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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 europerep on December 23, 2009, at 12:39:08
hey there..
i have a question concerning a possible switch from a combination of venlafaxine/mirtazapine to moclobemide, as treatment for a major depression..
i am somewhat desperate, because my current treatment isn't really working any longer, and my psychiatrist (at a university clinic) says she is running out of ideas, too.. currently i am on 600mg venlafaxine and 60mg mirtazapine..anyways, the point is that she is a relatively young doctor and she does everything according to textbook (this is her who said that). for the switch to moclobemide she wants to hospitalize me for "at least a month", with a washout period of 14 days between treatments.. for several reasons this is not really an option, so I'm kind of stuck.. my question would be whether there are people on here who have switched (themselves or others) the same medications, and if yes, how did you go about it?
i mean the half-life of venlafaxine is relatively short, and while some sources say that 14 days are required, others say four to five halflifes, which would be way less in the case of venlafaxine and its active metabolites.. plus i have a relatively rapid metabolization (according to my doctor).. of course I'm scared of a serotonin syndrome, and I don't want to take any risks, but.. well, I wonder whether I shouldn't search a doctor who'd be willing to do a switch outside of a hospital..yeah, that is it.. i'd greatly appreciate anyone who could give me advice on this (or is it a piece of advice? i think that's what my english prof used to tell me ;) ).. thanks!!!
Posted by Phillipa on December 23, 2009, at 12:56:25
In reply to switching from venlafaxine/mirtazap to moclobemide, posted by europerep on December 23, 2009, at 12:39:08
Welcome to babble as you say you are new. Lots of Maoi users here sure there will be many answers. I think most agree with the two week washout period though. Phillipa
Posted by SLS on December 23, 2009, at 13:06:30
In reply to switching from venlafaxine/mirtazap to moclobemide, posted by europerep on December 23, 2009, at 12:39:08
My first reaction is to say that moclobemide usually is not a very effective drug. It can produce improvements as early as in the first week, but one is always having to raise the dosage to maintain the effect until it finally stops working. I haven't seen too many people profit from moclobemide for more than a few months. You are better off trying Nardil or Parnate if you want to pursue MAO inhibitors.
If venlafaxine is partially effective, you might want to add nortriptyline or bupropion to it before discontinuing it. If you are to discontinue venlafaxine and/or mirtazapine, you really should taper them rather than stopping them abruptly. The withdrawal effects can be severe. Perhaps you can begin to taper the mirtazapine while adding nortriptyline or bupropion to the Effexor.
- Scott
Posted by inanimate peanut on December 23, 2009, at 14:46:16
In reply to Re: switching from venlafaxine/mirtazap to moclobemide » europerep, posted by SLS on December 23, 2009, at 13:06:30
I wouldn't think you would necessarily need to be in the hospital for the entire transition. The first week of my washout wasn't that bad. I did end up in the partial program at the hospital after my washout, but I never did end up inpatient. You have to think about how well you know yourself-- could you be a harm to yourself or others? I knew in my case that I would never harm myself or others no matter how bad I got, so I thought inpatient hospitalization was unnecessary. This may be something you need to talk to your support network about to see what they think about you taking this transition in/out of the hospital
Posted by bleauberry on December 23, 2009, at 17:43:04
In reply to switching from venlafaxine/mirtazap to moclobemide, posted by europerep on December 23, 2009, at 12:39:08
Moclobemide has a very poor track record in the real world. There must be some people out there getting benefit from it, but I've never seen them in over 15 years of looking.
What about reducing the effexor dose and adding a different complimentary med to it? I'm thinking Nortriptyline, Desipramine, Milnacipran (Savella in USA).
In the real world, Remeron is actually a rather poor performer as well, so I'm not surprised the combo isn't doing more than it is. Get a REAL med in there...like Nortriptyline or Savella...and you'll be in a whole new ballgame. If your gut tells you Effexor is just not the one, fine, switch to Cymbalta or Zoloft or Paxil. But for pete's sake, don't stay with a loser. Whatever you decide the primary SSRI or SNRI is to be, be absolutely sure it is partnered with one of the NRIs mentioned above.
Posted by West on December 24, 2009, at 8:33:47
In reply to Re: switching from venlafaxine/mirtazap to moclobemide, posted by bleauberry on December 23, 2009, at 17:43:04
Unless you have very mild depression please stay on what you're taking or switch to an SSRI...
