Psycho-Babble Medication Thread 86308

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high-dose Effexor - anyone?

Posted by Elizabeth on December 8, 2001, at 10:53:42

Has anyone found that taking very high doses of Effexor (and if so, how high) made it work a lot better? If you have, I'd like to hear about it -- what new effects did the Effexor have when you got above a certain dose? TIA.

-elizabeth

 

Re: high-dose Effexor - anyone?

Posted by michael on December 8, 2001, at 16:21:54

In reply to high-dose Effexor - anyone?, posted by Elizabeth on December 8, 2001, at 10:53:42

Elizabeth -

I got up to 225mg (I think that's high?). Don't recall any difference... But at the same time, I have to say that I didn't get much/any benefit at any time from effexor... mostly, just got a bit spacey, if I recall correctly. And anorgasmia. On the bright side, I do have to say that I miss the very vivid dreams that I had. michael

> Has anyone found that taking very high doses of Effexor (and if so, how high) made it work a lot better? If you have, I'd like to hear about it -- what new effects did the Effexor have when you got above a certain dose? TIA.
>
> -elizabeth

 

Re: high-dose Effexor - anyone? » michael

Posted by Elizabeth on December 8, 2001, at 20:11:28

In reply to Re: high-dose Effexor - anyone?, posted by michael on December 8, 2001, at 16:21:54

> I got up to 225mg (I think that's high?).

Oops sorry. I meant over 300 mg or so.

I've just started taking it -- kind of risky since I had one of these episodes that my doctors think might be seizures (no final word on that yet, and no diagnosis) last time I tried it. I'm only on 75 mg right now but want to get up to a pretty high dose. (I'm taking anticonvulsants now so my pdoc was more comfortable trying Effexor again.)

-elizabeth

 

Re: high-dose Effexor - anyone?

Posted by angel1 on December 9, 2001, at 6:51:30

In reply to Re: high-dose Effexor - anyone? » michael, posted by Elizabeth on December 8, 2001, at 20:11:28

> HI Elizabeth,

I'm sorry this is not about Effexor, but I thought
you were on desipramine. What happen to that?
Also, if you don't mind, what is your diagnosis?
Actually, I am on effexor 150mg xr for about six
weeks, total time on effexor nine weeks. It has
definitely helped me, but I feel there is still room for improvement and will ask my doc if I can increase to 225mgxr. From what I've read and understand as you go to higher doses with this med it targets more or different neurotransmitters. Do you know if that is correct? Thank you for reading my post. Good luck with the effexor........it seems to help lots of people. Angel1

 

Re: high-dose Effexor - anyone?

Posted by Noa on December 9, 2001, at 12:39:12

In reply to Re: high-dose Effexor - anyone?, posted by angel1 on December 9, 2001, at 6:51:30

I got up to 375 or 450 (sorry, can't remember) and it did add AD effect. My problem was I couldn't tolerate the adverse effects that intensified with increased doses. I now take 225.

 

Re: high-dose Effexor - anyone?

Posted by stjames on December 9, 2001, at 13:53:22

In reply to high-dose Effexor - anyone?, posted by Elizabeth on December 8, 2001, at 10:53:42

I take 300 mgs every day and do sometimes go to 450. Can only do this with XL, reqular would bother my tummy. Effexor makes me sweat just a bit for about an hour after taking it. When I go up to 450, I switch to night dosing for a few days
till I adjust, and don't sweat. Then i take it in the AM, but always after food. Other than that it works very well, no new side effects appear if I go to 450. The minor problems of short lived sweating and GI upset increase for almost nothing to minor for a few days and then go back to their previous level.

Never had to go to 600, 450 does the trick evertime. But my doc and I have discussed going to 600 if 450 does not work. I have major breakthru depression every 5 years, so we are seaking to stop this pattern with agressive doses when needed. It can leave a very funstional James quickly unable to leave the house for weeks/months. I'm now six years since the last one, knock wood !

Do keep in mind James tolerates everything very well med wise.

 

Re: high-dose Effexor - anyone? » angel1

Posted by Elizabeth on December 9, 2001, at 20:39:31

In reply to Re: high-dose Effexor - anyone?, posted by angel1 on December 9, 2001, at 6:51:30

> I'm sorry this is not about Effexor, but I thought
> you were on desipramine. What happen to that?

