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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by shadowmon on June 4, 2008, at 1:11:34
I was told by the pdoc that norethridine reuptake(sp) in effexor becomes more effective in dosages above 150 and serotonin reuptake acts for dosages below 150.
I used to take paxil cr at various dosages, and it handled my depression and anxiety very well, and was calm until recently, so I changed
Now If I have melancholic depression, am at 150mg and am still having anxiety upon early waking and after taking naps, what are the chances that going higher will help me with the anxiety and still help my depression? If I decide to go higher, won't the norephrenine mitigate the anxiety and the level of serotonin reuptake remain the same? I'm looking for the same calm that the paxil gave me when It was doing what it was supposed to. I don't mind the being more alert and activated (because I tend to be a lazy bum) either.
My doc doesnt want to change the dosage just yet, and I am trying to research whether this is a next logical step to ask when seeing her (in a month) I've been at 150 mg for about 2 weeks and well, while working and focusing on something I am ok, but other than that, there is not much else, other than the waking anxiety and the feeling of being "high strung" and the occasional moment of despair.
I know that there are a lot of people who take dosages in excess of 150 and was wondering how you felt.
Posted by torachan on June 4, 2008, at 2:28:22
In reply to Effexor dosages above 150mg? feedback?, posted by shadowmon on June 4, 2008, at 1:11:34
Generally the norepinephrine action doesn't take hold until around 225mgs. This action would presumably cause more activation which would aid with depression but could possibly be aggravating to your anxiety level.
Posted by shadowmon on June 4, 2008, at 2:46:42
In reply to Re: Effexor dosages above 150mg? feedback?, posted by torachan on June 4, 2008, at 2:28:22
If I go up on that dosage, what do they mean by activation? I have taken wellbutrin in the past and I know from studying that it's one of the most activating meds out there. Of course, It doesnt do anything for serotonin. It didnt increase my anxiety at all, but it did make it so I was up all day long. I mean, I couldnt rest (like take a nap, like I usually do) but I was not anxious. I was wondering if that what they mean by activating?
Posted by shadowmon on June 4, 2008, at 2:47:58
In reply to Re: Effexor dosages above 150mg? feedback?, posted by shadowmon on June 4, 2008, at 2:46:42
Oh another thing I forgot to ask when I posted. So what happens to the serotonin when the dosage goes that high? Does it start affecting less?
Posted by SLS on June 4, 2008, at 4:54:51
In reply to Effexor dosages above 150mg? feedback?, posted by shadowmon on June 4, 2008, at 1:11:34
Go up to 300mg if necessary. The anxiety will most likely disappear when your depression disappears.
Have you tried a tricyclic?
- Scott
Posted by sunnydays on June 4, 2008, at 10:23:37
In reply to Effexor dosages above 150mg? feedback?, posted by shadowmon on June 4, 2008, at 1:11:34
Two weeks isn't very long to be on it. I know it feels like forever, but it took me a full six weeks before I saw relief of my symptoms from the Effexor. It was really hard for me to wait that long, but my pdoc kept saying to wait and it did eventually kick in. Hang in there and give it some more time before you think about changing anything.
sunnydays
Posted by torachan on June 4, 2008, at 13:41:48
In reply to Effexor dosages above 150mg? feedback?, posted by shadowmon on June 4, 2008, at 1:11:34
If your primary problem is depression, I would agree with Scott, that going up in dose would produce improvement. And definitely heed the advice of Sunnydays; wait for a few weeks until you judge the effects of Effexor at whatever dose your on. you may want to remain at your current dose until you've reached the magical 4-6 week range of being on Effexor.
Also, as Scott suggested, consider a TCA as a sleep augmenting agent. It should help with anxiety and sleep. I'm trying Nortyptiline, but others have suggested maybe Doxepin, Amitryptiline, or Clomipramine as better alternatives. I may go to one of these if the Nortryptiline doesn't pan out.
Good luck.
Posted by shadowmon on June 4, 2008, at 21:30:49
In reply to Re: Effexor dosages above 150mg? feedback? » shadowmon, posted by torachan on June 4, 2008, at 13:41:48
I actually take Trazodone for sleep, and with the added serotonin, I actually feel better. Oh, and of course relaxed.
I'm still getting out of nowhere the morning anxiety, and also while I am napping and I am not sure but sometimes it seems to get stronger after I take the effexor. I do take a tiny bigt .5of klonopin to help get me going so that I can deal with work in the morning. Other than that I feel fine, but just not enough to say I feel relaxed. I feel a bit "high strung"
Posted by Molybdenum on June 5, 2008, at 5:33:19
In reply to Re: Effexor dosages above 150mg? feedback?, posted by shadowmon on June 4, 2008, at 21:30:49
Hi,
just to establish an upper non-lethal dose in something other than rats, I am on 600mg. I pushed my doc to keep increasing it when I probably should have left it alone or augmented it with something else. Well, actually I am augmenting it with 225mg mirtazapine (+ 150mg moclobemide for anxiety). What I should have done was just forget about it & let it do it's work.
I do recall feeling a significant increase in general anxiety when I started on venlafaxine AND with each small increase. The angst always passed in a week or so though. The last few increases I actually felt NO angst - just a bit of extra energy...eventually.
My theory is that there's a limit to how much of an effect my brain will accept from this drug. So if I could be bothered / was brave enough, I suspect I could taper down to 1/2 & still get the same result. Just no real reason to risk rocking the boat ATM.
I love oversimplifying things, so here comes a new analogy: The venlafaxine is like a long-haul diesel locomotive. It will get you where you need to go & it is very powerful but it can't be rushed. If you up the dose too quickly (without really establishing the effects of each dose), you'll just make the wheels spin on the tracks but the train won't move any faster.
That wasn't too shabby, was it? ;)
BTW, remember the train idea when you contemplate quitting one day. ie it takes a long time to stop that speeding monster too - but it can be done, just gradually....
Shadownman, it's normal to get excited about a new treatment & I'd say very healthy to be so positive about it. That's all good in my opinion. Every little bit helps.
So my advice is to just relax & go rent a video, ride your bike, whatever. If you feel some uncomfortable side effects you know what your options are by now, so just relax & let it work for you. You're paying "it" to do the work "for you", remember...?
If you concentrate too much on the project, you might get disappointed - and for no good reason. Just like a kid who keeps measuring his height every morning to see if he's any taller. Dig?
Take Care :)
Mr. Be Damned.
This is the end of the thread.
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