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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Petrucci914 on May 21, 2010, at 18:14:02
Hello everyone,
I've been on a ton of anti-depressants, mood stabilizers, and atypical antipsychotics. I finally had success with Effexor XR. I'm currently at 300mg and it has helped immensely with my GAD, Social Phobia, and OCD. It has also helped my ambition and motivation quite a bit. The problems I'm still having consist of lack of energy, fatigue, and trouble waking up in the morning. What could I add to the Effexor XR or what are my other options?
I see the following:
1. Increase Effexor XR to 450mg.
I believe a few people have done this before, but it seems like it could be a bit too high.2. Add Remeron
This combination has been quite popular but I'm afraid of it sedating me even more, even if I start at 30mg. I also don't need my appetite increased, as it is already too high.3. Add Wellbutrin
This was the first Antidepressant that worked great for me but it pooped out after about 2 months. I'm not sure if it would be more effective with Effexor, or if I'd be wasting my time again.4. Add Abilify
I've tried it on its own, and with Zoloft and it didn't do anything. Granted, I don't think I gave it adequate time. Also afraid of it increasing my weight.Thoughts and ideas are appreciated! Thanks!
Posted by linkadge on May 21, 2010, at 18:25:34
In reply to Effexor XR Combinations - My Options?, posted by Petrucci914 on May 21, 2010, at 18:14:02
What about some strong morning coffee? Have / do you drink coffee?
Linkadge
Posted by Petrucci914 on May 21, 2010, at 19:10:18
In reply to Re: Effexor XR Combinations - My Options?, posted by linkadge on May 21, 2010, at 18:25:34
Coffee actually makes me very tired and drowsy. Weird, I know. Plus, I'd have to get out of bed to get the coffee.
Posted by linkadge on May 21, 2010, at 20:26:34
In reply to Re: Effexor XR Combinations - My Options? » linkadge, posted by Petrucci914 on May 21, 2010, at 19:10:18
Sometimes I put the coffee maker right by the bed and have it filled and ready to go (timer) for morning.
If coffee doesn't work, bright light, provigil, methylphenidate / amphetamine, vitamin D, wellbutrin, desipramine may help. (not all at once of course)
Linkadge
Posted by Petrucci914 on May 21, 2010, at 20:57:02
In reply to Re: Effexor XR Combinations - My Options?, posted by linkadge on May 21, 2010, at 20:26:34
I've tried light boxes, Provigil and Adderall/Ritalin are unpredictable and sometimes make me tired and irritable. Wellbutrin used to work but pooped out on me, not sure if it would start working if I combined it with Effexor.
Posted by stargazer2 on May 21, 2010, at 20:58:19
In reply to Effexor XR Combinations - My Options?, posted by Petrucci914 on May 21, 2010, at 18:14:02
I would try either Wellbutrin or a stimulant, very small dose, to increase your energy. They both worked for me in combination with an AD.
Good luck.
Posted by Phillipa on May 21, 2010, at 23:20:43
In reply to Re: Effexor XR Combinations - My Options?, posted by linkadge on May 21, 2010, at 20:26:34
Link for real coffee by the bed? Phillipa
Posted by Hombre on May 22, 2010, at 3:40:32
In reply to Effexor XR Combinations - My Options?, posted by Petrucci914 on May 21, 2010, at 18:14:02
I combine Effexor XR and Remeron. I never gained weight from Remeron. The two work together synergistically.
Posted by softheprairie on May 22, 2010, at 4:51:51
In reply to Effexor XR Combinations - My Options?, posted by Petrucci914 on May 21, 2010, at 18:14:02
Have you had a sleep study to test for sleep apnea?
If yes and you have a C-PAP or BiPAP, do you use it?Unfortunately, I think that for the most part people with both anxiety and fatigue are utterly screwed right now, at this point where psychiatric science it at. A few can get adequate treatment of both with an SSRI, but if not, then we basically have to decide which is worse (the anxiety or the fatigue), and maybe treat it some, but for the most part, the treatments for anxiety worsen fatigue, and the treatments for fatigue worsen anxiety. Sorry, I guess that was a pessimistic or depressing statement. Keep trying various things. I did that and am currently pretty pleased with my cocktail (desipramine, Cytomel, perphenazine, and Bystolic).
Posted by linkadge on May 22, 2010, at 6:50:22
In reply to Re: Effexor XR Combinations - My Options?, posted by softheprairie on May 22, 2010, at 4:51:51
and I assume thyroid and B12 have been checked
Linkadge
Posted by Petrucci914 on May 22, 2010, at 20:50:57
In reply to Re: Effexor XR Combinations - My Options?, posted by linkadge on May 22, 2010, at 6:50:22
I have mild Sleep Apnea. I wear a CPAP and it has done nothing in terms of my energy and fatigue. I have had my thyroid and B12 tested and it's been normal.
