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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by zefdie on March 17, 2004, at 11:20:18
Hey all--I'm new here and headed to see my GP in a few hours and was hoping someone was around to give me some advice.
Psychiatrists are hard to come by where I'm at--they're all booked, and because I recently moved to a new city I can't see the doctor who prescribed Wellbutrin SR 150 for my major depression a few years ago. I've been very debilitated lately and after a week of frustrating calls, I found one pdoc who would see me right away. We had a regular preliminary appointment, I explained my problem (anxiety, severe concentration problems, despair, suicidal ideation, deteriorating vocabulary and cognitive function, that "loss of self" feeling, obsessive thoughts, self-sabotage and lack of anything resembling motivation) and she suggested that I, as someone who's already tried SSRIs, would benefit from trying Effexor XR augmented with the Wellbutrin.
I've researched Effexor and believe that for me the benefits are worth the risk--I've been depressed my whole life and am ready to try the only med that's worked for so many people I know. The problem is, this pdoc wouldn't take me on as a patient because she wanted to do psychoanalysis and I had thought, after speaking to her on the phone, that she offered more than one method. She took my check and left me in complete despair, because there are no other pdocs available right now who take my insurance.
I've found a psychologist to work with; all I need are meds. So I made an appointment with my GP to talk about my options. I need help RIGHT NOW, and I'm ready to try Effexor, especially after getting the pdoc's evaluation. I'm planning to see another pdoc for meds management as soon as a space becomes available. In the meantime, I really want to try Effexor. I've researched it thoroughly.
What are the recommended dosages for getting started? The pdoc told me that it works like a plain-old SSRI at lower dosages, and I don't want that. I want the SSNRI (or whatever it's called) effect, and I want to continue on Wellbutrin SR 150 as she recommended.
What do you suggest I ask for from my GP? I've done the research very thoroughly but could still benefit from some advice. I need something right away and my only other option is to go to the emergency room, where I'd probably see a general physician anyway.
Thanks!
Posted by King Vultan on March 17, 2004, at 12:51:03
In reply to Off to doctor in a few--help w/ Effexor questions?, posted by zefdie on March 17, 2004, at 11:20:18
Keep in mind that Wellbutrin is a CYP-450 2D6 inhibitor, and Effexor is a 2D6 substrate. What this means is that Wellbutrin can increase blood plasma levels of Effexor to higher levels than they would be with just the Effexor taken by itself. Even 150 mg of Wellbutrin can do this, based on my own experience combining this dosage of Wellbutrin with desipramine, which is a classic 2D6 substrate. Fortunately, my doctor and I were aware of this and were monitoring my desipramine blood plasma levels (they were increased by about a factor of about 3.5 times from what they would have been otherwise).
Effexor lacks the well known therapeutic blood plasma levels established over decades of use of tricyclics like desipramine, so you need to use your best judgement and make an educated guess. I guess what I am trying to say is that I would caution against trying to swing for the fences with a high initial dosage of Effexor. Start out at lower level and then go higher if you find you are able to tolerate any adverse effects. I guess if it were me, I would perhaps ask to start at 75 mg of Effexor with an eye towards maybe increasing this to 150 mg/day at some point.
One other thing, I don't know how your drug copays work, but these are two relatively expensive drugs. If the cost is burdensome, you may wish to consider the MAOIs Nardil or Parnate, which do essentially the same thing as Effexor + Wellbutrin, with lower cost and greater effectiveness. Most people seem to be scared off by the dietary restrictions, which are overblown, and the drug interactions, which are real, but these dangers can be minimized by doing a little research and exercising some prudence and caution.
Todd
Posted by zefdie on March 17, 2004, at 14:16:13
In reply to Re: Off to doctor in a few--help w/ Effexor questions? » zefdie, posted by King Vultan on March 17, 2004, at 12:51:03
Thanks so much for the quick reply. I got to my doctor and they had accidentally cancelled my appointment, so now I've got a few more hours of waiting around before I can go back to see another doctor.
I'm on a lot of other drugs for various other things and think I should avoid MAOIs. I'm definitely going to ask about Effexor 75 mg--is this XR? Is it once or twice a day?
Thanks again for your help. I want to be prepared, as I'm seeing a GP and not a psychiatrist.
> Keep in mind that Wellbutrin is a CYP-450 2D6 inhibitor, and Effexor is a 2D6 substrate. What this means is that Wellbutrin can increase blood plasma levels of Effexor to higher levels than they would be with just the Effexor taken by itself. Even 150 mg of Wellbutrin can do this, based on my own experience combining this dosage of Wellbutrin with desipramine, which is a classic 2D6 substrate. Fortunately, my doctor and I were aware of this and were monitoring my desipramine blood plasma levels (they were increased by about a factor of about 3.5 times from what they would have been otherwise).
>
> Effexor lacks the well known therapeutic blood plasma levels established over decades of use of tricyclics like desipramine, so you need to use your best judgement and make an educated guess. I guess what I am trying to say is that I would caution against trying to swing for the fences with a high initial dosage of Effexor. Start out at lower level and then go higher if you find you are able to tolerate any adverse effects. I guess if it were me, I would perhaps ask to start at 75 mg of Effexor with an eye towards maybe increasing this to 150 mg/day at some point.
>
> One other thing, I don't know how your drug copays work, but these are two relatively expensive drugs. If the cost is burdensome, you may wish to consider the MAOIs Nardil or Parnate, which do essentially the same thing as Effexor + Wellbutrin, with lower cost and greater effectiveness. Most people seem to be scared off by the dietary restrictions, which are overblown, and the drug interactions, which are real, but these dangers can be minimized by doing a little research and exercising some prudence and caution.
>
> Todd
Posted by King Vultan on March 17, 2004, at 14:50:47
In reply to Re: Off to doctor in a few--help w/ Effexor questions?, posted by zefdie on March 17, 2004, at 14:16:13
> Thanks so much for the quick reply. I got to my doctor and they had accidentally cancelled my appointment, so now I've got a few more hours of waiting around before I can go back to see another doctor.
>
> I'm on a lot of other drugs for various other things and think I should avoid MAOIs. I'm definitely going to ask about Effexor 75 mg--is this XR? Is it once or twice a day?
>
> Thanks again for your help. I want to be prepared, as I'm seeing a GP and not a psychiatrist.
>
The Effexor XR allows once a day dosing. The standard release form needs to be taken twice a day because of this med's very short half life. If you take the standard release form just once a day, you can actually start experiencing withdrawal symptoms in between doses. I mostly took the standard release form, probably because there was no XR version available when I started taking this in the mid 90's. Most people seem to take the XR version nowadays. What I meant by 75 mg was a total of 75 mg/day, whichever version you use.Todd
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