![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by shadowmon on June 23, 2008, at 22:54:20
ok Here I am on effexor 225 mg. been on it about 2 weeks now. Still feel profound sadness and overwhelmed with lifes stressors durning the morning toll about noonish, then slowly getting better. Not really feeling good at all. Also taking 1mg of klonopin as needed, but I don't really have any anxiety anymore. I also take 1mg of trazodone to sleepat night, of which I am getting about 5 hours of sleep at best.
I know I don't feel like the calm normal self that I am (or at least I thought I was) and I don't know what my options are. Can they raise the effexor more? Give me something else? I am NOT in the position to change meds again. anyone have any suggestios?
Posted by dbc on June 23, 2008, at 23:42:31
In reply to ok what to add to the cocktail effexor*Trazodone*, posted by shadowmon on June 23, 2008, at 22:54:20
Remeron
Not only would it replace the trazadone but reduce anxiety and potenate the effexor greatly. Its a well known and documented cocktail thats extremely potent. Effexor and remeron is commonly called California Rocket Fuel for reasons im not clear on but years its quite a ride of a combo.
Posted by Phillipa on June 24, 2008, at 0:17:33
In reply to Re: ok what to add to the cocktail effexor*Trazodo, posted by dbc on June 23, 2008, at 23:42:31
How bout wellbutrin? Good combo I've read. Phillipa
Posted by Molybdenum on June 24, 2008, at 0:43:16
In reply to Re: ok what to add to the cocktail effexor*Trazodo, posted by dbc on June 23, 2008, at 23:42:31
> Remeron
>
> Not only would it replace the trazadone but reduce anxiety and potenate the effexor greatly. Its a well known and documented cocktail thats extremely potent. Effexor and remeron is commonly called California Rocket Fuel for reasons im not clear on but years its quite a ride of a combo.Dear Shadowmon,
I absolutely agree 100% with dbc.
I have "melancholic" depression, ie no manic phase at all. I've been on the rocket fuel for over 2 years now. It really works VERY well.
I started on just the Effexor. I remember it actually made me anxious for the first week or two, then I'd settle into it & the angst went away. Every time I increased the dose I'd get anxiety again but it always passed in a week or so.
Then I read about the Rocket Fuel. If you have access to downloading torrents, search for Stephen M. Stahl - Essential Psychopharmacology.pdf It's a great book & highly respected. About 50MB. I'd mail it to you but my skinny link is incapable (I've tried & it just times out).
So I convinced my doc to up the Effexor & add Remeron. The max I got up to was 600mg Effexor XR & 225mg Remeron. I'm a bit of an idiot sometimes. I always want to get the best effect I can, so I tend to over-dose myself a bit & then cut it back when I realise I've overshot the max effect in me. Call me impatient if you want to be kind.. ;)
So now I'm on 450mg Effexor & 180mg Remeron. I *was* going to reduce it further but I found out yesterday I am severely narcoleptic...! So I'm not in the mood to adjust my meds any more for now.
Sorry - I digress, but the point is that the addition of Remeron is fantastic for making you sleep & it doesn't f*ck up your sleep patterns like the benzos do. Honestly, you can chuck the Trazodone out. The Remeron works REALLY well for sleep. So I take all my meds at 6pm except for the Remeron, which I take at 8pm. Often by 9pm I am a walking zombie looking for sleepybize land. It's that good. Plus it's another anti-depressant that has fewer side effects than most. Main side effects are sedation (perfect for taking at 8pm). You might feel some sedation the next day, but that will dissipate in a couple of weeks. The only other side effect I've had from Remeron is some weight gain. But at least that's something you can control. I mean, the drug doesn't make fat out of air & water - you have to actually eat lots of crap to get the weight gain. Remeron is also noted for it's relatively quick onset of AD effects (a few weeks) plus lack of sexual side effects.
Lastly, mirtazapine (Remeron) is off patent now so there's cheap legal generics. If cost is an issue for you then you'll also be looking forward to Effexor coming off patent this year.
