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Re: Switching from Abililfy to Saphris. » SLS

Posted by Robert_Burton_1621 on July 15, 2018, at 0:05:30

In reply to Re: Switching from Abililfy to Saphris., posted by SLS on July 14, 2018, at 11:54:42

> > >I'm guessing that the Effexor has made it worse temporarily. There is a trill in my voice and my hands are shaky.
> >
> > I think that could easily happen if you increase Effexor too rapidly. I do think the anxiety would respond to lorazepam or diazepam though.
> >
> > I do believe venlafaxine is a good antidepressant, although hardly first-line with the high incidence of withdrawal symtoms and initial nausea etc. Although higher dose are more effective for a subset, I must admit I'm unconvinced by the usefulness of ultra high doses vs licensed doses - especially since the approved maximum dose is already very high. Increasing beyond the approved dosage range often seems to cause more fatigue rather than more efficacy. I think it's probably more useful to wait longer (on 75mg/day in moderate depression and 150-225mg in severe depression), rather than ramping it up to 300-375mg too fast. I think people usually have fewer adverse effects and comparable response by doing this. Less initial agitation, nausea, tiredness etc.
> >
> > Oh, and you may find this interesting. Perhaps it is why duloxetine isn't a very good antidepressant compared to venlafaxine!
> >
> > https://www.ncbi.nlm.nih.gov/pubmed/26437230
>
> Interesting. Thanks, Ed.
>
>
> - Scott

As it happens, Scott, I can myself confirm the efficacy of Ed's suggestion. When on effexor some years ago, I found no extra benefit in increasing beyond 75mg - 150mg. My psychiatrist (not well-versed in psychopharmacology: when effexor pooped-out, he advised there were no further strategies for me! MAOIs far too dangerous, etc. etc.) advised, however, to keep pushing. I was on over 375mg and developed restless leg syndrome and agitation as a result. I had an excellent response to the lower doses for eight weeks(when the supposed NRI action had not kicked-in). But it pooped-out. This has been my experience with any SRI which worked: quite rapid improvement (very noticeable just a few days after first dose), but inevitable poop-out.

I suppose you'd already be familiar with the strategey of adding mirtazapine to effexor. I tried this without any benefit at all. M is pretty much just an extremely powerful H1 antagonist.

All the best. Sorry to hear the vortioxetine didn't agree with you (my experience was just the same).

R


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