Psycho-Babble Medication Thread 45713

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Re: effexor and prozac?? fatal combo? » Cindy W

Posted by MicheleR on October 2, 2000, at 22:20:11

In reply to Re: effexor and prozac?? fatal combo?, posted by Cindy W on October 2, 2000, at 22:06:32

>
> Michele, sounds like you're on a lot of stuff! Cam or somebody can give a more expert word. I've read on this board that people take Prozac in order to withdraw from Effexor-XR, to minimize side effects, so I doubt whether that's a fatal combination (unless you have overly high dosages and end up with serotonin syndrome). I'd definitely talk to your pharmacist and run it by Cam, including dosages, since that sounds like a lot of stuff to be taking at once.--Cindy W (who is combining Effexor-XR, Serzone, and now Seroquel also)(my brain must be quite confused, but I'm feeling better)

Thank you for responding Cindy, I have a stupid question...I am new here and that was my first post, who is Cam? Currently I am on the following daily dosage of each med: prozac 80mg, effexor 75mg, dexedrine 10mg, valium 20mg, and ambien 10mg.
Thanks again,
Michele

 

Re: effexor and prozac?? fatal combo? » MicheleR

Posted by Racer on October 3, 2000, at 1:01:42

In reply to Re: effexor and prozac?? fatal combo? » Cindy W, posted by MicheleR on October 2, 2000, at 22:20:11

I'm not the last word, but I take (and have for a year and a half) a combination of Effexor XR (225mg) and Prozac (10mg-20mg), with few side effects. I do tend to sweat more, but while that may be socially fatal when my deodorant fails (!), nothing worse has happened...

It's a combo that works great for me. Hope it helps you, too.

 

Re: effexor and prozac?? fatal combo?

Posted by JohnL on October 3, 2000, at 4:23:37

In reply to effexor and prozac?? fatal combo?, posted by MicheleR on October 2, 2000, at 21:37:02

> I have been on prozac for several years and a couple of months ago my doctor added effexor, I just recently heard that these two meds together could be a potentially fatal combination....I was wondering if anyone here had any information about this. If anyone has any information on the combination of meds I am on, please let me know. I am currently on prozac, effexor, dexedrine, valium, and ambien. I know this is not a place to get official medical advice but any thoughts any of you have would be helpful so that I can discuss this with my doctor or see if I need to change doctors.
> Thank you,
> Michele

Michele,
There's nothing wrong with adding Effexor to Prozac. The fatal reaction you heard about is called serotonin syndrome. Basically, it's too much serotonin too fast. It is an emergency room situation, and in severe cases death. The key to avoiding serotonin overload is to start or add doses at very low levels and increase them in small increments. That way, if you do reach a point of overload, you'll get some hints of it early before things get out of hand. When overload occurs, it is usually the result of taking two or more serotonin medications simultaneously. So with you, the risk does exist, but is of minor concern as long as you are aware of it. Just don't increase serotonin too much too fast.

The one thing that could be tricky with you is all the meds you are taking. The reason is because of liver enzymes. Most of our meds are broken down by our liver. They compete for a limited number of liver enzymes to metabolize them. As more and more meds are entered into the system, their are fewer enzymes to break them down, and thus the medication levels in our bloodstream accumulate at higher levels and remain there longer than normal. For example, if someone were taking Prozac and then added a tricyclic antidepressant, the Prozac level in the blood would increase anywhere from 2-fold to 9-fold. Simply adding the tricyclic effectively doubled the dose of Prozac, even though the amount of Prozac actually swallowed had remained the same. So with you, these kinds of things should be kept in mind. It will be very difficult to know exactly how each med is affecting the other. And the size dose of a med you are taking may actually be misleading. It could be a lot more. Not necessarily good or bad, but just something to be aware of.
John

 

Re: effexor and prozac?? fatal combo? » MicheleR

Posted by Cam W. on October 3, 2000, at 6:58:52

In reply to effexor and prozac?? fatal combo?, posted by MicheleR on October 2, 2000, at 21:37:02

Michele - John is right about taking Effexor & Prozac together. I have seen it done a few times, with no problems. Outside of the serotonin syndrome that John mentioned, the combination actually has some merits for severe depression; especially at higher doses of Effexor. Like John says, add the Effexor at low doses and increase the dose slowly, to avoid serotonin syndrome (flu-like symptoms, excess dizziness, headache, sweats, etc.).

