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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by porkpiehat on August 9, 2016, at 15:38:53
I really need a more vibrant AD to help with my motivation and social anxiety. Just taking Lamictal and little bit of klonopin now.
Celexa was my longest run. high doses made me impulsive and lazy. Low doses made me agitated.
I haven't tried the SNRI route but I hear it's NIGHTMARISH, especially going on and coming off. I tried cymbalta for two days and I felt bad/nervous, and my doctor said Effexor is much less NE active and might be the right thing.
How does it stack up with regards to motivation, focus, social anxiety? I react funny with NE maybe due to trauma history.
I don't want to endure the ramp up if it's going to suck and then endure the withdrawls. It would be nice to be able to participate in interviews without reducing to tears though :)
Posted by linkadge on August 9, 2016, at 16:00:48
In reply to Effexor worth the ramp up/down?, posted by porkpiehat on August 9, 2016, at 15:38:53
I never found Effexor withdrawal as bad as others mentioned. If I cross tapered to another AD, I barely noticed anything.
In theory, Effexor should behave very much like an SSRI. However, it tends to be activating, even in doses which theoretically should have no effect on norepinephrine.
Have you tried Zoloft? It has side action on the dopamine transporter (probably more so than Effexor has on norepinephrine). It is likely more motivating than celexa.
Prozac too can be more activating than celexa.
Linkadge
Posted by porkpiehat on August 10, 2016, at 6:09:46
In reply to Re: Effexor worth the ramp up/down?, posted by linkadge on August 9, 2016, at 16:00:48
Prozac was too numbing and Zoloft was great for a week or so (especially in social anxiety, self possession, and task completion at lower doses..before making me very irritable and detatched. At higher doses it I lost interest in most of my hobbies. I tried several times hoping it would be better.
I'm trying to taper off lamictal because it tends to have wonky effects when mixed with SSRIs.(sometimes good, some bad) but I can't get below 100 mgs without losing serious functioning. It would be awesome if losing the lamictal would make zoloft tolerable. Lamictal definitely made me a little overactivated, bordering on manic with the Celexa.
I've read that with Effexor you're either at the therapeutic dose or nothing, and there's no in-between...and that sweating and sex drive are the price paid at therapeutic dose.
Posted by linkadge on August 10, 2016, at 11:50:29
In reply to Re: Effexor worth the ramp up/down? » linkadge, posted by porkpiehat on August 10, 2016, at 6:09:46
>I've read that with Effexor you're either at the >therapeutic dose or nothing, and there's no in->between...and that sweating and sex drive are
>the price paid at therapeutic dose.Hmm. I've never heard of a therapeutic dose with Effexor. I don't know if there are any studies on blood level & response.
I too have a hard time with most SSRIs. I've come off them, and am generally doing better.
I am prescribed Effexor, but generally don't take it.
I agree that antidepressants and mood stabilizers don't always mesh well.
An NRI might go better with lamictal. Have you tried straterra or any of the TCAs?
Linkadge
Posted by Tabitha on August 10, 2016, at 12:59:23
In reply to Effexor worth the ramp up/down?, posted by porkpiehat on August 9, 2016, at 15:38:53
Personally I didn't have problems with ramp-up or ramp-down on SNRI. Twice I stopped Effexor with no taper. I recall experiencing the "brain zap" feeling once, but it wasn't really unpleasant.
I felt well on SNRI, but they created sexual dysfunction even worse than SSRI.
SNRI's I used were Effexor, cymbalta, and fetzima. Cymbalta had a bonus effect of helping chronic pain (it's FDA approved for fibromyalgia). I'm not sure of your age or gender, but FWIW I find SNRI's also help with post-menopausal hot flashes.
Posted by porkpiehat on August 10, 2016, at 14:31:36
In reply to Re: Effexor worth the ramp up/down?, posted by Tabitha on August 10, 2016, at 12:59:23
Can you tell me at which dose the sexual side effects started? I know on celexa I was able to at least minimize them at lower doses.
Thanks!
Posted by Tabitha on August 11, 2016, at 11:14:19
In reply to Re: Effexor worth the ramp up/down? » Tabitha, posted by porkpiehat on August 10, 2016, at 14:31:36
> Can you tell me at which dose the sexual side effects started? I know on celexa I was able to at least minimize them at lower doses.
>
> Thanks!
>I was on standard dose, whatever that is. I didn't try reduced doses because I was fighting really bad depression.
Now that you mention it, I recall that in the past I also used half dose of celexa trying to reduce sexual side effects and insomnia. I ended up with moderate depression, but tolerable side effects.