Posted by linkadge on December 24, 2009, at 14:25:52
In reply to switching from venlafaxine/mirtazap to moclobemide, posted by europerep on December 23, 2009, at 12:39:08
Switch the mirtazapine to amitriptyline or doxapin. They are better AD's and will still help with sleep. Perhaps lower the effexor a little if in combination with a TCA.
Linkadge
Posted by West on December 29, 2009, at 18:18:38
In reply to Re: switching from venlafaxine/mirtazap to moclobemide, posted by linkadge on December 24, 2009, at 14:25:52
I think there is a tendency here for people to reply with drugs that are helping them now, or have done so in the past.
Adding tricyclics to SSRIs or SNRIs except in very small doses for sleep is not usually necessary or justified. The combination of nortriptyline and sertraline, recommended by a Ken Gilman of psychotropical, remains a popular idea here for some reason - (I found his comments at one time quite interesting, but now see much of his opinions as being coloured by a general distrust of modern antidepressants based purely on their potencies.
Two pure NRIs are already available in Europe anyway. I'm not sure about the additional pharmacological actions of Nort/Desipramine, so there might be something there.
Why are you switching?
Posted by europerep on December 31, 2009, at 13:03:54
In reply to Re: switching from venlafaxine/mirtazap to moclobemide, posted by West on December 29, 2009, at 18:18:38
Hey all,
thanks very much for your answers.. excuse me for not replying earlier, in fact I didn't see my own thread on the babble board, so I figured I did something wrong, or my thread was erased, or something like that.. i only found this through (the 254th) google search "switch venlafaxine moclobemide" :).. anyways..
@philippa:
thanks :)@SLS:
yeah, from reading the board I could already tell that you don't seem to be too fond of moclobemide.. in fact, considering to switch to moclobemide was my own idea, because I read that MAOIs in general are a sort of last line of defense against depression, and without the stupid dietary restrictions it seemed like the perfect drug.. but I guess there are reasons for why it is commercially unsuccessful after all..
I might actually try reducing the mirtazapine, and then replace it with bupropion, maybe that'll do something..@bleauberry
yeah, I think that's what scott hinted at, about efficacy of moclobemide.. I was so convinced that venlafaxine plus mirtazapine would be great, because it seems to be so popular, etc., but now I'm really disappointed.. does switching from my combo to, say, paroxetine plus reboxetine, or something similar (i.e., SRI + NRI), make sense? I mean it's not that venlafaxine doesn't do anything, that's what I saw when I reduced the venlafaxine (because my pdoc said that maybe I'd be better with less - she had never ever had anyone with 600mg) to 375mg, there I stopped and increased it on my own, because it was terrible.. in the end, if increased serotonin from one medication doesn't make me feel better, will increased serotonin from a different agent do the trick? same for the NE..@linkadge:
i've been on amitriptyline before, up to 375mg, and it didn't work any longer (I've had already taken it for, um, 7 years).. that's why I switched to venlafaxine.. after initial improvement, that gradually disappeared, then came back when I raised the amount I took, then disappeared, etc... so amitriptyline doesn't do it, and I'm scared of the sedation of doxepine.. over here it is rarely used, if not in cases of opioid withdrawal for example,..@west:
well, I'm switching because everything has steadily gone downhill for the past six months, all the things I achieved or succeeded at re-introducing into my life (studying,...) are getting more and more difficult to sustain, if not impossible.. the life I am currently living is certainly not worth it for me, so I guess I have to do something..I don't understand the way I am treated at the university clinic.. I mean if I were a psychiatrist, I would be happy to have patients with TRD, I guess I'd have my own statistics for seeing how many patients respond to this or that treatment, etc.. instead I feel like I'm a liability, and every perspective of what I might try next results from my own suggestions.. my doc wants me to keep on taking venlafaxine/mirtazapine because maybe at some point something will happen.. I mean of course I know that I have to be patient, etc., but it's been months on this combo, I don't think much will change by continuing like this.. anyways.. would there be a point in raising mirtazapine? i read about a 600/120 combo here on the board.. if not, I will try venlafaxine plus bupropion..
Posted by West on January 3, 2010, at 11:12:32
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by europerep on December 31, 2009, at 13:03:54
Firstly, I wanted to remind you that in many ways, you are already on the way to remission. By seeking out treatment and alerting those with specialist psychiatric experience, you are already half way there. Try and hold on to this idea, however distant a reality it might seem now.
