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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Fred Potter on March 31, 2001, at 23:29:35
Does it?
Posted by SLS on April 1, 2001, at 16:51:27
In reply to Effexor XR Poop-out - does it happen?, posted by Fred Potter on March 31, 2001, at 23:29:35
> Does it?
Hi Fred.Effexor seems to be less likely to allow for a "poop-out" than the SSRIs.
Some doctors now feel that Effexor is not fully explored until dosages up to 600mg are used. If you find that you are getting diminishing returns from Effexor, it might simply be that an increase in dosage is necessary. I would not consider this to be a "tolerance" issue so much as a dosage adjustment. Some people may be slightly underdosed when using less than 150-225mg, and are perhaps subsyndromally depressed. A small change in biology might raise the threshold for relapse; these people experiencing an apparent poop-out.
I really don't know for sure. I am just trying to convey to you the impressions that doctors and pharmacists have given me.
I hope this helps a tiny bit.
- Scott
Posted by SalArmy4me on April 1, 2001, at 18:17:52
In reply to Effexor XR Poop-out - does it happen?, posted by Fred Potter on March 31, 2001, at 23:29:35
Maybe you can restart it with Lithium, a mood-stabilizer, T4, PINDOLOL (my favorite) or Mirapex.
The Ultimate poop-out source:
http://www.med.nyu.edu/Psych/aug
--Blood and Fire: the Salvation Army "WAR CRY" reaches more countries and has more readers than USA today, Christian Science Monitor or Newsweek
Posted by Ignatz on April 1, 2001, at 20:55:40
In reply to Re: Effexor XR Poop-out - does it happen?, posted by SalArmy4me on April 1, 2001, at 18:17:52
I had a relapse a month ago on Effexor-- I'd been taking 187.5 for 2 years before that. And I'd been feeling kind of under-the-weather (subsyndromally depressed?) for quite a while. The relapse came at a time of significant stress- a big thing coming due at work, and my upcoming marriage-- I suspect I would have limped along feeling vaguely glum otherwise. My p-doc raised the Effexor to 300 and added Depakote temporarily (yuck! seems to help, but makes me feel queasy-). I feel fine now- much better than I have for, say, 6 months. So my anecdotal evidence is, either the Effexor somewhat pooped out, or I needed a higher dosage (or a higher dosage plus Depakote? I hope not-).
Posted by SLS on April 1, 2001, at 21:05:33
In reply to Re: Effexor XR Poop-out - does it happen?, posted by Ignatz on April 1, 2001, at 20:55:40
> I had a relapse a month ago on Effexor-- I'd been taking 187.5 for 2 years before that. And I'd been feeling kind of under-the-weather (subsyndromally depressed?) for quite a while. The relapse came at a time of significant stress- a big thing coming due at work, and my upcoming marriage-- I suspect I would have limped along feeling vaguely glum otherwise. My p-doc raised the Effexor to 300 and added Depakote temporarily (yuck! seems to help, but makes me feel queasy-). I feel fine now- much better than I have for, say, 6 months. So my anecdotal evidence is, either the Effexor somewhat pooped out, or I needed a higher dosage (or a higher dosage plus Depakote? I hope not-).
Your experience is a perfect example of how the psychological and the biological can interact. Your recent stresses have increased what I like to call "depressive pressure". This added pressure caused what is known as "medication breakthrough". Simply raising the dosage of the previously effective antidepressant is often all that is needed to recapture the antidepressant response. I doubt the Depakote is necessary, but I'm sure your doctor wanted to maximize your chances.I'm glad that everything is working out.
- Scott
Posted by SalArmy4me on April 2, 2001, at 4:23:00
In reply to Re: Effexor XR Poop-out - does it happen?, posted by Ignatz on April 1, 2001, at 20:55:40
Your doctor had the right idea in adding depakote (a mood-stabilizer). I wonder why he didn't try Lithium first, because Lithium can "jumpstart" an antidepressant often within 48 to 72 hours.
If you feel the Depakote works reasonably well but the side-effects stink, you can switch to the recently approved Depakote _ER_ (2001) which is taken QD and I have no side-effects on it.
I was thinking of your trying the Effexor + Remeron "power" combination that is suggested in the Tips. Some claim that it is as effective as ECT.
Here is the ultimate authority on augmenation strategies (jumpstarting antidepressants):
http://www.med.nyu.edu/Psych/augSharing is Caring:
the Salvation Army in your community
Posted by Ignatz on April 2, 2001, at 9:08:19
In reply to Re: Effexor XR Poop-out - does it happen?, posted by SalArmy4me on April 2, 2001, at 4:23:00
Yeah,SLS- I've had 3 of exactly those "breakthroughs" in the past 5 years, always when significant stressors came along. I really wish I could figure out a way to NOT have them-- they're scary and painful and expensive (I've checked myself in to the hospital for a few days each time). And then, so far, i've pulled out of them quickly too. As for the depakote instead of lithium, it's probably because I took lithium as a booster for nortriptiline 10 years ago, and it didn't do much that I could tell except make me slur words and fall down a lot.
Posted by Fred Potter on April 2, 2001, at 17:10:45
In reply to Re: Effexor XR Poop-out - does it happen?-Sal and , posted by Ignatz on April 2, 2001, at 9:08:19
Thanks for your help everyone. I haven't persuaded my doc to give me Effexor yet. Typical of SSRI poop-out was Paxil. I waited the several weeks then it gave me one afternoon of feeling wonderful (I think feeling wonderful is OK BTW). Then it ditched me. I've had this with all the SSRIs I've tried. When an SSRI kicks in is an unmistakable feeling I think.
SalArmy - your suggestion of the Effexor/Remeron combo sounds really interesting. has anyone tried it?
Posted by SalArmy4me on April 3, 2001, at 2:26:57
In reply to Effexor XR +Remeron, posted by Fred Potter on April 2, 2001, at 17:10:45
I was on the Effexor/Remeron combination for a couple months. I took doses of each at bedtime that could kill and elephant: 600 mg of Effexor and about 90 mg of Remeron. I still had no side-effects--Remeron does get rid of the Effexor sexual-side-effects.
Though it didn't help with my depression, I know now that that was because I am a bipolar and respond better to anticonvulsants.
> Thanks for your help everyone. I haven't persuaded my doc to give me Effexor yet. Typical of SSRI poop-out was Paxil. I waited the several weeks then it gave me one afternoon of feeling wonderful (I think feeling wonderful is OK BTW). Then it ditched me. I've had this with all the SSRIs I've tried. When an SSRI kicks in is an unmistakable feeling I think.
>
> SalArmy - your suggestion of the Effexor/Remeron combo sounds really interesting. has anyone tried it?
This is the end of the thread.
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