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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by never2late on February 4, 2012, at 16:23:31
I have been taking effexor for 2 months working up from the starter dose and am not at 150. I also take klonopin. I used to take the klonopin only at night to stop racing thoughts and to fall asleep. Over the last week I have been feeling very restless. I no longer feel the anxiety that plagued me before, but this restless feeling and low moods is annoying. I tried taking klonopin during the day thinking that it was just a sign of anxiety ( my doc told me I could).
I called my doc and left him a message Friday, he should get back to me on monday. In the meantime, any ideas why all of a sudden I am experiencing low moods and restlessness? I have been on 150 for 3 weeks. Upon starting the drug I had knock out sleepiness which is why I take it at night.
I also take Conerta 54 during the day which gives me a mental energy boost to study and work ( i also have add). Effexor has eliminated my anxiety in most situations and for a while elevated my mood (relieved my unipolar depression), now I feel as if I have sunk halfway back into the abyss.
Any ideas? I dont think it is the Concerta as it seems to have a calming effect on me. I only added the klonopin during the day to try to rid myself of the restless feelings which I thought were anxiety.
Restlessness for me is that I am never satisfied with anything, I constantly feel like I need to do something but lack the motivation to do it. Even when I do accomplish my goals for the day the feeling remains thus leaving me in a low mood depressed state.
Any thoughts would be very appreciated.
Posted by tensor on February 5, 2012, at 4:16:10
In reply to Return of Depression on Effexor, posted by never2late on February 4, 2012, at 16:23:31
> I have been taking effexor for 2 months working up from the starter dose and am not at 150. I also take klonopin. I used to take the klonopin only at night to stop racing thoughts and to fall asleep. Over the last week I have been feeling very restless. I no longer feel the anxiety that plagued me before, but this restless feeling and low moods is annoying. I tried taking klonopin during the day thinking that it was just a sign of anxiety ( my doc told me I could).
>
> I called my doc and left him a message Friday, he should get back to me on monday. In the meantime, any ideas why all of a sudden I am experiencing low moods and restlessness? I have been on 150 for 3 weeks. Upon starting the drug I had knock out sleepiness which is why I take it at night.
>
> I also take Conerta 54 during the day which gives me a mental energy boost to study and work ( i also have add). Effexor has eliminated my anxiety in most situations and for a while elevated my mood (relieved my unipolar depression), now I feel as if I have sunk halfway back into the abyss.
>
> Any ideas? I dont think it is the Concerta as it seems to have a calming effect on me. I only added the klonopin during the day to try to rid myself of the restless feelings which I thought were anxiety.
>
> Restlessness for me is that I am never satisfied with anything, I constantly feel like I need to do something but lack the motivation to do it. Even when I do accomplish my goals for the day the feeling remains thus leaving me in a low mood depressed state.
>
> Any thoughts would be very appreciated.I think the rational to do is to raise the dose of Effexor to 225mg and see how you respond. If partial responsive you can go up to 300mg. This under your doctors supervision of course.
Posted by SLS on February 5, 2012, at 6:17:37
In reply to Re: Return of Depression on Effexor » never2late, posted by tensor on February 5, 2012, at 4:16:10
> I think the rational to do is to raise the dose of Effexor to 225mg and see how you respond. If partial responsive you can go up to 300mg. This under your doctors supervision of course.
Good advice.
If you sustain only a partial, but significant response to Effexor 300 mg, you have a plethora of augmentation strategies available.
Personally, I found that adding nortriptyline to Effexor helped me more than Effexor alone.
- Scott
Posted by bleauberry on February 5, 2012, at 6:50:20
In reply to Return of Depression on Effexor, posted by never2late on February 4, 2012, at 16:23:31
The first thing I notiuced is effexor aint doing a good job for you. But it's only been 3 weeks. If you are still like this in another 3 weeks, then that sucks because it would mean effexor was a bad choice and now the awful withdrawals are ahead of you if you want to move on to something that might actually work for you.
Need to try high doses of folate and B12 before abandoning as augmentation before abandoning.
Need to try adding rhodiola before abandoning.
The concerta could be a double edged sword because while it might be helping you function it is likely simultaneously not helping, or worsening, whatever the actual underlying biochemical problem is.
