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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Mr.Scott on August 8, 2002, at 18:29:20
I have been terribly depressed now for some time (the illness began 11 years ago, but this most recent flare up has been going on for a year). Anyways I find that within hours of raising my Effexor from 37.5mg to 75mg I first feel much better, then I feel agited and anxious but still better in terms of energy. Then over the course of a few days the agitation and anxiety really become unbearable and the benefit turns out to be too good to be true. I always return to 37.5mg
1) How could I respond so quickly? is that addiction relief or actual therapeutic relief? Or bipolar disorder??? What are your thoughts?
2) Should I just switch to a less agitating drug like Celexa, or try to use say 50mg a day in effexor IR tablets? What do you think?
Posted by Dinah on August 8, 2002, at 18:49:58
In reply to Effexor addiction vs. therapeutic benefit dilemma , posted by Mr.Scott on August 8, 2002, at 18:29:20
Sort of the same thing happened to me. On the way to nasty agitated mania I had a couple of days of feeling great, then a couple more on my way down again.
I think the same things that feel so nasty later, feel good at first. Energy at first, anxiety and agitation later. Same thing. Just different amounts.
Does that make any sense at all?
Posted by Mr.Scott on August 9, 2002, at 0:40:00
In reply to Re: Effexor addiction vs. therapeutic benefit dilemma » Mr.Scott, posted by Dinah on August 8, 2002, at 18:49:58
Ahha I'm not alone! So what did you do about it? Where are you at now with meds and life and diagnosis and all that??
Scott
Posted by Dinah on August 9, 2002, at 6:13:15
In reply to Re: Effexor addiction vs. therapeutic benefit dilemma » Dinah, posted by Mr.Scott on August 9, 2002, at 0:40:00
Hi Scott. I'm primarily OCD and I'm probably somewhere on the low end of the bipolar spectrum, since medications and sleep deprivation can cause me to be hypomanic. Pdoc is not big on diagnosis. Cyclothymic I think? But it doesn't fit all that well.
I quit the Effexor. Wellbutrin had the same effect on me. I had started Effexor anticipating some real life stressors that ended up working themselves out. The goal was the same effect as Luvox without the apathy and sexual side effects. So at the moment I'm only on Depakote and Klonopin. If the stressors in my life ever get too large, I guess I'll go back on Luvox. It flattened me and made me apathetic, but at least it didn't make me hypomanic or suicidal.
Is it possible the feelings that you experienced on Effexor were just a mild hypomanic euphoria? I think that's what I always realized they were. Not genuine feelings of normal, but definitely artificial feelings of better than normal. I enjoy those times, but I don't expect them to last. But once you've experienced them, you want them back, and anything else seems less than perfect.
I guess we're all striving for mildly hypomanic euphoria or the thing right below that. What is it? Euthymia? But I don't know if it's possible to achieve, and I've given up trying with meds. So I'll settle for relatively stable and use cognitive behavior therapy and insight therapy from there.
Not a popular position here on the meds board, I think. But I just don't have that much luck with antidepressants. Mood stabilizers are more useful for me, but they don't make you feel wonderful, just stable.
Sorry I can't be of more help.
Dinah
Posted by Iago Camboa on August 9, 2002, at 6:57:31
In reply to Effexor addiction vs. therapeutic benefit dilemma , posted by Mr.Scott on August 8, 2002, at 18:29:20
Hi Scott,
Please excuse me, my friend, but I must laugh... Let me explain it all in detail since the beginning...
I took myself 37.5mg Effexor for the first time in my life past July 17 at 4 pm and here is what I posted yesterday I felt, less than 2 hours after I took it: "a most welcome mild stimulation, a very gentle 'high', no jitters at all and no agitation/anxiety, but a very calm and 'focused' unforgettable positive effect..."