Many researchers think that the way antidepressants work is to increase the neurotransmitters, serotonin and norepinephrine (and even dopamine) levels in the body. If this is true, using Prozac and low dose Effexor together may block serotonin reuptake in the synaptic gap. This could possibly enhance the antidepressant activity of both of these drugs, while decreasing most of the side effects (due to these drugs binding to other receptors like cholinergic, alpha-1-adrenergic, etc.). The serotonin-induced side effects may be enhanced (sweating, weight gain, etc), but probably not to any appreciable extent.

High dose Effexor (higher than 225mg/day) and Prozac would possibly act like a tricyclic antidepressant (TCA) without all the drowsiness and heart problems. Both serotonin and norepinephrine reuptake pumps would be blocked; increasing levels of both of these neurotransmitters in the gap between nerver cells. Again, long term side effects of both of the drugs may be reduced.

It is worth a try. I don't like having to take more meds than I have to, but sometimes it is necessary.
Hope this helps - Cam

 

Re: effexor and prozac?? fatal combo? JohnLCamW

Posted by MicheleR on October 3, 2000, at 19:18:33

In reply to Re: effexor and prozac?? fatal combo? » MicheleR, posted by Cam W. on October 3, 2000, at 6:58:52

Thank you very much for the information you provided for me, it is very helpful. I learned alot that I can not often find just doing individualized searches for specific medication information. Thanks for taking the time to reply, its appreciated!
Michele

> Michele - John is right about taking Effexor & Prozac together. I have seen it done a few times, with no problems. Outside of the serotonin syndrome that John mentioned, the combination actually has some merits for severe depression; especially at higher doses of Effexor. Like John says, add the Effexor at low doses and increase the dose slowly, to avoid serotonin syndrome (flu-like symptoms, excess dizziness, headache, sweats, etc.).
>
> Many researchers think that the way antidepressants work is to increase the neurotransmitters, serotonin and norepinephrine (and even dopamine) levels in the body. If this is true, using Prozac and low dose Effexor together may block serotonin reuptake in the synaptic gap. This could possibly enhance the antidepressant activity of both of these drugs, while decreasing most of the side effects (due to these drugs binding to other receptors like cholinergic, alpha-1-adrenergic, etc.). The serotonin-induced side effects may be enhanced (sweating, weight gain, etc), but probably not to any appreciable extent.
>
> High dose Effexor (higher than 225mg/day) and Prozac would possibly act like a tricyclic antidepressant (TCA) without all the drowsiness and heart problems. Both serotonin and norepinephrine reuptake pumps would be blocked; increasing levels of both of these neurotransmitters in the gap between nerver cells. Again, long term side effects of both of the drugs may be reduced.
>
> It is worth a try. I don't like having to take more meds than I have to, but sometimes it is necessary.
> Hope this helps - Cam

 

Re: effexor and prozac?? fatal combo? » MicheleR

Posted by JaneST on October 8, 2000, at 13:16:02

In reply to effexor and prozac?? fatal combo?, posted by MicheleR on October 2, 2000, at 21:37:02

Michele:

Don't know if this helps but Dr. Stahl, a venerable psychopharmicist, advidly advocates prozac combined with effexor. Also, a friend just recently went on this combo and it's working really well for her.

As to the other mix of meds in your 'cocktail', obviously I have no idea...but when Cam can, he will steer you in the right direction. Additionally, I would be curious to know what your pdoc says in a answer to your question.

Peace,
Jane

 

Re: input from Dr. Stahl

Posted by Dr. Bob on October 17, 2000, at 3:13:13

In reply to Re: effexor and prozac?? fatal combo? » MicheleR, posted by JaneST on October 8, 2000, at 13:16:02

> Dr. Stahl, a venerable psychopharmicist, advidly advocates prozac combined with effexor...

I let him know his name was being invoked here again, and he replied with the below.

Bob

----------------

Date: Wed, 11 Oct 2000 03:44:50 -0400
From: "STEPHEN M. STAHL"

Bob, thanks for the chance to have input and to amplify this issue.

