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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by jms600 on January 31, 2009, at 12:37:16
Hi,
Does anyone know if Effexor / venlafaxine can help with depersonalization and derealization caused by severe anxiety??
Thanks
Posted by SLS on January 31, 2009, at 12:44:40
In reply to Depersonalization and Effexor..., posted by jms600 on January 31, 2009, at 12:37:16
> Hi,
>
> Does anyone know if Effexor / venlafaxine can help with depersonalization and derealization caused by severe anxiety??
>
> ThanksIf it is the right drug for you, it should get rid of both depression and anxiety, and along with it the depersonalization and derealization. You have a good shot with Effexor.
Do you have anhedonia (lack of pleasure or reward)?
- Scott
Posted by jms600 on January 31, 2009, at 13:30:35
In reply to Re: Depersonalization and Effexor... » jms600, posted by SLS on January 31, 2009, at 12:44:40
Hi SLS - yes I do have anhedonia, along with moderate depression (which seems to ease temporarily when I have a long cry). My main problem is anxiety (severe GAD, panic disorder, social phobia and depersonalization). Benzos are the obvious choice but I've developed a tolerance to them.
I'm currently on 175mg amitripyline, 600mg lithium and 40mg buspirone. Although this cocktail works a little I'm still suffering from the anxiety/depression.
I'm seeing my psychiatrist on Monday who is replacing the amitriptyline with Effexor. I'm hoping the Effexor/lithium/buspirone combo will finally help.
Is Effexor good for anhedonia??
Posted by SLS on January 31, 2009, at 16:41:49
In reply to Re: Depersonalization and Effexor... » SLS, posted by jms600 on January 31, 2009, at 13:30:35
> Hi SLS - yes I do have anhedonia, along with moderate depression (which seems to ease temporarily when I have a long cry). My main problem is anxiety (severe GAD, panic disorder, social phobia and depersonalization). Benzos are the obvious choice but I've developed a tolerance to them.
>
> I'm currently on 175mg amitripyline, 600mg lithium and 40mg buspirone. Although this cocktail works a little I'm still suffering from the anxiety/depression.
>
> I'm seeing my psychiatrist on Monday who is replacing the amitriptyline with Effexor. I'm hoping the Effexor/lithium/buspirone combo will finally help.
>
> Is Effexor good for anhedonia??Yes.
Depersonalization and derealization often have anhedonia as well as anxiety as a contributor.
Your doctor can give you no guarantees, but I find his choice of Effexor to be a good one.
- Scott
Posted by linkadge on February 1, 2009, at 7:37:39
In reply to Re: Depersonalization and Effexor... » jms600, posted by SLS on January 31, 2009, at 16:41:49
There is no evidence that SSRI's or SNRI's are effective for depresionalization disorder per se. However, if, as you say, they are solely the result of anxiety, then a medication which effetively controls anxiety could help.
Linkadge
Posted by SLS on February 1, 2009, at 7:50:25
In reply to Re: Depersonalization and Effexor..., posted by linkadge on February 1, 2009, at 7:37:39
> There is no evidence that SSRI's or SNRI's are effective for depresionalization disorder per se. However, if, as you say, they are solely the result of anxiety, then a medication which effetively controls anxiety could help.
>
> Linkadge
No. It seems that anhedonia is a component of D&D.I suffered from D&D. It resolved quickly when I responded the first time to an antidepressant. It recurs when I enter the more depressive episodes of my illness.
How do you address D&D when you suffer from it?
Do you have evidence that there is no evidence?
- Scott
Posted by SLS on February 1, 2009, at 8:05:52
In reply to Re: Depersonalization and Effexor..., posted by SLS on February 1, 2009, at 7:50:25
I think the bottom line is there is little or no investigation in the use of SSRIs or SNRIs for D&D. So, I guess there is no evidence as you say.
I found evidence of tricyclics helping with D&D, particularly imipramine and clomipramine. Whereas there is little evidence for SSRIs, I think I would take the chance with Effexor, a SNRI that shares some clinical properties with clomipramine.
If it were me, I would attack both the D&D with an antidepressant, an anxiolytic, and perhaps Lamictal.
- Scott
Posted by SLS on February 1, 2009, at 8:17:38
In reply to Re: Depersonalization and Effexor... » SLS, posted by jms600 on January 31, 2009, at 13:30:35
Hi.
A thought occurred to me. If Effexor 300mg doesn't help much, you could add desipramine to it.
The Effexor might be sufficient to treat the GAD and depression, and thus the D&D. However, if PD persists, Adding imipramine 200mg might help.
I still think your doctor probably has sufficient reason to choose Effexor. I don't think it was chosen blindly.
- Scott
Posted by SLS on February 1, 2009, at 9:17:51
In reply to Re: Depersonalization and Effexor..., posted by linkadge on February 1, 2009, at 7:37:39
Sorry, Linkadge.
You were right in what you said.
- Scott
Posted by linkadge on February 1, 2009, at 12:36:50
In reply to Re: Depersonalization and Effexor..., posted by SLS on February 1, 2009, at 7:50:25
>Do you have evidence that there is no evidence?
