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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 47 to 71 of 119. Go back in thread:
Posted by SLS on December 8, 2011, at 7:36:22
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 7, 2011, at 14:56:13
> I thinkk you just need tro strip everything down and start from scratch.
My baseline depression is too severe for me to live independently.
What did you have in mind?
Thanks.
- Scott
Posted by SLS on December 8, 2011, at 8:04:36
In reply to Re: Effexor 450 mg? » SLS, posted by Bob on December 7, 2011, at 17:40:13
> > My doctor acceded to my request to raise the dosage of Effexor to 450 mg. I'm not expecting miracles, but perhaps it will help enough so that I could return to work. He also prescribed prazosin, thinking that there might be a PTSD thing going on. I don't think there is, but I'll go along with it for now.
> What can you tell me about prazosin? How does it work and what are your experiences with taking it? Is this drug widely used for PTSD? Are there other drugs out there meant for the treatment of PTSD?
Prazosin is a specific alpha-1 NE receptor antagonist. It is supposed to help improve sleep and reduce nightmares. I really don't think it is an appropriate treatment for me. I do have occasional dreams of being bullied in high school. I don't know...
Topamax is an effective treatment for PTSD. It helps with re-experiencing and avoidance. I don't know what dosages are used. One study I came across used 100 mg.
- Scott
-----------------------------------
Posted by SLS on December 8, 2011, at 8:07:51
In reply to Re: Effexor 450 mg? » SLS, posted by ed_uk2010 on December 5, 2011, at 16:01:41
> Perhaps to taper off all or most of your medication over a period of a few months??
That is an appealing idea.
Thanks for sharing your knowledge and support.
- Scott
Posted by SLS on December 8, 2011, at 8:08:36
In reply to Re: Effexor 450 mg? » SLS, posted by ed_uk2010 on December 5, 2011, at 16:01:41
> Perhaps to taper off all or most of your medication over a period of a few months??
That is an appealing idea.
Thanks for sharing your knowledge and support.
- Scott
Posted by ed_uk2010 on December 8, 2011, at 8:44:42
In reply to Re: Effexor 450 mg? » ed_uk2010, posted by SLS on December 8, 2011, at 8:08:36
>That is an appealing idea.
I'm not sure how appealing it is (!) but it is possible that a period on less medication could make you more responsive to ADs again.
After being on a substantial combination of psych meds over a prolonged period, it is impossible to know how you would feel on less medication without actually trying it. Even though most of your current medications produced some benefit initially, who knows what they are doing for you right now? Obviously, you would have to reduce one medication at a time, and you would have to reduce gradually enough to avoid any rebound symptoms.
Posted by Phidippus on December 8, 2011, at 13:56:43
In reply to Re: Effexor 450 mg? » SLS, posted by ed_uk2010 on December 8, 2011, at 8:44:42
Go for it. I've done it on more than one occasion. Always worked out for the best.
Eric
Posted by Phidippus on December 8, 2011, at 13:59:25
In reply to Re: Effexor 450 mg? » Bob, posted by SLS on December 8, 2011, at 8:04:36
Prazosin is also being studied as a treatment for OCD. The University of Amsterdam is doing a studied.
Eric
Posted by Phidippus on December 8, 2011, at 14:18:26
In reply to Re: Effexor 450 mg? » Phidippus, posted by SLS on December 8, 2011, at 7:36:22
Are you bipolar? If so, then you suffer greatly from bipolar depression which can be very difficult to treat.
I'm just thinking you need to reevaluate what you're currently taking, maybe take a step back from it all and start from scratch.
Besides my OCD, my bipolar depression really causes me problems. Two medicines have basically saved my *ss: Lithium and Clomipramine. Why not start over with just these two medications. Clomipramine is considered the 'gold' standard for the treatment of depression. See what happens to your baseline depression, then add to the mix.
I would ditch Abilify. A lot of literature keeps popping up that it can contribute to depression. From personal experience, I prefer Seroquel(which has tons of print supporting it as an efficacious treatment for bipolar depression) and Latuda, which has really improved my mood.
I never see noratryptaline prescribed for more the few months after ECT. Its not that strong of an AD in the long term. Clomipramine will be a stronger replacement.
With the level of depression you suffer, I think having two mood stabilizers on board is working against you. Choose the lithium or the lamictal.
Consider alternative medications: Riluzole, Memanntine, opiates, tramadol, buprinephrine, Ketamine. All these show efficacy in treating depression.
Eric
ps. Do you ruminate a lot?
Posted by Bob on December 8, 2011, at 14:28:36
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 8, 2011, at 14:18:26
Clomipramine is considered the 'gold' standard for the treatment of depression.
>
> Eric
>
> ps. Do you ruminate a lot?
It is? I thought it was the go to drug for OCD.