More pragmatically, there is a chance that adding mirtazapine could improve mood, but it is not something I could gauge with any certainty. Others with experience in this area might be able to help you more. Do YOU think it is a possibility? How are you tolerating it? There are systems at work with higher doses that may worsen sleep, specifically noradrenergic firing. Some depressions respond better than others to drug therapy targetting NE and 5-HT roughly equally.
I need to know how much you think your current depression is the result of your cirmcustances - you mention difficulties studying. I don't know if you ascertain these as being the result of low mood?
Or have you had academic difficulties before becoming depressed? This is potentially a very important question regarding the nature of your diagnosis and further treatment.
Posted by europerep on January 10, 2010, at 10:37:11
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by West on January 3, 2010, at 11:12:32
hi west..
sorry for not replying earlier, but the last week was quite stressful, and I wanted to take some time for writing this..
I actually wanted to go down on mirtazapine, so that I can add bupropion soon, the problem is that at 600 venlafaxine/30 mirtazapine, I started to have some trouble sleeping, i.e. I woke up early in the morning, with difficulties to fall asleep again, or waking up again just a couple of minutes later, and so on.. that is why I decided to go back to 600/60 for the moment, because right now I need to be preparing for the upcoming exams, and for that I really need to have a sound sleep.. plus I am a little better than when I originally started my thread, but still, I am far from being well.. I am still wondering whether I should increase mirtazapine, I might at least have a try at it, but personally I don't think that will be the solution, the improvement I felt when starting to take it, and when increasing dosages, was very minimal..
Were you refering to duloxetine for example when you said that I might profit from a more equal targeting of NE and 5HT?
as for the circumstances.. of course it would be too easy to say that all the problems I currently have are a mere result of the depression.. I have already done a psychotherapy, and I guess I will start another one, so I am certainly not rejecting this approach to improving my current state.. however, there are limits as to what that can do for me, especially in the sense that, the way I feel right now, it would be very, very difficult to introduce substantial changes into my life.. I don't expect a better medication scheme to solve my problems, but merely to get me to the point (where I was already, before effexor lost its effectiveness), where I am confident that I can actually do this..
the difficulties with studying I was refering to are primarily a result of the inability to get up before noon or even later, which I experienced about a week ago.. now that is gone, and I am back to the situation I was used to, which is that I don't have trouble getting up, just that I need more sleep than others (eight to nine hours), in order to be able to study, concentrate, etc..
as for the last question, I did not have academic difficulties before being depressed. in fact, I am still doing rather well in classes etc., but that does not reflect a general state of well-being..thanks for taking the time to read this!
Posted by West on January 16, 2010, at 4:41:55
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by europerep on January 10, 2010, at 10:37:11
Hi, This is a late reply as well. I hope you're still feeling a bit more positive like you said.
I should avoid duloxetine since it's very tiring funnily enough, despite the binding profile. Keep us posted on the 600/60 combo, I would imagine you're getting enough NA action here (but watch out for hypertension and irritability.)
I mentioned academic difficulties since these can be extensions of other underlying attentional disorders, which can themselves cause depression and anxiety. But glad to hear you're doing well in class. Hope this continues.
W
> I actually wanted to go down on mirtazapine, so that I can add bupropion soon, the problem is that at 600 venlafaxine/30 mirtazapine, I started to have some trouble sleeping, i.e. I woke up early in the morning, with difficulties to fall asleep again, or waking up again just a couple of minutes later, and so on.. that is why I decided to go back to 600/60 for the moment, because right now I need to be preparing for the upcoming exams, and for that I really need to have a sound sleep.. plus I am a little better than when I originally started my thread, but still, I am far from being well.. I am still wondering whether I should increase mirtazapine, I might at least have a try at it, but personally I don't think that will be the solution, the improvement I felt when starting to take it, and when increasing dosages, was very minimal..
>
> Were you refering to duloxetine for example when you said that I might profit from a more equal targeting of NE and 5HT?
>
> as for the circumstances.. of course it would be too easy to say that all the problems I currently have are a mere result of the depression.. I have already done a psychotherapy, and I guess I will start another one, so I am certainly not rejecting this approach to improving my current state.. however, there are limits as to what that can do for me, especially in the sense that, the way I feel right now, it would be very, very difficult to introduce substantial changes into my life.. I don't expect a better medication scheme to solve my problems, but merely to get me to the point (where I was already, before effexor lost its effectiveness), where I am confident that I can actually do this..
