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Re: Antidepressants to combine with Effexor? Jay2112

Posted by SLS on April 16, 2023, at 8:30:08

In reply to Re: Antidepressants to combine with Effexor? Roslynn, posted by Jay2112 on April 15, 2023, at 18:11:55

Hi, Jay and Roselynn.

> Right now I take 150 of Effexor and 20mg of Prozac. I often adjust those, more if needed, but it is pretty stimulating, so I often come back down.

No comment by me is necessary if you answered properly the question I posed to you in a previous post.


> Amitriptyline and imipramine are two good sedating antidepressants you can take at bedtime with Effexor.

I didn't find imipramine to be at all sedating. If anything, it was somewhat energizing - especially in the beginning. Different strokes...

Amitriptyline is probably the best TCA indicated for the treatment of depression and insomnia. It is also at the top of the list of tricyclics that are approved by the FDA to treat depression. Doxepin is good, too, but probably has the weakest antidepressant properties. Doxepin is actually a stronger antihistamine than Benadryl (diphenhydramine) or Seroquel (quetiapine). Doxepin is the antihistaminic effects of doxepin that make it a sleep aid in a way similar to Seroquel (quetiapine) and Remeron (mirtazapine), but without the risk of EPS. If you decide to go with amitriptyline, you might as well use it at clinically effective doages to treat depression. It often retains it sedating/hypnotic properties. Amitriptyline would serve as a replacement for nortriptyline in the combination (polypharmaceutical) treatment that I recommended to Linkadge. Amitriptyline would fill the role of nortriptyline, which has the mildest anticholinergic side effects among tricyclics. Nortriptyline is a bit tricky to find the best dosage, though. It has a true "therapeutic window".

Nortriptyline dosage versus clinical antidepressant potency:

Too low = No response
Bullseye = Remission.
Too high = Relapse

Some people are low-dose responders (25-75 mg/day). Others are high-dosage responders (100-200 mg/day. Having blood tests to assay blood levels of nortriptyline are helpful as a guide to establish an individual's dosage window.

1) Nortriptyline (less sedating) OR amitripyline (more sedating) or trimipramine (normalizes sleep architecture).

2) Effexor

3) Wellbutrin

4) Lamictal

This combo covers a lot of ground. It is the one I recommended to Linkadge. He didn't bite, despite never having tried it. Yet, he asserts that nortriptyline gave him a 75% improvement. Why did he elect to discontinue taking nortriptyline instead of building a combination around it the most effective drug ? He exercises poor judgment in order to play with his toys. He has a poor understanding of how to use psychotropics effectively. He simply has not been exposed to doctors and researchers that have earned the reputation of being experts in treating cases of TRD. I have been treated by some of the best doctors and university research programs in Manhattan. I had many brains to pick and many a difficult drug-trial to endure while adhering to a treatment protocol. Some drugs made me feel hideously worse. Others produced side-effects that would be deal-breakers if they didn't dissipate over time. Unfortunately, there is only one way to know the clinical worth of a drug and the acceptability of its side effects.

* Low dosages of mirtazapine (7.5-30 mg/day) are also used for sleep. Again, EPS with mirtazapine is not generally not a problem. The *true* dosage range of mirtazapine to treat depression is 45-90 mg/day. Anything less is bound to result in failure. At these higher dosages, the energizing effects of mirtazapine emerge and predominate over the sedation produced by histamine receptor blockade.

> > Amitriptyline is still considered the most effective antidepressant in the world, by the WHO (World Health Organization), and is listed on the WHO's essential medication list.

That is an unfortunate representation. Clomipramine is the TCA that succeeds most often in treating depression. It is also considered the best drug of any class to treat Obsessive Compulsive Disorder. For the sake of marketing, my guess is that having the FDA approve clomipramine for OCD exclusively makes it an OCD drug in the minds of both patients and clinicians. It is the drug most capable of treating severe or treatment-resistant cases. Clomipramine is a genuine SNRI. It was the go-to TCA when imipramine or amitriptyline failed to produce an adequate clinical response.

> > > For me, Prozac (fluoxetine) has also been a go-to med to combine with my Effexor. Also, if you are looking to treat anxiety, a non-antidepressant, Lyrica, has worked quite well.

I am still fascinated with your combining Prozac with Effexor. Can you add any further comments? You may have discovered an important new weapon. Is there any reason why you would not recommend it to others?

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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