Posted by jrbecker on October 3, 2003, at 10:43:27
In reply to Re: Effexor XR need advice from other users, posted by Robert Fairburn on October 2, 2003, at 18:22:43
Robert,
first things first.
does your doc know your off the effexor. who's helping to make these pharmacological decisions?
Do you and your doc have a plan to get you off effexor? did you taper off? are you using benzo's for the withdrawal.are you cross-tapering onto something else?
effexor withdrawal is not as horrible as many on this board might claim, however, it can be a very bad transition period - even up to a month for some, especially if you're not tapering off right and going onto something else.
thanks for the meds rundown. you mentioned panic attacks. do you suffer from GAD (generalized anxiety) or do you have full-fledged panic attacks? Secondly how bad is the OCD normally (not on effexor and when on other ADs)?Are you aware of the diagnostic distinction between regular (melancholic) depression and atypical depression, or mixed (if mixed, which side is more prevalent)? Which one describes your symptoms. please explain your top five symptoms in descending order. Try to keep the symptoms as objective as possible.
> Ghankyou JRB for a reply to my email
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> I appreciate your well documented and thought out replies. Believe me It helps to get a response from someone who is knowledgable about drugs.
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> At the moment I have been off effexor for 5 days and I have been depressed. However I am not surprised by this due to the fact that effexor really effected my system. Im going to give you a list of drugs that I have taken and there results in the hope that you can see a common thread
>
> Peroxtine - Good results for 2.5 years slowly got ineffective finished using 30/12/2002
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> Lexapro - Didn't upset me however I didn't fix panic attacks (2 months) mind due the panic attacks were not that bad, sometimes I would feel agitated during some days, however I gave it up thinking that maybee another drug would give me a miracle cure. Boy was I dumb in believing such a thing
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> Prozac - I almost wanted to slash my wrists docter tried increasing the dose which made things very much worse ( 2 months)
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> Imipramine - had an interesting result, got improvement in depression caused from bad result with prozac. It seemd to work (in regards to depression) at lower doses, however at higher doses it made me feel depressed, this was due to when I tried to do relaxtion exercises it would agrevate me highly.In short doses below 50mg helped a little while doses over 50 mg ie 75 or 100 mg made me easily depressed. It also increased depression after a panic attack.
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> Dothiepin took this for a month, it didn't help my anxiety and any attempt to work on my anxiety would create a panic attack,( Ihad done breathing exercises when taking peroxtine and didn't get such a extreme reaction or even why I wasn't even on drugs) did get one good result which was that I got a good night sleep, didn't make me feel depressed on average, docter suggested trying another drug to work on my GAD and panic attacks. After stopping this drug I did have trouble getting to sleep
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> Effexor - what a mistake worse experience I have ever had with a drug could only take 19 days before having to completly stop taking it, still feeling very much worse with a inability to stop worrying about being OCD or becoming OCD
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> I have been feeling very depressed and might need to try another drug
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> So what drug should I try ?? Im sort of guessing between Fluvoxamine (Luvax) or Zoloft or Citalopram ( cant be much different to lexapro)
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> Or I could try taking peroxtine again
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> However I am a bit worried about trying anything that raises both seratonin and neophinphrine at the same time like the tricyclics which have a tendancy to make me feel worse at high doses. I am also coming to the conclusion that I might be very dose sensitive and higher doses make me worse while smaller amounts help a little
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> Ok guys what do you think
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> Im especially interesed in what you have to say JRB
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> > Hi Robert,
> >
> > you might be right in that the effexor is worsening your anxiousness, and perhaps even exacerbate your depression. but it's hard to tell. even though you have high levels of noradrenaline (norepinpehrine), this doesn't mean that taking effexor (a serotonin and norephiprine reuptake inhibitor) is going to make your depression worse.
> >
> > this is because, currently, the research is sort of unclear on whether depressive sufferers have increased or decreased norepinephrine (NE) levels. Most studies that have drawn blood sample have shown increased norepinephrine BLOOD levels (like yourself). However, this is only a measure of peripheral NE, not NE in the BRAIN. See, increased NE in the periphery can definitely cause ~physical~
> > symptoms of anxiety (sweating, heart palpiations, startle effect). However, it is unclear whether increased NE in the brain is helping or hindering anxiety/depression -- currently there is good evidence that NE drugs increase neurogenesis - which is thought to be the route of depression.