Desipramine did not work any better than Parnate had -- it helped, but not enough. I'm looking for something (and it may end up being a combination of somethings) that will help with the anhedonia and anergia that desipramine and Parnate didn't help with -- even though I wasn't all-out depressed, I still didn't have much interest in life or derive much enjoyment from things that I used to enjoy. This made it hard to function even though my mood was improved. Buprenorphine does help with the residual symptoms, but it's difficult to use (in various ways) and has a lot of side effects.

> Also, if you don't mind, what is your diagnosis?

"Major depressive disorder, recurrent, with melancholic features," in partial remission. Why?

> Actually, I am on effexor 150mg xr for about six
> weeks, total time on effexor nine weeks. It has
> definitely helped me, but I feel there is still room for improvement and will ask my doc if I can increase to 225mgxr. From what I've read and understand as you go to higher doses with this med it targets more or different neurotransmitters. Do you know if that is correct?

Yes, it is; Effexor and Remeron both have different effects that kick in at different doses. That's why I want to try to get above 300 mg/day. I'd say 75 is minimal, 150 is low, 225 is moderate, and 300+ is high. I've heard of people going much higher than 300, but I hope I won't need to.

-elizabeth

 

Re: high-dose Effexor - anyone? » stjames

Posted by Elizabeth on December 9, 2001, at 20:47:39

In reply to Re: high-dose Effexor - anyone?, posted by stjames on December 9, 2001, at 13:53:22

> I take 300 mgs every day and do sometimes go to 450. Can only do this with XL, reqular would bother my tummy.

Yeah, I had problems with vomiting from single doses of just 37.5 mg immediate-release Effexor. Effexor XR didn't seem to cause any problems, though.

Can I ask what kind of breakthrough symptoms you get that require the dose increases? I'm wondering what new effects appear at the higher doses.

> Do keep in mind James tolerates everything very well med wise.

All things considered, I think I do too. I might be nuts for going back on Effexor after what happened last time, but I'm hoping that the Trileptal will prevent any serious problems. I also am keeping the option open of adding Remeron if side effects start showing up.

Thanks for the data point. :-)

-e

 

Re: high-dose Effexor - anyone? » Elizabeth

Posted by Cam W. on December 9, 2001, at 22:14:57

In reply to high-dose Effexor - anyone?, posted by Elizabeth on December 8, 2001, at 10:53:42

Elizabeth - I went up to 450mg of Effexor XR, taken all in the morning. I found that, at this dose, I had major lethargy and some cognition problems (simple word and name finding were occasional, but very frustrating). I also found that I was very emotional labile and "Willy" never wanted to play.

At 375mg and 300mg daily (each for a week), I had tolerated these dose when titrating up, but titrating down (for 2 weeks each), I found that the side effects mentioned above were lessenedd, but still noticeable (especially the emotional lability), and, for me, unacceptable.

I have stabilized at 225mg for the past couple of months or so, and have found that this is the dose that works for me. I have few side effects (some morning lethargy; ie. dragging my butt at work), but I have found that 10mg of Dexedrine Spansules, first thing in the morning, solves this problem. Some days I take a second spansule around noon, but this hasn't been necessary very often for the past couple of weeks (and never necessary for my days off).

I am euthymic, and am happier than I have been in years at 225mg a day. "Willy" is active, as is my libido at this dose, as well. My journal reading, and comprehension and retension of same, has returned.

As for worrying about withdrawl symptoms, I'm not. My doc says that we will cross that bridge if we ever come to it. Besides, I am fairly confident that I can treat any withdrawl problems that could possibly arise. I've done it for others, so I am sure that I can do it for me.

I hope that this is what you were looking for, Liz. - Cam

 

Re: high-dose Effexor » Cam W.

Posted by Elizabeth on December 10, 2001, at 10:55:16

In reply to Re: high-dose Effexor - anyone? » Elizabeth, posted by Cam W. on December 9, 2001, at 22:14:57

Cam --

Thanks for posting about your response to various doses of Effexor. That was pretty encouraging to read, overall -- sounds like there were some problems but you worked them out, which is the best that I generally feel I can hope for. (Things that don't have side effects don't seem to have much effect at all, in my experience!)

Lethargy wasn't a side effect I ran into on SSRIs or Effexor, although having more trouble getting out of bed in the morning would be a problem for me. I often wake up early and am completely unable to sleep, but getting up for me is almost always a major effort (butt dragging, as you say) -- MAOIs helped with that, which I liked.

