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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Roslynn on August 14, 2013, at 10:04:16
Hi all,
Just a question about when you start up a new med...I noticed a tiny improvement at the starter dose...then that faded...when I increased the dose I noticed a significant improvement...though it is now starting to level off. I am on day 14 of the higher dose. Does this mean I will stay at this level of improvement...or will it decrease in effectiveness...or will it increase as time goes by and I get to the 4-to-6 weeks mark of taking it? Or does this mean I need to go to an even higher dose?
Has anyone had something similar happen?
Thank you for any help!
Roslynn
Posted by tensor on August 14, 2013, at 12:42:09
In reply to starting up a new med????, posted by Roslynn on August 14, 2013, at 10:04:16
> Hi all,
>
> Just a question about when you start up a new med...I noticed a tiny improvement at the starter dose...then that faded...when I increased the dose I noticed a significant improvement...though it is now starting to level off. I am on day 14 of the higher dose. Does this mean I will stay at this level of improvement...or will it decrease in effectiveness...or will it increase as time goes by and I get to the 4-to-6 weeks mark of taking it? Or does this mean I need to go to an even higher dose?
>
> Has anyone had something similar happen?
>
> Thank you for any help!
>
> Roslynn
>Is it Lamictal we are talking about? Because that's pretty much what happened to me. I stopped at 100mg and although I remained in remission for a while it was never like that one week after each dose increase. I think I read somewhere that the dopamine increases and then returns to normal after appr. one week, but don't quote me on that.
/tensor
Posted by Roslynn on August 14, 2013, at 12:47:23
In reply to Re: starting up a new med???? » Roslynn, posted by tensor on August 14, 2013, at 12:42:09
No, it's Effexor...
> >
>
> Is it Lamictal we are talking about? Because that's pretty much what happened to me. I stopped at 100mg and although I remained in remission for a while it was never like that one week after each dose increase. I think I read somewhere that the dopamine increases and then returns to normal after appr. one week, but don't quote me on that.
>
> /tensor
Posted by herpills on August 14, 2013, at 13:11:10
In reply to Re: starting up a new med????, posted by Roslynn on August 14, 2013, at 12:47:23
When I took Pristiq, which is similar to Effexor, it took awhile to get the whole benefits, the 4 to 6 week mark as you said. What dose of Effexor are you at now?
Posted by b2chica on August 14, 2013, at 13:42:14
In reply to starting up a new med????, posted by Roslynn on August 14, 2013, at 10:04:16
yes.
on pristiq.
when i first started had Great week. then went back to crap till it "really" kicked in to work. which thefirst time took almost 10 weeks. the second time (after had baby) took a couple weeks longer.no one really knows why there is this delay in antidepressants.
everyone i knew (and that my T at the time knew on pristine) had same effects.
For me it was Very worth the wait.
Best wishes.
b2c.
Posted by Phillipa on August 14, 2013, at 15:38:51
In reply to Re: starting up a new med????, posted by b2chica on August 14, 2013, at 13:42:14
I've not tried either is this different from say Lexapro? Phillipa
Posted by Roslynn on August 14, 2013, at 16:01:27
In reply to Re: starting up a new med???? » Roslynn, posted by herpills on August 14, 2013, at 13:11:10
150mg.
> When I took Pristiq, which is similar to Effexor, it took awhile to get the whole benefits, the 4 to 6 week mark as you said. What dose of Effexor are you at now?
Posted by Roslynn on August 14, 2013, at 16:03:32
In reply to Re: starting up a new med????, posted by b2chica on August 14, 2013, at 13:42:14
Thanks for your response...this gives me hope!
Roslynn
> yes.
> on pristiq.
> when i first started had Great week. then went back to crap till it "really" kicked in to work. which thefirst time took almost 10 weeks. the second time (after had baby) took a couple weeks longer.
>
> no one really knows why there is this delay in antidepressants.
>
> everyone i knew (and that my T at the time knew on pristine) had same effects.
>
> For me it was Very worth the wait.
> Best wishes.
> b2c.
Posted by Roslynn on August 14, 2013, at 16:05:12
In reply to Re: starting up a new med???? » b2chica, posted by Roslynn on August 14, 2013, at 16:03:32
Hi Scott, have you heard of this too when starting a med?
Thank you,
Roslynn
Posted by baseball55 on August 14, 2013, at 19:21:36
In reply to SLS please what do you think?, posted by Roslynn on August 14, 2013, at 16:05:12
The first psych med I took was lexapro. The first two weeks, I felt kind of euphoric and kind of emotional but in a good way. That effect wore off. Then I just felt calmer and less irritable -- much less irritable. That effect wore off after about a year. Then deep depression set in. I don't know if the lexapro stopped working or if the depression just got much worse as I stopped using drugs and alcohol and started doing intensive psychotherapy.
Posted by SLS on August 17, 2013, at 4:56:23
In reply to starting up a new med????, posted by Roslynn on August 14, 2013, at 10:04:16
With a drug like Effexor, people sometimes experience brief "blip" improvement. It can happen as soon as the third day of starting treatment and last a few days. However, just because this improvement disappears does not mean that it won't return later. It can take three weeks or longer at a higher dosage to receive the "true" antidepressant response. So, the question becomes, how do you know? You don't. You have no better choice than to keep taking Effexor to find out. Some people need 300 mg/day. Some can only tolerate 150 mg/day. Because biological tests are not yet ready for deployment in the field, there is nothing a doctor can do except rely on his clinical experience with previous patients in order to reach decisions. I would say that your blip improvements are a good sign (at least according to my doctors at the NIMH, NIH), and that it is worth continuing your trial of Effexor.
