Posted by torachan on May 28, 2008, at 22:37:34
In reply to Re: The best Tricyclic for anxiety...., posted by linkadge on May 28, 2008, at 20:30:34
> >Effexor is effective when treating generalized >anxiety disorder (GAD). That's what you should >focus on. It works better than the SSRIs, >including Paxil.
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> Yes and no. Wyeth did a number of head to head trials that favored their drug, but some of the SSRI companies fired back with trials that supported their drug. The SSRIs also appear to be more tollerable than venlafaxine.
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> >Take some time to look over the literature on >the Web regarding Effexor and GAD. At this point >in time, I think empirical observation must take >precedence over prediction based on theory.
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> But the "empirical" evidence is a little flawed.
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> I think if an indivudal is not gaining adequate relief with venlafaxine alone then it is not unreasonable to suggest something to augment it. There is good evidence that AP's can augment uptake inhibitors. Looking to drug mechanisms is may not work all the time, but the combination of a uptake inhibitor with some form of 5-ht receptor blocker does appear to have supporting literature in both human and animal models of anxiety.
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> >What is the rationale for using Remeron in >combination with Effexor?
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> I would not recomend this combination on account of significant noradrenergic stimulation.
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> >I would not give up on Effexor until you reach >300mg.
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> I would. Especially if you are experiencing unhealthy side effects like BP increase or a significant increase in anxiety.
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> I didn't sleep much at all on 150mg of effexor. I felt much better when I lowered it to 75mg and added 25mg of seroquel. I was also feeling much more suicidal as we went up on effexor. Effexor also causes dose dependant increases in cortisol (again probably a 5-ht2 related mechanism). 5-ht2 antagonists are strong anticortisol agents.
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> Doxapine, amitrpytaline, remeron, cyproheptadine, trimipramine, seroquel, risperidal, zyprexa and many more 5-ht2 antagonits have documented anticortisol effects. In contrast most pure uptake inhibitors (ie SSRI's etc) increase cortisol, sometimes even after prolonged adminstration. They may also ameliorate disrupted sleep profiles.
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> Many of the above 5-ht2 antagonists also increase slow wave sleep (a stage of sleep often lacking in depression). There is good evidence of this. If sleep is significantly disturbed sometimes a low dose of a 5-ht2 blocking drug would be very helpful.
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> Linkadge
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>Link, as I read in another one of your posts, you mentioned that the use of Effexor at 75 and Seroquel at 25 was good for your anxiety, correct. This is the drug combo my current doc is recommending, although he seems to be favoring a higher does of Seroquel. But I'm a bit confused here. You said that a 5HT2? blocker would be a good combination with Effexor, and you included in your list Remeron along with Seroquel, yet you said Effexor and Remeron would not be a good combo for anxiety due to excessive noradrenergic stimulation.
Wouldn't a low does of Remeron prevent the problem you speak of? With Seroquel and me, it's odd, because I don't seem to have the effects which most people experience like a single 25mg dose "knocking them out". I once tested the "knockout strength" of this drug early in the trial by taking 350mgs and I was still on my feet, after being up all night, which Effexor gives me the tendency to do. Also, I feel a bit disorientated on Seroquel which scratches at my edginess, so I'm a little confused as to why if Remeron and Seroquel are both 5HT blockers, and with me at least Remeron being a far superior sleep inducing agent, why would you recommend against the Rem?
I don't expect you to diagnose me and dispense with medical advice, just a little informed opinion. I just seem to trust your opinion and advice, and will discuss your thoughts, which have become my thoughts, with my doctor.
Thanks sincerely.
poster:torachan
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/831806.html