![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by jay on April 7, 2002, at 20:20:11
Hey folks:It seems really weird, but soon after taking a few years to be able to tolerate Effexor at a proper dose, it just doesn't do much of anything now for me.
I was wondering if anybody who has expierienced this could mention what meds they had switched to in order to overcome this. Just curious...
Thanx
Jay
Posted by TSA West on April 7, 2002, at 20:44:40
In reply to Effexor poop-out. Anybody???, posted by jay on April 7, 2002, at 20:20:11
Journal of Clinical Psychopharmacology, October 2000 "Lithium Augmentation of Venlafaxine: An Open-Label Trial":
"Lithium augmentation of venlafaxine therapy has not previously been reported. In this study, treating patients with depression with venlafaxine alone produced a significant response at week 7, and augmentation with lithium for 6 weeks provided a further improvement in response. The addition of lithium to venlafaxine treatment was well tolerated, and most adverse events were mild-to-moderate in severity. Only one patient discontinued for adverse events during augmentation. The tolerability profile with venlafaxine alone was consistent with that previously reported.
Overall, this patient population could be characterized as more severely depressed before treatment as evidenced by the duration of depression, the number of previous antidepressant treatments, and the mean rating scale scores at baseline. In addition, those patients requiring augmentation tended to have more severe depression on the basis of a longer duration and higher scores on depression rating scales.
Results from previous studies have indicated the benefits of lithium augmentation of selective serotonin reuptake inhibitors and tricyclic antidepressants. Lithium augmentation seems to be most effective when added sequentially to an adequate trial of an antidepressant in nonresponding patients, as was done here. Factors that may be predictive of a response to lithium augmentation include the presence of bipolar depression, less severe depression, and rapid improvement to lithium addition... Previous studies have indicated that a lithium plasma level of at least 0.7 mEq/L is required for maximal effectiveness during augmentation."
Posted by JohnX2 on April 7, 2002, at 20:55:20
In reply to Re: Effexor poop-out. Anybody??? » jay, posted by TSA West on April 7, 2002, at 20:44:40
> Journal of Clinical Psychopharmacology, October 2000 "Lithium Augmentation of Venlafaxine: An Open-Label Trial":
>
> "Lithium augmentation of venlafaxine therapy has not previously been reported. In this study, treating patients with depression with venlafaxine alone produced a significant response at week 7, and augmentation with lithium for 6 weeks provided a further improvement in response. The addition of lithium to venlafaxine treatment was well tolerated, and most adverse events were mild-to-moderate in severity. Only one patient discontinued for adverse events during augmentation. The tolerability profile with venlafaxine alone was consistent with that previously reported.
>
> Overall, this patient population could be characterized as more severely depressed before treatment as evidenced by the duration of depression, the number of previous antidepressant treatments, and the mean rating scale scores at baseline. In addition, those patients requiring augmentation tended to have more severe depression on the basis of a longer duration and higher scores on depression rating scales.
>
> Results from previous studies have indicated the benefits of lithium augmentation of selective serotonin reuptake inhibitors and tricyclic antidepressants. Lithium augmentation seems to be most effective when added sequentially to an adequate trial of an antidepressant in nonresponding patients, as was done here. Factors that may be predictive of a response to lithium augmentation include the presence of bipolar depression, less severe depression, and rapid improvement to lithium addition... Previous studies have indicated that a lithium plasma level of at least 0.7 mEq/L is required for maximal effectiveness during augmentation."TSA,
Effexor has stopped working for Jay. This abstract is from patients starting Effexor with no response? Does this imply that adding lithium after the fact will make Effexor work again? Huh?
John
Posted by jay on April 7, 2002, at 21:39:41
In reply to Re: Effexor poop-out. Anybody???, posted by JohnX2 on April 7, 2002, at 20:55:20
I have tried lithium augmentation in the past. For me, it seemed to make the side-effects of Effexor worse, in particular the fatigue and "sluggish" feeling, without doing anything for the anxious component of my depression.I might be willing to give it a try, yet again, maybe even using the sustained-release version. I also forgot to mention I take 2.5mg's of Zyprexa, which does seem to have a rather positive benefit.
I am trying to mostly focus on symptoms, but I am one of those who reacts to the tiniest hint of anxiousness or depression. Besides the research, I wanted to see what some of the most popular and working treatments are.
Thanks....
Jay
Posted by SLS on April 8, 2002, at 9:40:02
In reply to Re: Effexor poop-out: JohnX2 TSA West, posted by jay on April 7, 2002, at 21:39:41
> I might be willing to give it a try, yet again, maybe even using the sustained-release version. I also forgot to mention I take 2.5mg's of Zyprexa, which does seem to have a rather positive benefit.
Hi Jay.I think trying Zyprexa was a good choice. You might need 5.0mg, though.
I don't know how well you would tolerate it, but the minimum dosage of Effexor to give up on is 300mg. This is no longer considered to be high, and it is becoming accepted as being a target dosage. You might want to fully explore it before commiting to augmentation strategies.
Good luck.
- Scott
Posted by jay on April 8, 2002, at 13:27:44
In reply to Re: Effexor poop-out: JohnX2 TSA West » jay, posted by SLS on April 8, 2002, at 9:40:02
> > I might be willing to give it a try, yet again, maybe even using the sustained-release version. I also forgot to mention I take 2.5mg's of Zyprexa, which does seem to have a rather positive benefit.
>
>
> Hi Jay.
>
> I think trying Zyprexa was a good choice. You might need 5.0mg, though.
>
> I don't know how well you would tolerate it, but the minimum dosage of Effexor to give up on is 300mg. This is no longer considered to be high, and it is becoming accepted as being a target dosage. You might want to fully explore it before commiting to augmentation strategies.
>
> Good luck.
>
>
> - Scott
Thanks Scott. I hit the 375mg dose last summer, and for a number of months had both some really good times on it, and equal number of bad. The hardest part was how unpredictable my mood was, so we brought the dose down. The interesting thing I have found is once your body gets used to Effexor, I think it is one of the best a.d.'s out there.I also have gone up to 7.5mg's of Zyprexa, but that tends to leave me too "zombified" at that dose. I agree the Zyprexa is a simply excellent choice to augment Effexor with.
What I may try messing around with is the time of day I take my meds. My doctor even suggested trying "mid-day", as that is when I often have a difficult time with my symptoms. Or, there is also dose-splitting, which seems to help many folks.
Thanks for your ideas.
Jay
Posted by Zo on April 8, 2002, at 21:35:58
In reply to Re: Effexor poop-out » SLS, posted by jay on April 8, 2002, at 13:27:44
Whoa, I'm hearing mood swings in there, what is your dx? Come to find out, Effexor was swinging my mood a bit too, but pdoc continued me on it and added Lamictal. Lamictal, BTW, is sooo much more a first choice over lithium. In general--in general--the more modern drug beats the old ones.And tweaking anxiety with benzos is an excellent way to be able to tolerate any med that is otherwise beneficial.
Do you take your Zyprexa before bed? It is a FAB drug, for bipolar and lots else--IF it doesn't cause weight gain.
But that's a pretty high dose. You may be outside the window where it helps. With some of these meds, like Zyprexa and Provigil, more is not better, and we have to readjust our thinking!Best,
Zo
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.