Stop reading now. Put your pants on & run down to the doc to get a script...!
Go on....RUN...!!!!! :)
Posted by shadowmon on June 24, 2008, at 2:39:10
In reply to Re: ok what to add to the cocktail effexor*Trazodo » dbc, posted by Molybdenum on June 24, 2008, at 0:43:16
You know, initially I was on the remeron effexor combo back when I was at 75 mg, and it helped a bit... But I was still very sick. I am wondering though they keep on telling me that when you go up on the higher dosage of effexor, it starts to affect norepheneprhine and dopamine? So what do those neurotransmitters do? how has the higher dosage affected you? I'm not sure If I want to give up the trazodone, because it worked for me in the past. I remember when I tried somedrug to help me sleep, the trazodone stopped working for a while but I can't remember what the drug was. For now, I'm going to 1/2 up my dose of the trazodone to see if it affects how I feel in the morning. I don'thave the morning anxiety every morning, but juse feel that profound sadness.
At least I start some kind of therapy this week, of course I'm not sure how that will help either, seeing as I have ben through therapy for this depression before.
Posted by dbc on June 24, 2008, at 7:45:45
In reply to Re: ok what to add to the cocktail effexor*Trazodo, posted by shadowmon on June 24, 2008, at 2:39:10
Norepheneprhine and dopamine serve numerous purposes as far as being stimulating and addressing anxiety (i know that sounds weird but thats how dopamine works). There wont be much dopamine reuptake and any will simply be a side effect of all the norepinephrine.
Posted by Racer on June 24, 2008, at 11:34:20
In reply to Re: ok what to add to the cocktail effexor*Trazodo » dbc, posted by Molybdenum on June 24, 2008, at 0:43:16
> >
> Sorry - I digress, but the point is that the addition of Remeron is fantastic for making you sleep & it doesn't f*ck up your sleep patterns like the benzos do. The Remeron works REALLY well for sleep. Plus it's another anti-depressant that has fewer side effects than most. Main side effects are sedation (perfect for taking at 8pm). You might feel some sedation the next day, but that will dissipate in a couple of weeks.It's great that it's working for you, but not everyone has that reaction to it. I had one of those bad reactions to Remeron -- feeling out of control, enraged, etc -- and also had intense insomnia.
I'm not contradicting what you're saying, just want to make sure that those who have not had success with Remeron know that there's nothing wrong with them -- mileage, as we like to say, varies...
>The only other side effect I've had from Remeron is some weight gain. But at least that's something you can control. I mean, the drug doesn't make fat out of air & water - you have to actually eat lots of crap to get the weight gain. Remeron is also noted for it's relatively quick onset of AD effects (a few weeks) plus lack of sexual side effects.
>And again -- weight gain from meds often DOES happen without significant changes to eating patterns. The medications themselves cause metabolic changes, as well as causing food cravings, etc.
I'm glad your combination is working, and I hope it continues to work well for you.
As for ShadowMom, I'd offer two comments on your question:
First, two weeks isn't long enough to know whether the increased Effexor will help. Give it a little more time -- including a little more time before adding something else. Too many variables make it much harder to know what's helping and what's not.
Secondly, the Remeron/Effexor combo may be more helpful when the Effexor is at a therapeutic level -- and 75mg probably isn't high enough to know if it's a good fit for you. It's worth revisiting Remeron as an augmenting agent for the Effexor.
Good luck.
Posted by Bob on June 24, 2008, at 16:04:16
In reply to Re: ok what to add to the cocktail effexor*Trazodo » dbc, posted by Molybdenum on June 24, 2008, at 0:43:16
Is there any evidence of this "California Rocket Fuel" being effective with Cymbalta in place of Effexor?
Posted by emme on June 24, 2008, at 17:16:16
In reply to Re: what to add to effexor »ShadowMom » Molybdenum, posted by Racer on June 24, 2008, at 11:34:20
> And again -- weight gain from meds often DOES happen without significant changes to eating patterns.
