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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by andi on March 31, 2002, at 8:13:08
When I took my first dose of Celexa 20 mg, I had a serotonin overdose from it. I did not take any more. Now a new pdoc wants me to take Effexor XR. If I overdosed on the serotonin of low-dose Celexa, wouldn't I also overdose on this more powerful Serotonin drug? Drugs are in drawer while I sit and stew over it.
Posted by TSA West on March 31, 2002, at 9:08:40
In reply to Serotonin overdose and Effexor, posted by andi on March 31, 2002, at 8:13:08
It is true that Effexor is 5 times as potent an inhibitor of the serotonin pump than it is as an inhibitor of the norepinephrine pump (http://www.preskorn.com/cgi-bin/sp.pl?words=venlafaxine&wt=be&bl=an&IMAGE1.x=0&IMAGE1.y=0&d=/columns/9911.html). But however, venlafaxine is much weaker than most serotonergic drugs according to Figure 1B of Preskorn's on the previous webpage. Its 80% reuptake inhibition on the platelets at 75 mg does not compare with a tiny 20 mg fluoxetine dose producing the same 80% inhibition.
If a clinician confirms that what you really have from Celexa is serotonin "over-load," then the dosage range of 25-50 mg of venlafaxine sounds adequate for you. You may want to keep on hand some propranolol (5HT1a antagonist) or cyproheptadine as backup.
> When I took my first dose of Celexa 20 mg, I had a serotonin overdose from it. I did not take any more. Now a new pdoc wants me to take Effexor XR. If I overdosed on the serotonin of low-dose Celexa, wouldn't I also overdose on this more powerful Serotonin drug? Drugs are in drawer while I sit and stew over it.
Posted by jay on March 31, 2002, at 14:07:37
In reply to Serotonin overdose and Effexor, posted by andi on March 31, 2002, at 8:13:08
> When I took my first dose of Celexa 20 mg, I had a serotonin overdose from it. I did not take any more. Now a new pdoc wants me to take Effexor XR. If I overdosed on the serotonin of low-dose Celexa, wouldn't I also overdose on this more powerful Serotonin drug? Drugs are in drawer while I sit and stew over it.
Hi:
Do you mean "serotonin syndrome"? 20mg's of Celexa can be a big dose, especially if starting, for some, so if that is what you experienced, I wouldn't write off other medications.
What dose of Effexor did your doctor give you? You may be best to start at a low dose, and very slowly work up to a helpful dose.
Let us know...
Jay
Posted by andi on March 31, 2002, at 14:36:34
In reply to Re: Serotonin overdose and Effexor, posted by jay on March 31, 2002, at 14:07:37
> > When I took my first dose of Celexa 20 mg, I had a serotonin overdose from it. I did not take any more. Now a new pdoc wants me to take Effexor XR. If I overdosed on the serotonin of low-dose Celexa, wouldn't I also overdose on this more powerful Serotonin drug? Drugs are in drawer while I sit and stew over it.
>
> Hi:
>
> Do you mean "serotonin syndrome"? 20mg's of Celexa can be a big dose, especially if starting, for some, so if that is what you experienced, I wouldn't write off other medications.
>
> What dose of Effexor did your doctor give you? You may be best to start at a low dose, and very slowly work up to a helpful dose.
>
> Let us know...
>
> JayThe package insert listed symptoms for Serotonin Syndrome, and more severe symptoms for Serotonin Overdose. My symptoms matched the Serotonin Overdose description. The article TSA West referred to shows that 20 mg of Celexa has the same action on serotonin as 75 mg of Effexor. This doc gave me a starter kit of 7 days at 37.5 and 7 days at 75 mg. It seems like that would be asking for trouble. Also, why would you take another drug that increases your serotonin supply when it seems you already have enough of that stuff.
Posted by geno on March 31, 2002, at 18:47:12
In reply to Re: Serotonin overdose and Effexor » andi, posted by TSA West on March 31, 2002, at 9:08:40
I have a psychopharmocoly book from my pdoc. Its a mind nuts dream. It lists all the meds and receptors and rates each receptor potency. How it rates the effectiveness is by a + mark.
Paxil shows +++++. Which is the highest. Effexor shows +++. Celexa shows ++++. Id say keep effexor at the lowest dose. Paxil i keep at 10mg.Norepinephrine values of effexor or NE shows ++. Desipramine shows +++++. So actually if you want a powerful combo of seratonin and norepinephrine, take paxil and desipramine. Dopamine Reuptake shows shows welbutrin only at ++. Zoloft shows the same, but i suspect only at high doses.
+ are the k values.
geno
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