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Re: Disappearance of chronic pain with Effexor? flipsactown

Posted by SLS on July 7, 2004, at 8:05:59

In reply to Re: Disappearance of chronic pain with Effexor? SLS, posted by flipsactown on July 6, 2004, at 23:59:59


> Do you think Effexor would be an effective AD,

I can understand anyone being apprehensive about trying Effexor (venlafaxine) given all of the negative posts to be read here on Psycho-Babble. The fact still remains that it has demonstrated itself to superior to the SSRIs in the percentage of people who respond to it and in the quality the of response obtained (more people achieve remission).

> I had to quit Effexor in less than 2 weeks because of vertigo, nausea & vomiting?

I guess I don't have to expouse the virtues of the "low and slow" paradigm of dosage titration. What dosages did you use to begin trestment? Usually, these side effects are only temporary. That, of course, is the ideal explanation for your experience. I hope a slower titration will help mitigate these effects for you.

> as well as a pain med,

There are no guarantees, but there is some precedent for using Effexor to treat pain associated with depression and chronic pain disorders in the absence of depression (fibroneuralgia, diabetic neuropathy).

> I had the greatest depression relief with Prozac or Zoloft with Desipramine lasting over 5 years.

This might indicate that combining the reuptake inhibition of both serotonin (5-HT) and norepinephrine (NE) is important to treat your depression and perhaps the pain as well. Effexor, a dual-action drug, does both of these things at the same time at higher dosages. Did your pain remit during those 5 years? It might make sense to add desipramine now if you wish to remain on an SSRI and avoid Effexor. That's pretty much common sense, as desipramine is a NE reuptake inhibitor. Then, if that doesn't work, you could investigate the antidepressantes Effexor, imipramine, amitriptyline, and Cymbalta, all of these being combination 5-HT / NE reuptake inhibitors. Cymbalta might become available by the time you have competed your current drug trial (wishful thinking).

From a totally different class of drugs, Neurontin has been used to treat pain disorders.

What are your feelings at this point?

- Scott




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