Although I do advocate adding Effexor XR to an SSRI such as Prozac, it is generally when an SSRI is not working or only having a partial effect, rather than the other way around, i.e. adding an SSRI to inadequate treatment response to Effexor XR. THis is because adding Effexor to an SSRI adds noradrenergic action whereas adding an SSRI to Effexor largely duplicates the serotonergic action of Effexor. When Effexor itself does not work adequately, I would generally add something else, such as Remeron or Wellbutrin.

 

Re: input from Dr. Stahl » Dr. Bob

Posted by Cam W. on October 17, 2000, at 6:57:10

In reply to Re: input from Dr. Stahl, posted by Dr. Bob on October 17, 2000, at 3:13:13

Dr.Bob - Think you can get me an autograph from Dr.Stahl? - Cam
;^)

 

Re: input from Dr. Stahl

Posted by Cindy W on October 17, 2000, at 9:47:23

In reply to Re: input from Dr. Stahl » Dr. Bob, posted by Cam W. on October 17, 2000, at 6:57:10

> Dr.Bob - Think you can get me an autograph from Dr.Stahl? - Cam
> ;^)

Dr. Bob and Cam, I just started reading Dr. Stahl's "Essential Pharmacology" book last night and it is really wonderful! So far I've only read chapter l but it is so clear and concise that I can't wait to read the rest.

 

Re: input from Dr. Stahl

Posted by JohnB on October 18, 2000, at 23:17:39

In reply to Re: input from Dr. Stahl, posted by Dr. Bob on October 17, 2000, at 3:13:13


> Although I do advocate adding Effexor XR to an SSRI such as Prozac, it is generally when an SSRI is not working or only having a partial effect, rather than the other way around, i.e. adding an SSRI to inadequate treatment response to Effexor XR. THis is because adding Effexor to an SSRI adds noradrenergic action whereas adding an SSRI to Effexor largely duplicates the serotonergic action of Effexor. When Effexor itself does not work adequately, I would generally add something else, such as Remeron or Wellbutrin.

-This statement doesn't seem logical. If Prozac duplicates Effexor's serotonergic action, then why do it the other way around? ie., rather than adding Effexor to Prozac, why not drop the Prozac and start Effexor by itself rather than duplicate the serotonergic action of the Prozac?

 

Re: input from Dr. Stahl » JohnB

Posted by Cam W. on October 19, 2000, at 7:17:54

In reply to Re: input from Dr. Stahl, posted by JohnB on October 18, 2000, at 23:17:39

John - Prozac's long half-life makes it an attractive drug to augment with Effexor in several situations. As Dr.Stahl mentioned, Effexor augmentation is especially done when the Prozac (at a couple different dosages) has brought partial relief of depressive symptoms. This partial serotonergic effect can be maintained or slightly inhanced (watch for signs of serotonin syndrome) at low Effexor doses and, as you increase the Effexor dose, the NRI portion kicks in hopefully bringing even more relief.

At this point one could maybe try to take away the Prozac, but if there are hints of non-compliance to the medication therapy, the Prozac should be left in the regimen to avoid serotonin withdrawl symptoms (eg if the person is missing too many consecutive Effexor doses). Non-compliance with Effexor can bring rapid onset of withdrawl symptoms because of this drug's short half-life. Prozac's 100 hour half-life prevents the onset of serotonin withdrawl syndrome in non-compliant patients. The absence of the symptoms of this syndrome may improve the compliance of someone taking Effexor.

Also, some researchers have stated that while SRIs block the serotonin reuptake pump, they may do so at different sites on the pump. Thus, theoretically a combination of both Prozac and Effexor may give a slightly more effective reuptake blockade than either drug separately, giving more than just an additive serotonergic effect.

Also, you have to look at side effect profiles of the 2 drugs. Both drugs have different affinities for secondary receptors, those that contribute to side effects. Using both drugs together gives enhanced serotonergic activity with decreased side effects caused by the different secondary receptor concentrations of the 2 drugs (eg decreased intensity of cholinergic, antihistaminergic & or alpha-adrenergic side effects, etc.).

There are a couple other reasons for this strategy, but I can't come up with them off of the top of my head. Hope this helps - Cam

 

Re: input from Dr. Stahl » Cam W.

