Posted by kid47 on May 8, 2001, at 14:36:13
In reply to Re: Effexor: MY Conclusions » kid47, posted by SLS on May 8, 2001, at 8:18:39
Hi Scott. Thanks for your input. Yes, unfortunately I have tried lots of psycmeds & with the exception of Celexa, which seemed to trigger a psychotic rage I gave them all at least a 6 week trial.They did little to deal with my depression & anxiety which was eventually dx'd (although I believe incorrectly) as Bipolar II. Cocktails with Lamictal, Neurontin, Topamax, etc. were introduced with little improvement. Klonopin was the only thing that made me feel better temporarily, but it seemed to aggrevate my depression if I took very much. I was concerned/ nervous about taking MAOI 's but was considering a TCA. Then about a year ago my new pdoc suggested FXR xr & I noticed improvement after about 4wks. This continued till I felt well enough to stop all psycmeds & succesfully weaned off FXR w/little or no discontinuation fx! (Prozac @20mg/day I think was the key).
I wish I could find info on how many rx's for FXR are written annually to get a better handle on the % of people who have problems with FXR. Any ideas? Also is FXR xr always what is rx'd?. I think the xr version is less likely to cause problems.
The reason I am not convinced that FXR should be a first line AD is the fact that it has the potential to effect more brain chemistry. You can make a short leap & say it also has a greater range for side fx potential. For those of us who have tried enough meds to be aware of what to expect (& are desperate enough) side fx might not be as traumatic as would be to the newly initiated. I agree that FXR has a greater potential to be more effective....than say an SSRI, but in some cases it might be considered overkill.
I am cautiously optomistic (which is quite a feat in itself) but am always ready for the other shoe to drop. I would not hesitate to resume a regimine of meds should I or my pdoc think it necessary. I was hospitalized initially when this all began at the tender young age of 46 & I do not wish to repeat that experience.
If you have read any of my pevious posts, you know I have tried to provide some balance to the very negative & sometimes hysterical anecdotes concerning FXR. I would hate to know that someone who might have been helped by FXR was disuaded from considering it after reading some of the frightening posts at PB. I have even been accused of being a drug company undercover agent.....Bond...Kid Bond...lol
Once again I appreciate your response. I have found you to be one of the very knowledgable & considerate posters on this list & I always read your comments.
I hope you are having success with your treatment. Take care.
14 (whew!! I am a little superstitious) days Med free & still pretty dogone happy about it.
Kid
> Hi Kid.
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> Don't worry. No sh_t coming your way. :-)
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> > Hello.I have just successfully weaned off of 13 mos. @ 300mg/day of FXR xr. I tried 7 different AD's & countless "cocktails" but FXR xr was the only one that actually "cured" my depression.
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> Just a few thoughts. Some facts. No absolute advice.
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> Some physicians would classify you as being treatment-resistant. You would indeed qualify if you have tried 7 different antidepressants, having fully explored high dosages and allowed for a clinically sufficient time period to evaluate each. You might be at a greater risk of relapse given your treatment history. If your medical history of depression is one of chronic recurrence, this risk becomes greater still. Often, when someone in your position discontinues an antidepressant and relapses, the previously effective drug is no longer effective. For the average person with the average depression (unipolar and not bipolar), 13 months is a reasonable amount of time to remain well on an antidepressant before stopping. In my opinion, the key phrase is "remain well". I would not count the period between initiating medication and reaching full improvement as part of this 13 months. The risk of relapse can be significantly reduced by coming off an antidepressant very gradually. So too can be the withdrawal effects. Most people do not do this. The most likely time until relapse, should it occur, is during the first 4 months. It might be best for you to remain wary, and perhaps keep a mood diary. If you see yourself beginning to slide back towards depression, you might want to consider returning to Effexor as soon as possible and titrate the dosage up as quickly as you can tolerate.
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> > I don't think this is a drug that should be given as a first line AD.
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> This will be an issue of debate, as it has been the experience of many doctors that Effexor is better than any of the SSRIs. A recent study that included between 1000 and 2000 patients has recently concluded the same. Not only does Effexor get more people well, but it gets these people more well.
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> > I think a discontinuation strategy should be discussed with your doc before being rx'd FXR.
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> ...or any other antidepressant, along with the possible side effects. Withdrawal phenomena and treatment-emergent side effects occur with almost ALL of the antidepressants currently available. Of course, these occurences are variable for different drugs. I don't believe that Effexor can reasonably be singled-out. Perhaps Effexor is more visible now because it is becoming more frequently chosen as the "first line" by physicians.
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> > I think there should be comprehensive studies on discontinuation & a protocol established for it.
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> I agree, both aspects of your statement are happening right now. Unfortunately, the psychiatric community has been woefully neglectful of these things.
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> > But I do believe this drug for some, is the closest thing to a miracle cure we have for very treatment resistant depression, especially with comorbid conditions (IMHO). I know I will catch some shit for this statement. Just (as Dr Bob would say) Please be civil.
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> Since 1992, Effexor (venlafaxine) has shown a tendency to be somewhat superior to the SSRIs when treating treatment-resistant depression (TRD). However, MAOIs might have a better record still.
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> > 13 days med free & loving it!!!
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> 13 months - 13 days.
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> I hope you are not superstitious. :-)
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> - Scott
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> > PS As always your mileage may vary.
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> With the prices of gas and psychiatric care on the rise, it is probably best to move ahead with careful planning.
poster:kid47
thread:13781
URL: http://www.dr-bob.org/babble/20010507/msgs/62149.html