I would love to see you hit the bullseye. If it turns out that Effexor is only partially effective, some people find that adding Wellbutrin, nortriptyline, Remeron, or even lithium as adjuncts is a better choice than simply switching to another drug. For me, I found it necessary to build a regime around a core treatment of a combination of MAOI and TCA. To that, I added several mood stabilizers and augmentors. It is not an ideal answer, but, so far, it is the best we have come up with. I look forward to the arrival of "deep TMS" to trigger a more robust improvement. The first 100 machines are due to be deployed in the US by the Brainsway company in Israel very soon. This new H-coil device was approved by the FDA in January. It can penetrate to more than twice the depth in the brain as the Neurostar machine. Supposedly, it can induce a current directly into important limbic structures rather than rely on a secondary effect.
I don't know why I wrote so much. Perhaps it was to impart to you a feeling of hopefullness that there are treatments that you may not have tried yet and that have a genuine chance of improving the quality of your life. I have had a pretty rough time recently with negative outlook towards my treatment. I guess I needed some positive reinforcement.
- Scott
Posted by Roslynn on August 17, 2013, at 11:14:37
In reply to Re: starting up a new med???? » Roslynn, posted by SLS on August 17, 2013, at 4:56:23
Scott,
Thank you so much. I really appreciate and value your help.
I'm going to continue on the Effexor, it hasn't even been 3 weeks, after all. I could add nortriptyline eventually, as you mentioned. I'm already on lithium. I can't take Wellbutrin unfortunately because it gives me motor tics. Remeron, I would be worried about the weight gain and appetite increase.
Thank you for the information about the deep TMS. It gives us hope. And thank you for the information about Effexor and how it may yet work for me.
I'm sorry if you've been a little down lately. Please post and let us help you too. Seems like it's always you helping us!!
Thanks again,
Roslynn> With a drug like Effexor, people sometimes experience brief "blip" improvement. It can happen as soon as the third day of starting treatment and last a few days. However, just because this improvement disappears does not mean that it won't return later. It can take three weeks or longer at a higher dosage to receive the "true" antidepressant response. So, the question becomes, how do you know? You don't. You have no better choice than to keep taking Effexor to find out. Some people need 300 mg/day. Some can only tolerate 150 mg/day. Because biological tests are not yet ready for deployment in the field, there is nothing a doctor can do except rely on his clinical experience with previous patients in order to reach decisions. I would say that your blip improvements are a good sign (at least according to my doctors at the NIMH, NIH), and that it is worth continuing your trial of Effexor.
>
> I would love to see you hit the bullseye. If it turns out that Effexor is only partially effective, some people find that adding Wellbutrin, nortriptyline, Remeron, or even lithium as adjuncts is a better choice than simply switching to another drug. For me, I found it necessary to build a regime around a core treatment of a combination of MAOI and TCA. To that, I added several mood stabilizers and augmentors. It is not an ideal answer, but, so far, it is the best we have come up with. I look forward to the arrival of "deep TMS" to trigger a more robust improvement. The first 100 machines are due to be deployed in the US by the Brainsway company in Israel very soon. This new H-coil device was approved by the FDA in January. It can penetrate to more than twice the depth in the brain as the Neurostar machine. Supposedly, it can induce a current directly into important limbic structures rather than rely on a secondary effect.
>
> I don't know why I wrote so much. Perhaps it was to impart to you a feeling of hopefullness that there are treatments that you may not have tried yet and that have a genuine chance of improving the quality of your life. I have had a pretty rough time recently with negative outlook towards my treatment. I guess I needed some positive reinforcement.
>
>
> - Scott
>
Posted by Phillipa on August 17, 2013, at 20:19:13
In reply to Re: starting up a new med???? » Roslynn, posted by SLS on August 17, 2013, at 4:56:23
Scott in all seriousness there is not a TV show Mystery Diagnosis that we record to watch later. Discovery Fitness & Health Channel. True stories many very scary. But lately I wonder how many illnesses including mental health are genetically linked. Did you ever see a geneticist? What appears as one thing could be a very rare illness that is missed till the right doc runs the right tests. I am going to do a lot of researching on autoimmune illnesses. Seems many of the what looks as something obvious is not. Phillipa
Posted by SLS on August 18, 2013, at 3:55:48
In reply to Re: starting up a new med???? » SLS, posted by Phillipa on August 17, 2013, at 20:19:13
> Scott in all seriousness there is not a TV show Mystery Diagnosis that we record to watch later. Discovery Fitness & Health Channel. True stories many very scary. But lately I wonder how many illnesses including mental health are genetically linked. Did you ever see a geneticist? What appears as one thing could be a very rare illness that is missed till the right doc runs the right tests. I am going to do a lot of researching on autoimmune illnesses. Seems many of the what looks as something obvious is not. Phillipa
These are good ideas.
- Scott
This is the end of the thread.
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