Amen!!!
Posted by Molybdenum on June 24, 2008, at 19:05:37
In reply to Re: what to add to effexor »ShadowMom » Molybdenum, posted by Racer on June 24, 2008, at 11:34:20
Racer's quite right of course,
I try to be impartial when it comes to recommendations, but I obviously failed miserably this time...!
Still, I do think that it's more likely someone will get the positive effects I mentioned from mirtazapine than the negative ones Racer unfortunately suffered. Everybody's different of course but the effects I described and the concept of rocket fuel working is a pretty widely accepted treatment.
But I agree it's important to know the possibilities.
And most certainly, 2 weeks on 75mg Effexor is nowhere near long enough to decide if Effexor is effective. I'd be taking 225-300mg for a couple of months before I'd be able to decide.
Trouble with depression & the AD drugs is that we need to feel better ASAP, particularly if there's suicidal feelings involved. And the damn drugs just take too long to kick in fully (assuming they work at all!). So if Shadowmon feels really bad & just can't bear waiting all that time to do it scientifically, I don't see a problem with adding mirtazapine & increasing the venlafaxine as fast as can be tolerated. If he/she feels better sooner, then IMHO that's worth buggering up the experiment a bit.
You can always cut back slowly once you're feeling better. No real danger of overshooting your ideal dose.
So thanks for pulling me up on this Racer, I will try to be a bit more balanced in future! :)
Mr. M.
Posted by Racer on June 24, 2008, at 21:17:21
In reply to Re: what to add to effexor » Racer, posted by Molybdenum on June 24, 2008, at 19:05:37
> Racer's quite right of course,
>
> I try to be impartial when it comes to recommendations, but I obviously failed miserably this time...!
>I'm sorry if I gave you that impression. I just worry that if someone else had the sort of bad reaction I had, reading that Remeron was entirely good might trigger some pretty hopeless feelings. I know that I'm depressed now, and hear people talking about drugs that are working well for them -- and then feel worse, and much more critical of myself, thinking things like, "there's no hope for me," or worse yet, that there's something wrong with me that I won't try those drugs again. For me, depression comes with a huge dose of self-criticism, so I wanted to try to offer support for anyone else who might have similar feelings.
But I will agree with the basic premise of your post -- the combination of Remeron and Effexor has shown very good results for many, many people. It's well worth trying -- especially since the dose of Effexor was so low when she did try it.
So, peace? I think you contribute a lot to this community, and really didn't want you to feel I was criticizing you -- I just wanted to add that there are adverse effects for some people, for the reasons listed above.
Posted by Molybdenum on June 24, 2008, at 21:25:16
In reply to Re: ok what to add to the cocktail effexor*Trazodo » Molybdenum, posted by Bob on June 24, 2008, at 16:04:16
> Is there any evidence of this "California Rocket Fuel" being effective with Cymbalta in place of Effexor?
Hi Bob,
Trouble is that the defacto bible on such matters - "Stephen M. Stahl - Essential Psychopharmacology 2nd edition", is printed in 2000. Cymbalta (Duloxetine) was not approved by the US FDA until 2004. So that's one reason why it might not be as popular as venlafaxine + mirtazapine.
Incidentally, I just read Wiki's blurb on Duloxetine at http://en.wikipedia.org/wiki/Duloxetine. It doesn't sound like a fantastic AD. In fact, Wiki's article really makes it sound like a pointless medication for treating depression. It apparently has some other uses. Maybe that's the justification for it's existence.
IMHO "if I were you" and I was feeling horribly depressed, I would want to feel better ASAP. So choosing a combination of drugs that commonly produces positive effects and that has been prescribed together for years would be my choice over something different or new. Assuming you don't have a problem with venlafaxine, why not go with the tried & true approach? It's not like Eli Lilly is going to pay you to run experiments on yourself.
We all think that newer = better, but it's often simply untrue.
So there's my 5c worth. ;)
Good Luck - I hope you're feeling better soon.
Mr. M.
