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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by bigcat on December 2, 2005, at 19:37:14
I've been on Effexor about ten days and have been doing wonderfully on it. I've titrated the dose up to 187mgs, and will probably move it up slowly from there. At some point in the latter part of the day, I've been experiencing a troubling shortness of breath. It just feels like the air isn't going into my lungs and I become fatigued. This reaction pretty much goes away soon after taking another pill (raising the dose for the day). I suppose it could have something to do with the fact that I've been very active the last couple days after such an extended period of lethargy.
I was at 75mgs a few days ago (working great for a few days, then dropping off some later in the day, and more so after a couple days at this starting dose. I'm already up to 187 mgs, as the shortness of breath makes me grab for another pill. Will this go away? I am taking the XR version, and it is possible that my initial great response needs time to settle in, but the shortness of breath is uncomfortable, and seems to be relieved shortly after adding a dose to my daily routine. This appears like an easy enough question, but this Effexor remission is very precious to me, the first real remission after six years of deperate trials, and I don't want to keep pushing the dose and become too tolerant too quick and lose the antidepressant effect. It's not that I go "down", it's just that I feel quite physically uncomfortable; taking deep breaths doesn't give me much relief. Do you have any suggestions from either first-hand or otherwise acquired experience/knowledge? The relief I'm experiencing is mindblowing and this is but a small issue, but an issue nonetheless. Sweating like hell, constipated, and no orgasms, but as I've said before, you could chop off my balls to achieve this kind of remission. I am so grateful for what I have, just wondering if this will go away with time, or if it a clear indication that I should keep raising the dose to catch some air.
All My Love,
-matt-
Posted by cablegirl on December 3, 2005, at 4:40:02
In reply to Effexor and shortness of breath, posted by bigcat on December 2, 2005, at 19:37:14
Did you start out at the 187 mg. dose? As doc. stsrted me at 75 mg.and then increased to 150 mg. after about a week. Maybe the 187 mg. to start was just too much for your body to handle all at once, hence the shortness of breath????
Talk to your Doctor and Good Luck!!!!!
Posted by bigcat on December 3, 2005, at 8:34:17
In reply to Re: Effexor and shortness of breath » bigcat, posted by cablegirl on December 3, 2005, at 4:40:02
Hey Cablegirl,
Thanks for responding! I actually started the Effexor very low. I had a liquid solution made up so my starting doses were in the 10mg range probably. I did the same as you- a week on 75, a few days at 150mgs, and now I'm at 187mgs. I had a good sleep last night and feel refreshed. We'll see how I do later in the day. My God I love this drug.Maybe the shortness of breath is an indication that I should practice the art of breathing. There's a lot to be said about sitting comfortably, stopping all thoughts, and following the breath. Hopefully now that I'm feeling better I'll have the patience and discipline to practice this natural method for alligning body and mind. Or maybe it will go away on it's own. I'm just so happy to be well after such a long and arduos struggle. I hope you're doing well too, and I think you're right that my body needs time to adjust to dose increases and that I should take things slow. Thanks again.
Much Love,
-matt-
Posted by ed_uk on December 3, 2005, at 15:05:38
In reply to Effexor and shortness of breath, posted by bigcat on December 2, 2005, at 19:37:14
Hi Matt :-)
>I've been on Effexor about ten days and have been doing wonderfully on it.
:D
>I was at 75mgs a few days ago (working great for a few days, then dropping off some later in the day, and more so after a couple days at this starting dose.
75mg was working well in most respects. Perhaps you should decrease the dose back down to 75mg. Effexor XR has a *short* duration of action, you may need to take it *twice* daily to get the best effect. Taken as the single daily dose, problems may arise. Withdrawal symptoms can occur between doses!
Here is my suggestion.........
Tomorrow: 75mg in the morning, 75mg in the evening.
The next couple of days: 75mg in the morning, 37.5mg in the evening
Then: 37.5mg in the morning, 37.5mg in the evening.
Kind regards
Ed
Posted by bigcat on December 4, 2005, at 21:01:05
In reply to Re: Effexor and shortness of breath » bigcat, posted by ed_uk on December 3, 2005, at 15:05:38
> Hi Matt :-)
>
> >I've been on Effexor about ten days and have been doing wonderfully on it.
>
> :D
>
> >I was at 75mgs a few days ago (working great for a few days, then dropping off some later in the day, and more so after a couple days at this starting dose.
>
> 75mg was working well in most respects. Perhaps you should decrease the dose back down to 75mg. Effexor XR has a *short* duration of action, you may need to take it *twice* daily to get the best effect. Taken as the single daily dose, problems may arise. Withdrawal symptoms can occur between doses!
>
> Here is my suggestion.........
>
> Tomorrow: 75mg in the morning, 75mg in the evening.