Yes, but not off the top of my head. I did a small paper on depersonalization disorder a few years back for school. Basically, from what I was able to find, research has not found SSRI's to be particularly effective for depersonalization disorder. There were some reports of anticonvulsants (ie tegretol) showing more sucess (although lamotrigne faired poorly in a study for depersonalization) and some doctors claiming sucess with AP's or opiate antagonists.
It could be totally different when depresonalization is a symptom of another.
I'm not telling you not to search the literature, but from what I recall, a few years back, the data was conflicting on the efficacy of AD's in depresonalization.
- Well, to be honest there is conflicting evidence of the efficacy of AD's in depression too, so I guess you just need determine what kind of evidence you are looking for.
Linkadge
Posted by linkadge on February 1, 2009, at 12:45:15
In reply to Re: Depersonalization and Effexor..., posted by linkadge on February 1, 2009, at 12:36:50
Just thinking aloud. Depersonalization can definately be a responce to severe stress. During intense stress, the brain releases several compounds which could produce depersonalzation.
I am thinking about isatin (a endogenios benzodiazapine antagonist), endorphins, and substances that bind to the same receptors as PCP.Linkadge
Posted by jms600 on February 1, 2009, at 14:12:35
In reply to Re: Depersonalization and Effexor... » jms600, posted by SLS on February 1, 2009, at 8:17:38
Adding desipramine to venlafaxine for panic disorder sounds interesting; however, I'm not sure if my psychiatrist is brave enough to do it. He's probably more likely to add an SSRI (and I don't think he would want to do that very much either)!
Is desipramine only indicated for major depression? Would it help anxiety much?
> Hi.
>
> A thought occurred to me. If Effexor 300mg doesn't help much, you could add desipramine to it.
>
> The Effexor might be sufficient to treat the GAD and depression, and thus the D&D. However, if PD persists, Adding imipramine 200mg might help.
>
> I still think your doctor probably has sufficient reason to choose Effexor. I don't think it was chosen blindly.
>
>
> - Scott
Posted by jms600 on February 1, 2009, at 14:23:06
In reply to Re: Depersonalization and Effexor..., posted by linkadge on February 1, 2009, at 12:36:50
An article on Wikipedia noted that naltrexone had be used with some success (although I don't have a hope in hell of being prescribed that)!
Apparently SSRIs bought about some improvement but only by reducing associated anxiety and depression.
Clomipramine also bought about significant improvement.
I'm starting Efexor tomorrow so maybe I'll find some relief from that (in some form or another).
> >Do you have evidence that there is no evidence?
>
> Yes, but not off the top of my head. I did a small paper on depersonalization disorder a few years back for school. Basically, from what I was able to find, research has not found SSRI's to be particularly effective for depersonalization disorder. There were some reports of anticonvulsants (ie tegretol) showing more sucess (although lamotrigne faired poorly in a study for depersonalization) and some doctors claiming sucess with AP's or opiate antagonists.
>
> It could be totally different when depresonalization is a symptom of another.
>
> I'm not telling you not to search the literature, but from what I recall, a few years back, the data was conflicting on the efficacy of AD's in depresonalization.
>
> - Well, to be honest there is conflicting evidence of the efficacy of AD's in depression too, so I guess you just need determine what kind of evidence you are looking for.
>
> Linkadge
>
>
>
>
Posted by Sigismund on February 1, 2009, at 14:50:58
In reply to Re: Depersonalization and Effexor..., posted by linkadge on February 1, 2009, at 7:37:39
>There is no evidence that SSRI's or SNRI's are effective for depresionalization disorder per se. However, if, as you say, they are solely the result of anxiety, then a medication which effetively controls anxiety could help.
That was the line in "Feeling Unreal".... the depression and anxiety that caused or resulted from the depersonalisation could be helped, but not the depersonalisation as such.
Posted by Sigismund on February 1, 2009, at 14:55:55
In reply to Re: Depersonalization and Effexor..., posted by linkadge on February 1, 2009, at 12:36:50
I'm not sure that any drugs are helpful for depersonalisation, and I'm sure some are worse than useless because they do not contribute to mental clarity.
The ones that might be helpful are (no surprises) drugs of abuse.
One attempt at cure mentioned in the book was methamphetamine combined with ECT. This was a long time ago now.
Posted by SLS on February 1, 2009, at 15:19:14
In reply to Re: Depersonalization and Effexor..., posted by Sigismund on February 1, 2009, at 14:55:55
At its worst, I tried perphenazine. This was before I tried antidepressants. It really didn't help.
I think Linkadge and Sigismund are right about the exposure to extreme stress as being a trigger for D&D.
Can you identify those things that were the stressors at the time you fell into the oblivion of D&D? For me, it was the loss of a girlfriend mixed in with a whole lot of other stuff. Once triggered, it came on very quickly. It felt something like what I would imagine going on a LSD trip would be, and getting stuck in the trip. It took years to dissipate to the point where I am no longer bothered by it.