Posted by shadowmon on June 24, 2008, at 22:04:41
In reply to Re: ok what to add to the cocktail effexor*Trazodo » dbc, posted by Molybdenum on June 24, 2008, at 0:43:16
> > Remeron
> >
> > Not only would it replace the trazadone but reduce anxiety and potenate the effexor greatly. Its a well known and documented cocktail thats extremely potent. Effexor and remeron is commonly called California Rocket Fuel for reasons im not clear on but years its quite a ride of a combo.
>
> Dear Shadowmon,
>
> I absolutely agree 100% with dbc.
>
> I have "melancholic" depression, ie no manic phase at all. I've been on the rocket fuel for over 2 years now. It really works VERY well.
>
> I started on just the Effexor. I remember it actually made me anxious for the first week or two, then I'd settle into it & the angst went away. Every time I increased the dose I'd get anxiety again but it always passed in a week or so.
>
> Then I read about the Rocket Fuel. If you have access to downloading torrents, search for Stephen M. Stahl - Essential Psychopharmacology.pdf It's a great book & highly respected. About 50MB. I'd mail it to you but my skinny link is incapable (I've tried & it just times out).
>
> So I convinced my doc to up the Effexor & add Remeron. The max I got up to was 600mg Effexor XR & 225mg Remeron. I'm a bit of an idiot sometimes. I always want to get the best effect I can, so I tend to over-dose myself a bit & then cut it back when I realise I've overshot the max effect in me. Call me impatient if you want to be kind.. ;)
>
> So now I'm on 450mg Effexor & 180mg Remeron. I *was* going to reduce it further but I found out yesterday I am severely narcoleptic...! So I'm not in the mood to adjust my meds any more for now.
>
> Sorry - I digress, but the point is that the addition of Remeron is fantastic for making you sleep & it doesn't f*ck up your sleep patterns like the benzos do. Honestly, you can chuck the Trazodone out. The Remeron works REALLY well for sleep. So I take all my meds at 6pm except for the Remeron, which I take at 8pm. Often by 9pm I am a walking zombie looking for sleepybize land. It's that good. Plus it's another anti-depressant that has fewer side effects than most. Main side effects are sedation (perfect for taking at 8pm). You might feel some sedation the next day, but that will dissipate in a couple of weeks. The only other side effect I've had from Remeron is some weight gain. But at least that's something you can control. I mean, the drug doesn't make fat out of air & water - you have to actually eat lots of crap to get the weight gain. Remeron is also noted for it's relatively quick onset of AD effects (a few weeks) plus lack of sexual side effects.
>
> Lastly, mirtazapine (Remeron) is off patent now so there's cheap legal generics. If cost is an issue for you then you'll also be looking forward to Effexor coming off patent this year.
>
> Stop reading now. Put your pants on & run down to the doc to get a script...!
>
> Go on....RUN...!!!!! :)
>
>Moly,
I have the same meloncholic depression too. Badly... I've gotten to the point to know that if I am changing meds that I have to buy some ensure because I won't eat... I was wrong to post that I tried remeron and effexor. It was respiradl and effexor. Is remeron the one that the dosage is backward? if you want to sleep more, you take less and if you want to sleep less you take more? I took a drug like that before and I think it was remeron but I can't remember what it was. I think though that was the drug that stopped making the trazodone work for a while.
I don't know, but I love trazodone. It has been my steady eddie so to speak in terms of medication for years and am not sure I want to give it up.
Posted by Molybdenum on June 24, 2008, at 23:19:10
In reply to Re: ok what to add to the cocktail effexor*Trazodo, posted by shadowmon on June 24, 2008, at 2:39:10
> I am wondering though they keep on telling me that when you go up on the higher dosage of effexor, it starts to affect norepheneprhine and dopamine?
