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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by jay on April 5, 2002, at 21:16:23
Hey folks:I am on a medium dose of Effexor XR, at 225mgs, and was wondering if anyone else combines an SSRI..any of them...with that. My major concern would be with serotonin syndrome, and a possible manic reaction (I am on Zyprexa also for BPII) but I would really like to hear from you guys.
Thanks!
Jay
Posted by petters on April 5, 2002, at 22:33:09
In reply to Combine Effexor + SSRI.?? Anyone???, posted by jay on April 5, 2002, at 21:16:23
Hi...
There is no problem to combo ssri with Effexor. But you should stick to Celexa or Zoloft. These two agent are less likely to interact with the Effexor, and the risk for serotonin syndrom is minimal.
One I add 30 mg Celexa to 375 mg Effexor, without any problem.
Sorry for the spelling. Not from U.S
Sincerely...//Petters
Posted by TSA West on April 5, 2002, at 23:23:05
In reply to Combine Effexor + SSRI.?? Anyone???, posted by jay on April 5, 2002, at 21:16:23
This talks about mixing effexor with Prozac and others: http://www.dr-bob.org/tips/split/Mixing-antidepressants.html
Posted by DebbieLynn on April 6, 2002, at 23:55:11
In reply to Re: Combine Effexor + SSRI.?? Anyone??? » jay, posted by TSA West on April 5, 2002, at 23:23:05
It depends on the person, in my opinion. If you are medicine sensitive, then when you start the combo, you will know if it benefits you. From personal experience, I am on Effexor XR 225mg and have tried Celexa (started at 10mg then up to 20mg) and "flipped out". I just could not tolerate the combo, but thats me. I did have some success adding Wellbutrin SR 150mg. (for altered libido) but it made be irritable. So, I weighed the benefits with the risks and decided to stay on one med, Effexor XR, I am considering taking my pdocs advise and titrating up to 300-325mg. 325mg is a new therapeutic dose for Effexor. I guess I just do not handle SSRI's very well. Technically speaking Effexor XR is a "bicyclic" and Wellbutrin is kind of in a class of its own. It is a weak reuptake inhibitor of serotonin, dopamine, and norepinephrine. Effexor is I guess an SNRI. By the way, I am a nursing student in my 3rd year, majoring in psychiatric nursing!! I am currently taking an abnormal psychology course which is AWESOME! The brain is a complicated organ. Anyway...If you have any questions or opinions (good or bad) send them!
Good Luck...by the way...why do you want to add a ssri to your current regiman??????
Hope this helps!! ;)
Debbie
Posted by Elizabeth on April 8, 2002, at 0:56:20
In reply to Combine Effexor + SSRI.?? Anyone???, posted by jay on April 5, 2002, at 21:16:23
I actually heard some very good things about this from a pdoc I knew in Boston who was really up on all the latest tricks and techniques. It seems like a weird thing to do (I mentioned it to another MD and he responded, "That's a lot of serotonin!"), but apparently it really works great for some people.
The serotonin syndrome shouldn't be a problem as long as you start out adding a very low dose of the SSRI (like 5 mg Prozac or Paxil, 12.5-25 of Zoloft, etc.) and increasing very gradually, watching for any side effects.
I've had the CSS several times (don't ask how this happened), including twice when it was pretty severe, and I'm alive and well today. So it's not like it's always fatal, or anything. Really there's a continuum from general serotonin-mediated side effects to the CSS. So those types of side effects are the ones you want to watch for: jitters, nausea, diarrhea, dilated pupils, abnormal sweating, etc. The milder CSS symptoms, in other words. Increase the dose only as tolerated; if you start getting some side effects, stay at that dose for a while and see if they recede.
If you're interested, I posted some stuff about the serotonin syndrome recently:
http://www.dr-bob.org/babble/20020402/msgs/101847.html
-elizabeth
Posted by Elizabeth on April 8, 2002, at 0:56:34
In reply to Re: Combine Effexor + SSRI.?? Anyone???, posted by DebbieLynn on April 6, 2002, at 23:55:11
> It depends on the person, in my opinion. If you are medicine sensitive, then when you start the combo, you will know if it benefits you.
I don't know if I really believe in the concept of a medicine-sensitive person. Like, obviously some people will be more sensitive to certain types of medicines than others. But are some people sensitive to medicines in general? That seems weird. Like, what possible explanation is there for that?
What do you think?
> 325mg is a new therapeutic dose for Effexor.
I though the maximum recommended dose of Effexor was 375 mg...? (It's lower for Effexor XR, but I thought it was *much* lower, like 225.)
> Technically speaking Effexor XR is a "bicyclic" and Wellbutrin is kind of in a class of its own.
"Aminoketone," I think. But Wellbutrin is a lot like amphetamine. For that matter, Effexor is also a phenethylamine.
> It is a weak reuptake inhibitor of serotonin, dopamine, and norepinephrine.
Wellbutrin? I don't think anyone knows what Wellbutrin does (well, what action is responsible for the AD effect, that is), although monoamine reuptake inhibition doesn't seem to be it. It also doesn't seem to be related to serotonin at all.
> By the way, I am a nursing student in my 3rd year, majoring in psychiatric nursing!!
I think that is terrific! I have lots of admiration for people who recover from mental illness and then get involved in mental-health-related professions themselves. There need to be more psychiatrists, psych nurses, etc. who've "been there." For a while I was working on taking the classes I still need to apply to med school (all I have left to take is organic chemistry and biology, I did most of the others in college), but then I started having depression problems [again]. Maybe one day I'll hop on the bandwagon too, but I have to get past some hurdles (mainly the money hurdle) before I can get back to that. :-(
-elizabeth
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