Posted by Cindy W on October 19, 2000, at 9:12:28

In reply to Re: input from Dr. Stahl » JohnB, posted by Cam W. on October 19, 2000, at 7:17:54

> John - Prozac's long half-life makes it an attractive drug to augment with Effexor in several situations. As Dr.Stahl mentioned, Effexor augmentation is especially done when the Prozac (at a couple different dosages) has brought partial relief of depressive symptoms. This partial serotonergic effect can be maintained or slightly inhanced (watch for signs of serotonin syndrome) at low Effexor doses and, as you increase the Effexor dose, the NRI portion kicks in hopefully bringing even more relief.
>
> At this point one could maybe try to take away the Prozac, but if there are hints of non-compliance to the medication therapy, the Prozac should be left in the regimen to avoid serotonin withdrawl symptoms (eg if the person is missing too many consecutive Effexor doses). Non-compliance with Effexor can bring rapid onset of withdrawl symptoms because of this drug's short half-life. Prozac's 100 hour half-life prevents the onset of serotonin withdrawl syndrome in non-compliant patients. The absence of the symptoms of this syndrome may improve the compliance of someone taking Effexor.
>
> Also, some researchers have stated that while SRIs block the serotonin reuptake pump, they may do so at different sites on the pump. Thus, theoretically a combination of both Prozac and Effexor may give a slightly more effective reuptake blockade than either drug separately, giving more than just an additive serotonergic effect.
>
> Also, you have to look at side effect profiles of the 2 drugs. Both drugs have different affinities for secondary receptors, those that contribute to side effects. Using both drugs together gives enhanced serotonergic activity with decreased side effects caused by the different secondary receptor concentrations of the 2 drugs (eg decreased intensity of cholinergic, antihistaminergic & or alpha-adrenergic side effects, etc.).
>
> There are a couple other reasons for this strategy, but I can't come up with them off of the top of my head. Hope this helps - Cam
Cam, does adding Serzone to Effexor-XR increase or interfere with Effexor's effects? And to deal with hypomanic episodes, what med would stabilize mood without interfering with antidepressive or anti-OCD effects of Effexor-XR? Thanks!--Cindy W

 

Re: input from Dr. Stahl

Posted by noa on October 19, 2000, at 9:27:14

In reply to Re: input from Dr. Stahl » Cam W., posted by Cindy W on October 19, 2000, at 9:12:28

My personal experience (no substitute for Cam's educated viewpoint) is that Serzone adds AD effect when added to Effexor xr, PLUS it counters the 5HT-2 effects of effexor xr, what I call having too much serotonin, which causes me restlessness, jitteriness, insomnia, muscle twitching, etc.

 

Re: input from Dr. Stahl » Cindy W

Posted by Cam W. on October 19, 2000, at 17:16:53

In reply to Re: input from Dr. Stahl » Cam W., posted by Cindy W on October 19, 2000, at 9:12:28

> Cam, does adding Serzone to Effexor-XR increase or interfere with Effexor's effects? And to deal with hypomanic episodes, what med would stabilize mood without interfering with antidepressive or anti-OCD effects of Effexor-XR? Thanks!--Cindy W

Cindy - As Noa said, Serzone blocks the serotonin-2 (5HT-2) receptor which corrects serotonin-induced sleep disturbances and restlessness, etc. I think (but am not sure) that the cause of some of the sexual dysfunctions (eg anorgasmia, decreased libido, etc.) are because of the stimulation of the 5HT-2 receptor (this is not the whole cause of the SRI sex-related problems). Effexor, by stimulating these receptors are also causing the insomnia and restlessness seen in some people taking SRIs.

Also, Serzone blocks serotonin-3 receptors (5HT-3). This decreases the nausea and stomach problems that can be caused by SRIs. There are also 5HT-3 receptors in the brain, but I don't know what they do.

Taking Effexor with Serzone can, in rare instances, result in serotonin syndrome (heart palpitations, swaeting, etc.). This is when the two drugs increase serotonin levels too much. This usually only happens when you use 2 antidepressants with different mechanisms of action are taken together (eg MAOIs with SSRIs). Since Serzone and Effexor increase serotonin in a very similar way, the risk of serotonin syndrome is greatly decreased.

Some people are sensitive to the side effects of some serotonergic antidepressants. Each SSRI blocks the serotonin reuptake pump, but each of these antidepressants also stimulate (or block) other receptors (eg å1- & å2-adrenergic receptors, norepinephrine reuptake pump, histamine -H1 receptor, mucarinic receptors, etc.). It is the stimulation of these different receptors that differentiates one SSRI from another. This is why each of them have slightly different side effects profiles, and perhaps slightly different efficacy in different subtypes of depression.