Hi shadowmon,
Venlafaxine (Effexor) is thought of as a potent serotonin-norepinephrine reuptake inhibitor (SNRI). Apparently it does have a very slight ability to inhibit the reuptake of dopamine too, but it's not significant. And I can't find ANY references in the data I have to indicate that it affects one neurotransmitter more than the other at different doses. Some ADs DO have this trait - but I don't believe venlafaxine is one of them.
If you want to kick your dopamine up, I think Bupropion (Wellbutrin) is a popular choice. It's classed as a norepinephrine and dopamine reuptake inhibitor.
I believe that it is a widely accepted idea that serotonin, norepinephrine (aka noradrenaline) and dopamine are the main neurotransmitters that seem to be involved in depression. (BTW, my pdoc believes that these 3 are just the tip of the iceberg.)
So in general, taking drugs that (one way or another), increase the amount of these neurotransmitters in your head, is thought to be an appropriate angle of attack in the battle against depression. Anecdotally, many people also find stimulants and opiates help them overcome depression too. Western doctors are a bit squeamish when it comes to controversial matters, so it's less often you'll hear of them using these - especially opiates. Maybe that's unfair. Truth is that these drugs can easily cause you more harm than good. Hippocrates is credited with the saying "...make a habit of two things to help, or at least to do no harm." And I appreciate doctors who respect this idea.
I don't think anybody yet knows why some people respond to one AD & not to another. The best you can hope for from your doc is that he/she chooses one that they believe is most likely to work. If it doesn't start to relieve your depression in "x weeks", the doc may want to wait a little longer, increase the dose, switch to another type in the same class, switch to an entirely different class or augment your current med with a second one.
Therefore there's an almost infinite number of "treatments" available. So a good doc will try you on ones that they have commonly seen working for more people than not. Each drug comes with it's own mix of side effects, some of which will pass in a week or two, some of which you may find intolerable, some you are prepared to tolerate and some you might like! So your feedback to the doc will influence their choice too.
So my point (here it comes) is that there's no clear right & wrong treatments within the mainstream approaches. And once you get on a drug or a combination that subjectively makes YOU feel better, that's the place to stop - or at least it's an important milestone & somewhere from which to rest and maybe "fine tune" your treatment further. And I am sure that although venlafaxine & mirtazapine is working very well for me, there's probably numerous other combos that would work just as well. It's just impractical to try them all - we won't live long enough...! Plus it's pointless too. If you feel OK, then that's what matters. And given that my combo is working for me, it would be stupid to make any major changes when basically the only direction for me to go is "worse"..!
My depression made me feel very suicidal, and I didn't like that at all. So I was thinking "damn the side effects, just give me a big dose of something that works well for more people than not". That's why I'm on the rocket fuel.Man....sorry for typing such a huge blob. Hope somebody gets something out of it.
Take Care & good luck.
Mr. Molybdenum
Posted by Molybdenum on June 24, 2008, at 23:36:52
In reply to No, no, no! » Molybdenum, posted by Racer on June 24, 2008, at 21:17:21
But Racer,
You really were right. I did sound like a rocket fuel salesman. And it was wrong of me to just write & write without taking care to appreciate my audience. So thanks for pointing it out - sincerely. The last thing I want to do here is contribute to someone getting the wrong idea about ADs & maybe prolonging their suffering with a bad or ineffective treatment. Oh god no...
>
> So, peace? I think you contribute a lot to this community, and really didn't want you to feel I was criticizing you -- I just wanted to add that there are adverse effects for some people, for the reasons listed above.Peace, peace, peace...! (When will Dr Bob get around to letting us use graphical smilies.!!!)
And thanks for the complement. You are kind. But what I wrote originally really should have been tempered with a few "IMHOs", etc. :)
Best Regards
Mr. Molly Be Damned.
Posted by Molybdenum on June 24, 2008, at 23:57:06
In reply to Re: what to add to effexor » Racer, posted by emme on June 24, 2008, at 17:16:16
> > And again -- weight gain from meds often DOES happen without significant changes to eating patterns.
