011, at 16:25:37
In reply to Re: Effexor 450 mg?, posted by ed_uk2010 on December 5, 2011, at 16:16:27
Which drugs/combinations have you responded to in the past?
Posted by sigismund on December 5, 2011, at 16:43:39
In reply to Re: Effexor 450 mg? » Phidippus, posted by SLS on December 5, 2011, at 7:33:09
The other thing that I am not clear about is the nature of your depression. What you have described (what I have paid attention to) sounds like chronic fatigue. At least you do not seem to suffer from despair (except at treatment options!) or terrible distress, but rather a slowed down state which affects all of you, your mind and body.
Is that right?
Posted by ed_uk2010 on December 5, 2011, at 16:56:57
In reply to Re: Effexor 450 mg? » SLS, posted by sigismund on December 5, 2011, at 16:43:39
>What you have described (what I have paid attention to) sounds like chronic fatigue.....a slowed down state which affects all of you, your mind and body.....
I suppose what I was thinking is that chronic fatigue and slowness are among the symptoms most likely to be aggravated by continuous psych medication. For me at least, tiredness has been a side effects of almost everything that I've taken. Even if it hasn't initially been a problem, it has been after months/years of treatment. On stopping offending medication, I've sometimes felt more tired for a while while I adjusted, but better in the long run. I still take medication but much less than I did.
Posted by Phidippus on December 5, 2011, at 17:16:29
In reply to Re: Effexor 450 mg?, posted by jono_in_adelaide on December 4, 2011, at 22:41:46
> Effexor 300 mg
> nortriptyline 150 mg
> Lamictal 200mg
> Abilify 10 mg
> lithium 300 mg>I'm pretty much out of ideas.
Let's do this:
900 mg Lithium
150 mg Clomipramine
80 mg LatudaSee how you feel :)
Eric
Posted by Phidippus on December 5, 2011, at 17:18:44
In reply to Re: Effexor 450 mg? » Phidippus, posted by SLS on December 5, 2011, at 7:33:09
Ketamine might be a good option for you. It shown to be a powerful antidepressant.
DBS is tricky...You might want to opt for VNS.
Eric
Posted by Phillipa on December 5, 2011, at 18:07:55
In reply to Effexor 450 mg?, posted by SLS on December 1, 2011, at 12:20:25
Living in the NE could lymes disease possibly be a factor as when I was diagnosed had no idea been bitten by a tic. Just a thought. Phillipa
Posted by Bob on December 5, 2011, at 23:34:48
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 5, 2011, at 17:18:44
> Ketamine might be a good option for you. It shown to be a powerful antidepressant.
>
> DBS is tricky...You might want to opt for VNS.
>
> Eric
Why do you say DBS is tricky?
Posted by SLS on December 6, 2011, at 17:34:28
In reply to Re: Effexor 450 mg? » Phidippus, posted by Bob on December 5, 2011, at 23:34:48
My doctor acceded to my request to raise the dosage of Effexor to 450 mg. I'm not expecting miracles, but perhaps it will help enough so that I could return to work. He also prescribed prazosin, thinking that there might be a PTSD thing going on. I don't think there is, but I'll go along with it for now.
- Scott
Posted by SLS on December 6, 2011, at 17:39:23
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 5, 2011, at 17:18:44
> Ketamine might be a good option for you. It shown to be a powerful antidepressant.
I would love to try ketamine. It might fill a role so as to "kick-start" other antidepressants.
- Scott
Posted by SLS on December 6, 2011, at 17:49:46
In reply to Re: Effexor 450 mg? » SLS, posted by sigismund on December 5, 2011, at 16:43:39
> The other thing that I am not clear about is the nature of your depression. What you have described (what I have paid attention to) sounds like chronic fatigue.
Yeah. It's like having a combination of CFS and Alzheimer's.
> At least you do not seem to suffer from despair (except at treatment options!) or terrible distress, but rather a slowed down state which affects all of you, your mind and body.
>
> Is that right?Perfect explanation.
Anergia
Psychomotor retardation
Anhedonia
Flat affect
Cognitive slowing
Memory impairment
Intrusive thoughts (offset by CBT)
Negative thinking (offset by CBT)
Depressed mood (offset by CBT)
- Scott
Posted by SLS on December 6, 2011, at 17:59:44
In reply to Re: Effexor 450 mg?, posted by jono_in_adelaide on December 5, 2011, at 16:25:37
> Which drugs/combinations have you responded to in the past?
A combination of Parnate + desipramine led to an extended remission lasting 9 months. The doctor had me discontinue both drugs when mania developed. I am no longer responsive to this combination.
I have experienced "blip" responses to quite a few drugs that comprise 1-3 days of improvement followed by relapse.