>
> The next couple of days: 75mg in the morning, 37.5mg in the evening
>
> Then: 37.5mg in the morning, 37.5mg in the evening.
>
> Kind regards
>
> Ed
>
>So Ed, you think I should back off on the dose? I can sense that this may be the thing to do, especially since it's counterintuitive, and my intuition has had me trying to chase my tail for so long. But, could you explain your reasoning? I definately need to divide the dose. Maybe 37.5mgs three times a day or something?? I've been taking 150mgs in the morning, and then 37.5 or 75 in the evenings when I reflect on the day and the current moment and can tell to what degree I've been slipping. It's crazy this drug- one minute I'm convinced I'm good, then the next I'm confused and scared sh*tless that I'm already losing the therapuetic effect. I'm worrying and short of breath, but at moments I do feel quite good. You are DEFINATELY right about the short half life. I don't know where I stand. Two days ago I was ready to sign up for Master's courses in Bio, now I'm terrified at this prospect. I just can't predict the future and am ambivalent to take steps that could have devastating consequences if I should fail yet again.
There was one morning when I took 75mgs of Effexor and five minutes later I couldn't remember if I had taken the Lamictal with it. (I've moved the dose up on my own- my pdoc is entirely too timid. So I've been taking 400mgs Lamictal [up from 225mgs]). So when I couldn't remember if I had taken the Lamictal with it, I popped one just 'cause I thought it couldn't hurt (I'm bad, I know). Within ten minutes I felt an undeniable lift. Is this (600mgs) an extremely high dose of Lamictal? I wonder if the Effexor and Lamictal are playing off eachother, and the Effexor is finally helping the Lamictal do something. My head is all over the place. My recent remission has shown me that perhaps my worst depressive symptom has been the obsessing, which may be rearing it's ugly head again. Since the Effexor kicked in immediately, could it still need time to settle in? For some reason I think this right now is the totality of it's effect, and that it may not be leading towards something to keep me more stable and consistantly calm. Maybe I need to toy around with some Adderal and/or Ativan. Maybe some Seroquel during the day. I have a great deal of social anxiety. I can tell when I'm good by my level of articulation. I stumble when the depression is ruling, and the thoughts just flow seamlessly from my lips when I feel just right. At least the Effexor is stirring something up, but I'm so confused. This hurts.
-matt-
Posted by ed_uk on December 5, 2005, at 15:47:49
In reply to Re: Effexor and shortness of breath » ed_uk, posted by bigcat on December 4, 2005, at 21:01:05
Hello Matt my friend :-)
>But, could you explain your reasoning?
You're falling into the trap of making too many changes to your regimen too quickly! You've been there before Matt!
75mg-150mg is the usual 'target' dose for the first few weeks. If, after several weeks, 75-150mg has not been adequately effective, increasing the dose can help.
Effexor XR is claimed to be suitable for administration as a single daily dose. In practice, some people find that they need to take it twice daily in order to avoid withdrawal symptoms - which can occur between doses.
>Since the Effexor kicked in immediately, could it still need time to settle in?
Yes, definitely. You need to give it time. Don't keep increasing the dose based on the expectation that a higher dose will be immediately beneficial - it most likely won't be :-(
>So Ed, you think I should back off on the dose?
If you're worried about decreasing to 75mg, you could decrease to 150mg. Take 75mg in the morning and 75mg in the evening. You need to maintain a constant level of Effexor in your body. Don't be tempted to increase the dose any further until you've been on 150mg/day for at least a month. I know it's hard (impossible!) but you *must* be patient :-)
>Is this (600mgs) an extremely high dose of Lamictal?
No, it's high but not extremely high. Take care though, you need to determine the effect that Effexor is having on your depression. You won't be able to do this unless you remain on a constant dose of Lamictal!
>I wonder if the Effexor and Lamictal are playing off eachother, and the Effexor is finally helping the Lamictal do something.
It's certainly possible. Effexor + Lamictal can be a very useful combination.
Love
Ed
Posted by bigcat on December 5, 2005, at 20:43:16
In reply to Re: Effexor and shortness of breath » bigcat, posted by ed_uk on December 5, 2005, at 15:47:49
Well Ed, as usual you're right. I'm gonna stay on the Effexor for a LONG while. I'm so stupid to keep making the same mistakes and being impatient. Switching meds gets me back into the merrygoround and provides no progress whatsoever. I think I'll cut back to 150mgs tomorrow so I don't have a terrible withdrawal. Will stay at that dose for a good deal of time. You're always so reassuring.