>
> Amen!!!Really? I just know that I've gained a lot of weight on mirtazapine and I know why. I get cravings for chocolate. I won't tell you how much I've consumed in a day - too embarrassing! I am 6 feet tall and weighed 87kg/191lbs before I started with the mirtazapine. Now I weigh 105kg/231lbs..!
On the ever-increasing list of things I am not, please add "dietician".
But I just don't understand how a drug could make me gain so much weight if I had the willpower to keep to my "pre mirtazapine" diet? (Assuming exercise remained the same too). I "blame" the mirtazapine, but I really feel that it wouldn't have happened without the increased amounts of sugar & fat in my diet. Can a drug like mirtazapine really lower my metabolism so much to bring about such an increase?
Posted by Bob on June 25, 2008, at 0:08:43
In reply to Re: ok what to add to the cocktail effexor*Trazodo » Bob, posted by Molybdenum on June 24, 2008, at 21:25:16
> > Is there any evidence of this "California Rocket Fuel" being effective with Cymbalta in place of Effexor?
>
> Hi Bob,
>
> Trouble is that the defacto bible on such matters - "Stephen M. Stahl - Essential Psychopharmacology 2nd edition", is printed in 2000. Cymbalta (Duloxetine) was not approved by the US FDA until 2004. So that's one reason why it might not be as popular as venlafaxine + mirtazapine.
>
> Incidentally, I just read Wiki's blurb on Duloxetine at http://en.wikipedia.org/wiki/Duloxetine. It doesn't sound like a fantastic AD. In fact, Wiki's article really makes it sound like a pointless medication for treating depression. It apparently has some other uses. Maybe that's the justification for it's existence.
>
> IMHO "if I were you" and I was feeling horribly depressed, I would want to feel better ASAP. So choosing a combination of drugs that commonly produces positive effects and that has been prescribed together for years would be my choice over something different or new. Assuming you don't have a problem with venlafaxine, why not go with the tried & true approach? It's not like Eli Lilly is going to pay you to run experiments on yourself.
>
> We all think that newer = better, but it's often simply untrue.
>
> So there's my 5c worth. ;)
>
> Good Luck - I hope you're feeling better soon.
>
> Mr. M.
>
>Actually I have tried Effexor. I tried it way back when it first came on the market, innocently thinking it was not significantly different from the other pure SSRIs on the market at the time. I eventually gained significant weight, developed nasty bruxism, carb cravings, anhedonia and lethargy, and hypersomnia... and then I finally tried to taper off. I ran into serious discontinuation problems and contacted the makers. They didn't acknowlege any withdrawal problems and told me to stop it "over a couple days". To this day (it's been more than 10 years) I've never had a withdrawal quite as severe. So, I'm quite reticent to jump back into something like that, especially since I'm in far worse shape these days and literally don't know if I'd be able to weather another severe episode like that.
Ironically my sister started taking Cymbalta last year and it was like a spiritual awakening for her. She went back to school to become a teacher. Unfortunately, what works for others never seems to work for me.
Posted by Bob on June 25, 2008, at 0:17:39
In reply to Re: ok what to add to the cocktail effexor*Trazodo » shadowmon, posted by Molybdenum on June 24, 2008, at 23:19:10
>
> My depression made me feel very suicidal, and I didn't like that at all. So I was thinking "damn the side effects, just give me a big dose of something that works well for more people than not". That's why I'm on the rocket fuel.
>
> Man....sorry for typing such a huge blob. Hope somebody gets something out of it.
>
> Take Care & good luck.
>
> Mr. Molybdenum
>
>
It's funny how we all have different thresholds for what we'll put up with. My doc just told me at my last appointment that he has patients with serious mental illness that won't take a drug "because they gained" 5 lbs.
Posted by emme on June 25, 2008, at 6:57:02
In reply to Re: Weight gain » emme, posted by Molybdenum on June 24, 2008, at 23:57:06
Hi there. I suspect a nutritionist and being able to ditch the chocolate would help. The chocolate thing is easier said than done, I know :) When I took Remeron, I counted calories (eating less than pre-Remeron) and went running a lot. I gained weight, but I was able to keep it minimal. In your case, it may be the combination of tweaked metabolism and lots of cravings. The good news is that when I went off of it, the weight I gained came off quickly. Good luck.
emme
> > > And again -- weight gain from meds often DOES happen without significant changes to eating patterns.