- Scott
Posted by Phillipa on December 6, 2011, at 18:22:52
In reply to Re: Effexor 450 mg? » jono_in_adelaide, posted by SLS on December 6, 2011, at 17:59:44
Scott and you are positive that thyroid okay as those symtoms are also of thyroid. Have you had ANA tested and thyroid antibodies? Phillipa
Posted by Phidippus on December 7, 2011, at 14:56:13
In reply to Re: Effexor 450 mg? » Phidippus, posted by SLS on December 6, 2011, at 17:39:23
I thinkk you just need tro strip everything down and start from scratch.
Eric
Posted by Phidippus on December 7, 2011, at 14:58:00
In reply to Re: Effexor 450 mg? » Phidippus, posted by Bob on December 5, 2011, at 23:34:48
Placement of stimulators is very hit and miss, where as VNS stimulation targets only the Vagal Nerve.
Eric
Posted by Phidippus on December 7, 2011, at 15:05:32
In reply to Re: Effexor 450 mg? » SLS, posted by Phillipa on December 5, 2011, at 18:07:55
Lymes ends up being a systemic problem. NE isn't going to rock the boat.
Eric
Posted by Bob on December 7, 2011, at 17:07:05
In reply to Re: Effexor 450 mg? » Bob, posted by Phidippus on December 7, 2011, at 14:58:00
> Placement of stimulators is very hit and miss, where as VNS stimulation targets only the Vagal Nerve.
>
> Eric
Yes, but then the question becomes, what areas of the brain is the Vagal nerve affecting? Obviously if there is any benefit at all, then at least one of the innervated areas is responsible.I haven't heard much at all about VNS lately.
Posted by hyperfocus on December 7, 2011, at 17:19:24
In reply to Re: Effexor 450 mg? » jono_in_adelaide, posted by SLS on December 5, 2011, at 7:05:45
What meds were you taking immediately before you started with the Parnate/desipramine?
Posted by Bob on December 7, 2011, at 17:40:13
In reply to Re: Effexor 450 mg?, posted by SLS on December 6, 2011, at 17:34:28
> My doctor acceded to my request to raise the dosage of Effexor to 450 mg. I'm not expecting miracles, but perhaps it will help enough so that I could return to work. He also prescribed prazosin, thinking that there might be a PTSD thing going on. I don't think there is, but I'll go along with it for now.
>
>
> - Scott
>
>
Scott -What can you tell me about prazosin? How does it work and what are your experiences with taking it? Is this drug widely used for PTSD? Are there other drugs out there meant for the treatment of PTSD?
Bob
Posted by huxley on December 7, 2011, at 21:53:11
In reply to Effexor 450 mg?, posted by SLS on December 1, 2011, at 12:20:25
Hi Scott,
I went up to 600mg of effexor.
Did nothing it did't do at 200mg.
Posted by SLS on December 8, 2011, at 7:30:04
In reply to Re: Effexor 450 mg?, posted by huxley on December 7, 2011, at 21:53:11
> Hi Scott,
>
> I went up to 600mg of effexor.
>
> Did nothing it did't do at 200mg.
Thanks for the input, Huxley.Did you experience any side effects?
- Scott
Posted by SLS on December 8, 2011, at 7:34:09
In reply to Re: Effexor 450 mg? » SLS, posted by hyperfocus on December 7, 2011, at 17:19:24
> What meds were you taking immediately before you started with the Parnate/desipramine?
I had been drug-free for almost a year prior to treatment. Baron Shopsin had recommended that I stay "clean" as much as possible. Unfortunately, my depression became too severe not to treat.
- Scott
Posted by SLS on December 8, 2011, at 7:36:22
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 7, 2011, at 14:56:13
> I thinkk you just need tro strip everything down and start from scratch.
My baseline depression is too severe for me to live independently.
What did you have in mind?
Thanks.
- Scott
Posted by SLS on December 8, 2011, at 8:04:36
In reply to Re: Effexor 450 mg? » SLS, posted by Bob on December 7, 2011, at 17:40:13
> > My doctor acceded to my request to raise the dosage of Effexor to 450 mg. I'm not expecting miracles, but perhaps it will help enough so that I could return to work. He also prescribed prazosin, thinking that there might be a PTSD thing going on. I don't think there is, but I'll go along with it for now.
> What can you tell me about prazosin? How does it work and what are your experiences with taking it? Is this drug widely used for PTSD? Are there other drugs out there meant for the treatment of PTSD?
Prazosin is a specific alpha-1 NE receptor antagonist. It is supposed to help improve sleep and reduce nightmares. I really don't think it is an appropriate treatment for me. I do have occasional dreams of being bullied in high school. I don't know...
Topamax is an effective treatment for PTSD. It helps with re-experiencing and avoidance. I don't know what dosages are used. One study I came across used 100 mg.
- Scott
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