My Effexor remission and subsequent return to depression has made me understand more than at anytime in my life that my obsessing is absolutely insane. I just have cycling thought patterns that reinforce these exact same patters. I'm locked down and exhausted by all this. I guess obsessing is really just a variety of anxiety. Smoking pot in the past has given me the same revelation. I'm going to stay on the Effexor, don't worry about that, and I'll cut the Lamictal back to 600mgs. BUT, what do you think about the suggestion to add Remeron. How about putting either Anafrinil, Luvox or Wellbutrin into the mix? I wouldn't even consider making any of these changes any time soon (TRUST ME), but I'd like your opinion now anyways. Hope you're virus is on the way out.
all my best,
-matt-
Posted by Bob on December 5, 2005, at 21:04:09
In reply to Effexor and shortness of breath, posted by bigcat on December 2, 2005, at 19:37:14
I hate to say this, but I've had the "shortness of breath" problem on a number of different drugs through the recent years. If I had to guess, I'd say that for me it has something to do with norepinephrine stimulation. I got it on the stimulants: Ritalin, Provigil, etc, and I got it on Welbutrin with my most recent go 'round. It became quite unpleasant and no one was ever able to tell me what was going on. I never got any relief from it, but ironically, these drugs helped my mood and motivation like nothing else. The sad thing is, I took Effexor, and Anafranil before these problems, and never got any breathing problems with them. I dunno, maybe my body is degenerating.
I think I know exactly how you feel with that breathing problem though.
Posted by ed_uk on December 6, 2005, at 14:39:17
In reply to Re: Effexor and shortness of breath » ed_uk, posted by bigcat on December 5, 2005, at 20:43:16
Hi Matt :-)
How is your depression today?
>I'm going to stay on the Effexor, don't worry about that, and I'll cut the Lamictal back to 600mgs.
Please stay on 150mg Effexor and 600mg Lamictal! Don't make *any* changes for at least a month! Take 75mg Effexor in the morning and 75mg in the evening.
>BUT, what do you think about the suggestion to add Remeron.
If Effexor alone isn't enough, adding Remeron might help, but not for at least 6 weeks, OK?! :-)
>How about putting either Anafrinil, Luvox or Wellbutrin into the mix? I wouldn't even consider making any of these changes any time soon (TRUST ME), but I'd like your opinion now anyways.
Adding Anafranil or Luvox wouldn't really make sense. Effexor is intensely serotonergic in its own right. Wellbutrin + Effexor can often provide additional relief of depression, but often at the cost of increased anxiety.
>Hope you're virus is on the way out.
I'm fatigued...... and now I've got a cough too!
Love
Ed
Posted by bigcat on December 6, 2005, at 21:34:11
In reply to Re: Effexor and shortness of breath » bigcat, posted by ed_uk on December 6, 2005, at 14:39:17
Howdy Ya'll,
I didn't wake up in as bad a mood as I thought, and I had a decent conversation with my mom in the early a.m., but not a good day at all. I'm consciously trying to break out of the obsessive cycle and hold a still mind, but I'm hopelessly wound up in my head. What do you think of blueberries' idea of adding zyprexa to boost the Effexor and "guard" against poopout. He made some interesting observations.I took your advice today, and will continue on the 75mgs in the morning and 75mgs at night. My pdoc writes the scripts but you know a hell of a lot more than she does. Maybe if/when I get insurance I can consult a true psychopharmacologist. I'll still run any and all ideas past you though :-) Her great insight last time was that she "had a patient who didn't respnd to lexapro and then responded to Zoloft". As if that is news to me. She seemed surprised that this kind of thing happens. Lady I don't know HOW you got through med school. But while on the Effexor I don't need a genius to be taking care of me. I will give the Effexor/Lamictal combo time and not throw anything else into the mix. I WOULD however like to hear your take on Zyprexa.
Also, I moved the Lamictal up to 600mgs on my own. My pdoc has me at 225mgs, but I have tons of samples so it ain't a big deal. But the 600 was just for a day. I should probably go back down to 400 or maybe even 225?? Effexor Effexor Effexor, and Time Time Time is my motto. I'm gonna do this one the right way and just in case I haven't mentioned it YOU RULE. I wish I could solve that cough for you. :(
-matt-
Posted by ed_uk on December 11, 2005, at 15:59:53
In reply to Re: Effexor and shortness of breath » ed_uk, posted by bigcat on December 6, 2005, at 21:34:11
Hi Matt
How are you feeling lately?
Sorry for the delay in responding. I haven't had internet access for the last few days. I'm back now though :-)
>75mgs in the morning and 75mgs at night
Have you continued at this dose?!
>Her great insight last time was that she "had a patient who didn't respnd to lexapro and then responded to Zoloft"
LOL Matt, that was funny!
>My pdoc has me at 225mgs, but I have tons of samples so it ain't a big deal. But the 600 was just for a day. I should probably go back down to 400 or maybe even 225??