Let us see it in detail:
How could you 'respond so quickly'? Well, the same thing happened to me that memorable day AND MANY TIMES SINCE... and I can guarantee these are not 'addiction relief' for I never took it before! You have also the testimony of DINAH... It is genuine 'actual therapeutic relief' and you can't 'afford' to let this opportunity go downriver!... And with me there is and there was never (in more than 25 years now) the least trace of bipolar disorder... There are some differences between the two of us, but those differences can be easily explained and leave to me no doubts:
These differences are due to 2 facts: 1. I was NOT depressed at all, but was only trying to find alternative AD medicines that I could use in myself with efficacy... 2. I had in my system a powerful anxiolytic (Xanax 2mg/day) and that is perhaps the reason I felt no jitters, no agitation and no anxiety. I'm not pushing on you the Xanax (which I know is a very controverted medicine), but I'm sure that if you get to control the anxiety, you can up safely your dose of Effexor and reap its benefits as I did with mine (I'm now on 112.5mg/day Effexor and have now almost abandoned my former AD). Please notice I have a very quick metabolism and I felt no s.e. -- except for insomnia (every time I upped my dose of Effexor or anticipated the time of taking up the drug) -- and you may have to go a little slower... I also have been using always the IR tablets...Good luck and keep us posted!...
Iago> I have been terribly depressed now for some time (the illness began 11 years ago, but this most recent flare up has been going on for a year). Anyways I find that within hours of raising my Effexor from 37.5mg to 75mg I first feel much better, then I feel agited and anxious but still better in terms of energy. Then over the course of a few days the agitation and anxiety really become unbearable and the benefit turns out to be too good to be true. I always return to 37.5mg
>
> 1) How could I respond so quickly? is that addiction relief or actual therapeutic relief? Or bipolar disorder??? What are your thoughts?
>
> 2) Should I just switch to a less agitating drug like Celexa, or try to use say 50mg a day in effexor IR tablets? What do you think?
Posted by Ritch on August 9, 2002, at 13:05:07
In reply to Effexor addiction vs. therapeutic benefit dilemma , posted by Mr.Scott on August 8, 2002, at 18:29:20
> I have been terribly depressed now for some time (the illness began 11 years ago, but this most recent flare up has been going on for a year). Anyways I find that within hours of raising my Effexor from 37.5mg to 75mg I first feel much better, then I feel agited and anxious but still better in terms of energy. Then over the course of a few days the agitation and anxiety really become unbearable and the benefit turns out to be too good to be true. I always return to 37.5mg
>
> 1) How could I respond so quickly? is that addiction relief or actual therapeutic relief? Or bipolar disorder??? What are your thoughts?
>
> 2) Should I just switch to a less agitating drug like Celexa, or try to use say 50mg a day in effexor IR tablets? What do you think?Scott,
It sounds like dysphoric hypomania to me. In people that respond to and tolerate SSRI's well, they tend to become rather calm and a little sleepy on them with time instead. Does the Effexor screw up your sleep? If you get a significant enough sleep disruption, the sleep disruption may be what is triggering the dysphoria. That is why I think that stimulants didn't cause any hypomania for me. They washed out so rapidly, I just crashed and had nice solid sleep. The 50mg IR Effexor might be the trick. That way it would be clearing your body more quickly by bedtime.
Just an idea,
Mitch
Posted by morgan26 on August 9, 2002, at 13:30:58
In reply to Effexor addiction vs. therapeutic benefit dilemma , posted by Mr.Scott on August 8, 2002, at 18:29:20
Regarding your question about how Effexor can create such a quick effect: compared to similar drugs (Prozac, Zoloft, Paxil, Celexa) Effexor has an EXTREMELY short half life in the body. In fact, the "regular" form (as opposed to the XR form) is typically taken 2-3 times per day. I take the XR formulation at 75 mg q.d. and have found that if I forget the meds, my threshold for uncontrollable crying (what it was intended to treat in the first place) goes way down within 24 hours. Likewise, when I remember and take the meds, that threshold improves significantly within a few hours. So it is not at all unusual that you feel immediate effects from the drug.
The anxiety, however, is an adverse effect that will likely not improve with the short acting form. It sounds like you may do better on something that is a bit longer acting and less notorious for aniety side effects. Perhaps Zoloft or Prozac? You did not mention if you had tried these. They take a little longer to kick in (you might not feel improvement for a week or two), but produce a more stable effect.
Another possiblity to consider: As you can see from the many participants on this board, Effexor is famous for a "rebound" effect when discontinued. Is it possible that the anxiety is a result of it wearing off rather than a result of it being in your system? Keeping a journal for a few days of when you take the meds and when you feel the anxiety might help sort that out...
Hope this helps.
Posted by Mr.Scott on August 9, 2002, at 14:50:42
In reply to Re: Effexor addiction vs. therapeutic benefit dilemma » Mr.Scott, posted by Dinah on August 9, 2002, at 6:13:15
Actually Dinah..your post is tremendously helpful to me! Thanks for elaborating so well!
