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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by scs3371 on July 2, 2004, at 10:48:04
Does anyone out there know anything about taking SAMe or St. John's Wort while you are trying to withdrawal from Effexor? I am wanting to get off my Effexor and go to something herbal but don't know if you can mix the two while you are going through withdrawal (not looking forward to the withdrawal by the way!). Any help would be appreciated!!!
Thanks,
Stacy
Posted by Larry Hoover on July 2, 2004, at 13:19:49
In reply to Effexor Withdrawal and Herbal Supplements????, posted by scs3371 on July 2, 2004, at 10:48:04
> Does anyone out there know anything about taking SAMe or St. John's Wort while you are trying to withdrawal from Effexor? I am wanting to get off my Effexor and go to something herbal but don't know if you can mix the two while you are going through withdrawal (not looking forward to the withdrawal by the way!). Any help would be appreciated!!!
>
> Thanks,
> StacyFrom:
http://benzo.org.uk/healy.htmMANAGEMENT OF WITHDRAWAL
"Withdrawal from SSRIs is something to be done in consultation with your physician. You may wish to show this to your GP. Over-rapid withdrawal may even be medically hazardous, particularly in older persons.
1. Convert the dose of SSRI you are on to an equivalent dose of Prozac liquid. Seroxat/Paxil 20mg, Efexor 75mg, Cipramil/Celexa 20mgs. Lustrat/Zoloft 50mgs are equivalent to 20mg of Prozac liquid. The rationale for this is that Prozac has a very long half-life, which helps to minimise withdrawal problems. The liquid form permits the dose to be reduced more slowly than can be done with pills.
2. Stabilise on the Prozac for a week, then halve the dose.
3. If there has been no problem with step 2, the dose can be further halved. Alternatively if there has been a problem from this point on the dose can be reduced even more slowly in weekly increments.
4. From a dose of Prozac 10mgs liquid, consider reducing by 1mg every few days over the course of several weeks - or months if need be. With Prozac liquid this can be done by dilution.
5. If there are difficulties at any particular stage the answer is to wait at that stage for a longer period of time before reducing further.
6. Withdrawal and dependence are physical phenomena. But some people can get understandably phobic about withdrawal particularly if the experience is literally shocking. If you think you may have become phobic, a clinical psychologist may be able to help manage the phobic problem.
7. Self-help support groups can be invaluable. Join one. If there are none nearby, consider setting one up. There will be lots of other people with a similar problem.
There is anecdotal evidence and some theoretical grounds to believe that another option is to substitute St John's Wort for the SSRI. If a dose of 3 tablets of St John's Wort is tolerated instead of the SSRI, this can then be reduced slowly - by one pill per fortnight or even per month.
Some people for understandable reasons may prefer this approach. But it needs to be noted that St John's Wort has its own set of interactions with other pills and its own problems and you may wish to consult your physician if this is the option you choose."
Posted by KaraS on July 2, 2004, at 22:09:54
In reply to Re: Effexor Withdrawal and Herbal Supplements???? » scs3371, posted by Larry Hoover on July 2, 2004, at 13:19:49
> > Does anyone out there know anything about taking SAMe or St. John's Wort while you are trying to withdrawal from Effexor? I am wanting to get off my Effexor and go to something herbal but don't know if you can mix the two while you are going through withdrawal (not looking forward to the withdrawal by the way!). Any help would be appreciated!!!
> >
> > Thanks,
> > Stacy
>
> From:
> http://benzo.org.uk/healy.htm
>
> MANAGEMENT OF WITHDRAWAL
>
> "Withdrawal from SSRIs is something to be done in consultation with your physician. You may wish to show this to your GP. Over-rapid withdrawal may even be medically hazardous, particularly in older persons.
>
> 1. Convert the dose of SSRI you are on to an equivalent dose of Prozac liquid. Seroxat/Paxil 20mg, Efexor 75mg, Cipramil/Celexa 20mgs. Lustrat/Zoloft 50mgs are equivalent to 20mg of Prozac liquid. The rationale for this is that Prozac has a very long half-life, which helps to minimise withdrawal problems. The liquid form permits the dose to be reduced more slowly than can be done with pills.
>
> 2. Stabilise on the Prozac for a week, then halve the dose.
>
> 3. If there has been no problem with step 2, the dose can be further halved. Alternatively if there has been a problem from this point on the dose can be reduced even more slowly in weekly increments.
>
> 4. From a dose of Prozac 10mgs liquid, consider reducing by 1mg every few days over the course of several weeks - or months if need be. With Prozac liquid this can be done by dilution.
>
> 5. If there are difficulties at any particular stage the answer is to wait at that stage for a longer period of time before reducing further.
>
> 6. Withdrawal and dependence are physical phenomena. But some people can get understandably phobic about withdrawal particularly if the experience is literally shocking. If you think you may have become phobic, a clinical psychologist may be able to help manage the phobic problem.