Believe it or not, I've rarely had sexual problems from ADs -- I seem to be in the minority here. I did try Effexor XR once before (got up to 225 mg, backed down to 187.5 when I started getting overly wired/possibly hypomanic, then had an episode of ?serotonin syndrome? which scared me away, now hoping to fend off any serious reactions) and didn't have this problem on it.

Re emotional lability: are you bipolar or anything like that? I haven't had this problem from ADs at all that I can think of, although it has been a withdrawal symptom. (It also happened when Nardil pooped out, but I sort of conceptualize what happened there as withdrawal. Have you ever heard of people getting better on MAOIs at first, then getting very dysphoric after a while? My doctor thought it might have been a mixed (hypo)mania, but anticonvulsants didn't help.)

I'm thinking that Effexor + a stimulant might work for me too, but I'm currently stuck living in a place where I may have trouble convincing a pdoc to prescribe even something fairly common like Dexedrine. This move is taking some major adjusting for me. I'm used to pdocs who listen to my ideas and don't just view me as a passive object for them to manipulate. I've also found the pdocs I've encountered here to be very inflexible, which is very bad for me because I need somebody who's willing to continue prescribing the buprenorphine that I've been taking for a year (and of course, I have tried most of the conventional things and need some room to experiment). I'm just having trouble figuring out how to talk to the pdocs here -- you know?

> I hope that this is what you were looking for, Liz.

Very helpful, as usual! Thanks!

(But for future reference: I prefer "Elizabeth." :-) )

-e

 

Re: high-dose Effexor--Cam

Posted by Noa on December 10, 2001, at 17:41:48

In reply to Re: high-dose Effexor » Cam W., posted by Elizabeth on December 10, 2001, at 10:55:16

Cam--glad to hear you are feeling well!

 

Re: high-dose Effexor

Posted by Noa on December 10, 2001, at 17:55:44

In reply to Re: high-dose Effexor » Cam W., posted by Elizabeth on December 10, 2001, at 10:55:16

I am feeling ambivalent about my effexor, or at least about the dose, lately. I just recently lowered it from 262.5 to 225, sort of by accident--I forgot that 37.5 pill a few times and then decided to try not taking it. So here I am about a week and a half later. Starting to feel a bit low, wondering if the lowered dose is the cause. Confounding factor is that I forgot to refill my oral contraceptive scrip so it's been about the same amount of time without the hormone regulation. And, it's been about that much time that I've been taking .25 mg ativan every night. So, which is the culprit?

The question is why am I wanting my effexor lower? I am not really sure. Part of it is that effexor still causes some of these tic-like side effects that I tolerated for a long time but am starting to get annoyed with. They were much worse at higher doses, but there is still this feeling of nervous energy just under the skin, and the impulse to shake my leg, splay my fingers, etc. Some of which would be helped by exercising which I haven't done any of for over 2 months. And, there is the muscle tension in my jaw.

The thing is, effexor was the first med to really attack my depression. But I was starting to feel dysthymic again and wondered how much good the effexor is really doing anyway. And, so many other meds have been piled on top of the effexor since starting it 6 years ago, I don't know what is doing what. So, hence my ill-thought out, misguided, passive experiment in lowering my dose.

 

Re: high-dose Effexor » Elizabeth

Posted by Cam W. on December 10, 2001, at 19:00:13

In reply to Re: high-dose Effexor » Cam W., posted by Elizabeth on December 10, 2001, at 10:55:16

> Re emotional lability: are you bipolar or anything like that?

Elizabeth - No, I don't think I am bipolar; my work ethic isn't that good. I was extremely emotionally labile while taking Zoloft™ (sertraline) as well, so it is sort of weird that high doses of Effexor also does this. - Cam

 

Re: high-dose Effexor » Noa

Posted by Cam W. on December 10, 2001, at 19:00:59

In reply to Re: high-dose Effexor--Cam, posted by Noa on December 10, 2001, at 17:41:48

> Cam--glad to hear you are feeling well!

Thanks Noa! It is good to hear from you, as well. - Cam

 

Re: high-dose Effexor » Cam W.

Posted by Elizabeth on December 10, 2001, at 19:16:18

In reply to Re: high-dose Effexor » Elizabeth, posted by Cam W. on December 10, 2001, at 19:00:13

> Elizabeth - No, I don't think I am bipolar; my work ethic isn't that good. I was extremely emotionally labile while taking Zoloft™ (sertraline) as well, so it is sort of weird that high doses of Effexor also does this. - Cam

< g > I don't think that being bipolar necessarily gives you a good work ethic! People do all sorts of irresponsible things when manic.