Posted by rjlockhart37 on August 12, 2016, at 0:48:28
In reply to Re: Effexor worth the ramp up/down?, posted by Tabitha on August 11, 2016, at 11:14:19
the only norephenieprine meds i've been on is strattera, wellbutrin, and cymbalta....
strattera made me irrtible as hell, on edge.....wellbutrin made me awake and more content with daily functioning but it also did have anxiety side effect.....
cymalta was kinda like a kick in the mornings....i only got up to 30mg but this was all the way back in 2004.....
effexor actually they use it for anxiety, which is odd since it increases NE levels which would increase alertness and anxiety, but still it's a good med......you could try to increase the dose to the max i think it's like 375mg or something
prozac is the best for me, if i don't take it i get into horrible pits.....other people hate prozac and say it's numbing....i take max dose of it
you could also think about adding remeron to effexor ... it's a term known as 'california rocket fuel' in a medical term
Posted by Christ_empowered on August 13, 2016, at 9:48:01
In reply to Re: Effexor worth the ramp up/down?, posted by linkadge on August 10, 2016, at 11:50:29
i forget...have you tried wellbutrin or remeron with an ssri?
Posted by porkpiehat on August 15, 2016, at 16:12:53
In reply to Re: Effexor worth the ramp up/down?, posted by Christ_empowered on August 13, 2016, at 9:48:01
> i forget...have you tried wellbutrin or remeron with an ssri?
Every time I've taken Wellbutrin with Celexa I felt good for a few days then angry and dissociated.
When I take it with just lamictal it doesn't seem to have this effect. I do get more edgy but not ragey.
I've taken remeron on its own but never with anything. It knocked me out and I binged on eclairs lol... what is the benefit of using with SSRI?
Posted by porkpiehat on August 15, 2016, at 16:19:48
In reply to Re: Effexor worth the ramp up/down?, posted by rjlockhart37 on August 12, 2016, at 0:48:28
so stratera made you ragey but Cymbalta did not?
Maybe I should push through the cymbalta agitation...I did feel really awful
I'll check out the rocket fuel
Posted by rjlockhart37 on August 15, 2016, at 20:47:19
In reply to Re: Effexor worth the ramp up/down? » rjlockhart37, posted by porkpiehat on August 15, 2016, at 16:19:48
strattera for some people improves attention and being in a alert state of mind. I originally took it in 2003, as a add on to adderall and i noticed it improved my attention, and state of mind where you just feel you can get things done.....but i discontinued it, i started it again in 2007 and it made me alert but unpleasant, and i was in a agitated semi-state.....
strattera could be a good option but, from the longest period i took it i was somewhat too alert, and edgy
the max dose i think for effexor is 225mg, but still they prescibe 150mg XR effexor, you could take 2 of them which would be 300mg, but i've heard of the withdrawl effexor has....it's amoung the most unpleasant of most antidepressants, yet it's depression improvement is superior to prozac and some other SSRI's
remeron i've never taken it, but i researched 'califnornia rocket fuel' as a add on to effexor
just ask maybe to take 2 150mg XR's and see what happens
Posted by Christ_empowered on August 16, 2016, at 13:43:29
In reply to Re: Effexor worth the ramp up/down? » Christ_empowered, posted by porkpiehat on August 15, 2016, at 16:12:53
remeron is used at lower doses in the us than in european countries (why, I have no idea...). One of its big uses these days is to boost other antidepressants.
I would think ssri+remeron would be good for anxiety, ocd, some types of depression. remeron+wellbutrin can help take the edge off wellbutrin start up for some people, without having to resort to a neuroleptic. remeron+effexor is "california rocket fuel," which is supposed to help more severe, treatment resistant depressives get better.
I dunno. From what little I've read about it, adding remeron makes more people respond and/or recover, at the group level.
Just a thought.
Posted by porkpiehat on August 16, 2016, at 14:02:00
In reply to Re: Effexor worth the ramp up/down?, posted by Christ_empowered on August 16, 2016, at 13:43:29
After a pretty dispirited long weekend in a beautiful beach town, I started effexor today. I took half of a 37.5 XR capsule. I feel funny in a zoney, confused kind of way that I've felt before, not sure when.
It's certainly not like starting an SSRI for me. Anyway I'll just hope it gets better and go from there. I'm wondering if the side effects get better at a higher dose or if it makes more sense to stop if they don't improve.
Posted by herpills on August 17, 2016, at 0:52:32
In reply to Re: Effexor worth the ramp up/down? » Christ_empowered, posted by porkpiehat on August 15, 2016, at 16:12:53
You can also combine Remeron with other things besides SSRIs, I've done Remeron+Lamictal with decent results, also Remeron+Lyrica...regarding Effexor and titrating, another option would be Pristiq. You start at 50mg and that's it, and to go off it you just stop. I didn't have nearly as bad withdrawls as I thought I would when I stopped Pristiq considering it is so similar to Effexor, and we've all heard the horror stories. Good luck feel better soon herpills
Posted by porkpiehat on August 20, 2016, at 10:17:27
In reply to Re: Effexor worth the ramp up/down? » porkpiehat, posted by herpills on August 17, 2016, at 0:52:32
so...I'm on day five. There is definitely a sense of foggy confusion, although mood and anxiety are both better.
I get to a stage of tired/irritable about noon or two hours after dosing and I assumed it was the combo with my Lamictal (It did the same thing with celexa). Tried switching to night last night and I really didn't sleep at all.
I'm only taking aobut 20 mgs xr cause I'm sensitive. Does this foggy feeling go away with time or dose increase?
Thanks everyone
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