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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by hemingwaykitten on September 30, 2009, at 22:33:32
Any info about Effexor XR jumping ship and leaving you high and dry would be appreciated. After 10 years, I have none to very little response to my 450 mg/dy of Effexor. MDD/GAD symptoms reappeared 2 months ago. Still responding to 1 mg/Klonopin 3x/dy as needed.
I'm back in college at 42 and the anxiety is overwhelming. I began treatment for MDD and GAD at 19. Effexor XR has quit working after 10 years (started 1999). I have all the symptoms of lack of serotonin, and MORE anxiety than when I started the drug.
I'm frustrated by Pdocs now trying to augment the Effexor XR with drugs which NEVER WORKED for me when I tried them the first time. List of failed drugs is LONG. Pamelor, BuSpar, Zoloft, Paxil, Wellbutrin, Provigil, Lexapro, Celexa, Neurontin, probably more I've forgotten. Prozac worked 1997-98 and pooped out. Effexor XR started at that point. It WAS my miracle drug.
I'm rapidly losing functionality. I can dress and feed myself, but have to force myself not to hide under the bed from fear. I was an avid reader, now I can't focus, comprehend or read properly. Extreme noise sensitivity, migraine-prone, easily distracted. Cannot organize my thoughts or keep up with simple homework or chores. Disability Services at college can only help so much with my instructors. No other drama, I should having the time of my life in school.
Augmentation with Clonidine, BuSpar both a bust. Now augmenting with Prozac and Neurontin. No response yet. I don't see the point. I've been through withdrawal of Effexor XR twice to try Celexa and Lexapro due to side effects. Withdrawals were not a party but managable with some Prozac to extend Effexor XR half-life.
I DON'T UNDERSTAND. ARE PDOCS THAT SCARED OF EFFEXOR? My opinion is start me on a different SNRI or give me ECT. I need a big gun for this beast. I can't flunk out of college after waiting 24 years for the opportunity to attend. 24 years of MDD/GAD making me a spectator in my own life is ENOUGH!
All feedback is appreciated, thanks!
Posted by psych chat on September 30, 2009, at 23:20:05
In reply to HELP! 10 years on Effexor XR - now it quits on me!, posted by hemingwaykitten on September 30, 2009, at 22:33:32
Sorry to hear about your troubles. I was once on the SSRI/SNRI merry go round for way too long.
If I understand correctly, for atypical depression, after Effexor, it's common protocol to try a second trial of Wellbutrin as an augment, before moving on to another drug class. If that doesn't work, you might want to check into Remeron or a MAOI. Ensam may be a good MAOI to start with, but that alone may increase your anxiety.
For depression that's not atypical, Lamictal may be worth exploring as a next step.
Go to this algorithm chart and click on "consultation" or "flow chart" to check your options if you don't want to go through numerous, time-consuming, miserable SSRI/SNRI trials that seem to causing adverse effects to your education endeavors.
http://mhc.com/Algorithms/ver4/startDep.html
Good luck to you. Maybe starting school led to your symptom changes and they will subside in time?
Posted by hemingwaykitten on October 1, 2009, at 20:54:37
In reply to Re: HELP! 10 years on Effexor XR - now it quits on me!, posted by psych chat on September 30, 2009, at 23:20:05
> Sorry to hear about your troubles. I was once on the SSRI/SNRI merry go round for way too long.
>
> If I understand correctly, for atypical depression, after Effexor, it's common protocol to try a second trial of Wellbutrin as an augment, before moving on to another drug class. If that doesn't work, you might want to check into Remeron or a MAOI. Ensam may be a good MAOI to start with, but that alone may increase your anxiety.
>
> For depression that's not atypical, Lamictal may be worth exploring as a next step.
>
> Go to this algorithm chart and click on "consultation" or "flow chart" to check your options if you don't want to go through numerous, time-consuming, miserable SSRI/SNRI trials that seem to causing adverse effects to your education endeavors.
>
> http://mhc.com/Algorithms/ver4/startDep.html
>
> Good luck to you. Maybe starting school led to your symptom changes and they will subside in time?
>
>
>
>Thanks for the info, the algorithm is great! I followed the steps and came up with Effexor XR augmented with Prozac and Wellbutrin.
Today a new Pdoc at the local nuthouse ER took me off the BuSpar and gave me Prozac 20mg/dy and Neurontin titrating up from 100mg/dy to 300/dy. Could not sway her to give me Wellbutrin.
Did a short trial of Remeron several years ago with terrible side effects, limb heaviness and unable to move much. Let's hope I don't have to go to an MAOI. Lots of contraindications with those.
The Prozac makes sense to me, even if only to ease the withdrawals if I end up going off Effexor. The Neurontin makes no sense--it didn't work in conjunction with Effexor 4 years ago. However, with my Effexor at 450mg/dy it appears no one wants to prescribe Wellbutrin because it is another stimulant. I'll keep my head up and hope to function well enough not to fail my classes.
If there are other opinions out there, PLEASE share! There's no such thing as too much information when you are faced with going down the rabbit hole!
Posted by psych chat on October 17, 2009, at 18:27:24
In reply to Re: HELP! 10 years on Effexor XR - now it quits on me!, posted by hemingwaykitten on October 1, 2009, at 20:54:37
How's the Prozac working out for you?
I took Wellbutrin with Effexor years ago. That combination worked great, for a while. I don't see what the problem is for your taking that combo.
Hope you are doing better, take care.
Posted by hemingwaykitten on October 18, 2009, at 1:15:22
In reply to Re: HELP! 10 years on Effexor XR - now it quits on me! » hemingwaykitten, posted by psych chat on October 17, 2009, at 18:27:24
It's been...odd. Effexor had definitely given up the ghost--the only way I know I used to take Effexor is finally my muscle tension is gone! The few times I missed my dose of Effexor, I would often figure it out because I could actually relax enough to take a nap that day.
The Prozac is taking up the slack serotonin wise--I forgot how SSRIs make you soooooooo fatigued and sleepy! Now I remember why I started Wellbutrin in the first place, to combat the SSRI fatigue. The last combination I had was Prozac and Provigil, which worked well until Effexor rocked my world.
I've been wallowing around the house over fall break at school. I've kind of been desperate for norepinephrine and dopamine, to tell the truth. I went to GNC and got a big bottle of L-Tyrosine, the amino acid supplement which is made into nor/dop. I'm taking 2000mg before bed, and I have felt better over the past week. More ambitious than watching TV!
My psych was afraid of what Effexor withdrawal would do, I believe. Its not a party, but so far it hasn't been bad. At this point I have titrated down from 450mg Effexor to 150mg/dy, simultaneously going up from 20mg Prozac to 60mg/dy. The Prozac is working, my brain is screaming for nor/dop, but the L-Tyrosine seems to be helping that. I just have to hang on long enough to get the Effexor OUT!!!
Psych won't prescribe 2 stimulant based meds (Wellbutrin and Effexor) at the same time so she insists I be free of Effexor before I get the Wellbutrin. Private psychs are not so cautious, but I see the one from my university student health center. The only ones MORE CAUTIOUS are the psychs in subsidized public health--which I understand, they get so many drug seekers.
Thanks for letting me ramble (no focus or organizational skills here yet) and thanks very much for asking after me. I appreciate it.
This is the end of the thread.
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