Can you characterize the mood lability you got from Zoloft(TM) and Effexor(TM) more precisely?

(So, you're not going to tell me how you did the superscript "TM"s, huh?)

-elizabeth

 

Re: high-dose Effexor

Posted by Cam W. on December 10, 2001, at 19:42:09

In reply to Re: high-dose Effexor » Cam W., posted by Elizabeth on December 10, 2001, at 19:16:18

> Can you characterize the mood lability you got from Zoloft(TM) and Effexor(TM) more precisely?

Elizabeth - I get more weepy, and am more sensitive to criticism (as well as holiday-time long distance telephone commercials). I think that I am also more quick to anger at these times, but I personally notice the weepiness more (others probably notice the anger more than I do). - Cam


 

Re: high-dose Effexor » Cam W.

Posted by Elizabeth on December 10, 2001, at 20:25:52

In reply to Re: high-dose Effexor, posted by Cam W. on December 10, 2001, at 19:42:09

> > Can you characterize the mood lability you got from Zoloft(TM) and Effexor(TM) more precisely?
>
> Elizabeth - I get more weepy, and am more sensitive to criticism (as well as holiday-time long distance telephone commercials). I think that I am also more quick to anger at these times, but I personally notice the weepiness more (others probably notice the anger more than I do). - Cam

That sounds a lot like what happened to me after I'd been on Nardil for about 6-9 months -- I got really moody and dysphoric (more on the angry side than you, maybe). The Nardil had been working well until that happened. And nothing I tried helped except going off it and then restarting after a couple months. (I tried Nardil twice and this happened both times.)

I wonder what's up with that.

-elizabeth

 

Re: high-dose Effexor

Posted by Noa on December 11, 2001, at 16:48:48

In reply to Re: high-dose Effexor, posted by Noa on December 10, 2001, at 17:55:44

Today I went back to taking 262.5, although I took my meds very late because I forgot about them.

Still ambivalent but this morning I was able to recall what the alternative is. But I still do wish there were an easy way to look at the effectiveness of each med I'm on.

Any advice welcome.

 

Re: high-dose Effexor - anyone?

Posted by bob on December 11, 2001, at 23:09:01

In reply to Re: high-dose Effexor - anyone? » Elizabeth, posted by Cam W. on December 9, 2001, at 22:14:57

Cam:

How long have you been on Effexor? Do you get a significant amount of bruxism? What about weight gain?

 

Re: high-dose Effexor - anyone?

Posted by Poppy on December 12, 2001, at 5:25:56

In reply to Re: high-dose Effexor - anyone?, posted by bob on December 11, 2001, at 23:09:01

I have been on 450 awhile now maybey 4months. I havent had anyside effects really. I getblurry vision often but try to ignore it. But in general i only went up thta high because the effexor xr worked then would stop, so i think it was a tolerance thing, however i didnt find an increase in adverse effects as the dose went up
take care

 

Re: high-dose Effexor - anyone?

Posted by Cam W. on December 12, 2001, at 8:44:00

In reply to Re: high-dose Effexor - anyone?, posted by bob on December 11, 2001, at 23:09:01

> Cam:
>
> 1) How long have you been on Effexor? 2) Do you get a significant amount of bruxism? 3) What about weight gain?

bob - 1) Since May.

2) I have no bruxism - actually had it before being treated, and my dentist had considered giving me something to wear at night..

3) I actually weigh less (but it was a conscious effort...on-going struggle... of changing my diet and eating habits).

- Cam

 

Re: high-dose Effexor - anyone?

Posted by bob on December 12, 2001, at 21:01:37

In reply to Re: high-dose Effexor - anyone?, posted by Cam W. on December 12, 2001, at 8:44:00

I took the non-XR version of Effexor back inn '94 and '95. I was on it for well over a year (probably more than a year and a half) and was at approx 300mg briefly. Among the intolerable side-effects I had were: horrific appetite, weight gain, constipation, sweating, bruxism, almost complete absence of sexual function (complete at higher doses), and the most devastating effect of all... severe morning sedation. I often would not hear my alarm clock, and wasn't lucid enough to even think about getting out of bed until 1 or 2 o'clock in the afternoon. The weight/appetite and sedation took a few months to develop. None of these effects ever resolved, so I eventually had to get off of it. It's hard to live your life getting up at 2:00pm everyday.