> the difficulties with studying I was refering to are primarily a result of the inability to get up before noon or even later, which I experienced about a week ago.. now that is gone, and I am back to the situation I was used to, which is that I don't have trouble getting up, just that I need more sleep than others (eight to nine hours), in order to be able to study, concentrate, etc..
> as for the last question, I did not have academic difficulties before being depressed. in fact, I am still doing rather well in classes etc., but that does not reflect a general state of well-being..
>
> thanks for taking the time to read this!
Posted by West on January 16, 2010, at 15:08:10
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by West on January 16, 2010, at 4:41:55
If this doesn't work then consider asking your doc about adding bupropion, though it is often a bit hit and miss. I don't know anything about the noradrenergic tricyclics like desipramine/nortriptyline, but some here are adding them to their primary antidepressants with good results.
Other ideas might be adding a DA agonist (pramipexole, cabergoline, bromocriptine, piribedil (NE effects also, probably more activating than the others), amantadine, any of the psychostimulants (few protocols call for this though). Looking up pramipexole I found this doc's opinion:
"Recently, I have been prescribing ropinirole, which is similar to pramipexole except that it possesses some opioid characteristics. In the few months that I have been prescribing it, I find that patients prefer it to pramipexole and that it is more likely to raise self-esteem than pramipexole or conventional antidepressants. However, it seems to induce sleepiness as a side effect more often than does pramipexole."
W(http://ajp.psychiatryonline.org/cgi/content/full/159/2/320-a)
Posted by europerep on January 18, 2010, at 15:58:39
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by West on January 16, 2010, at 15:08:10
hmm, well last week seems to have been some sort of "interlude", because now I am feeling (much) worse than before, without an apparent reason.. so staying on this combination is certainly not an option.. if I switch to venlafaxine/bupropion, I'd necessarily have to gone down on venlafaxine, because (as I said earlier) when I reduce mirtazapine I start to have a very weird sleep and dreams (just like when I started venlafaxine.. it seems mirtazapine is just so heavily anti-histaminergic that it "offsets" this side effect), and to make things worse, I know that bupropion is associated with similar problems.. since bupropion is purely DA/NE, I wonder whether I'd still have enough action at 5HT.. but I think venlafaxine is already one of the strongest serotonergic agents, no? so I guess adding a third agent wouldn't really make sense, would it?
I did look into dopaminergic agents a little earlier, and I was wondering why they are not more frequently prescribed for depression, or why wikipedia always lists them at best as being on trial for depression, but I think my doc wouldn't prescribe me something "experimental" before I haven't spent 1/2 year hospitalized trying all kinds of "regular" meds..
I know it's not how it is supposed to be, but I guess I will start to try what I think is best for me.. I did already obtain a box of bupropion some time ago, haven't touched it yet, but I guess I'll go with that now, after I have stopped taking mirtazapine..
some time ago my doc was mentioning lithium as an add-on strategy, indeed there are some studies suggesting effectiveness for TRD, but is it a good idea? I mean of course one never knows which medication might work, but I am sure there are certain strategies that are (purely statistically) more likely to help than others..
Posted by conundrum on January 19, 2010, at 6:12:18
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by europerep on January 18, 2010, at 15:58:39
bupropion is not very strong on norepinephrine. It works more through dopamine and nitric oxide. If you need norepinephine you may need to add a NRI just for that.
Posted by europerep on January 19, 2010, at 9:54:54
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by conundrum on January 19, 2010, at 6:12:18
hm, I just saw my doc, she really knows how to make me feel hopeless.. and when I asked her which MAOIs are existing in my country, she didn't even know, but she assured me she can look it up.. great.. but anyway, in the end it doesn't matter that much who signs my prescriptions..
i now have a prescription for lithium, but I am not sure whether to go with that, or to try bupropion.. can anyone give me advice? i guess it's like throwing a coin, but.. hey, who knows, maybe I'm actually gonna do that.. ;)
Posted by conundrum on January 19, 2010, at 11:05:10
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by europerep on January 19, 2010, at 9:54:54
My pdoc equated trying to find the best treatment like throwing darts at a board randomly.