After saying all that; what my point was: using 2 antidepressants with fairly similar antidepressant action, but with differing side effects profiles enables you to use lower doses of each of the antidepressants separately, thus acheiving better serotonin reuptake pump blockade, while minimizing side effects.

As to your question of a mood stabilizer with these antidepressants; there are several different mood stabilizers that may work. Everything from the atypical antipsychotics (Zyprexa, Risperdal, and perhaps even Seroquel); Lamictal™ (lamotrigine) is another choice (although I don't see it used as the sole mood stabilizer; it is usually used as an adjunct to another mood stabilizer); can't forget lithium and Depakote either (Tegretol may affect the metabolism of Serzone and Effexor); Neurontin™ (gabapentin) and Topamax™ (topiramate).

Talk to your doctor about the options. See what he/she feels most comfortable prescribing (it's easier for a doc to follow your progress if he/she has an idea of what to expect from a drug combination).

Hope this helps - Cam

 

Re: input from Dr. Stahl - question...

Posted by MicheleR on October 19, 2000, at 18:01:22

In reply to Re: input from Dr. Stahl » Cindy W, posted by Cam W. on October 19, 2000, at 17:16:53

I appreciate all the information I have been able to read about regarding taking prozac and effexor xr. My doc added the effexor a few months ago, and I have not noticed any changes and am still struggling with depression. With the two meds combined how high of a dose would be safe to go up to with the effexor... I currently take 75mg, and my doc refuses to increase my prozac, right now I am taking 80mg/day. I want to ask my doc to increase the effexor but wanted advice from all of the very knowledgable people here...should I increase the effexor? if so, what is a safe higher does in combination with the prozac.
Thank you,
Michele

 

Re: input from Dr. Stahl

Posted by Sunnely on October 19, 2000, at 20:36:38

In reply to Re: input from Dr. Stahl » Cindy W, posted by Cam W. on October 19, 2000, at 17:16:53

> Also, Serzone blocks serotonin-3 receptors (5HT-3). This decreases the nausea and stomach problems that can be caused by SRIs.

Hi Cam,

No disrespect, but I don't think Serzone blocks 5HT3 receptors. Therefore, gastrointestinal symptoms such as nausea and diarrhea can still become a problem.

Remeron, on the other hand, blocks both 5HT2 and 5HT3 receptors. Therefore, these properties lead to its anti-anxiety and sleep-enhancing actions, little or no sexual dysfunction, and little or no nausea or diarrhea.

Just my own 2 cents.

 

Re: input from Dr. Stahl

Posted by Cindy W on October 19, 2000, at 21:53:07

In reply to Re: input from Dr. Stahl » Cindy W, posted by Cam W. on October 19, 2000, at 17:16:53

> > Cam, does adding Serzone to Effexor-XR increase or interfere with Effexor's effects? And to deal with hypomanic episodes, what med would stabilize mood without interfering with antidepressive or anti-OCD effects of Effexor-XR? Thanks!--Cindy W
>
> Cindy - As Noa said, Serzone blocks the serotonin-2 (5HT-2) receptor which corrects serotonin-induced sleep disturbances and restlessness, etc. I think (but am not sure) that the cause of some of the sexual dysfunctions (eg anorgasmia, decreased libido, etc.) are because of the stimulation of the 5HT-2 receptor (this is not the whole cause of the SRI sex-related problems). Effexor, by stimulating these receptors are also causing the insomnia and restlessness seen in some people taking SRIs.
>
> Also, Serzone blocks serotonin-3 receptors (5HT-3). This decreases the nausea and stomach problems that can be caused by SRIs. There are also 5HT-3 receptors in the brain, but I don't know what they do.
>
> Taking Effexor with Serzone can, in rare instances, result in serotonin syndrome (heart palpitations, swaeting, etc.). This is when the two drugs increase serotonin levels too much. This usually only happens when you use 2 antidepressants with different mechanisms of action are taken together (eg MAOIs with SSRIs). Since Serzone and Effexor increase serotonin in a very similar way, the risk of serotonin syndrome is greatly decreased.
>
> Some people are sensitive to the side effects of some serotonergic antidepressants. Each SSRI blocks the serotonin reuptake pump, but each of these antidepressants also stimulate (or block) other receptors (eg å1- & å2-adrenergic receptors, norepinephrine reuptake pump, histamine -H1 receptor, mucarinic receptors, etc.). It is the stimulation of these different receptors that differentiates one SSRI from another. This is why each of them have slightly different side effects profiles, and perhaps slightly different efficacy in different subtypes of depression.
>
> After saying all that; what my point was: using 2 antidepressants with fairly similar antidepressant action, but with differing side effects profiles enables you to use lower doses of each of the antidepressants separately, thus acheiving better serotonin reuptake pump blockade, while minimizing side effects.
>
> As to your question of a mood stabilizer with these antidepressants; there are several different mood stabilizers that may work. Everything from the atypical antipsychotics (Zyprexa, Risperdal, and perhaps even Seroquel); Lamictal™ (lamotrigine) is another choice (although I don't see it used as the sole mood stabilizer; it is usually used as an adjunct to another mood stabilizer); can't forget lithium and Depakote either (Tegretol may affect the metabolism of Serzone and Effexor); Neurontin™ (gabapentin) and Topamax™ (topiramate).
>
> Talk to your doctor about the options. See what he/she feels most comfortable prescribing (it's easier for a doc to follow your progress if he/she has an idea of what to expect from a drug combination).
>
> Hope this helps - Cam