Scott
Posted by Mr.Scott on August 9, 2002, at 14:54:56
In reply to Re: Effexor addiction vs. therapeutic benefit dilemma » Mr.Scott, posted by Ritch on August 9, 2002, at 13:05:07
Posted by inertia on August 9, 2002, at 15:32:50
In reply to Re: Effexor addiction vs. therapeutic benefit dilemma » Mr.Scott, posted by Iago Camboa on August 9, 2002, at 6:57:31
> These differences are due to 2 facts: 1. I was NOT depressed at all, but was only trying to find alternative AD medicines that I could use in myself with efficacy...
Why would you try an antidepressant if you're not depressed?
Posted by totoslim on August 9, 2002, at 16:08:21
In reply to Re: Effexor addiction vs. therapeutic benefit dilemma » Dinah, posted by Mr.Scott on August 9, 2002, at 14:50:42
I hate effexor-anxiety suicidal thoughts tiredness - I hate it.
Posted by pharmer on August 10, 2002, at 2:24:10
In reply to Effexor addiction vs. therapeutic benefit dilemma , posted by Mr.Scott on August 8, 2002, at 18:29:20
My response to effexor sounds quite simular to yours regarding increased irritability as the dose increases. I like effexor but anything over 37.5 causes me to become quite short tempered. I have been taking ads for 15 years and have never been prescribed a mood stabilizer other than clonazepam,which is not a true stabilizer,I think. My pdoc started me on depakote 250mg/bid last week and increased my effexor to 75mg. So far I feel better than I have in quite some time and feel I could tolerate more effexor if need be. best of luck, Rick.
Posted by Mr.Scott on August 10, 2002, at 3:08:25
In reply to Re: Effexor addiction vs. therapeutic benefit dilemma , posted by pharmer on August 10, 2002, at 2:24:10
Thanks Rick! I think that your experience and mine and many others really does provide evidence that us anxious/irritable/agitated depressives are actually on the bipolar spectrum. In fact maybe all depressives really are!?
Scott
Posted by Iago Camboa on August 10, 2002, at 5:08:58
In reply to Re: Effexor addiction vs. therapeutic benefit dilemma » Iago Camboa, posted by inertia on August 9, 2002, at 15:32:50
Hi Inertia,
Good question. I just I'm trying not to have a relapse (which happened several times in the past - last time some 15 months ago - and can be nasty enough...)
But as of now I am NOT (technically) depressed [the devil be deaf, blind and dumb!, as say the very old Portuguese hags, to make sure nothing will rise against what has been just stated...] and use less than half the dose (in the case of Effexor I suspect less than 1/3 will do the trick) I would need if I were ('depressed full time'); I use a 'maintenance dose' if you prefer things put that way.
I also think the best time to look for alternative medications is while things are not (yet) bad; worse still: my AD (before I begin to experiment with Effexor) was doing a fine job and was not pooping out in any way, but I don't want to be dependent on a single drug that may be discontinued one day without warning (by the manufacturer, as it did happen in the past with other drugs...)
When one gets middle-aged (like me) one gets more prudent and cautious than when one is a young person (as is perhaps the case with you...)Take care,
Iago> > These differences are due to 2 facts: 1. I was NOT depressed at all, but was only trying to find alternative AD medicines that I could use in myself with efficacy...
>
> Why would you try an antidepressant if you're not depressed?
>
Posted by inertia on August 12, 2002, at 15:54:07
In reply to Clearing up... » inertia, posted by Iago Camboa on August 10, 2002, at 5:08:58
Thanks for the clarification.
May you continue to be well!
Posted by Mr. Scott on August 13, 2002, at 0:57:37
In reply to Effexor addiction vs. therapeutic benefit dilemma , posted by Mr.Scott on August 8, 2002, at 18:29:20
So if I decide to ditch the 37.5mg capsule I'm taking...Assuming I'm not one of those folks who falls outside the bell shaped curve...how long can I expect to suffer? And how should I treat it?
I've got Celexa and Prozac on hand.
Scott
Posted by Ritch on August 13, 2002, at 8:40:31
In reply to One more related question on Effexor XR 37.5mg, posted by Mr. Scott on August 13, 2002, at 0:57:37
>
>
> So if I decide to ditch the 37.5mg capsule I'm taking...Assuming I'm not one of those folks who falls outside the bell shaped curve...how long can I expect to suffer? And how should I treat it?
