![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 39. Go back in thread:
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?
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
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
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.
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
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
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.
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 - CamCam 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!!
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!!)
;)
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
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!
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.)
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
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
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 - CamCam, 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
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!
Posted by Noa on October 21, 2000, at 13:30:30
In reply to effexor and sleep disturbance - dosage timing?, posted by tenuous on October 20, 2000, at 10:04:53
I take all of the Effexor XR in the morning for the same reason. I still have sleep difficulties, but these are helped by serzone. In any event, you can see if moving the dose to the am allows you to fall asleep without the trazodone at night, but you might still need a small dose of trazodone to fall asleep.
BTW, I missed my serzone dose last night, because I misplaced the new prescription paper, and it was really rough. I am still feeling jittery today.
Posted by Noa on October 21, 2000, at 13:33:50
In reply to Re: effexor and sleep disturbance - dosage timing? » tenuous, posted by Cam W. on October 20, 2000, at 19:20:00
Cam, like Cindy, I have been taking it in one morning dose for a long time. The regular effexor, I had to dose several times a day, but the xr has been fine in one dose. In fact, it is better because of sleep problems.
The short half life, though, does mean no skipping doses, and trying to keep a very regular morning dosing time.
Posted by tenuous on October 22, 2000, at 6:15:19
In reply to Re: effexor and sleep disturbance - dosage timing?, posted by Noa on October 21, 2000, at 13:30:30
Thanks for letting me know that someone had already successfully tried this, it let me know that it was not only reasonable,
but possible. I tried moving my whole dose to the morning and it turns out I'm one of the people who can't do that. Guess
I'll have to wait for the insomnia to resolve itself. Thanks for the info, you guys have a better grip on the application
of these drugs than the doctors I've run into. Nothing replaces real life experience along with decent research skills!
Posted by Cam W. on October 22, 2000, at 10:54:45
In reply to Re: effexor and sleep disturbance - dosage timing? » Cam W., posted by Noa on October 21, 2000, at 13:33:50
Noa & Cindy - Thanks for the info. I was at the store yesterday and was playing with the new computer system. I brought up all the people in my store taking Effexor and Effexor XR. To my surprize, 75% of those taking the XR, take it once daily in the morning (one person is taking 450mg Effexor XR, all in the morning). I haven't filled a regular Effexor prescription since February.
Also, prescribing information for Effexor XR say to take it ONCE DAILY. (Doh!). I will be offering the other 25% of those taking Effexor XR twice daily to take it all once daily (unless side effects or some other problem limits this).
Sorry guys, I'll try to pay more attention to what I am writing. - Cam
Posted by Kaarina on October 22, 2000, at 13:34:44
In reply to Re: effexor and dosage timing? - Cindy Noa , posted by Cam W. on October 22, 2000, at 10:54:45
I started taking Effexor XR 37.5mg about three weeks ago. I had to play around with the time because it gave me a burst of energy.
The doctor had given me two weeks worth of sample before writing a prescription. When I filled the prescription I was suprised because the pharmascist questioned me about side effects. He said the heart pounding was one of them, which I had expected since I've had it with other anti-depressants. Is it not listed as side-effect for others?
I also find that the effect of the Effexor XR doesn't last all day, so yesterday I took another one around three. Could it be just that the dose isn't high enough?
Or is it addictive? I use to get a headache a few hours before the next dose and have noticed that it comes sooner, but yesterday adding a second dose I had no headache.
Posted by Cindy W on October 22, 2000, at 21:03:57
In reply to effexor and sleep disturbance - dosage timing?, posted by tenuous on October 20, 2000, at 10:04:53
> 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.)
tenuous, I take all 375 mg/Effexor-XR in the morning, and STILL was having trouble sleeping (my sleep though has never been normal...I have always had a very short REM latency, mid night awakening, and early morning awakening). With Seroquel at night, however, my sleep has MARKEDLY improved, to the point that I sleep very soundly and feel quite rested, which is really wonderful!!--Cindy W
Posted by tenuous on October 23, 2000, at 5:55:44
In reply to Re: effexor and sleep disturbance - dosage timing?, posted by Cindy W on October 22, 2000, at 21:03:57
Well what do you know, those symtoms from moving the effexor dosage have turned out to be the beginning of a
depression instead. Since I was not currently in a depression when I start the med we didn't know what dose
I would need. Looks like I will need to have it upped this week. So, ignore what I reported about not being
able to move the dose.Cindy - thanks for the tip about the Seroquel; I'll ask about it in a couple of weeks. I can't ask for it at
the same time as I ask to up the Effexor because I'm always afraid that the docs will think I'm just fishing
for drugs. (Intense fear of what others think is just another of my many attractive symptoms! hahahaha)
Posted by Maribeth on October 23, 2000, at 7:42:35
In reply to Re: effexor and sleep disturbance - Cindy Cam, posted by tenuous on October 23, 2000, at 5:55:44
> Well what do you know, those symtoms from moving the effexor dosage have turned out to be the beginning of a
> depression instead. Since I was not currently in a depression when I start the med we didn't know what dose
> I would need. Looks like I will need to have it upped this week. So, ignore what I reported about not being
> able to move the dose.
>
> Cindy - thanks for the tip about the Seroquel; I'll ask about it in a couple of weeks. I can't ask for it at
> the same time as I ask to up the Effexor because I'm always afraid that the docs will think I'm just fishing
> for drugs. (Intense fear of what others think is just another of my many attractive symptoms! hahahaha)Hi --its me the newbie, Maribeth. I cannot believe how appropiate the postings have become just since I began following a couple of days ago!
I too have been on Seroquel (300 mgm, 100mgm 3x daily) Effexor XR 350 each AM --each of these for nine months. On my last visit with my
pdoc this past Thursday, 10/19/00, he started me on Topamax, 50 mgm at bedtime this for a week. Then I will build up slowly probably to
300mgm. I ALWAYS gorked out exactly one and a half hours after taking the Seroquel even when he broke up the dose to kick the auditory
hallucinations (he just bumped that up from 250 to 300 on Thursday. I am DID but have pretty well unified in twelve years of intense but
excellent, therapy. Am also serious ADD --Ritalin does wonders, but spouse objects. Took Wellbutrin SR for very brief time until it produced
psychotic episode that nearly killed me. So as you can see I've been there done that a little too. I guess I am asking what could be causing
my insomnia? --I guess I'll take Bdryl. Any other thoughts? Maribeth
Posted by S.D. on October 23, 2000, at 21:09:51
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
> ;^)I have his autograph, but it's on one of those prescription-pad pages. Does that count? You could maybe have it but I wonder if trading those things around is frowned upon due to fear of people faking prescriptions?
peace and health
S.D.
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