>
> 7. Self-help support groups can be invaluable. Join one. If there are none nearby, consider setting one up. There will be lots of other people with a similar problem.
>
> There is anecdotal evidence and some theoretical grounds to believe that another option is to substitute St John's Wort for the SSRI. If a dose of 3 tablets of St John's Wort is tolerated instead of the SSRI, this can then be reduced slowly - by one pill per fortnight or even per month.
>
> Some people for understandable reasons may prefer this approach. But it needs to be noted that St John's Wort has its own set of interactions with other pills and its own problems and you may wish to consult your physician if this is the option you choose."
>
>Larry,
I've been taking 37.5 mg. of Effexor and added 300 mg. of SJW in order to help me withdraw completely from the Effexor. So far it has been working out well but I just read a posting by "Linkage" on the regular P-B board. He claims it's very dangerous to mix them - that he ended up in the hospital from serotonin syndrome while he was taking 10 mg. of Celexa and an unspecified amount of SJW. Could you please advise or give me more guidelines for using SJW for this purpose?Thanks,
Kara
Posted by Larry Hoover on July 3, 2004, at 9:40:37
In reply to Re: Larry, Effexor Withdrawal and SJW????, posted by KaraS on July 2, 2004, at 22:09:54
> Larry,
> I've been taking 37.5 mg. of Effexor and added 300 mg. of SJW in order to help me withdraw completely from the Effexor. So far it has been working out well but I just read a posting by "Linkage" on the regular P-B board. He claims it's very dangerous to mix them - that he ended up in the hospital from serotonin syndrome while he was taking 10 mg. of Celexa and an unspecified amount of SJW. Could you please advise or give me more guidelines for using SJW for this purpose?
>
> Thanks,
> KaraWhat's missing from what you carry forward from Linkage is another key variable, dose.
In crude terms, you can estimate the likelihood of serotonin syndrome from therapeutic dose levels. You are at 37.5 mg Effexor, which is roughly one quarter of the smallest therapeutic dose. You are at 300 mg SJW, which is about one third of the minimum therapeutic dose. Add those together, and you get less than 60% of a therapeutic dose.
Now, that said, everyone has there own unique threshold for serotonin syndrome. Some people are especially sensitive to serotonergic meds, and get serotonin syndrome at recommended therapeutic doses. Usually, though, serotonin syndrome involves therapeutic doses of one med, plus therapeutic doses of another similar med, or even overdose of one or the other or both. But you are not even close to therapeutic dose.
You might want to use half a 37.5 Effexor for a while, instead of dropping straight to zero, but I do not foresee a problem with your combination.
Lar
Posted by scs3371 on July 3, 2004, at 12:36:56
In reply to Re: Larry, Effexor Withdrawal and SJW???? » KaraS, posted by Larry Hoover on July 3, 2004, at 9:40:37
DISCLAIMER: I am the one who posted the original post and have been doing research myself. I am in NO WAY offering medical advice - just stating what my feelings are after reading literature.
I have to agree that it seems likely that the risk of serotonin syndrome is extremely low with the 37.5 dose of Effexor. The risk of StS (serotonin syndrome) is increased with multiple therapeutic doses of SSIs...if you are on more than one SSI (Effexor AND Zoloft as an example - I don't even know if these are usually combined, but this is just hypothetical). The treatment for SSI is to remove the causative agent (the drug) so just be familiar with the signs and symptoms of StS and get medical treatment if you feel like you are experiencing any of those symptoms. (However some of the symptoms do mask withdrawal symptoms so that is where it gets tricky). From reading pharmaceutical info, it seems Effexor has a half life of about 5 hours and it's metabolite has a half life of about 11 hours. I have been off of Effexor for about 36 hours now (was on 75 mg) and plan to start taking SJW this afternoon. That is my choice...I am not in any way saying it's right for everyone or anyone! I just wanted to let you know what I was going to do after doing some research. The person who posted to NOT take SJW while you are trying to get off of Effexor did not say if she was on other meds, but said she was on, I believe, Celexa (? - I may be wrong about that). I am not discrediting her experience at all, just saying that for me, I am going to take the chance. I am an RN (again DISCLAIMER: I am NOT offering medical advice) and after reading the literature, I feel that I will take the chance on taking SJW. My e-mail address is scs3371@yahoo.com if anyone wants to chat/support each other, etc! Good luck!
Stacy :o)
> > Larry,
> > I've been taking 37.5 mg. of Effexor and added 300 mg. of SJW in order to help me withdraw completely from the Effexor. So far it has been working out well but I just read a posting by "Linkage" on the regular P-B board. He claims it's very dangerous to mix them - that he ended up in the hospital from serotonin syndrome while he was taking 10 mg. of Celexa and an unspecified amount of SJW. Could you please advise or give me more guidelines for using SJW for this purpose?
> >
> > Thanks,
> > Kara
>
> What's missing from what you carry forward from Linkage is another key variable, dose.