Posted by West on January 20, 2010, at 8:37:56
In reply to Re: switching from venlafaxine/mirtazap to moclobe » europerep, posted by conundrum on January 19, 2010, at 11:05:10
Usually lithium/lamotrigine or an typical antipsychotic like olanazapine are used to augment SSRIs, personally I would prefer to try lamotrigine before lithium, but I've no idea about which has better efficacy. Then again I have trouble dealing with side effects a lot of the time, I had akathisia from 7.5mg mirtazapine.
I do think that while bupropion is somewhat dopaminergic, it is a bigger hitter of NE, and can give you a right kick up the posterior.
Give that a shot first if you're doc's willing before trying lithium/lamotrigine, maybe add a something like zopiclone at night initially to help you get to sleep. I take it with a sedating antihistamine called doxylamine which also has hypnotic properties and find it to have less hangover than diphenhydramine, though either will do (and probably lots more like it.)
I actually found less twitchiness and agitation from high dose venlafaxine with bupropion on board (or perhaps noticed it less), maybe because of the dopaminergic action. Some people find the opposite and feel dysphoric. This might be explained by its blocking the release of dopamine as well as its uptake.
Posted by europerep on January 24, 2010, at 10:39:58
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by West on January 20, 2010, at 8:37:56
hmm, well she told me that lithium augmentation and quetiapine augmentation were the only possibilites left that would not require a washout-period, i.e. stopping venlafaxine.. she didn't even mention bupropion and lamotrigine, but I will certainly try these before stopping venlafaxine..
I will go with lithium for now, since it is a quite well documented augmentation, also the CANMAT (Canadian Network for Mood and Anxiety Treatment) psychopharmacological guidelines of 2009 give it as the first augmentation strategy to be tried.. I'm a little scared about it, from what I've read here on the board, but then, some people (in the studies) achieved remission with it, so who knows..
i do still have a prescription for zolpidem from a while ago, and my doc certainly wouldn't hesistate to give me another one if I asked for it, but I have to say I'm a little wary of these "Z-substances".. I mean I know they are not benzos, but I try to stay away from anything that has an abuse or dependency potential, because I really do not want to add a substance issue to my already quite f##ked up situation..I believe - it's what my doc suggested - that I have a very fast metabolism, which does also make sense seeing how much i eat without gaining weight (well, on mirtazapine I have, but I think that is just the typical side effect).. that might explain why I do not show symptoms associated with high dose venlafaxine (as you said, twitchiness etc., high blood pressure, and so on)..well, anyway..
on sciencedirect.com i found an article on four cases of resistant depression with partial response to venlafaxine, which was treatable by adding a SSRI (sertraline, paroxetine, citalopram) to the venlafaxine.. sounds strange, but it did actually work, one patient even had ECTs before, and with the combo she was in remission for nine months or so when the article was written.. maybe that would be an option, too.. I'll see, first I'll try the lithium anyway..
oh btw, west, I thought you were a doctor who gave his advice to people on the board :) , but now I see you are "only" a patient too, right?..
Posted by West on January 25, 2010, at 7:18:01
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by europerep on January 24, 2010, at 10:39:58
> hmm, well she told me that lithium augmentation and quetiapine augmentation were the only possibilites left that would not require a washout-period, i.e. stopping venlafaxine.. she didn't even mention bupropion and lamotrigine, but I will certainly try these before stopping venlafaxine..
She is wrong about this. Venlafaxine doesn't appear to have any siginificant interaction with the cytochrome P450, in which the metabolism of so many drugs are involved, including bupropion (a CYP2D6 inhibitor). As I mentioned I have taken both and survived. The two have been combined safely in cases of refractory depression in at least two (admittedly anecdotal) documented cases in medical literature. The STAR*D algorithm also mentions it - you and your doctor should be looking at this right now - it was designed to address patients in exactly your current situation.
> I will go with lithium for now, since it is a quite well documented augmentation, also the CANMAT (Canadian Network for Mood and Anxiety Treatment) psychopharmacological guidelines of 2009 give it as the first augmentation strategy to be tried.. I'm a little scared about it, from what I've read here on the board, but then, some people (in the studies) achieved remission with it, so who knows..
This, among others is one option. Please do consider the others outlined in STAR*D.
> i do still have a prescription for zolpidem from a while ago, and my doc certainly wouldn't hesistate to give me another one if I asked for it, but I have to say I'm a little wary of these "Z-substances".. I mean I know they are not benzos, but I try to stay away from anything that has an abuse or dependency potential, because I really do not want to add a substance issue to my already quite f##ked up situation..
