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GI troubles landed me in ER....Effexor to blame?

Posted by BGB on July 13, 2007, at 13:33:14

Hello all,

Here's my background, sorry it's so long!

I have been taking meds for my bipolar disorder for
11 years now. My current cocktail is:

Depakote ER 1000mg (bedtime)
Lamictal 200mg (bedtime)
Seroquel 25-100mg prn for sleep
Provigil 200mg (am)

I've been on the Depakote and Lamictal for 8 years, and other AD's including Effexor XR 300mg (for 3 years, about 3 years ago), Prozac 80mg (2 years), Paxil, Remeron, Wellbutrin (monotherapy, before diagnosed as BP), Celexa (2 years), Zoloft (1 month).

While taking the Depakote, Lamictal, and Provigil, I switched from Celexa 40mg to Zoloft 200mg because I was feeling my depression return. After taking the Zoloft for about a month, I became extremely depressed and obsessed about death, so my pdoc decided to switch me to Effexor XR again, since it worked before and had been a few years since I had taken it. So I started with 75mg for two days, up to 150 for two days, 225 for two days, and then maintain at 300mg for a week or two before checking in by phone and going to 375mg. He said that Effexor had an effect on dopamine that didn't happen until the higher dosage (300+mg) hit, and that since I always tolerated high dosages of any medicine I've taken, he was comfortable with the rapid titration.

After four days of taking 300mg with no problems at all, I starting having nausea, gas, and diarrhea. It got worse and worse over the next three days but I continued to take 300mg, hoping the symptoms would subside. The eighth day, I woke up in the worst pain of my life. It was a horrible, bloated feeling, as though my stomach may explode. I was vomiting uncontrollably, so I went to the ER since it was only 6am. The ER doctor said to me "So, your stomach is upset because of your antidepressant. Why are you here and exactly what do you want me to do about it?" I just said "Help me! This is the worst pain of my life" and she got the nurse to give me Zofran, which was a huge help. Once the labs came back, they showed that I was dehydrated and had a high white blood cell count. I guess the Dr. had finally bothered to read the list of all of the other medications that I was on and became concerned by the white count because she magically became caring and super-duper nice to me. She sent me home with Promethazine and it's been helping. My pdoc thinks that I probably got a nasty GI infection because my stomach was irritated from the Effexor and left susceptible to viruses, then the Effexor aggravated the resulting infection. Sounds plausible to me, since I've never really had any GI side effects from any of my numerous meds before.

My pdoc says I don't have to take the Effexor if I don't want to, but that I should take two right away if I start to feel any of the withdrawal symptoms, especially brain zaps (he kept stressing that I *must* take the Effexor if I feel the zaps but I can ignore other symptoms if they're not very bothersome). So far, so's been more than 48 hours since my last dose and no signs of withdrawal at all. I'm finally feeling a little bit better and not vomiting, and I didn't even have to take a promethazine today (yet).

Okay, so finally, my question is: Should I consider trying the Effexor again or go a different route? I need something stimulating, becuase I am constantly tired and exhausted. I have no motivation of any kind. I am thinking Effexor and an augmenting AD of some kind (like maybe Wellbutrin?). My pdoc wants to increase my Lamictal to 400mg, that may help any AD, right?

The other option is to go with something totally different, but what? I'm open to an MAOI but I don't think that pdoc would be open to that until we try out some other options first. I'm totally willing to try a tricyclic, or anything else. Whatever will lift this hell.

Thanks to anyone who read all of this. I appreciate your input! =) My pdoc is an amazing man (he's been with me through my entire 11 year hell) and always wants my input on what I think about treatments. I always respond with "whatever you think will work best for're the one getting paid for this s**t!" but instead of humor I think I'd like to at least have a suggestion for this time. :-)

PS Just for clarification...I'm a 29 year old male. Also, I've taken Lithium before and it made me a complete, drooling zombie, totally unable to function (I think I was taking a relatively high dose).




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