Posted by Zinya on November 22, 2002, at 14:48:01
In reply to Re: Effexor dose--lowering it? Cam-anyone? » shar, posted by Cam W. on August 10, 2000, at 1:26:15
I'm working my way through these posts for the first time and still in posts from 2 yrs ago so I don't know yet who is still on here or not, but now find myself with a Q to post before I forget it ...
Both Cam and i think Kimberley have talked about how the multiple effects of Effexor kick in at different dosages -- that at lower doses it's more of a serotonin effect, higher levels bring on noreneprine effects, the highest leves add dopamine effect. Does anyone know if these vary by individual? Or is it possible to 'quantify' at what levels these additive effects take place? The posts I'm reading here imply that at 225mg, people are at more of (or equal effects on?) noreprenephron levels and advising people who are going off that at some point they will re-enter a 'serotonin-only' effect stage... Does anyone know what level that distinction happens at (for someone going on the way up or down in dosage levels?) Specifically, at 150 mg, can one expect to already be gaining both effects or is that still more of a serotonin effect level?
fyi: I have tried either an AD (prozac) or a bipolar med (lithium, and one other - i think it was depakote) about 4 times scattered over past 15 yrs each time (except once) giving it at least a month but the combo of side effects and failure to feel any decrease in depression led me to quit. Not coincidentally, I think, that time frame coincided with both grief (my dad's death 15 yrs ago) and diagnosis of fibromyalgia/chronic fatigue syndrome at that same time 15 yrs ago with lesser and greater struggles with the latter even since. Now as of 3-1/2 months ago, my mom has passed away after my taking care of her (alzheimer's) for 8 years, at the end moving her to live with me, buying home in order to do so, only to discover that she had an undiagnosed cancer and that enormous output whereby as recently as 10 months ago, i was cooking on 5 burners at once in the process of escrow, moving her and me, with expectation of having several years yet with her. I would say 80% of my identity became caring for her, happily so, as she was very precious to me. The sudden loss has been fairly devastating, and I increasingly realize as much to my own sense of self (purpose, future direction, resume career i'd put on hold to care for her, etc.) as the grief and loss itself... This led me to feel that I by now perhaps this was more depression I'm dealing with than guilt per se, and so went to my md. yesterday who I hadn't seen in over a year -- an md. who had been previously helpful in suggesting new paths for dealing with a hormonal imbalance. But I went to him already saying I thought it was time to try an AD if there was now a new one and a different one I hadn't already tried. I'd heard of Lexapro and also Paxil CR, neither of which i'd tried. He said Lexapro was so new he'd had no experience with it, that Paxil CR might be okay, but proposed Effexor XR instead, telling me only that it works on both serotonin and norepinephrine (adrenalin levels, right?) too--which sounded good since I've long felt my adrenalin levels were erratic and mostly unreliably low [and actually tested low once 2 yrs ago]. He said nothing about how different levels of the Effexor yield different mixes of effects and so I assumed it would work on both equally from the outset. (He also said nothing about dopamine levels that two of you have mentioned -- and I don't know what that does to one's system except one of you mentioned that it offsets serotonin effects -- which sounds odd as to why a drug would have one thing offsetting another) ...
Since I'd never heard of Effexor, I decided to check out the web last night before starting it today and stumbled on this site first of all. I've read just enough already that I've postponed starting it until I read all these posts and other websites first.
I had allowed myself, I now realize, to sort of "forget" the realities of side effects -- last time I tried any such AD was 2 yrs ago briefly Celexa than an endocrinologist thought would be the ticket for me and I couldn't tolerate it (as I recall I became agitated, but i could be forgetting the specific side effect) and that was a case of not even making it to a month's worth on the drug...
I've added this background of my own situation in case it helps to know where I'm coming from in asking this question about dosage levels and effects... Again, I haven't started yet. What he gave me was 37.5 to take for 1 week, then 75 mg to take for 3 wks with the idea that I would then go to 150 mg if okay a month from now on the lesser dosages. I'm partly wondering, after reading these posts so far, if for the first month, not yet up to 150, will I only be getting the serotonin effects? One person spoke of having superordinate energy levels in first month (which sounds wonderful to me if it didn't mean agitatedly so -- my single biggest manifestation of depression is zero energy to do much of anything -- a 180 degree contrast looking back to where I was just 10 months ago.... or even 4 months ago in the throes of being nurse 24/7 to my mom etc... Even my doc and a bereavement counselor I have seen suggest and recognize that the grief process itself could be much or most of this zero-energy but since it seems to have gotten worse instead of easing up--and since a prior history makes me think that this grieving is not an isolated phase but bringing to bear full force a predisposition that was already there but somehow more often masked than unmasked, that was why I began to feel a need to try an anti-dep but now I'm reminding myself from reading here that the concern with side effects possibly making this grief period actually worse instead of better... Of course, I'll never know if I dont' try, but I am trying to avoid making too hasty a decision here and wondering if I should postpone trying an AD again to see. And yet holiday season looms as a time that always was a rough time even when I had energy.)
Well, enough babbling/background. If anyone has advice, answers, thoughts on any of this, I will greatly appreciate it... Meanwhile, I'll keep reading your postings up to the present...
Thanks.
poster:Zinya
thread:13781
URL: http://www.dr-bob.org/babble/20021122/msgs/128795.html