As an example. Assume someone has a moderate degree of adrenal fatigue. The snapshot of a single moment in time from a lab test is useless so symptoms count more than lab. Ok. Concerta is probably going to help them function because it's going to provide the umph the adrenals are not doing. The problem is it will also overdrive and overtax the adrenals in the process, making the adrenal fatigue even worse, and creating yet even more bizarre puzzling things that cause you and your doctor to scratch your heads in confusion.
Posted by SLS on February 5, 2012, at 8:04:13
In reply to Re: Return of Depression on Effexor, posted by bleauberry on February 5, 2012, at 6:50:20
> The first thing I notiuced is effexor aint doing a good job for you.
Effexor doesn't often do a good job until a dosage of 300 mg/day is reached. I don't believe that any conclusions can be rendered at a low dosage, even if another 6 weeks were allowed to expire.
- Scott
Posted by polarbear206 on February 5, 2012, at 10:03:35
In reply to Re: Return of Depression on Effexor, posted by SLS on February 5, 2012, at 8:04:13
Effxor is an excellent antdepressant. My sweet spot is 300mg. I agree with Scott. IMOP I would proceed with caution with a stimulat and an Snri.
Posted by polarbear206 on February 5, 2012, at 10:04:34
In reply to Re: Return of Depression on Effexor, posted by SLS on February 5, 2012, at 8:04:13
Effxor is an excellent antdepressant. My sweet spot is 300mg. I agree with Scott. IMOP I would proceed with caution with a stimulat and an Snri.
Posted by ed_uk2010 on February 5, 2012, at 15:36:03
In reply to Return of Depression on Effexor, posted by never2late on February 4, 2012, at 16:23:31
>Effexor... I have been on 150mg for 3 weeks.
Before you took 150mg, were you taking 75mg? How were you feeling on the lower dose? I'm interested that you say the restless feeling has only recently started, while you are on the higher dose. Is this restless feeling something you've experienced before?
Posted by never2late on February 5, 2012, at 16:06:17
In reply to Return of Depression on Effexor, posted by never2late on February 4, 2012, at 16:23:31
Thanks for the responses everyone.
I am taking folate 1 mg a day along with d3 5000 mg daily (per my doc). I was deficient in both when I had my blood test.
I would say that the restless feeling has always been there, it is just more severe now. Between 75 and 112 (i think that was the dosage) I had periods of relief from the reestlessness that were brief in duration. It felt like mood swings. My doc told me the periods of relief that I was experiencing was a good sign, that I Effexor may be a good fit for me. At that point he briefly discussed augmentation for dealing with mood swings if they continued in the future. I believe he said he thought Depakote could be an option down the road.
The restlessness now feels constant and impacts daily basis. I dont feel like I am accomplishing anything and therefore I question my decisions.
I have read many posts about higher dosages of effexor being needed to treat both anxiety and depression. But I have also read about about sh*tty tapering down is if it discontinued.
Does anyone agree that the "flashes" of relief I experienced before this downturn mean that the effexor is the right fit for me? I am sleeping at night and it is getting easier to et up out of bed than it was when I first started it. But this restlessness is negatively impacting my mood and mindset.
Again any comments or advice would be very appreciated. Thanks again for everyones advice so far.
Posted by papillon2 on February 5, 2012, at 18:38:21
In reply to Re: Return of Depression on Effexor, posted by never2late on February 5, 2012, at 16:06:17
I experienced a distinct boost in anti-depressant effect from each doseage increase. I've come across many anecdotal reports of the same. The effect is almost immediate.
Tapering off Effexor is the hardest at the pointy end (75mg to 37.5mg, 37.5mg to opening the capsule and dumping half). Reductions at the higher end aren't rainbows and lollipops -- just as you experience a definite anti-depressant effect at doseage increases, you experience a definite depressant effect from doseage reductions! -- but they are bearable. I would take Effexor again in a heartbeat and I went through Effexor withdrawal hell.
I say keep pushing it up, with your pdoc's approval. Effexor can a very good anti-depressant, you have TONNES of room to go (I was on 375mg to 450mg!).
Posted by phidippus on February 8, 2012, at 16:54:51
In reply to Return of Depression on Effexor, posted by never2late on February 4, 2012, at 16:23:31
>I also take klonopin.
Klonopin can cause depression, it antagonizes 5hta receptors.
>I have been taking effexor for 2 months working up >from the starter dose and am not at 150.
150 is a lower a dose. It may be time to raise your dose.
>Any ideas?