> >
> > Amen!!!
>
> Really? I just know that I've gained a lot of weight on mirtazapine and I know why. I get cravings for chocolate. I won't tell you how much I've consumed in a day - too embarrassing! I am 6 feet tall and weighed 87kg/191lbs before I started with the mirtazapine. Now I weigh 105kg/231lbs..!
>
> On the ever-increasing list of things I am not, please add "dietician".
>
> But I just don't understand how a drug could make me gain so much weight if I had the willpower to keep to my "pre mirtazapine" diet? (Assuming exercise remained the same too). I "blame" the mirtazapine, but I really feel that it wouldn't have happened without the increased amounts of sugar & fat in my diet. Can a drug like mirtazapine really lower my metabolism so much to bring about such an increase?
>
>
Posted by Molybdenum on June 25, 2008, at 7:18:24
In reply to Re: ok what to add to the cocktail effexor*Trazodo » Molybdenum, posted by shadowmon on June 24, 2008, at 22:04:41
> I have the same meloncholic depression too. Badly... I've gotten to the point to know that if I am changing meds that I have to buy some ensure because I won't eat... I was wrong to post that I tried remeron and effexor. It was respiradl and effexor. Is remeron the one that the dosage is backward? if you want to sleep more, you take less and if you want to sleep less you take more? I took a drug like that before and I think it was remeron but I can't remember what it was. I think though that was the drug that stopped making the trazodone work for a while.Heya shadowmon,
I'm not sure I understand what you meant about the not eating. I believe that Effexor can commonly produce nausea as a side effect and that's another reason Remeron is often combined with it to counteract this effect. Remeron commonly stimulates appetite.
And you're quite right about Remeron being the backward one - at least that's what the textbook says. So if you want more sedation, take a small (15mg?) dose. If you want more of the anti-depressant effects, take a higher dose. Just to throw a spanner in the works, I have always gotten good sleep from the Remeron, despite being on very high doses. And whenever I'd increase the Remeron, I'd get extra sleep inducing effects immediately. My pdoc says that it's not supposed to work that way but it does with me. He's also fond of saying that there is hardly any research into combinations of drugs, aka "polypharmacy" so it's all uncharted waters is his point.
I have never used trazodone, but if you know it's a reliable hard-working thing for you, then why not stick to it.
When my pdoc was away, I saw one of his colleagues. I was on just the Effexor at the time and he added Risperdal (chemical name risperidone). I only took a couple of tabs before I chucked it out. It turned me into a zombie and I was not pleased. I'm sure it's great for some people but not for me.
Steady Eddie - he does make me laugh... ;)
Posted by Molybdenum on June 25, 2008, at 7:38:36
In reply to Re: ok what to add to the cocktail effexor*Trazodo » Molybdenum, posted by Bob on June 25, 2008, at 0:08:43
>
> Actually I have tried Effexor. I tried it way back when it first came on the market, innocently thinking it was not significantly different from the other pure SSRIs on the market at the time. I eventually gained significant weight, developed nasty bruxism, carb cravings, anhedonia and lethargy, and hypersomnia... and then I finally tried to taper off. I ran into serious discontinuation problems and contacted the makers. They didn't acknowlege any withdrawal problems and told me to stop it "over a couple days". To this day (it's been more than 10 years) I've never had a withdrawal quite as severe. So, I'm quite reticent to jump back into something like that, especially since I'm in far worse shape these days and literally don't know if I'd be able to weather another severe episode like that.
>
> Ironically my sister started taking Cymbalta last year and it was like a spiritual awakening for her. She went back to school to become a teacher. Unfortunately, what works for others never seems to work for me.Hey Bob,
sounds like Effexor is not a good drug for you. And I have heard that they initially didn't acknowledge withdrawals. Now everyone knows it's the "king of the hill" for withdrawal effects. At the moment, I have no plans to stop taking it unless it poops out on me.