This is something to be concerned about I agree. It depends on how serious the situation is. Like anything, it will be a study in risk vs benefit.
> I believe - it's what my doc suggested - that I have a very fast metabolism, which does also make sense seeing how much i eat without gaining weight (well, on mirtazapine I have, but I think that is just the typical side effect).. that might explain why I do not show symptoms associated with high dose venlafaxine (as you said, twitchiness etc., high blood pressure, and so on)..well, anyway..
>
> on sciencedirect.com i found an article on four cases of resistant depression with partial response to venlafaxine, which was treatable by adding a SSRI (sertraline, paroxetine, citalopram) to the venlafaxine.. sounds strange, but it did actually work, one patient even had ECTs before, and with the combo she was in remission for nine months or so when the article was written.. maybe that would be an option, too.. I'll see, first I'll try the lithium anyway..I would venture to say that adding drugs with opposing mechanisms of action might have a greater outcome both in tolerability and efficacy. But it sounds as if, since you're suggesting it, you might benefit from a stronger serotonergic action. If this is the case, consider whether the bottom of venlafaxine, primarily an SSRI, has simply fallen out altogether. In which case you should be looking at switching to escitalopram or sertraline, perhaps augmenting a second drug as per the STAR*D algorythm
> oh btw, west, I thought you were a doctor who gave his advice to people on the board :) , but now I see you are "only" a patient too, right?..
You flatter me :) I am my own doctor...we all are here!
Posted by europerep on January 25, 2010, at 14:43:09
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by West on January 25, 2010, at 7:18:01
>
> She is wrong about this. Venlafaxine doesn't appear to have any siginificant interaction with the cytochrome P450, in which the metabolism of so many drugs are involved, including bupropion (a CYP2D6 inhibitor). As I mentioned I have taken both and survived. The two have been combined safely in cases of refractory depression in at least two (admittedly anecdotal) documented cases in medical literature. The STAR*D algorithm also mentions it - you and your doctor should be looking at this right now - it was designed to address patients in exactly your current situation.1) yes i know, i did also find a psychopharmacology manual advising the combo, so I am definitely going to try it out.. I think my doc won't have none of that, since, quite frankly, she believes to be the ultimate source of pharmacological knowledge, but that is not the problem.. I did already obtain a box of bupropion by consulting a different doctor and telling her I was regularly taking it, so she give me a prescription for it.. if necessary, I'll just do that again.. I did not take it yet, because, as I mentioned earlier, when reducing mirtazapine I had sleeping troubles.. so far (yesterday was the first day w/o mirtazapine, the days before 15mg) I haven't had any problem sleeping, maybe because I shifted the venlafaxine from 300-150-150 to 375-150-75.. I'm such a genius ;)
at any rate, I will certainly not let these options "untouched", I just have to say that slowly I am wondering what for, because, unless the medication I am taking and I have taken did not produce its pharmcological effect (i.e., raising neurotransmitter concentration), then different meds doing effectively the same thing won't do the trick.. also, I read that reserpine, which depletes neurotransmitters, did only induce depression in a small group of individuals, so there has to be more to depression than just the monoamine hypothesis.. well, I'll see..>
> This, among others is one option. Please do consider the others outlined in STAR*D.2) I will, but, you know, if I lose another eight weeks now, that is just a drop in the ocean..
>
>
> This is something to be concerned about I agree. It depends on how serious the situation is. Like anything, it will be a study in risk vs benefit.
>
>
> I would venture to say that adding drugs with opposing mechanisms of action might have a greater outcome both in tolerability and efficacy. But it sounds as if, since you're suggesting it, you might benefit from a stronger serotonergic action. If this is the case, consider whether the bottom of venlafaxine, primarily an SSRI, has simply fallen out altogether. In which case you should be looking at switching to escitalopram or sertraline, perhaps augmenting a second drug as per the STAR*D algorythm3) well, I don't know whether it's serotonin, or NE, or DA, that is missing, or maybe all three.. I just found the extraordinary response to venlafaxine+SSRI quite impressing, especially after ECT..
>
> > oh btw, west, I thought you were a doctor who gave his advice to people on the board :) , but now I see you are "only" a patient too, right?..
>
> You flatter me :) I am my own doctor...we all are here!4)yeah, true.. unfortunately :(
>
This is the end of the thread.
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