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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 Roslynn on July 21, 2013, at 12:38:04
Dear Scott,
Am I stupid to try Effexor if Pristiq did not work for me? I am hearing different viewpoints on this. My mother is terrified of Effexor and doesn't want me trying any more meds anyway. My pdoc said, well maybe it could work even if Pristiq did not, but he didn't seem sure. He instead wanted me to retry Vibryd, or maybe even Lexapro, stuff I had already tried and failed.
I feel like I have no support in my upcoming trial of Effexor!!
Roslynn
Posted by SLS on July 21, 2013, at 18:53:04
In reply to Dear SLS re Effexor, posted by Roslynn on July 21, 2013, at 12:38:04
> Dear Scott,
>
> Am I stupid to try Effexor if Pristiq did not work for me? I am hearing different viewpoints on this. My mother is terrified of Effexor and doesn't want me trying any more meds anyway. My pdoc said, well maybe it could work even if Pristiq did not, but he didn't seem sure. He instead wanted me to retry Vibryd, or maybe even Lexapro, stuff I had already tried and failed.
>
> I feel like I have no support in my upcoming trial of Effexor!!
>
> Roslynn
I thought that your doctor was more sure of himself in choosing Effexor than he now appears to be. It really does sound like you need a second opinion. Effexor (venlafaxine) is the parent molecule to Pristiq (desvenlafaxine). Effexor turns into Pristiq once it is metabolized in the body. One could argue that the two drugs are interchangeable, but I don't believe that they are. Some people prefer how they feel on Pristiq than to Effexor. I should think that you would have a better chance of responding to something different than going back to something already tried. I don't wish to take the responsibility of telling you not to try Effexor if for some reason it turns out to be the right drug for you. If it were me, I would look to try something from another class of drug before coming back around. I would not discount Cymbalta, though.What have you tried so far?
Did any drug make you feel somewhat better - even if for only a short period of time?
- Scott
Posted by Roslynn on July 22, 2013, at 13:47:16
In reply to Re: Dear SLS re Effexor » Roslynn, posted by SLS on July 21, 2013, at 18:53:04
Hi Scott,
First, thank you for your concern and willingness to help.
To respond to your questions:I am currently taking Seroquel 75mg, lithium 675mg and Ativan. The Seroquel and lithium dont seem to do anything beneficial, and cause huge cognitive impairment, but when I try to wean off them I have return of panic/terror feelings (anxiety and depersonalization).
History:
1st episode of depression 20 years ago. A severe episode lasting about 9 months, was given Prozac and lithium which turned around the depression in about 2 wks. Stayed on meds for a year then stopped as advised. This combo has never been effective since, nor was either med separately.
2nd episode in 1999, a moderate episode. Mostly symptoms of extreme fatigue. Tried Wellbutrin which made me feel more awake but cause tics. Tried Zoloft without success.
3rd episode, 2007 to current. Severe depression. In 2007, the Seroquel and lithium were added. Various meds have been tried...
Meds tried:
Prozac, alone and augmented by lithium, thyroid and others.
Cymbalta, Lexapro, Zoloft, Depakote, Geodon, Vibryd, Buspar, thyroid augmentation, Deplin, Paxil, protryptyline, nortriptyline, Savella, Abilify, Zyprexa, lamictal, Strattera, none of these were beneficial and all caused side effects so I could not continue. Lamictal especially caused horrible cognitive side effects. Parnate, Nardil, very problematic side effects.What has worked?
The combo of Prozac and lithium pulled me out of a severe depression within two weeks, nearly 20 years ago.
Desipramine had worked a bit at one time but not on subsequent trials.
EMSAM made me feel more alert but caused terrible rashes, had to stop.
About 2 years ago, a doctor was attempting to transition me from Prozac to an MAOI and gave me clomipramine for the transition. The combination of the Prozac and clomipramine produced a lessening of my depression, much to my surprise. The effect last maybe 6 months and then faded out.Thank you,
Roslynn>
> What have you tried so far?
>
> Did any drug make you feel somewhat better - even if for only a short period of time?
>
>
> - Scott
Posted by SLS on July 22, 2013, at 18:00:38
In reply to Re: Dear SLS re Effexor » SLS, posted by Roslynn on July 22, 2013, at 13:47:16
> EMSAM made me feel more alert but caused terrible rashes, had to stop.
What were the problems with Nardil and Parnate?
- Scott
Posted by Roslynn on July 22, 2013, at 19:39:48
In reply to Re: Dear SLS re Effexor » Roslynn, posted by SLS on July 22, 2013, at 18:00:38
Nardil, basically bed-ridden with dizziness at smallest dose..Parnate, painful heart palpitations that were not going away and woke me up at night.
>
> What were the problems with Nardil and Parnate?
>
>
>
> - Scott
Posted by SLS on July 22, 2013, at 21:48:32
In reply to Re: Dear SLS re Effexor » SLS, posted by Roslynn on July 22, 2013, at 19:39:48
I can appreciate your doctor's lack of surety in choosing a treatment for you.
> > What were the problems with Nardil and Parnate?
> Nardil, basically bed-ridden with dizziness at smallest dose..Parnate, painful heart palpitations that were not going away and woke me up at night.
Marplan might be worth considering (MAOI). It should be less apt to produce the side effects you experienced with Nardil and Parnate.
I am not a big believer in the efficacy of moclobemide, but I should at least mention it. Moclobemide is a special MAOI that has almost no side effects. It is not available in the US. I imported it from Canada. I did not react well to it.
Keep the lithium. You might want to lower the dosage if you never had a manic episode. (300 - 600 mg/day). This will help prevent kidney and thyroid toxicity.
What happens when you bring the dosage of Seroquel up to 400 mg/day? Have you thought to try Saphris (asenapine) along with the Seroquel? I've seen this combination act to treat bipolar depression with anxiety and panic attacks.
Because of my success with prazosin, I sometimes mention it to people who have some history of trauma or PTSD. The severe depression itself can be traumatic. Prazosin helps me quite a bit. For me, it feels like a clean antidepressant.
If you are totally lost, you might try starting with clomipramine and lithium, and use that combination as a core around which to build a treatment regime. I have been taking 7 drugs. I started with TCA + MAOI and through some experimentation, added drugs to it until I reached an effective regime.
Remeron sometimes works as an adjunct to Effexor and TCA.
Don't forget about TMS. I am waiting for "deep TMS" (Brainsway) to become available. My therapeutic response has plateaued, and I am experiencing diminishing returns. I am hoping that TMS sparks a more robust improvement.
There are still alternatives.
- Scott
Posted by Roslynn on July 23, 2013, at 12:41:59
In reply to Re: Dear SLS re Effexor » Roslynn, posted by SLS on July 22, 2013, at 21:48:32
Scott, thank you for your thoughts, I appreciate it.
Roslynn
This is the end of the thread.
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