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Re: Are maximum doses more effective?

Posted by SLS on April 22, 2009, at 8:30:37

In reply to Are maximum doses more effective?, posted by matt sanz on April 21, 2009, at 20:35:57

What you are describing is called a "therapeutic window". It is a condition where a drug exerts its therapeutic effect within a range of dosages and not above or below. Nortriptyline is an example of an antidepressant drug that has a therapeutic window. Most people respond to 75-100mg. These same people lose their response at 125mg and above.

To my knowledge, Effexor is not such a drug. If you have been tolerating the drug well, it might not be a bad strategy to save time by moving up quickly. I guess it depends on your treatment history. Once you respond, you can then reduce the dosage methodically to find the minimum effective dosage.

In general, I don't think other antidepressants have efficacy windows as does nortriptyline. However, they still have a therapeutic index that must be evaluated. It is a way to weigh therapeutic response versus adverse effect. Lithium has very narrow therapeutic index. One can suffer intolerable side effects or become toxic at dosages not very much higher than are known to be effective.

- Scott




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