Citalopram pooped out on me. I was up to 80mg and it slowly pooped over a year. Then when I quit it I just lowered the dose by 20mg each week. So in a month I was completely off it. And the strange thing is that I didn't get any withdrawals. my "theory" - and I hope it's true, is that maybe I missed out on the withdrawals BECAUSE it had pooped out. So if I never stop the Rocket Fuel until it poops, I might not be in for such a bad ride. Anyway, it's a pointless discussion I've started. Now advantage to pondering what I may or may not feel in the future. :)
One thing you said that I think might be very relevant is that your sister did very well on Cymbalta. So that would have to add some weight to the argument that it may be a good choice for you. I take it you are blood relatives.
take care :)
Posted by Racer on June 25, 2008, at 15:58:59
In reply to Re: ok what to add to the cocktail effexor*Trazodo » Bob, posted by Molybdenum on June 25, 2008, at 7:38:36
> And the strange thing is that I didn't get any withdrawals. my "theory" - and I hope it's true, is that maybe I missed out on the withdrawals BECAUSE it had pooped out.
Nope -- I stopped Effexor in large part because it *had* pooped out on me, and had a pretty horrible time of it. The withdrawal happens because our bodies become used to having the medication in our systems, so any medication which stays in our systems for a longer time -- that would suggest that it kinda tapers off more slowly -- will likely cause less withdrawal than those which are quickly eliminated. Celexa has a much longer half life than Effexor, so the withdrawal is likely to be much milder.
Hope that helps.
Posted by Bob on June 25, 2008, at 16:39:29
In reply to Re: ok what to add to the cocktail effexor*Trazodo » Bob, posted by Molybdenum on June 25, 2008, at 7:38:36
> Hey Bob,
>
> sounds like Effexor is not a good drug for you. And I have heard that they initially didn't acknowledge withdrawals. Now everyone knows it's the "king of the hill" for withdrawal effects. At the moment, I have no plans to stop taking it unless it poops out on me.
>
> Citalopram pooped out on me. I was up to 80mg and it slowly pooped over a year. Then when I quit it I just lowered the dose by 20mg each week. So in a month I was completely off it. And the strange thing is that I didn't get any withdrawals. my "theory" - and I hope it's true, is that maybe I missed out on the withdrawals BECAUSE it had pooped out. So if I never stop the Rocket Fuel until it poops, I might not be in for such a bad ride. Anyway, it's a pointless discussion I've started. Now advantage to pondering what I may or may not feel in the future. :)
>
> One thing you said that I think might be very relevant is that your sister did very well on Cymbalta. So that would have to add some weight to the argument that it may be a good choice for you. I take it you are blood relatives.
>
> take care :)
Actually, Effexor is not the worst overall experience I've had trying to treat my mental illness, but I'll save that for another post. I will say that I forgot to mention that after a month of taking it all sexual ability was essentially eradicated until a year later when I finally got off of the drug. I can't really single out Effexor for this though, because just about any drug with sertonergic properties does this to me eventually to varying degrees.I would normally think that a drug my sister responded to would be good for me, except that theory kinda lost credibility years ago when the drugs both my mother and sister took (Paxil, Zoloft, Celexa, etc.) were always better for them than for me. At least for a little while. I've done very badly with meds pretty much across the board. They've enabled me to stay alive somehow so far, but I've never even come close to getting my life back in any way. Not even close.
Posted by Molybdenum on June 25, 2008, at 17:55:50
In reply to Re: ok what to add to the cocktail effexor*Trazodo » Molybdenum, posted by Racer on June 25, 2008, at 15:58:59
Well damn that :(
That wasn't any help at all Racer..!!
I could have stayed with my happy delusion for years before I proved it wrong..!
Oh well..... ;)
This is the end of the thread.
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