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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by emme on April 14, 2007, at 7:14:01
Hi All,
I recently added 12.5 mg of Effexor to my combo of Lamictal, Abilify, Focalin, and atenolol (+ xanax prn). Adding the Effexor seems to have cleaned up quite of bit of the remaining depression. I do feel some side effects, such as a bit of insomnia. But it's not bad. I just wanted to mention this for those of you who are sensitive and slow metabolizers. Taking just 1/10 of a normal adult dose has definitely had an effect.
emme
Posted by linkadge on April 14, 2007, at 19:11:40
In reply to Low dose Effexor, posted by emme on April 14, 2007, at 7:14:01
Thats the way it was with me. Low doses, <=37.5 made a huge difference. Doctors took me off AD's entirely as they felt such a low dose was the same as nothing at all.
It is hard to convince doctors to continue ultra/low dose therapies.
Linkadge
Posted by emme on April 14, 2007, at 20:50:47
In reply to Re: Low dose Effexor, posted by linkadge on April 14, 2007, at 19:11:40
> Thats the way it was with me. Low doses, <=37.5 made a huge difference. Doctors took me off AD's entirely as they felt such a low dose was the same as nothing at all.
>
> It is hard to convince doctors to continue ultra/low dose therapies.They do need to listen to the patient's input about whether something is helping. The doctors I've dealt with have been good that way. My doctor and I learned together that I generally require/tolerate very low doses. She's really happy that this little tiny bit is helping.
Posted by linkadge on April 14, 2007, at 23:33:54
In reply to Re: Low dose Effexor » linkadge, posted by emme on April 14, 2007, at 20:50:47
Well I've got one of these doctors that goes by the book and wants to make everything systematic and methodical. There has to be a clear diagonsis and then treatment must begin at "theraputic level" only.
Linkadge
Posted by spriggy on April 15, 2007, at 0:41:10
In reply to Re: Low dose Effexor, posted by linkadge on April 14, 2007, at 23:33:54
I might try that..
I am on Ultram ER and have no problems with it (even though it hits seratonin and norepiphrine).
If this Ultram wears/poops- I think I'll try Effexor.
Posted by cloudnine on April 15, 2007, at 6:01:58
In reply to Re: Low dose Effexor, posted by spriggy on April 15, 2007, at 0:41:10
> I might try that..
>
> I am on Ultram ER and have no problems with it (even though it hits seratonin and norepiphrine).
>
> If this Ultram wears/poops- I think I'll try Effexor.
Hi,
I take Effexor XR 75,but sometimes I add Tramadol 50,with wellbutrin sr 300 and it gives me a real good feeling for a day or 2,then I stop
Cloudnine
Posted by emme on April 15, 2007, at 8:21:01
In reply to Re: Low dose Effexor, posted by linkadge on April 14, 2007, at 23:33:54
> Well I've got one of these doctors that goes by the book and wants to make everything systematic and methodical. There has to be a clear diagonsis and then treatment must begin at "theraputic level" only.
>
> LinkadgeThat really is a shame. I take it you don't have much choice in doctors? Wish I could package up mine and send her to you for an hour or two.
emme
Posted by flmm on April 15, 2007, at 10:04:28
In reply to Re: Low dose Effexor » linkadge, posted by emme on April 15, 2007, at 8:21:01
Any med that effects ne as well as seretonin, I need lower doses than what the docs say.It is wierd, but I guess it means to much seretonin leads to apathy, to much ne leads to anxiety. A delicate balance is the key when it comes to ssnri meds.
Posted by Phillipa on April 15, 2007, at 22:23:00
In reply to Re: Low dose Effexor, posted by flmm on April 15, 2007, at 10:04:28
Same here lucky my pdoc old one starts at low does of them all. She is old and I think she learned. Phillipa
Posted by polarbear206 on April 16, 2007, at 10:51:52
In reply to Re: Low dose Effexor, posted by linkadge on April 14, 2007, at 19:11:40
> Thats the way it was with me. Low doses, <=37.5 made a huge difference. Doctors took me off AD's entirely as they felt such a low dose was the same as nothing at all.
>
> It is hard to convince doctors to continue ultra/low dose therapies.
>
> Linkadge
Link,Are you saying that you p-doc doesn't believe that some people are med sensitive and can only take low doses? And many combos of low doses work well for people? Any open minded p-doc, would trust your judgement, esp. with all of your knowlege. My p-doc is great. If I present to him a new drug combo I want to try, he is usually agrees with it and we give it a go. Just recently we added a low dose of Lithium with my lamictal, which has enabled me to cut back on effexor due to some soft cycling and it has made a huge difference. Sex drive even better!
polarbear
Posted by linkadge on April 16, 2007, at 11:47:40
In reply to Re: Low dose Effexor » linkadge, posted by polarbear206 on April 16, 2007, at 10:51:52
He just doesn't believe that low doses could actually do anything.
