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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by cerose on August 22, 2001, at 21:40:57
I have been on Effexor XR for about 6 weeks now. I have gradually gone up from 75 mg to 225 mg. I feel nothing, except sweaty. I don't feel better, I don't feel worse.
I have also tried Zoloft, from 25 mg to 100 mg. No side effects, but not better either.
I am being treated from Major Depressive Disorder and Anxiety. I would guesstimate that I have been this way for at least 13 years. I don't really know what it feels like to be different then this.
Any one have any ideas?
Posted by Janelle on August 22, 2001, at 22:18:28
In reply to Effexor, feel nothing.. anyone experience this?, posted by cerose on August 22, 2001, at 21:40:57
I got more anxious on the average dose of 150 mg of EffexorXR, and got very little benefit from Zoloft.
I also have depression with anxiety and PAXIL helped for many years. I've heard that of the SRI's, Paxil is most targeted toward both depression and anxiety. Only a suggestion that you try it and if you don't get results, perhaps you're just not responsive to SRI's and may want to consider another class of a-d's.
Good luck!
Posted by Shellye on August 23, 2001, at 3:59:54
In reply to Re: Effexor, feel nothing.. anyone experience this? » cerose, posted by Janelle on August 22, 2001, at 22:18:28
Go back to doc and let him/her know. Perhaps a combination of Effexor and something else would help as different meds work on different chemicals in the brain.
I have had a lot of success with Effexor. But it did take some trial and error before I found the success.
Most important is to work with doc....closely.
Posted by JohnL on August 23, 2001, at 4:09:00
In reply to Effexor, feel nothing.. anyone experience this?, posted by cerose on August 22, 2001, at 21:40:57
> I have been on Effexor XR for about 6 weeks now. I have gradually gone up from 75 mg to 225 mg. I feel nothing, except sweaty. I don't feel better, I don't feel worse.
>
> I have also tried Zoloft, from 25 mg to 100 mg. No side effects, but not better either.
>
> I am being treated from Major Depressive Disorder and Anxiety. I would guesstimate that I have been this way for at least 13 years. I don't really know what it feels like to be different then this.
>
> Any one have any ideas?I agree with Janelle that one more SSRI should be tried, and Paxil is a good choice. However, I would not bother with the six week trial thing. Instead, go for two weeks. If you have not felt some kind of a hint of goodness within two weeks, then the odds of experiencing anything good later on are not good. Not to misunderstand me, I'm not talking about total recovery in two weeks. I'm talking about a hint of recovery. If there isn't even a hint in two weeks, forget it. Definitely there are people who do not feel anything in a 2 to 6 week period who then later on get better. But the percentage of people that that happens to is small. In my own layman way of thinking, such a situation indicates a med that is way off target. Even though it is off target, it can work if given enough time, through domino chain reactions that eventually get around to the real underlying problem indirectly.
After the third SSRI, then it is high time to move into a different category of meds, such as the antipyschotics. The newer ones such as Zyprexa and Risperdal are truly wonderful for all kinds of psychiatric symptoms besides just schizophrenia. It's just my opinion, but I think the highest odds for success are in that category.
As Andrew said in another post, the universe of drugs can be sort of viewed like a toolbox. Up to this point, of all the tools in that toolbox, only the hammer and nail have been tried. If after a short trial of a third SSRI you are getting nowhere, then it's time to reach in that toolbox for a wrench instead. Forget the hammer and nail because you already proved they couldn't do the job.
John
Posted by SalArmy4me on August 23, 2001, at 7:07:15
In reply to Effexor, feel nothing.. anyone experience this?, posted by cerose on August 22, 2001, at 21:40:57
Year Book of Psychiatry and Applied Mental Health
Volume 1999(8) Annual 1999 pp 366-367
Pharmacological Choices After One Antidepressant Fails: A Survey of UK Psychiatrists"Pharmacological Choices After One Antidepressant Fails: A Survey of UK Psychiatrists
Shergill SS, Katona CLE (Maudsley Hosp, London; UCL Med School, London); J Affect Disord 43:19-25, 1997
Introduction.-Approximately one third of patients with depression fail to respond to first-line antidepressants, and up to 21% have not recovered after 2 years of adequate dosage and compliance. A popular option in such cases is lithium augmentation, but it is not known whether most psychiatrists are aware of treatment choices for refractory depression. This question was examined in a survey of practicing psychiatrists in the United Kingdom.
Methods.-The survey, sent to 300 randomly selected physicians on the membership roll of the Royal College of Psychiatrists, presented a detailed vignette of a "typical" case of depression with initial treatment failure. The patient was a white woman, aged 40, who had been depressed for about 4 months. She sought treatment after intrusive suicidal thoughts led her to consider crashing her car. Her history included sexual abuse by her stepfather, migraine headaches, and a sister who had been treated for an episode of major depression. Treatment consisted of amitriptyline, 150 mg daily; and intensive individual, group, marital, and occupational therapy. No improvement was seen after 6 weeks.