>
> In crude terms, you can estimate the likelihood of serotonin syndrome from therapeutic dose levels. You are at 37.5 mg Effexor, which is roughly one quarter of the smallest therapeutic dose. You are at 300 mg SJW, which is about one third of the minimum therapeutic dose. Add those together, and you get less than 60% of a therapeutic dose.
>
> Now, that said, everyone has there own unique threshold for serotonin syndrome. Some people are especially sensitive to serotonergic meds, and get serotonin syndrome at recommended therapeutic doses. Usually, though, serotonin syndrome involves therapeutic doses of one med, plus therapeutic doses of another similar med, or even overdose of one or the other or both. But you are not even close to therapeutic dose.
>
> You might want to use half a 37.5 Effexor for a while, instead of dropping straight to zero, but I do not foresee a problem with your combination.
>
> Lar
Posted by Dr. Bob on July 3, 2004, at 15:41:43
In reply to Effexor Withdrawal and Herbal Supplements????, posted by scs3371 on July 2, 2004, at 10:48:04
Re: New to Effexor XR, my side effects, anyone els
Posted by KaraS on July 2, 2004, at 20:27:05
In reply to Re: New to Effexor XR, my side effects, anyone els, posted by linkadge on July 2, 2004, at 15:08:09
Really? How much SJW did you take? I was taking 37.5 mg. of Effexor with 300 mg. of SJW with no problems. Larry Hoover on the Altnernative Board was quoting Dr. Healy who advises using SJW for this purpose. But I guess better safe than sorry. Try to get Prozac.
--
Re: New to Effexor XR, my side effects, anyone els
Posted by linkadge on July 3, 2004, at 10:11:53
In reply to Re: New to Effexor XR, my side effects, anyone els, posted by KaraS on July 2, 2004, at 20:27:05
The reason I am so cautions is because the symptoms of serotonin syndrome might mimic symptoms of withdrawl.
Serotonin snydrome can cause severe anxity diarea, flu like symptoms, shivering etc.
One difference is that serotonin snydrome is
potentially fatal and effexor withdrawl is not.If you are going to try adding SJW, get a list of serotonin snydrome symptoms and be cautious.
Linkadge
Posted by KaraS on July 3, 2004, at 21:09:01
In reply to Re: Larry, Effexor Withdrawal and SJW???? » KaraS, posted by Larry Hoover on July 3, 2004, at 9:40:37
Thanks so much for clarifying that. I am now taking 3/4 of 37.5 mg. pill of Effexor per night. I'm going to decrease very slowly as I am job hunting now and can't afford to be nonfunctioning at all. It's such a drag though. Can't wait for the time when I don't have to worry about it and can start adding in other things I've wanted to try. I need the energy and motivation and ability to concentrate desperately right now yet can't seem to summon it. It sounds like you have faced similar challenges in your own work life but have found some adequate relief. That's very encouraging.
Posted by jay on July 6, 2004, at 19:54:11
In reply to Re: Effexor Withdrawal and Herbal Supplements???? » scs3371, posted by Larry Hoover on July 2, 2004, at 13:19:49
Lar...do you know of a good website (i.e. one that is not pushing to sell) re: amino acids and psychiatry? Here in Canada, a whole bunch of things, including Aminos and Melatonin, are now much more widely available as of this year. I can even now buy Melatonin at 5-6 bucks at Shoppers Drug Mart. What about the 'calming' Aminos like L-Taurine and GABA, and their uses? These are also nice and cheap now, so I'd like to really experiment. Thanks!
Jay
Posted by Larry Hoover on July 7, 2004, at 11:41:45
In reply to Re: Amino Acids and Effexor withdrawl???? » Larry Hoover, posted by jay on July 6, 2004, at 19:54:11
> Lar...do you know of a good website (i.e. one that is not pushing to sell) re: amino acids and psychiatry?
No, not literally. I had a good link, but now you have to pay to read their work.
If you have the patience to wade through the indexes, you can get lots of information here:
http://www.thorne.com/alternative/back.htmlOther info:
http://www.indstate.edu/thcme/mwking/aminoacidderivatives.html
http://www.brainplace.com/bp/supplements/default.asp
http://wiz2.pharm.wayne.edu/biochem/aametab.html> Here in Canada, a whole bunch of things, including Aminos and Melatonin, are now much more widely available as of this year.
New regulations came into effect on Jan. 1.
> I can even now buy Melatonin at 5-6 bucks at Shoppers Drug Mart. What about the 'calming' Aminos like L-Taurine and GABA, and their uses? These are also nice and cheap now, so I'd like to really experiment. Thanks!
>
> JayI think that there has been a lot of talk on this board recently about oral GABA. Taurine is a very interesting subject. I do plan to give it a whirl, but I'm currently involved in other treatment experiments, so I have to wait. Taurine regulates thyroid function, and influences HPA hormone interactions. It's definitely got activity. I just haven't yet nailed down the specifics. It is calming, no doubt.
Lar
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