It was imipramine that made such a huge difference while I was in the midst of it. It allowed me to emerge from the depression, cleared and energized my head, and made everything seem real.
- Scott
Posted by Jim45 on February 3, 2009, at 15:25:27
In reply to Re: Depersonalization and Effexor... » jms600, posted by SLS on January 31, 2009, at 12:44:40
I just wanted to warn you about Effexor.
I went through TERRIBLE trauma for over a year after stopping high-dose effexor I'd been taking for 4 or 5 years.
If I had an enemy, I wouldn't want them to go through the mental agony I did. After 2 years off the stuff I still wasn't myself. Many meds can cause the very problems they're designed to treat by downregulation or related neurological homeostasis. I caution people to be careful with psych meds (dose and duration of treatment)
I do admit I took more than I needed to function. I took a lot because it helped me but it helped too much. I almost left my precious Wife. Others who have used or known someone on Effexor often tell similar stories. Not mania, but close. It was like being a silly teenager again.
SO....if you must take Effexor, and it helps you, take as little as needed as short a time as possible.
Good luck!
Jim
Posted by SLS on February 3, 2009, at 16:14:43
In reply to Re: Depersonalization and Effexor..., posted by Jim45 on February 3, 2009, at 15:25:27
> SO....if you must take Effexor, and it helps you, take as little as needed as short a time as possible.
That is an ideal way to use a drug.
Unfortunately, one often encounters a dilemma. There exists the possibility that if one relapses after discontinuing the drug, they won't respond to it again when it is restarted. So, how does one know when is the right time to discontinue a drug. There is still quite a bit of debate over this, but if it is a first episode and there is no family history, an argument can be made to discontinue after 6-12 months. However, if the depression has been chronic or recurrent, or that there is a family history for mental illness, it is suggested that one take the drug for a year or more. I wish there were a test to be able to determine at what point it is safe to discontinue treatment. There are people who can go on and off the same drug over time without loss of effectiveness. How does one know who is who?
- Scott
Posted by antigua3 on February 3, 2009, at 20:02:11
In reply to Re: Depersonalization and Effexor... » Jim45, posted by SLS on February 3, 2009, at 16:14:43
When I first started seeing my pdoc he lowered the boom and said I would probably be on meds for life. Why? Re-occuring bouts of severe depression triggered about every seven years or so, if I'm counting correctly. Pdoc cited the statsitcs of my increased likelhood for repeated bouts of depression, at stronger duration, leading me to "you will probably be on meds for the rest of your life."
Two years later, I'm off my recent anti-depresent Cymbalta and tapering off Lyrica and Klonopin. I know I'm trying to prove my pdoc wrong, but I'm already wondering about the price I might be paying. Am I getting depressed again? Do I feel badly again? I don't know. I wanted off the drug because I didn't like the anxiety it was causing, and plus, I wanted to prove that I was well enough not to need it anymore. stupid, right? self-defeating for sure.
Why or why does the thought of being on meds for the rest of my life make me feel awful? It's stupid; they are something I need to survive, just as someone else needs something every day.
Being told that the depressive episodes will become more frequent and more severe is frightening.
I, too, wish there were a test to determine at what point it is safe to discontinue treatment, and also one that would say, "yep, it's time to get back on the meds," without having to go through the train wreck getting there.
antigua
Posted by Cécile on February 5, 2009, at 11:29:29
In reply to Depersonalization and Effexor..., posted by jms600 on January 31, 2009, at 12:37:16
> Hi,
>
> Does anyone know if Effexor / venlafaxine can help with depersonalization and derealization caused by severe anxiety??
>
> ThanksHi,
I started taking Venlafaxine (extended release capsules) 6 months ago for extreme anxiety and panic and even more severe chronic depersonalisation and derealisation disorder. My depersonalisation was so bad that I was too scared to stand up/speak/be left alone etc and was on the verge of being sent to psychiatric hospital when I started on effexor.
I am now almost fully recovered with hardly any of my former symptoms so from my point of view, Venlafaxine has been a complete miracle. Obviously this medication wouldn't work for everyone but it is definitely worth a try.
Posted by SLS on February 5, 2009, at 13:35:28
In reply to Re: Depersonalization and Effexor..., posted by Cécile on February 5, 2009, at 11:29:29
Hi Cécile.
Thanks for posting your experience with Effexor. It was extremely helpful.
- Scott
> > Hi,
> >
> > Does anyone know if Effexor / venlafaxine can help with depersonalization and derealization caused by severe anxiety??
> >
> > Thanks
>
> Hi,
>
> I started taking Venlafaxine (extended release capsules) 6 months ago for extreme anxiety and panic and even more severe chronic depersonalisation and derealisation disorder. My depersonalisation was so bad that I was too scared to stand up/speak/be left alone etc and was on the verge of being sent to psychiatric hospital when I started on effexor.
>
> I am now almost fully recovered with hardly any of my former symptoms so from my point of view, Venlafaxine has been a complete miracle. Obviously this medication wouldn't work for everyone but it is definitely worth a try.
>
>
>
This is the end of the thread.
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