Cam and Noa, will ask my pdoc about what you've said. I'm starting to think my episodes of overspending and "up" times (I'll spend more than my paycheck each month going to thrift stores and used bookstores, drive too fast, talk too fast, sleep less for several days, dress a little more boldly, etc.) may be hypomanic, not OCD related. It's been going on for years, long before Effexor-XR, Serzone, or Seroquel, so think it is not a reaction to AD's. What dose of Seroquel is reasonable, for mood stabilization? I'm currently taking Effexor-XR 375 mg/day, Serzone 75 mg/day, and Seroquel at night (l25 or l50 mg). The Seroquel has made me feel calmer and I sleep much better and feel better. But I still feel I'm having mood swings. Would an increase in Seroquel stabilize my moods, and if so, at what dosage? (I'm not crazy, so don't want to go to the max of Seroquel because then I'd never wake up again!!!). Thanks!!

 

Re: input from Dr. Stahl

Posted by Cindy W on October 19, 2000, at 21:55:25

In reply to Re: input from Dr. Stahl, posted by Sunnely on October 19, 2000, at 20:36:38

> > Also, Serzone blocks serotonin-3 receptors (5HT-3). This decreases the nausea and stomach problems that can be caused by SRIs.
>
> Hi Cam,
>
> No disrespect, but I don't think Serzone blocks 5HT3 receptors. Therefore, gastrointestinal symptoms such as nausea and diarrhea can still become a problem.
>
> Remeron, on the other hand, blocks both 5HT2 and 5HT3 receptors. Therefore, these properties lead to its anti-anxiety and sleep-enhancing actions, little or no sexual dysfunction, and little or no nausea or diarrhea.
>
> Just my own 2 cents.

Sunnely, I'm going to go back and reread Dr. Stahl's book about depression, and see which is which; I get confused. The only one I'm pretty sure of it that anything that blocks 5HT2 receptors interferes with sex (I looked that up, first, of course!!)
;)

 

Re: input from Dr. Stahl

Posted by Cam W. on October 20, 2000, at 7:28:45

In reply to Re: input from Dr. Stahl, posted by Sunnely on October 19, 2000, at 20:36:38

> > Also, Serzone blocks serotonin-3 receptors (5HT-3). This decreases the nausea and stomach problems that can be caused by SRIs.
>
> Hi Cam,
>
> No disrespect, but I don't think Serzone blocks 5HT3 receptors. Therefore, gastrointestinal symptoms such as nausea and diarrhea can still become a problem.
>
> Remeron, on the other hand, blocks both 5HT2 and 5HT3 receptors. Therefore, these properties lead to its anti-anxiety and sleep-enhancing actions, little or no sexual dysfunction, and little or no nausea or diarrhea.
>
> Just my own 2 cents.

Thanks Sunnely - The reference table I was using (in Dr.S.Preskorn's - Outpatient Management of Depression) has nefazodone next to mirtazapine, and like my driving, I didn't stay in the proper lane when scrolling down the column.