I remember I was on 10mg of celexa (which for me was too much - I would have liked to be on 5mg), but he said to stop taking it since it couldn't possably be doing anything at such a low dose.
Infact, there was one study that I am trying to locate which was very interesting.
It said that something like 50% of people responded to 5mg of prozac, and that in comparison to those on 20mg, there was a slight (5%) increase in responce rates, but a massive increase in side effects.
Linkadge
Posted by polarbear206 on April 16, 2007, at 12:08:51
In reply to Re: Low dose Effexor, posted by linkadge on April 16, 2007, at 11:47:40
> He just doesn't believe that low doses could actually do anything.
>
> I remember I was on 10mg of celexa (which for me was too much - I would have liked to be on 5mg), but he said to stop taking it since it couldn't possably be doing anything at such a low dose.
>
> Infact, there was one study that I am trying to locate which was very interesting.
>
> It said that something like 50% of people responded to 5mg of prozac, and that in comparison to those on 20mg, there was a slight (5%) increase in responce rates, but a massive increase in side effects.
>
> Linkadge
>
>
Link,Check this out
http://www.lef.org/magazine/mag2003/mar2003_cover_effects_01.html
>
Posted by cloudnine on April 16, 2007, at 12:58:20
In reply to Re: Low dose Effexor, posted by linkadge on April 16, 2007, at 11:47:40
I too never needed more than Tofranil 75,Prozac20,Celexa20 Effexor 75...etc
More than that was be tooo much.
I think it has to do with metabolism of enzymes in the liver.
Im sure I read that people who are poor metabolizers need much lower doses.I think they found that some caucasians and a lot of asians,arabs,american indians,and afro americans are slow metabolizers,just as one example.....
I know a japanese who lived in the states for sometime and his japanese doctor prescribed him 37.5 efexor and told him not to take more,cause japanese respond differently....I think he meant differences in Cyt P 450 metabolism.
Posted by linkadge on April 16, 2007, at 16:39:16
In reply to Re: Low dose Effexor » linkadge, posted by polarbear206 on April 16, 2007, at 12:08:51
Boom! Thats the study.
"Meanwhile, troubled by the reactions I saw, I searched the medical literature for explanations. I found more than I anticipated. A study published before Prozac's® approval showed that just 5 mg helped 54% of patients, while 20 mg-the recommended dose-helped 64%.6 In other words, quadrupling the dose only improved efficacy 10%. To me, this meant that 5 mg was a reasonable starting dose, yet doctors were told to start everyone at 20 mg, even the 54% who needed only 5 mg! I was shocked and appalled."
Posted by linkadge on April 16, 2007, at 16:40:07
In reply to Re: Low dose Effexor metabolism P450, posted by cloudnine on April 16, 2007, at 12:58:20
I think higher doses are used just to hook patients.
Linkadge
Posted by Phillipa on April 16, 2007, at 19:37:34
In reply to Re: Low dose Effexor, posted by linkadge on April 16, 2007, at 11:47:40
Link when prozac first came out only available in a 20mg capsule and first day on it felt great, day 2 anxiety and wasn't anxious at the time day 3 panic all day. Quit the med and three days to get over it with xanax. When I told the pdoc he begged me to take once every three days but I didn't was too devasted by the side effects and had to work. Now you have pills and I believe firmly in low doses. Love Phillipa
Posted by linkadge on April 17, 2007, at 6:03:35
In reply to Re: Low dose Effexor » linkadge, posted by Phillipa on April 16, 2007, at 19:37:34
Perhaps you were taking too much. Maybe by day 3, too much drug had accumulated in your system, and it was making you too agitated.
Linkadge
Posted by JaneB on April 17, 2007, at 12:02:24
In reply to Re: Low dose Effexor, posted by linkadge on April 17, 2007, at 6:03:35
Thank you, thank you, thank you.
Convinced that I needed a lower dose of prozac I was told to just take 20 mg every 2-3 days. That did not work for me. I kept asking myself "Am I taking too much, am I taking too little?" Wavering back and forth every day, feeling awful on the days I took 20mg. But crashing by day 3. That article posted by polabear is just what I needed. I can mix the capsule in liquid! Right?
Jane
Posted by emme on April 17, 2007, at 13:13:27
In reply to Just the info I needed, posted by JaneB on April 17, 2007, at 12:02:24
> Thank you, thank you, thank you.
> Convinced that I needed a lower dose of prozac I was told to just take 20 mg every 2-3 days. That did not work for me. I kept asking myself "Am I taking too much, am I taking too little?" Wavering back and forth every day, feeling awful on the days I took 20mg. But crashing by day 3. That article posted by polabear is just what I needed. I can mix the capsule in liquid! Right?
> JaneYou can get a tablet and chop it, can't you? I had tablets of generic prozac. If you have a capsule, you can open it up and divide the contents. You can leave some in each half and plug the ends with peanut butter, creating two doses. You could get empty capsules from a compounding pharmacy. You might also be able to get a liquid and use a syringe. Many options.
emme
This is the end of the thread.
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