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Re: Effexor poops out at the higher dosage. » Lamdage22

Posted by SLS on December 3, 2015, at 7:12:25

In reply to Re: Effexor poops out at the higher dosage., posted by Lamdage22 on December 3, 2015, at 3:12:50

> I wonder if i could try Bupropion instead. It is reported to be pro psychotic though especially in high dosages.

Yes. That was my concern as well. Having two antipsychotics on board would minimize this risk. There is no guarantee, though. Ever since I have been taking Abilify (which I know causes akathisia in you), I have not had a manic/psychotic reaction to the drugs that I sometimes have. Supposedly, Wellbutrin is one of the least likely to cause a switch to mania, but I don't know about psychotic depression.

I would stay with the Effexor for now and establish the minimum effective dosage through a methodical titration. Stay on that dosage for a few more weeks to see in what direction your sexual side effects go. If they still bother you, you can then add Wellbutrin (or other drugs) to try to recapture your ability to reach orgasm. Remember, this is really nothing more than an experiment. You can discontinue the experiment whenever you would like. I know it would be a great relief to you to imagine having another option to switch to instead of taking Effexor. But for right now, I think it makes sense to continue the Effexor experiment. You are already taking it, albeit at a subtherapeutic dosage. Don't sacrifice the time you have already invested and the potential for obtaining a strong response with continued titration. Your brief improvements at such low dosages beg that you give Effexor a chance.

Three ideas:

1. Add Remeron (mirtazapine) to Effexor - increase the potential for a good response to Effexor. I have always wondered if Remeron might help reduce sexual side effects because of its overlap with cyproheptadine. I never pursued a literature search to test my hypothesis (until now). *See below.

2. Switch to Viibrd (vilazodone) - Low potential for sexual side effects.

3. Switch to Brintellix (vortioxetine)

4. Switch from Seroquel to Saphris (asenapine)

* Mirtazapine Augmentation for Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: A Retropective Investigation

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079186/


- Scott


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