That's what I like about this site; it keeps us honest. Thanks again - Cam

 

Re: input from Dr. Stahl » Cindy W

Posted by Cindy W on October 20, 2000, at 9:34:48

In reply to Re: input from Dr. Stahl, posted by Cindy W on October 19, 2000, at 21:53:07

> > > Cam, does adding Serzone to Effexor-XR increase or interfere with Effexor's effects? And to deal with hypomanic episodes, what med would stabilize mood without interfering with antidepressive or anti-OCD effects of Effexor-XR? Thanks!--Cindy W
> >
> > Cindy - As Noa said, Serzone blocks the serotonin-2 (5HT-2) receptor which corrects serotonin-induced sleep disturbances and restlessness, etc. I think (but am not sure) that the cause of some of the sexual dysfunctions (eg anorgasmia, decreased libido, etc.) are because of the stimulation of the 5HT-2 receptor (this is not the whole cause of the SRI sex-related problems). Effexor, by stimulating these receptors are also causing the insomnia and restlessness seen in some people taking SRIs.
> >
> > Also, Serzone blocks serotonin-3 receptors (5HT-3). This decreases the nausea and stomach problems that can be caused by SRIs. There are also 5HT-3 receptors in the brain, but I don't know what they do.
> >
> > Taking Effexor with Serzone can, in rare instances, result in serotonin syndrome (heart palpitations, swaeting, etc.). This is when the two drugs increase serotonin levels too much. This usually only happens when you use 2 antidepressants with different mechanisms of action are taken together (eg MAOIs with SSRIs). Since Serzone and Effexor increase serotonin in a very similar way, the risk of serotonin syndrome is greatly decreased.
> >
> > Some people are sensitive to the side effects of some serotonergic antidepressants. Each SSRI blocks the serotonin reuptake pump, but each of these antidepressants also stimulate (or block) other receptors (eg å1- & å2-adrenergic receptors, norepinephrine reuptake pump, histamine -H1 receptor, mucarinic receptors, etc.). It is the stimulation of these different receptors that differentiates one SSRI from another. This is why each of them have slightly different side effects profiles, and perhaps slightly different efficacy in different subtypes of depression.
> >
> > After saying all that; what my point was: using 2 antidepressants with fairly similar antidepressant action, but with differing side effects profiles enables you to use lower doses of each of the antidepressants separately, thus acheiving better serotonin reuptake pump blockade, while minimizing side effects.
> >
> > As to your question of a mood stabilizer with these antidepressants; there are several different mood stabilizers that may work. Everything from the atypical antipsychotics (Zyprexa, Risperdal, and perhaps even Seroquel); Lamictal™ (lamotrigine) is another choice (although I don't see it used as the sole mood stabilizer; it is usually used as an adjunct to another mood stabilizer); can't forget lithium and Depakote either (Tegretol may affect the metabolism of Serzone and Effexor); Neurontin™ (gabapentin) and Topamax™ (topiramate).
> >
> > Talk to your doctor about the options. See what he/she feels most comfortable prescribing (it's easier for a doc to follow your progress if he/she has an idea of what to expect from a drug combination).
> >
> > Hope this helps - Cam
>
> Cam and Noa, will ask my pdoc about what you've said. I'm starting to think my episodes of overspending and "up" times (I'll spend more than my paycheck each month going to thrift stores and used bookstores, drive too fast, talk too fast, sleep less for several days, dress a little more boldly, etc.) may be hypomanic, not OCD related. It's been going on for years, long before Effexor-XR, Serzone, or Seroquel, so think it is not a reaction to AD's. What dose of Seroquel is reasonable, for mood stabilization? I'm currently taking Effexor-XR 375 mg/day, Serzone 75 mg/day, and Seroquel at night (l25 or l50 mg). The Seroquel has made me feel calmer and I sleep much better and feel better. But I still feel I'm having mood swings. Would an increase in Seroquel stabilize my moods, and if so, at what dosage? (I'm not crazy, so don't want to go to the max of Seroquel because then I'd never wake up again!!!). Thanks!!

Cam, what dosage of Seroquel is typical for mood stabilization for hypomania? Thanks!

 

effexor and sleep disturbance - dosage timing?

