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Re: Effexor for Hypersomniac Major Depressive

Posted by noa on December 5, 2003, at 11:09:00

In reply to Re: Effexor for Hypersomniac Major Depressive, posted by Camille Dumont on December 2, 2003, at 7:11:57

Four thoughts, followed by a way too long description of some of my experiences:

1. What I've learned here at Babble is that some people find Effexor activating and some find it sedating.

2. Have you had a good endocrine work up? Especially thyroid?

3. Is it possible you might have a sleep disorder, like obstructive sleep apnea? Or Restless Leg Syndrome, etc.?

4. Some doctors combine antidepressants with stimulants for depression with low energy, or to potentiate the antidepressant effects of the ADs, especially with "Atypical" depression. I also read an interview with a pdoc who adds stimulants to the treatment of depression with low energy in patients with signs of hypothyroidism.

My story:

I take effexor as part of a "cocktail" for chronic recurrent major depression on top of dysthymia, ie, "double depression". I was extremely depressed, and lethargic and sleepy all the time, and slept many hours each day. Sometimes, I would be too tired to drive home from work, so I'd lay down on the floor to my office and take a nap first. I'd come home and sleep, get up to eat and then go to bed.

Adding a stimulant to the effexor helped somewhat with energy and mental alertness. It also seemed to potentiate the antidepressant effect of the effexor since I wasn't great at tolerating higher doses.

This improved things for a while, but I was still having recurrent episodes. It turns out I had hypothyroidism. My pdoc had me tested and the results were determined to be "subclinical". He said that there were anecdotal reports that adding cytomel (Thyroid hormone T3) helped patients like me who were having "Atypical" depression with low energy etc. Thyroid treatment helped, and we subsequently added Synthroid (T4) because my symptoms persisted, despite a bit of improvement, and the thyroid tests were still not great. Again, this improved things for a while.

But again, despite improvement, after a while, I was having more episodes of major depression. It turns out that for years, I was undertreated for the hypothyroidism, so my depression didn't really start to get better until a few years later when I consulted an endocrinologist who began more aggressive treatment, i.e., higher doses of thyroid hormones based on how my symptoms responded vs. the conventional way of doing it which was to get the TSH under 5 (my endo told me and my PC doc that for some patients with hypothyroidism and depression, we need to have our TSH much lower, even under 1, which most docs consider dangerously into hyperthyroid territory).

In between when I first started taking thyroid hormone (but not enough) and when the endo prescribed more aggressive treatment, I also figured out I had obstructive sleep apnea. I was waking up with headaches every morning. Never felt rested, etc. etc. I started realizing that I was having dreams about being under water unable to breathe and trying desperately to come to the surface. I looked up apnea on the web, got a good book, and then went to my primary care doctor to get referred for a sleep study, which confirmed that I had moderate-severe apnea. I was getting only a quarter of the required REM sleep each night, and had moderate oxygen desaturation.

Starting CPAP saved my life that way. The headaches, sleepiness, etc. all went away. In addition, my acid reflux went away, as did my sore throats, dry mouth, and frequent upper respiratory infections.

This helped my depression a lot. But when my hypothyroidism got worse again about a year or two later, my lethargy returned. I was not quite as *Sleepy* perse as I had been before the apnea was treated, but was much sleepier than usual, had no energy, and felt like I had cotton balls stuffed in my head where my brain should be. My limbs ached, I felt weak. I had to rest just from walking to my car. I couldn't think straight. And was horribly depressed. The worst ever, I think. That's when I saw a book about hypothyroidism that described many of the same symptoms I had and so I went to the endo, with the results I described above.

I still take a stimulant, although not the same one I started with. I think that although Effexor is activating for me, and although I no longer have the sleepiness I used to, I still do have some mental efficiency problems that might be from effexor or another of my meds. For me, the stimulant (adderall) helps me focus better and actually makes me feel calmer (Effexor is a bit agitating for me).

In addition to the combination with thyroid hormones and adderall, I've been able to lower the dose of effexor xr by:

1. combining it with Serzone, which I take at night. Serzone has added AD effect and seems to counteract some of the agitating effects of the Effexor.

2. Taking fish oil supplements (I take some other supplements recommended by my pdoc as well, but the biggest effect from a supplement has been from the fish oil). I started fish oil about 1 year ago and after a couple of months or so, I lowered my Effexor dose from 262.5 to 225 mg.

BTW, for more info on thyroid--see

for more info on sleep disorders, see




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