>
> I've got Celexa and Prozac on hand.
>
> Scott
>
>Scott,
You *could* open the 37.5mg XR capsule and divide the contents in two and take half a capsule. That's what I do with a 37.mg XR (divided into thirds-for 12.5mg). It is approximate, but it works ok. My pdoc knows how sensitive to meds I am and isn't concerned with the method. If you switch I would go with the Celexa. If you make any changes later the Prozac takes too long to go away. You also indicated possibly flipping to Celexa anyhow.
good luck,
Mitch
Posted by Roo on August 13, 2002, at 9:04:56
In reply to Re: One more related question on Effexor XR 37.5mg » Mr. Scott, posted by Ritch on August 13, 2002, at 8:40:31
Mr. Scott--
Just wanted to pipe in to say I had the same thing
happen when I very first started effexor at 33 mg's--
after just one dose I felt GREAT! I felt pretty good
for a week, then lost the effect. I figured I must need
to increase so I went up to 75 mg's...but I continued to
feel really shitty...an agitated suicidal like depression that
was unrelentless and didn't seem to be improving. This sunday I
forgot to take my medicine until around 5pm--because
it was so late, I decided to take a 33 mg instead, so maybe I
wouldn't have trouble sleeping. I noticed I felt a little less
depressed--not great mind you--but a tiny bit better. The next day,
I didn't take anything, and I felt quite a bit better. I didn't have
any of these horrible withdrawal symptoms I keep hearing about..except
insomnia...no big deal. I now wonder if it was the effexor that was
making me feel like shit. But then it makes no since that initially,
that first day and a few days after, I felt so great...
confusing...
anyway, I think I'm going off...Now that I feel better from not taking
it, it seems like it would be silly to pop another pill that will probably
make me feel like shit.
Keep us posted,
Posted by Mr. Scott on August 13, 2002, at 14:33:34
In reply to Re: One more related question on Effexor XR 37.5mg » Mr. Scott, posted by Ritch on August 13, 2002, at 8:40:31
Thanks Mitch,
Individual differences aside, I believe we suffer from the same beast. Whats your current cocktail? (I call it the bipolar spectrum anxiety disorder thingy with neurological ADHD stuff)
I can't regular doses of meds like 1500mg of Depakote, or 1200mg LiCO3, etc so I too prefer to take bits of stuff.
250mg Depakote
300 Neurontin
7.5mg Tranxene
tiny dose of AD's (today I took 25mg of Effexor)And I get by, but am always searching for improvement. Let me know what your currently taking if you would.
Scott
Posted by Ritch on August 13, 2002, at 22:55:18
In reply to Re: One more related question on Effexor XR 37.5mg » Ritch, posted by Mr. Scott on August 13, 2002, at 14:33:34
> Thanks Mitch,
>
> Individual differences aside, I believe we suffer from the same beast. Whats your current cocktail? (I call it the bipolar spectrum anxiety disorder thingy with neurological ADHD stuff)
>
> I can't regular doses of meds like 1500mg of Depakote, or 1200mg LiCO3, etc so I too prefer to take bits of stuff.
> 250mg Depakote
> 300 Neurontin
> 7.5mg Tranxene
> tiny dose of AD's (today I took 25mg of Effexor)
>
> And I get by, but am always searching for improvement. Let me know what your currently taking if you would.
>
> ScottScott,
I think you are right, and I like that diagnostic description, BTW! ;)
I once thought up GCD-NOS (Generalized Cluelessness Disorder-not otherwise specified) in response to someone who was mystified by my absent-mindedness at work.I can't take "regular" doses of much of anything either. The highest doses of anything I have ever taken were probably Lithium and doxepin a LONG time ago. I got up to 1800mg/day of Li and 150mg/day of doxepin for a short while. Of course-I had to stay near a toilet all day because of the constant diarrhea from the lithium and had to change my posture slowly to combat the orthostatic hypotension from the doxepin, yuck.
Anyhow, I now take:
250mg Depakote (bedtime)
.25mg Clonazepam (bedtime)
12.5mg EffexorXR (AM first thing)
12.5mg Bupropion (AM first thing-it's tough to divide a 75mg bupropion tab into sixths)OTC/supplements:
25mg Diphenhydramine (at bedtime)
500mg L-tyrosine (AM-first thing)
250mg Vitamin-C + sublingual B-complex (AM-first thing)
1G of Flax oil with first two meals of the day.--Mitch
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