Posted by tenuous on October 20, 2000, at 10:04:53

In reply to Re: input from Dr. Stahl » Cindy W, posted by Cindy W on October 20, 2000, at 9:34:48

I've been on 150/mg day of Effexor XR, 75 in the am and 75 at night, and 50mg/at night of trazadone.
So far it's working on my depression. However, I have only been able to sleep for about 3 - 4 hrs at
night, plus a 45 minute nap at mid-day. The nighttime sleep only comes after taking the trazadone
(I have tried to skip the trazadone and after 3 hours I finally gave up.) I'm guessing that the Effexor
is the problem since I usually only have trouble sleeping during a depression and that's not happening
right now. I'd like to try moving both doses of the Effexor to the morning in the hope that I'll be able
to sleep; would I get withdrawal type symptoms by not using a split dosage? (My doctor is a general
practitioner with very little experience prescribing this drug.)

 

Cindy » Cindy W

Posted by Cam W. on October 20, 2000, at 19:14:30

In reply to Re: input from Dr. Stahl ª Cindy W, posted by Cindy W on October 20, 2000, at 9:34:48

> Cam, what dosage of Seroquel is typical for mood stabilization for hypomania? Thanks!

Cindy - I don't think I've seen Seroquel used for hypomania, but I suppose it could be. As a bedtime med I see doses of around 300mg to 500mg. Some people are taking 100mg at bedtime, but usually in combination with another atypical.

Your situaion is a little different. The Serzone and Seroquel are metabolized by the same cytochrome enzyme (CYP-3A4). Since Serzone inhibits this enzyme (slows the production of the CYP-3A4 enzyme) there will be less of the enzyme to metabolize the Seroquel. This means that Seroquel's metabolism will be slowed and you will need less of the drug to get an adequate effect.

Still, your dose needs to be tailored to suit you. This will be based on how you feel and your doc's judgement. Your dose will probably be in the 100mg to 300mg range, but this is only a guess.

Hope this helps - Cam

 

Re: effexor and sleep disturbance - dosage timing? » tenuous

Posted by Cam W. on October 20, 2000, at 19:20:00

In reply to effexor and sleep disturbance - dosage timing?, posted by tenuous on October 20, 2000, at 10:04:53

Tenuous - Unfortunately, because of the short half-life of Effexor XR, you need to take it twice a day. Taking it once a day may put you at risk of serotonin withdrawl syndrome.

Unfortunately sleep disturbance is fairly common with SSRIs, but many times it will fade after long term use of Effexor. The trazodone is a relatively safe sleeping med.

Hope this helps - Cam

 

Re: effexor and sleep disturbance - dosage timing? » Cam W.

Posted by Cindy W on October 20, 2000, at 22:16:16

In reply to Re: effexor and sleep disturbance - dosage timing? » tenuous, posted by Cam W. on October 20, 2000, at 19:20:00

> Tenuous - Unfortunately, because of the short half-life of Effexor XR, you need to take it twice a day. Taking it once a day may put you at risk of serotonin withdrawl syndrome.
>
> Unfortunately sleep disturbance is fairly common with SSRIs, but many times it will fade after long term use of Effexor. The trazodone is a relatively safe sleeping med.
>
> Hope this helps - Cam

Cam, thank you for the above post about Seroquel! Will pass your comments on to my pdoc when I see him Monday after work. Also, your response to tremulous puzzled me...I've been taking Effexor-XR once a day for over a year, and it doesn't seem to "wear off" or anything, for me. I used to take the doses a couple of hours apart, then decided it wasn't worth trying to keep track of them (I work at a prison, and don't even take a purse inside!). The short half-life is one of the things I like about it (interferes much less with sexual functioning). So what happens, if you take it for OCD and depression, and it wears off during the day every day? Am reading Dr. Stahl's psychopharm book and find it very interesting (although a little above my head, still). Thank for your input, Cam! I really appreciate your taking the time to respond thoughtfully to questions.--Cindy W

 

SSRI's and sleep disturbance:thanks Cam (m)

Posted by tenuous on October 21, 2000, at 5:47:25

In reply to Re: effexor and sleep disturbance - dosage timing? » Cam W., posted by Cindy W on October 20, 2000, at 22:16:16

Thanks for the info Cam. What kind of time frame should I expect for the adjustment
4 - 6 weeks or are we talking months here? I'm kind of wondering how long I will be
able to function on this little sleep. So far, so good. It sure opened up a lot of
free time to read and surf the web!


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