Raise your Effexor to 300ish dose and switch from clonazepam to Ativan.
Restlessness sucks. I get the same feelings from time to time. There's nothing wrong in just busying yourself.
Eric
Posted by never2late on February 8, 2012, at 22:45:47
In reply to Return of Depression on Effexor, posted by never2late on February 4, 2012, at 16:23:31
Thanks for your responses guys. I still havnt heard back from my doctor. I guess he is just waiting till I see him on Monday to speak with me.
I would like to raise my effexor dosage and am not really afraid of tapering if it dosnt work. I have read people saying that they had bad side effects if they missed their dose by a couple of hours. I dont have that. I take it before I go to bed and sometimes that varies by a few hours depending on what I am doing. I never really have any of the horrendous effects that I have read.
I am curious about klonopin causing depression. If Ativan is also a benzo wouldnt it have the same effect on receptors as Klonopin? Whats the difference- the half life? How would one be better than the other?
Posted by tensor on February 9, 2012, at 3:52:58
In reply to Re: Return of Depression on Effexor, posted by never2late on February 8, 2012, at 22:45:47
> Thanks for your responses guys. I still havnt heard back from my doctor. I guess he is just waiting till I see him on Monday to speak with me.
>
> I would like to raise my effexor dosage and am not really afraid of tapering if it dosnt work. I have read people saying that they had bad side effects if they missed their dose by a couple of hours. I dont have that. I take it before I go to bed and sometimes that varies by a few hours depending on what I am doing. I never really have any of the horrendous effects that I have read.
>
> I am curious about klonopin causing depression. If Ativan is also a benzo wouldnt it have the same effect on receptors as Klonopin? Whats the difference- the half life? How would one be better than the other?
>
>Clonazepam may affect serotonin in a negative way, but I think it's more about benzodiazepines in general depress the CNS. Especially in long-term use.
/t
Posted by SLS on February 9, 2012, at 5:25:17
In reply to Re: Return of Depression on Effexor » never2late, posted by tensor on February 9, 2012, at 3:52:58
> Clonazepam may affect serotonin in a negative way,
Yes. Clonazepam is unique among the BZDs in this way. I think it inhibits the release of serotonin
> but I think it's more about benzodiazepines in general depress the CNS.
Taking Ativan (lorazepam) for an extended period of time while my depression was in remission was not depressogenic. I had no depression at all. Clonazepam beats the crap out of me. It makes my depression worse.
Xanax can act as a euphoriant for some people, and can probably do so indefinitely.
> I am wondering if Valium (diazepam) can produce depression after long-term use. I have a vague recollection of this being described.
- Scott
Posted by tensor on February 9, 2012, at 6:00:59
In reply to Re: Return of Depression on Effexor » tensor, posted by SLS on February 9, 2012, at 5:25:17
> > Clonazepam may affect serotonin in a negative way,
>
> Yes. Clonazepam is unique among the BZDs in this way. I think it inhibits the release of serotonin
>
> > but I think it's more about benzodiazepines in general depress the CNS.
>
> Taking Ativan (lorazepam) for an extended period of time while my depression was in remission was not depressogenic. I had no depression at all. Clonazepam beats the crap out of me. It makes my depression worse.
>
> Xanax can act as a euphoriant for some people, and can probably do so indefinitely.
>
> > I am wondering if Valium (diazepam) can produce depression after long-term use. I have a vague recollection of this being described.
>
>
> - ScottThe same mechanism that makes clonazepam supposedly depressogenic could be the same which makes it effective for social phobia. Though I have never taken lorazepam I'm seriously thinking of trying it.
/t
Posted by never2late on February 10, 2012, at 1:25:02
In reply to Return of Depression on Effexor, posted by never2late on February 4, 2012, at 16:23:31
Yikes. What I thought was helping could actually be hurting. I really am annoyed that I am no longer getting positive effects from the Effexor. I seem to be in a funk that is making me get annoyed with people alot easier. Inner restlessness, which causes me to have a low idiocy threshold. It sucks because I deal with alot of annoying people at work (customers) and it is getting harder to be pleasant.
I do notice I dont feel anxious anymore. I just feel restless depressed and irritable. I am questioning my life decisions one minute then I am feel apathetic for a period of time, then back and forth most of the day.
Unless I drink coffee, it seems to make me happy to drink coffee. Well maybe not happy but more content less depressed. Any thoughts?
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