Posted by softheprairie on May 22, 2010, at 21:00:30
In reply to Re: Effexor XR Combinations - My Options?, posted by Petrucci914 on May 22, 2010, at 20:50:57
> I have mild Sleep Apnea. I wear a CPAP and it has done nothing in terms of my energy and fatigue. I have had my thyroid and B12 tested and it's been normal.
>I'm sorry these things didn't help. I think I/others were going after the low-hanging fruit first (looking for the easiest answers, but you had already done that). My overall persistant fatigue is the main thing keeping me on disability for now. :(
Posted by manic666 on May 23, 2010, at 3:51:44
In reply to Re: Effexor XR Combinations - My Options?, posted by linkadge on May 21, 2010, at 18:25:34
you guys an coffee //i dont drink it //england see i have had 2 mugs of strong tea already an i have only been up 1 hour//strong tea an a splash of milk///good wake up try a redbull energy drink
Posted by linkadge on May 23, 2010, at 6:06:23
In reply to Re: Effexor XR Combinations - My Options?, posted by Petrucci914 on May 22, 2010, at 20:50:57
Not sure what you want us to say! It seems like you have tried all the standard energy boosting medications.
Linkadge
Posted by linkadge on May 23, 2010, at 6:09:07
In reply to Re: Effexor XR Combinations - My Options?, posted by manic666 on May 23, 2010, at 3:51:44
Did you say you have tried amitriptyline, doxapin or surmontil? Alhough traditionally sedating, they can improve sleep quality.
For me they tend to counteract the daytime listlessness I get from escitalopram.
Linkadge
Posted by ed_uk2010 on May 23, 2010, at 9:14:08
In reply to Re: Effexor XR Combinations - My Options?, posted by manic666 on May 23, 2010, at 3:51:44
> you guys an coffee //i dont drink it //england see i have had 2 mugs of strong tea already an i have only been up 1 hour//strong tea an a splash of milk///good wake up try a redbull energy drink
And now they do Redbull in a 'shot'. I didn't try it though. Seems overpriced.
Posted by manic666 on May 23, 2010, at 10:51:13
In reply to Re: Effexor XR Combinations - My Options? » manic666, posted by ed_uk2010 on May 23, 2010, at 9:14:08
when i was a mad drunk//in the morning with a hangover//i would drink a shwepps tonic water ,ice cold///take a big swig an hold it in your mouth//it was like a volcano erupting in your mouth//thousands of bubbles fizzing an popping //it sent a shock wave through your body saying wake up you bum// but dont it have quinine in it, is that good or bad//i think it can make you jittery is that right//shore gave me a wake up call
Posted by europerep on May 23, 2010, at 13:39:05
In reply to Re: Effexor XR Combinations - My Options?, posted by Petrucci914 on May 22, 2010, at 20:50:57
maybe it's already been said, sorry if so, but I'd go ahead with effexor, maybe trying 375mg before 450mg..
also because here effects will be there more or less immediately, and you know whether it works or not.. I am on 600mg/d effexor XR, and I am not the only one, though I admit it's rare..
all this of course if you think that it would be a good idea, if you don't experience side effects that are already hard to take at 300mg, etc..
Posted by ed_uk2010 on May 23, 2010, at 15:03:24
In reply to Re: Effexor XR Combinations - My Options?, posted by manic666 on May 23, 2010, at 10:51:13
>but dont it have quinine in it
Yes, but you'd have to drink a lot of tonic water to overdose.
Posted by Phillipa on May 23, 2010, at 18:56:42
In reply to Re: Effexor XR Combinations - My Options?, posted by manic666 on May 23, 2010, at 3:51:44
Doesn't the milk block the tanin in tea and that's a good things? Phillipa
Posted by Petrucci914 on May 24, 2010, at 18:32:47
In reply to Re: Effexor XR Combinations - My Options? » manic666, posted by Phillipa on May 23, 2010, at 18:56:42
My psychiatrist is giving me Focalin XR to try. I'm a bit skeptical as all stimulants I've tried haven't been very predictable and have made things worse in the past.
I don't think energy drinks are the answer. They don't do anything for me, the same with Caffeine.
Posted by Phillipa on May 24, 2010, at 19:42:18
In reply to Re: Effexor XR Combinations - My Options? » Phillipa, posted by Petrucci914 on May 24, 2010, at 18:32:47
Good luck hope it works for you. Phillipa
Posted by hyperfocus on May 25, 2010, at 20:35:56
In reply to Effexor XR Combinations - My Options?, posted by Petrucci914 on May 21, 2010, at 18:14:02
I think it would be safe to go to 450mg. I have depression comorbid with social phobia and obsessive thoughts too, and my pdoc says that in these cases you may have to go outside the mainstream dosages. If you're tolerating the 300mg well it's worth it to try 450mg.
When do you take the Effexor? It could be you feel better once the blood levels of Effexor peak, but are crappy before. I'd be wary going too far out with other drugs - you don't want to 'upset' your Effexor response too much. I wouldn't be looking at taking an SSRI, for example.
I hope you continue to get better. Good luck to you.
This is the end of the thread.
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