Posted by Phidippus on December 8, 2011, at 14:34:29
In reply to Re: Effexor 450 mg? » SLS, posted by Bob on December 7, 2011, at 17:40:13
Bob,
Prazosin is a sympatholytic drug used to treat high blood pressure and Anxiety, PTSD and Panic Disorder. It belongs to the class of alpha-adrenergic blockers. Specifically, prazosin is selective for the alpha-1 receptors on vascular smooth muscle. These receptors are responsible for the vasoconstrictive action of norepinephrine, which would normally raise blood pressure and cause increase in anxiety and panic. By blocking these receptors, prazosin reduces blood pressure and reduces anxiety and panic.
From wikipedia:
Symptom management: potentially useful medication classes
SSRIs (selective serotonin reuptake inhibitors). SSRIs are considered to be a first-line drug treatment.[130][131] SSRIs for which there are data to support use include: citalopram, escitalopram,[132] fluoxetine,[133] fluvoxamine,[134] paroxetine,[135] and sertraline.[133][136]
Among the anti-depressants described in this section, bupropion and venlafaxine have the lowest patient drop-out rates. Sertraline, fluoxetine, and nefazodone have a modestly higher drop-out rate (~15%), and the heterocyclics and paroxetine have the highest rates (~20%+).[137] Where drop-out is caused or feared because of medication side-effects, it should be remembered that most patients do not experience such side-effects.[138]
Alpha-adrenergic antagonists. Prazosin ("Minipress"), in a small study of combat veterans, has shown substantial benefit in relieving or reducing nightmares.[139] Clonidine ("Catapres") can be helpful with startle, hyperarousal, and general autonomic hyperexcitability.[140]
Anti-convulsants, mood stabilizers, anti-aggression agents. Carbamazepine ("Tegretol") has likely benefit in reducing arousal symptoms involving noxious affect,[133] as well as mood or aggression.[141] Topiramate ("Topamax")[139] has been effective in achieving major reductions in flashbacks and nightmares, and no reduction of effect was seen over time.[139] Zolpidem ("Ambien") has also proven useful in treating sleep disturbances.[140]
Lamotrigine ("Lamictal") may be useful in reducing reexperiencing symptoms, as well as avoidance and emotional numbing.[139][142][143][144] Valproic acid ("Depakene") and has shown reduction of symptoms of irritability, aggression, and impulsiveness, and in reducing flashbacks.[140] Similarly, lithium carbonate has worked to control mood and aggressions (but not anxiety) symptoms.[141] Buspirone ("BuSpar") has an effect similar to that of lithium, with the additional benefit of working to reduce hyperarousal symptoms.[140]
Antipsychotics. Risperidone can be used to help with dissociation, mood issues, and aggression.[145]
Atypical antidepressants.[146] Nefazodone ("Serzone") can be effective with sleep disturbance symptoms, and with secondary depression, anxiety, and sexual dysfunction symptoms.[133] Trazodone ("Desyrel") can also reduce or eliminate problems with disturbed sleep, and with anger and anxiety.[133]
Beta blockers. Propranolol ("Inderal") has demonstrated possibilities in reducing hyperarousal symptoms, including sleep disturbances.[140][147]
Benzodiazepines. These can be used with caution for short-term anxiety relief,[145][148] hyperarousal, and sleep disturbance.[140] While benzodiazepines can alleviate acute anxiety, there is no consistent evidence that they can stop the development of PTSD, or are at all effective in the treatment of posttraumatic stress disorder. Additionally benzodiazepines may reduce the effectiveness of psychotherapeutic interventions and there is some evidence that benzodiazepines may contribute to the development and chronification of PTSD. Other drawbacks include the risk of developing a benzodiazepine dependence and withdrawal syndrome; additionally individuals with PTSD are at an increased risk of abusing benzodiazepines.[130][149]
Glucocorticoids. Additionally, post-stress high dose corticosterone administration was recently found to reduce 'PTSD-like' behaviors in a rat model of PTSD. In this study, corticosterone impaired memory performance, suggesting that it may reduce risk for PTSD by interfering with consolidation of traumatic memories.[150] The neurodegenerative effects of the glucocorticoids, however, may prove this treatment counterproductive.[151]
Heterocyclic / Tricyclic anti-depressants anti-depressants. Amitriptyline ("Elavil") has shown benefit for positive distress symptoms, and for avoidance, and Imipramine ("Tofranil") has shown benefit for intrusive symptoms.[133]
Monoamine-oxidase inhibitors (MAOIs). Phenelzine ("Nardil") has for some time been observed to be effective with hyperarousal and depression, and is especially effective with nightmares.[133]
Miscellaneous other medications. Clinical trials evaluating methylenedioxymethamphetamine (MDMA, "Ecstasy") in conjunction with psychotherapy are being conducted in Switzerland[152] and Israel.[153]
Eric
Posted by Phidippus on December 8, 2011, at 14:46:58
In reply to Re: Effexor 450 mg? » Phidippus, posted by Bob on December 7, 2011, at 17:07:05
The vagal nerve is tthe longest nerve in the cranium. When stimulated electrically it produces a myriad of effects, including antidepressant effects.