What dose did you decide to take? Have you been taking the same dose every day?
>Zyprexa
Zyprexa can help both depression and anxiety, as well as acting as an anti-manic 'mood stabiliser' and antipsychotic. Seroquel and Zyprexa have similar uses in psychiatry, but some people respond better to one drug than to the other. Zyprexa is renowned for causing weight gain!
My cough is gone btw :-)
Warm regards
Ed
Posted by bigcat on December 12, 2005, at 7:31:25
In reply to TO BIGCAT » bigcat, posted by ed_uk on December 11, 2005, at 15:59:53
> Hi Matt
>
> How are you feeling lately?
>
> Sorry for the delay in responding. I haven't had internet access for the last few days. I'm back now though :-)
>
> >75mgs in the morning and 75mgs at night
>
> Have you continued at this dose?!
>
> >Her great insight last time was that she "had a patient who didn't respnd to lexapro and then responded to Zoloft"
>
> LOL Matt, that was funny!
>
> >My pdoc has me at 225mgs, but I have tons of samples so it ain't a big deal. But the 600 was just for a day. I should probably go back down to 400 or maybe even 225??
>
> What dose did you decide to take? Have you been taking the same dose every day?
>
> >Zyprexa
>
> Zyprexa can help both depression and anxiety, as well as acting as an anti-manic 'mood stabiliser' and antipsychotic. Seroquel and Zyprexa have similar uses in psychiatry, but some people respond better to one drug than to the other. Zyprexa is renowned for causing weight gain!
>
> My cough is gone btw :-)
>
> Warm regards
>
> Ed
>
>
Here's how my Effexor trial is going:
For the last four days I've been taking 150mgs Effexor, 225mgs Lamictal and 600mgs Seroquel for sleep. Moving the Effexor dose back down to 150mgs actually worked well. The last few days have been great. I havent't been without some serious problems, however. First off, sleep is horrendous. My nigthtmares amount to what I believe is post-traumatic stress. I'm insanely depressed in my dreams, and relive my time at college when every moment was living hell. I've woken up screaming, the dreams are so unbelievably real. I wake up at 4:30-5am every night and either can't get back to sleep, or take more seroquel, and get a little more disprupted, restless sleep. I believe akathesia is the word for what I experience. It's actually quite horrendous. When I can't stand the physical discomfort and mental strain, I get out of bed, have breakfast, putz around for a short while, and feel unbelievably fatigued. I literally can't do anything but retire to the couch, where I sleep another few hours, however this is a deep sleep, and it is not med-induced. Then I'll wake up and feel so fatigued, I'll lie on the couch for hours. If I go to bed at 11pm, wake up for breakfast at 8am, I'll be confinede to the couch until 1pm in the afternoon. This has been the pattern.I've been exercising, which has been great, but today at 2pm, I just hit a brick wall. I went straight back into depression, and was mute at work today. My mind just shut off and I was obsessing and worrying and frustrated beyond belief. I'm going to add 37.5mgs Effexor tonight and stay with that for a week probably, see what happens. The frightful sleep and mornings where I am too fatigued to do anything (which I fret about horribly) are real problems. And like I said, I went right back into depression by midday today.
The variables I'm working with are dose, timing of doses, and sleep/sleep meds. Even with 1000mgs Sweroquel before bed, I'll wake up 4:30am. And Seroquel has NEVER hung me over anywhere near this bad before. It's definately the Effexor. I definately think a 37.5 mg dose increase is what I need. How would you recommend timing the doses (so that I take 187.5mgs a day). And what about sleep? I have Valium and Ativan and Ambien and Lunesta (which I cannot tolerate because of the taste which stays on my mouth 24 hours and makes me sick).
thanks,
-matt-
Posted by Jeroen on December 12, 2005, at 12:08:16
In reply to TO BIGCAT » bigcat, posted by ed_uk on December 11, 2005, at 15:59:53
Hi ed, i want to get off Seroquel, i take 100 mg and 400 mg at night, the seroxat is my life saver not anti psychotics
PLEASE TELL ME HOW TO SAFELY WITHDRAW. ILL START ASAP
Posted by Dr. Bob on December 12, 2005, at 16:28:06
In reply to TO ED UK PLEASE HELP ME!!!!!!!!!!!!!!!!!!!!!!!!!!!, posted by Jeroen on December 12, 2005, at 12:08:16
> PLEASE TELL ME HOW TO SAFELY WITHDRAW.
Sorry to interrupt, but I'd like to redirect follow-ups regarding withdrawal to Psycho-Babble Withdrawal. Here's a link:
http://www.dr-bob.org/babble/wdrawl/20051018/msgs/588382.html
Thanks,
Bob
This is the end of the thread.
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