Ironically, I don't think I ever took another med that helped me so much so quickly -- especially in the beginning. It bogged down though.

 

Re: high-dose Effexor - anyone?

Posted by ArtChee on December 12, 2001, at 23:46:45

In reply to high-dose Effexor - anyone?, posted by Elizabeth on December 8, 2001, at 10:53:42

> Has anyone found that taking very high doses of Effexor (and if so, how high) made it work a lot better? If you have, I'd like to hear about it -- what new effects did the Effexor have when you got above a certain dose? TIA.
>
> -elizabeth

Two years ago I took EFFEXOR at 150mg/day. No positive results, only minor side effects.

Over two months ago, with the suggestion of a psychotherapist, I returned to the psychiatrist and he put me on a dosage schedule to get me to 300mg/day. When I said that I was not expecting any better results, he said that he would prove me wrong.

After 10 weeks, I was suffering irritating side effects of sweating, sleeping difficulty, fatique, headaches, shortness of breath, light-headedness (woozy), and - about the time I reached the 300mg/day dosage - increased anxiety (indicated by my picking at the quiks of my thumbs & pulling skin flicks off to the point of having raw thumbs. Nothing new for when I get anxious for some REASON, but must band-aid the thumbs to keep from being raw.)

After a gradual withdrawal of minus 75mg/day, the second day completely off the medication I experienced serious side effects; primarily a woozy, spaced out sensation not unlike being intoxicated, but certainly NO FUN. I was concerned about my ability to drive. I could not function for three days. Dosages of 20mg Adderall today seemed to help restore some energy and some clarity, but still have headache & light-headedness. Supposed to subside within the week. I HOPE SO!

My sister in another state is on the same dosage of EFFEXOR XR (have a big bottle to send to her) and reports that she has experienced an energy boost from it (that's all she said -- we talk but don't communicate much :-) )

Certainly, this is not encouraging, BUT my point must be: everyone reacts differently. I had no positive response the first time to the smaller dosage, with minor side effects. The SECOND time, the reaction was the same, BUT - as the dosage was larger - the side effects were worse.

If you have had sucess with a smaller dosage, hopefully the larger dose will be even more effective. But, will likely "enhance" the side effects as well.

Good Luck, & HAPPY HOLIDAYS!!!!

 

Re: high-dose Effexor - anyone?

Posted by Elizabeth on December 13, 2001, at 15:19:45

In reply to Re: high-dose Effexor - anyone?, posted by ArtChee on December 12, 2001, at 23:46:45

I should clarify. The reason I asked this question is because Effexor is supposed to have different effects that kick in at different doses. I was hoping to hear from someone who found that it had new benefits at a high dose. I'm not really interested in hearing about side effects -- I tolerate medications pretty well.

Thanks everyone.

-elizabeth

 

Re: high-dose Effexor - anyone? » Elizabeth

Posted by Cam W. on December 13, 2001, at 15:45:49

In reply to Re: high-dose Effexor - anyone?, posted by Elizabeth on December 13, 2001, at 15:19:45

Elizabeth - I wonder if one can use dosages to determine when the noradrenergic effects of Effexor would kick in. Everyone will have different complements of each of the receptors, as well as different rates of metabolism. We especially see differences in CYP-2D6 polymorphism. I think that this factor might have something to do with the protracted withdrawl that some people experience (ie. those with naturally higher levels of CYP-2D6 metabolize the drug faster, thus setting themselves up for the withdrawl syndrome). Perhaps this, as well as Effexor-induced changes in certain receptor concentrations, could make the withdrawl syndrome hell for some people).

I have wondered for a while if blood levels may give a more accurate indication of noradrenegic response (I doubt it, though). Phenotyping, when available, may give a better indication. I know that I really didn't respond until I was over 150mg of Effexor. Since I didn't respond to Paxil or Zoloft, even though I increased the dose to 60mg and 200mg, respectively - and did respond (at one time) to Wellbutrin - I think that the noradrenergic effects may have kicked in at 150mg to 225mg (although Paxil does have a fairly significant noradrenergic reuptake blocking effect - at least in vitro - I did not benefit from it, except for sleeping 10 hours a day). - Cam


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