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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by TriedEveryMedication on October 12, 2013, at 21:09:54
me: ADD, depression, social phobia, some sort of ischemic lesion or something in my insula
been taking 450mg of effexor for about 3 weeks (150mg for 6 months and then 300mg for a few weeks before)
I think its helping slightly. Like a glimpse of what being normal is like, a taste. Not there yet.
So, should I continue to go up (doc seems to be ok going to 525mg) or should I try to augment with something and if so, what?
Thank you very much.
Posted by Phillipa on October 12, 2013, at 22:51:23
In reply to 450mg Effexor - seems to be helping slightly. Q, posted by TriedEveryMedication on October 12, 2013, at 21:09:54
I'd go by your positive response so far and your pdocs recommendations. Good luck. Phillipa
Posted by SLS on October 13, 2013, at 0:52:07
In reply to 450mg Effexor - seems to be helping slightly. Q, posted by TriedEveryMedication on October 12, 2013, at 21:09:54
Add Wellbutrin or nortriptyline?
- Scott
Posted by TriedEveryMedication on October 13, 2013, at 1:22:44
In reply to Re: 450mg Effexor - seems to be helping slightly. Q » TriedEveryMedication, posted by SLS on October 13, 2013, at 0:52:07
> Add Wellbutrin or nortriptyline?
>
>
> - ScottThanks, Scott.
I'd love to add a tricyclic, but effexor blocks CYP3d6 I think which breaks down all of the TCAs.
I added desipramine a couple of times at a lower effexor dose and it wasn't exactly fun.
I guess wellbutrin is an option.
Posted by SLS on October 13, 2013, at 7:30:38
In reply to Re: 450mg Effexor - seems to be helping slightly. Q » SLS, posted by TriedEveryMedication on October 13, 2013, at 1:22:44
> > Add Wellbutrin or nortriptyline?
> >
> >
> > - Scott
>
> Thanks, Scott.
>
> I'd love to add a tricyclic, but effexor blocks CYP3d6 I think which breaks down all of the TCAs.
>
> I added desipramine a couple of times at a lower effexor dose and it wasn't exactly fun.
>
> I guess wellbutrin is an option.
>Nortriptyline is generally "smoother" and more tolerable than desipramine.
I experienced an improvement while taking a combination of Effexor 300 mg/day and nortriptyline 75 mg/day. I think I could have benefited from going even higher with the nortriptyline. I am an extensive metabolizer (2D6). Perhaps you can start nortriptyline at 10 mg/day and go up slowly while using blood tests to guide you. I think it is doable.
Effexor 300 mg/day OR Pristiq 100 mg/day in combination with Wellbutrin 300 mg/day is worth a try in my estimation.
- Scott
Posted by europerep on October 13, 2013, at 8:55:58
In reply to 450mg Effexor - seems to be helping slightly. Q, posted by TriedEveryMedication on October 12, 2013, at 21:09:54
> me: ADD, depression, social phobia, some sort of ischemic lesion or something in my insula
>
> been taking 450mg of effexor for about 3 weeks (150mg for 6 months and then 300mg for a few weeks before)
>
> I think its helping slightly.Hi,
there is some scientific documentation, as well as anecdotal reports (such as mine) of patients going up to 600mg/day of venlafaxine (Effexor). I was on that dose for about a year and a half, without noticeable side effects (except for the first few weeks, but they quickly disappeared after that). So, if you are not having problems with side-effects or blood pressure, I wouldn't see a reason to not try out 525 mg/d.
If that fails, you can indeed try combination treatments. CYP2D6 metabolizes tricyclic antidepressants (TCAs), but it's by far not the only cytochrome doing that, and as far as I know not even the most important one for tricyclics (I think those are 1A2 and 3A4). So you may have have to start with low amounts of a TCA, but there's no reason you can't take them at all.
If you have problems with ADD as you say, an option might also be to add methylphenidate. Here one has to be careful with blood pressure though. But I took the combination without any problems, it just didn't really do anything for me. Before trying a stimulant, bupropion might be worth a try though.
I hope this helps...
ER
Posted by SLS on October 13, 2013, at 11:19:51
In reply to Re: 450mg Effexor - seems to be helping slightly. Q » TriedEveryMedication, posted by europerep on October 13, 2013, at 8:55:58
I suggested Wellbutrin and nortriptyline because they both have the potential to treat ADD.
- Scott
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