Results.-Surveys were returned by 175 psychiatrists (63%). Respondents were predominantly men (61%) working as consultants (51%) in general psychiatric practice (62%). They had spent a mean of 13 years in the field and saw a mean of 9 patients per year with refractory depression. The most popular treatment choices in such cases were increasing dosages of tricyclic medication and change of medication to selective serotonin reuptake inhibitors; augmentation with tri-iodothyronine or with tryptophan or monoamine oxidase inhibitors was rarely chosen. Psychiatrists with elderly patients were more likely to choose lithium augmentation; electroconvulsive therapy was the preferred choice of those seeing more patients with resistant depression.
Conclusion.-The best established treatments for resistant depression were underused by psychiatrists in the United Kingdom, many of whom (39%) expressed a lack of confidence in treating this problem. Resistant depression should be included as a topic in continuing professional development courses.
[r tri, filled] In this survey of Fellows of the Royal College of Psychiatrists in the United Kingdom (all of whom would be considered well-trained, often-senior people) regarding their choice of treatment after initial antidepressant failure, almost half the respondents would have increased the dosage, and another third would have switched from the tricyclic antidepressant used as the initial treatment in the case vignette to a selective serotonin reuptake inhibitor. However, the findings that only 1% of respondents would potentiate with tri-iodothyronine and that only 12% would have chosen to augment with lithium were surprising. Although most of these psychiatrists had executed most of the treatment choices, a third of the respondents were not confident treating resistant depression. The need for information in this clinical area is clear. There are very few data by which to guide these treatment decisions, and unfortunately the literature is not always useful to the practicing clinician. The authors suggest that additional training and postgraduate education are important in enhancing the skills of psychiatrists-even the best-educated ones-in the management of this population."
R.B. Lydiard, Ph.D., M.D.
Posted by Jane D on August 24, 2001, at 20:17:48
In reply to Effexor, feel nothing.. anyone experience this?, posted by cerose on August 22, 2001, at 21:40:57
> I have been on Effexor XR for about 6 weeks now. I have gradually gone up from 75 mg to 225 mg. I feel nothing, except sweaty. I don't feel better, I don't feel worse.
>
> I have also tried Zoloft, from 25 mg to 100 mg. No side effects, but not better either.
>
> I am being treated from Major Depressive Disorder and Anxiety. I would guesstimate that I have been this way for at least 13 years. I don't really know what it feels like to be different then this.
>
> Any one have any ideas?Cerose,
If you've been going up gradually you've only just gotten to this dose. Give it a little more time. Some people also go up a little higher. The mechanism by which Effexor works changes at higher doses.Switching to another SSRI, as has been suggested, is also a good idea if Effexor ends up not working. It doesn't need to be Paxil - all of these are fairly similar. Also, be aware that the theory that you can tell whether a drug is working after 2 weeks is very controversial.
Give it a little more time.
Jane
Posted by Jane D on August 24, 2001, at 20:23:38
In reply to Re: Effexor, feel nothing.. anyone experience this? » cerose, posted by SalArmy4me on August 23, 2001, at 7:07:15
Sal,
This seems to be about what Psychiatrists do, not what they should do. It's also about the UK. I understand from other posters here that the UK's health system restricts the drugs that doctors can prescribe. So, unless Cerose is located in the UK, I don't see how this is relevant. Can you explain?
Jane
Posted by Joy on August 26, 2001, at 20:00:00
In reply to Effexor, feel nothing.. anyone experience this?, posted by cerose on August 22, 2001, at 21:40:57
My bf is on 262.5 Effexor XR for three years. Gradually the pdoc brought him to this dose and added Buspar for anxiety. He takes 100 mg Trazadone at night. His whole life has changed. If he goes higher to 300 mgs Effexor XR, it's too high. If he goes down toward 200-225 the dose is too low. Ask your doc about adding Buspar starting low 7.5 mgs twice a day and gradually seeing if that dose, or 15 mgs 2x day. Also while going through all this hell [you might feel more anxiety first 4 or 5 days on Buspar]you can take a little Xanax [generic usually okay] when needed until you are feeling okay [should be within a couple of weeks. Give the Effexor XR a chance. You may need a higher dose; check with doc and ask about adding Buspar. Effexor has really helped my bf. I hope it helps you too. Best wishes.
Joy> I have been on Effexor XR for about 6 weeks now. I have gradually gone up from 75 mg to 225 mg. I feel nothing, except sweaty. I don't feel better, I don't feel worse.
>
> I have also tried Zoloft, from 25 mg to 100 mg. No side effects, but not better either.
>
> I am being treated from Major Depressive Disorder and Anxiety. I would guesstimate that I have been this way for at least 13 years. I don't really know what it feels like to be different then this.
>
> Any one have any ideas?
This is the end of the thread.
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