Psycho-Babble Medication Thread 1105566

Shown: posts 1 to 10 of 10. This is the beginning of the thread.

 

high dose of venlafaxine (effexor)

Posted by longrunner on August 2, 2019, at 6:53:22

hi,
i am treated with venlafaxine for 6 years for depression.
till 3 months ago I took 300 mg, then the med stopped working.
from exploring the web I've learnt that higher dosages can be given, and indeed 450 mg was beneficial for me, then 600 mg (after 450 mg stopped doin' the job).
now 600 mg is not enough..
has anyone tried higher doses of this med ? is it safe ?

thanks

 

Re: high dose of venlafaxine (effexor)

Posted by linkadge on August 2, 2019, at 11:54:01

In reply to high dose of venlafaxine (effexor), posted by longrunner on August 2, 2019, at 6:53:22

I personally would not go higher.

The problem is that you saturate the serotonin transporter and then higher doses don't do much. Even at 75mg, you get something like 80% occupancy of the serotonin transporter.

I would lower that back down and look for augmentation strategies. Some doctors use higher doses (possibly) to engage other neurotransmitter systems. For example, at higher doses, Effexor can start to work on norepinephrine and dopamine. However, there are much easier ways to do this.

I would look at augmentation with nortriptyline, or Wellbutrin (if you have not already).

Linkadge

 

Re: high dose of venlafaxine (effexor)

Posted by longrunner on August 2, 2019, at 13:28:56

In reply to Re: high dose of venlafaxine (effexor), posted by linkadge on August 2, 2019, at 11:54:01

i think I will try 675 to 750 mg, not more.
i feel that the episode is at its end and would not want to change "horses" now.
also taking edronax & abilify.
thanks.

 

Re: high dose of venlafaxine (effexor)

Posted by linkadge on August 2, 2019, at 16:21:39

In reply to Re: high dose of venlafaxine (effexor), posted by longrunner on August 2, 2019, at 13:28:56

You could swap endronax for a more effective antidepressant (say desipramine).

Effexor can cause seizures if the dose is too high.

Linkadge

 

Re: high dose of venlafaxine (effexor)

Posted by longrunner on August 2, 2019, at 20:44:26

In reply to Re: high dose of venlafaxine (effexor), posted by linkadge on August 2, 2019, at 16:21:39

desipramine may be an option, thanks

 

Re: high dose of venlafaxine (effexor)

Posted by linkadge on August 3, 2019, at 8:04:36

In reply to Re: high dose of venlafaxine (effexor), posted by longrunner on August 2, 2019, at 20:44:26

I'm not saying reboxetine can't work (I have no idea), but it seems to have failed enough trials that the FDA decided not to approve it.

With Effexor doses beyond (say) 150mg, you're likely maxed out on the serotonin effect. Higher doses can provide additional norepinephrine and dopamine reuptake inhibition, but Effexor is still pretty weak in this regard.

Endronax is fairly selective for norepinephrine. Bupropion is a bit more balanced for norepinephrine and dopamine, which may make it better for augmentation. I would consider Wellbutrin and desipramine to be more effective antidepressants than endronax.

Linkadge

 

Re: high dose of venlafaxine (effexor)

Posted by longrunner on August 3, 2019, at 8:34:50

In reply to Re: high dose of venlafaxine (effexor), posted by linkadge on August 3, 2019, at 8:04:36

Edronax alone is weak but is great as an adjunct to serotonergic meds. Even prof. Stephen Stahl writes about this med in one of his books, and he is an American..
My problem is that as of today I need 24 mg from it in order to get it work, far over the maximal recommended dosage.
Since my condition is getting better and better along the last 6 years, I wanna believe that the need to raise the doses of my 2 meds is part of the healing process, anyone here with a similar experience ?
maybe Dr. Bob wants to comment here. how do I refer him to my question ?

 

Re: high dose of venlafaxine (effexor)

Posted by linkadge on August 3, 2019, at 10:16:16

In reply to Re: high dose of venlafaxine (effexor), posted by longrunner on August 3, 2019, at 8:34:50

In theory, reboxetine should be as effective as any other norepinephrine reuptake inhibitor. However, a drug like atomoxetine for example (a potent NRI) has little / no antidepressant effects. Reboxetine could be a decent adjunct, but yet not super effective on its own right. I'm guessing that if you put reboxetine and desipramine head to head, desipramine would prove a more effective antidepressant.

Some people do need higher doses of meds, and that's not an issue. However, 750mg of Effexor is a really high dose and it may be indicative of other issues. For example, have you been tested for ADHD? It's possible that the (short term) stimulant like qualities of Effexor could be treating ADHD for a time. Fetzima (levomilnacipran) may also be more effective than endronax.

Have you considered adding a mood stabilizer? Sometimes these meds can help antidepressants work better (via balancing glutamate / gaba systems).

Linkadge

 

Re: high dose of venlafaxine (effexor)

Posted by longrunner on August 3, 2019, at 16:29:22

In reply to Re: high dose of venlafaxine (effexor), posted by linkadge on August 3, 2019, at 10:16:16

I guess I will give a chance to the 750 mg .
a week ago the doc added to my combo 2.5 mg of abilify, maybe this will help.
as for ADHD - I do suffer from difficulty to concentrate , but depression itself causes attention deficit..

 

Re: high dose of venlafaxine (effexor)

Posted by linkadge on August 3, 2019, at 17:33:48

In reply to Re: high dose of venlafaxine (effexor), posted by longrunner on August 3, 2019, at 16:29:22

Just be sure to monitor blood pressure as it can be an issue with higher doses of venlafaxine (especially with endronax on board).

Should this dose of venlafaxine not help, there are other options. Hitting a different target may be of help.

Linkadge


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