Posted by bleauberry on January 5, 2012, at 10:25:40
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
The phenomenon you are referring to....emotional blunting....has been reported here so many times over the months and years. I have seen it happen with myself and others and I think it is far more common than doctors are willing to admit. I'm sure they see it, but they somehow explain it away with some ridiculous reasoning or they just blow it off or add wellbutrin or something.
Anyway, what meds have been involved in the emotional blunting? Here are ones I remember people commenting about....
SSRIs....all of them, zoloft and prozac being less guilty but still guitly.
Nortriptyline. Reboxetine. Adderall. Ritalin. Antipsychotics.So you see, while we tend to think of this phenomenon as a serotonin/dopamine thing, it happens with pure or dopamine sometimes too norepinephrine too. How can a potent stimulant like ritalin cause someone ADD to become calm and grounded? Kind of the same phenomenon we are talking about here....boosting a certain neurotransmitter can have an opposite effect depending on the sensitivities of the receptors involved. Depending on how the dopamine circuits are set up, one person may become stimulated and euphoric while another may become calm and focused and yet another will become anxious and depressed, all from the same drug.
That said, serotonin is usually the more guilty party I believe. Effexor happens to be a very potent serotonin med with very little effect on norepinephrine or dopamine. Why it is called a SNRI instead of a SSRI is a mystery to me because it really doesn't have much effect on norepinephrine....30 parts serotonin to 1 part norepinephrine....not exactly an equal balance and actually not even close....almost pure serotonin. I think it is a marketing thing to call it a SNRI but isn't really supported much by the facts.
So what to do? Well, adding something dopamine does make sense. Me personally, any motivation/pleasure issues respond much better to norepinephrine strategies than dopamine strategies. I find NE much more involved than dopamine, but understand we are all different.
Probably the most common strategy I am aware of is to add wellbutrin. I am not a fan of that drug, but it is a common strategy. Whether it works or not, I don't know, haven't seen it happen very much. Other options would include adding a med to balance out NE, which would mean either nortriptyline, desipramine, or savella.
Now here is the problem.....you are already taking a dopamine/norepinephrine med....adderall. But you are still flat. Maybe it is itself involved in the flatness? Dunno, maybe, maybe not. But for sure, it is not helping to undo negative effects of effexor.
Gut instincts. Mine tell me effexor is probably not a good choice for you because if it is causing that kind of flatness this early in the game at that low of a dose, well, that doesn't predict a great future. It predicts you may likely be dealing with that problem for a long time. On the other hand, maybe some would claim the flatness will slowly go away as the body gets accustomed to the med over months. I've just hardly ever seen that happen so I tend not to agree.
Anyway, some stuff to think about.
If it were me, what would I do?
I would lower effexor to 37.5mg (that dose works great for a lot of people) and I would add the herb Rhodiola Rosea to it. Both of those moves are directed at antidepression and antiflat with minimal side effects.
poster:bleauberry
thread:1006132
URL: http://www.dr-bob.org/babble/20111226/msgs/1006414.html