Eric
Posted by Phidippus on December 8, 2011, at 14:50:26
In reply to Re: Effexor 450 mg?, posted by Bob on December 8, 2011, at 14:28:36
Read this: http://www.psychotropical.com/dual_action_ads.shtml
Eric
ps. SSRIs are the go to drugs for OCD.
Posted by SLS on December 8, 2011, at 21:50:45
In reply to Re: Effexor 450 mg? » Bob, posted by Phidippus on December 8, 2011, at 14:50:26
I'm feeling better now than I was last week.
Wouldn't it be cool if...
- Scott
Posted by ed_uk2010 on December 9, 2011, at 7:35:04
In reply to Re: Effexor 450 mg?, posted by SLS on December 8, 2011, at 21:50:45
> I'm feeling better now than I was last week.
>
> Wouldn't it be cool if...
>
>
> - ScottHope it helps Scott.
Posted by SLS on December 9, 2011, at 14:10:24
In reply to Re: Effexor 450 mg? » SLS, posted by ed_uk2010 on December 9, 2011, at 7:35:04
> > I'm feeling better now than I was last week.
> >
> > Wouldn't it be cool if...> Hope it helps Scott.
Thanks, Ed.
- Scott
Posted by Phillipa on December 9, 2011, at 19:30:11
In reply to Re: Effexor 450 mg? » ed_uk2010, posted by SLS on December 9, 2011, at 14:10:24
It sure would finger crossed. Phillipa
Posted by huxley on December 11, 2011, at 3:28:30
In reply to Re: Effexor 450 mg? » huxley, posted by SLS on December 8, 2011, at 7:30:04
> > Hi Scott,
> >
> > I went up to 600mg of effexor.
> >
> > Did nothing it did't do at 200mg.
>
>
> Thanks for the input, Huxley.
>
> Did you experience any side effects?
>
>
> - ScottFrom the higher dose? Nope, just the same SEs as at lower levels. Although I only stayed up there for a couple of weeks.
Posted by SLS on December 11, 2011, at 11:05:37
In reply to Re: Effexor 450 mg?, posted by huxley on December 11, 2011, at 3:28:30
Posted by Phillipa on December 11, 2011, at 17:55:24
In reply to Re: Effexor 450 mg?, posted by huxley on December 11, 2011, at 3:28:30
Huxley I forget are you med free today? Phillipa
Posted by huxley on December 13, 2011, at 4:56:57
In reply to Re: Effexor 450 mg? » huxley, posted by Phillipa on December 11, 2011, at 17:55:24
Hi Phillipa,
Not quite. I am still on 50mg of Pristiq.
Life is very flat. I think I have what you call Anhedonia. But also quite peaceful after my nasty withdrawals.
Going down very slowly on the pristiq.
Posted by SLS on December 13, 2011, at 15:29:41
In reply to Re: Effexor 450 mg?, posted by huxley on December 13, 2011, at 4:56:57
So far, Effexor 450 mg is doing nothing for my depression, and is making me feel dazed. I can't get myself to do things. I am losing hope. I'm not sure why I should have had any in the first place. I may have to go back to a MAOI and accept living a meager existence. I am resistant to the idea of going for DBS.
- Scott
Posted by Phidippus on December 13, 2011, at 16:42:00
In reply to Re: Effexor 450 mg?, posted by SLS on December 13, 2011, at 15:29:41
Just rethink your med combo. Start from scratch. Reduce your medications. Meager existance? I doubt that. You're a great help to the people around here and that's something.
Eric
Posted by Phillipa on December 13, 2011, at 18:18:12
In reply to Re: Effexor 450 mg?, posted by SLS on December 13, 2011, at 15:29:41
Scott sorry you feel worse. What is it about DBS that has you concerned? And you are a loved and valued person. Who knows maybe the MAOI in the original combo you took that worked might now work again? You still need meds after DBS right? Could that boost the response to the meds? I don't know just asking. Phillipa
Posted by huxley on December 13, 2011, at 19:07:06
In reply to Re: Effexor 450 mg?, posted by SLS on December 13, 2011, at 15:29:41
I agree with phiddiphus. You are a big help to people round here. Even me.
Just a question, do you do alot of exercise and eat healthily?
Not saying it will cure you but it really takes the edge off for me.
Posted by Bob on December 13, 2011, at 23:54:38
In reply to Re: Effexor 450 mg?, posted by SLS on December 13, 2011, at 15:29:41
> So far, Effexor 450 mg is doing nothing for my depression, and is making me feel dazed. I can't get myself to do things. I am losing hope. I'm not sure why I should have had any in the first place. I may have to go back to a MAOI and accept living a meager existence. I am resistant to the idea of going for DBS.
>
>
> - ScottWhat are the main reasons why you are hesistant to looking into DBS?
Bob
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