> >
> > Since this is sort of a more complicated topic, I'd suggest you read this article (it provides a good summary on the role of NE as well as how it's tied to the stress system, the HPA)...
> >
> > http://www.sciam.com/search/search_result.cfm
> >
> > Back to addressing your concerns about effexor,
> > many people have problems beginning on effexor. you should read the Tips section on Effexor (you can find the link at the top of the psycho-babble page). Perhaps you should cut back to 37.5mg tablets and go slow. I would also advise you to take it in the morning if it is disrupting your sleep. Once again, I can assure you that the side effects will decrease, by how much, well I can't tell you since that's individually determined.
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> > couple other notes...
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> > Effexor is a great drug, and it usually works better in cases of atypical depression, not regular unipolar (melancholic) depression. Most melancholics find that an SSRI usually works best. This is a general theory, not a rule. But there was probably a reason why your doc put you on effexor besides effexor being known to be good for GAD and depression, can you infer what those reasons were? were there any other options discussed?
> >
> > Have you been taking benzo's and have they been helping?
> >
> > I'd suggest you stick it out for 2-3 weeks and then see if you're fairing better. If not, maybe a simple SSRI, like Lexapro, Celexa, or Paxil is better for you.
> >
> > good luck, keep in touch with us.
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> > JRB
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> > > In reply to your questions
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> > > 1 Before taking the med I was suffering from GAD but not OCD or depression now I feel depressed plus slightly OCD.
> > >
> > > 2 I am taking the 75 mg at dinnertime
> > >
> > > 3 I am feeling very anxious depressed
> > >
> > > Before taking the drug I had a test that showed that i had abnormal high levels of noradrenaline. I think what effexor is doing is that its making me so anxious that it causing the depression and OCD. For me depression fellows anxiety attacks not the other way around
> > >
> > >
> > > Thanks for your reply JRB Im interested in what you have to say from my answers
> > >
> > >
> > > Regards Robert
> > > > hang in there robert.
> > > >
> > > > yes, for many, including myself, you can feel worse before you get better when taking an antidepressant.
> > > >
> > > > couple questions...
> > > >
> > > > 1) so if I'm correct, you said you only had anxiety and slight OCD tendencies but not majorly depressed?
> > > >
> > > > 2) what is your current dose of effexor?
> > > > 3) when you say you're more depressed now, vs. before you started. how depressed are we talking here, are you speaking more to your energy or sense of anxiety/excitation (some get this on effexor). Or is the depression more of the common melancholy, emptiness, etc.?
> > > >
> > > > Unless, you feel you're doing substantially worse than when you started, I'd give it at least 5-6 weeks before you can fully start judging whether effexor is right. the side effects as well as the benefit of the drug will be leveling out all the way up until then.
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> > > >
> > > > as for the benzo's your doc gave you...he might have the right idea there. see, where effexor is great for mental anxiety, it can sometime exacerbate physical anxiousness (restlessness/excitability). this is due to the noradrenergic effect of the effexor. for me, this side effect dwindled with time, and was such a minor tradeoff to the pwerful antidepressant effect I was getting from the drug. However, I did benefit from taking a low dose of a benzo as well to help with the anxiousness. Just a quick caveat, keep the dose of the benzo as low as possible, since it can worsen your current depressive symptoms (by making you feel numb). secondly, make sure you are taking the benzo dosage consistently. for instance, if you are taking a short-half-life benzo like ativan (less than 12hr half-life). make sure you are not missing your doses (but keep them small). for some, especially those sensitive to meds, missing doses of a benzo can lead to a decrease in mood. think of it in terms of early withdrawal symptoms before the drug is fully out of your system and full withdrawal occurs. for me, it's either take a benzo on a regimented schedule or not at all. missing a dose leads to a slight depressive effect.
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> > > > good luck
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> > > > JRB
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> > > > > I have been taking effexor for 19 days and for the last 4 days I have been starting to feel a lot worse. I was taking effexor for anxiety but know Im feeling depressed and slightly OCD I cant seem to get worrying thoughts out of my mind. The docter has told me to hang on in there and given me some Benzo's to help calm me down. Is this a common experince for some people who still contined to take the drug and things got better, or the opposite the continued to take the drug and got worse and had to stop taking the drug.
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> > > > > Anyones thoughts would be well appreciated
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poster:jrbecker
thread:263682
URL: http://www.dr-bob.org/babble/20030928/msgs/265197.html