Posted by Caleb96 on November 8, 2003, at 13:13:28
In reply to Re: Someone, please help me. , posted by Robert Fairburn on November 5, 2003, at 5:27:42
OK jbec, don't give up--several years ago I ran into the same problem you're having. I had tried every SSRI on the market, but continued to have problems (sleepiness, sexual dysfunction, jittery). I was also drinking quite a bit to alleviate my stress. The doctor (internal med) put me on alprazolam (Xanax) to help with the heebie-jeebies, but I still kept drinking, too. That's a bad combination.
Finally, I quit drinking completely and then things started to get better. I went three and a half years without taking a drink, then one night--for some strange reason--I drank a bottle of red wine. It didn't even give me a buzz--just heartburn and a queasy feeling. I swore I'd never touch alcohol again, and I haven't since that night. (Although the German's make some pretty good non-alcoholic beers that are nice on a hot summer day.)
Anyway, back to your problem. After several very successful years on Zoloft, I started to get depressed and lost interest in everything. My internist increased the dose to 100 mg/d and that helped for about six months. Then I hit a brick wall. I was in grad school trying to finish up my PhD, but I couldn't get myself to do anything. One day in desperation, I went to see one of the universities psychologists. He immediately referred me to a psychiatrist who, he said, was an expert with meds. The psychiatrist put me on Remeron (I agreed to try it)even though he warned me about all the side-effects. Whoa! That stuff is horrible! The doctor warned me it's a very strong histamine blocker and it would make me tired. My wife said I was like a zombie. I also gained weight--I went from 170 lbs to 200 lbs (I'm 5' 11")in just a few weeks! My sister-in-law who's a nurse said they give Remeron to elderly patients in nursing homes--they give it to them because elderly people tend to eat like birds and the Remeron makes them eat like starving pigs. That's good if your thin and frail, but I found it useless as an antidepressant. I told the doctor I couldn't take the stuff.
The doctor then put me on Effexor XR. At first I was scared to take the drug because I looked on the internet and read all these horror stories people had posted about Effexor. Also, I looked at the chemical structure and was concerned because Effexor is very similar to opioids because it almost follows the "morphine rule." In fact (I found this out later)it's one carbon bond removed from the opioid analgesic Tramadol. Now if you don't know anything about organic chemistry you might not follow what I'm saying. And I'm not trying to scare anyone, but from what I've read, venlafaxine (Effexor) was originally developed as a treatment for fibromyalgia. Anyway, I started taking the Effexor XR and within a few days I felt great. As time went by I had to have the dose adjusted, but I've been on 300 mg/d of Effexor for 2 1/2 years now. The doctor later added 300 mg/d Wellbutrin to try and counteract the sexual disfunction caused by the elevated serotonin levels.
I'm not sure what dose of Effexor you were taking, but my psychiatrist told me the literature says you can go up to 450 mg/d. He says some doctors prescribe even higher. Also, unlike the SSRIs Effexor is dual acting--it elevates both serotonin and norepinephrine in the post synaptic juction. This combined effect is supposed to be more resistant to losing its activity. Also the Wellbutrin is very stimulating so it helps with any sleepiness (if you look at its chemical structure it looks a lot like speed, but you can't read too much into a chemical's structure since a minor change may result in a totally inactive compound). Also, I've switched from Xanax to Klonopin. Xanax has a very short half-life and leaves you feeling worse when it wears off. Klonopin has a relatively long half-life, so it doesn't make you feel like you're falling off the edge as it wears off. I don't know why doctors don't prescribe the longer-acting benzodiazepines instead of drugs like Xanax. Personally, I think it's easier to get addicted to the short-acting benzos, and it's easier to wean yourself off the long-acting benzos.
Anyway, the bottom line is I would recommend you talk to your doctor about trying a combination of drugs. The Effexor and Wellbutrin combination has worked for me. Effexor has a really short half-life, so if you want to have "normal" sex, I've found I can cut out the Effexor for a few days. You have to plan ahead, that kills the spontaneous passion, but it works for me. You'll have a great orgasm. Another problem I have with cutting out Effexor for a few days is on the second day, I get a hellatious, splitting headache. It usually can be brought under control by taking about six ibuprofen.
Also, try to cut out or cut way down on your alcohol intake. Alcohol is a depressant and it's also hard on your internal organs. Consider the volume of alcohol one has to consume to get a calming buzz: if you drink three beers, that's roughly 84 GRAMS of alcohol, or about 84,000 times one 1 mg Xanax tablet! In order for your body to metabolize alcohol, it has to remove electrons from the molecule, which results in the generation of free radicals. Free radicals damage cells and ultimately damage tissues and organs. From a biochemical point of view, I think it's really bad stuff, but that's my opinion.
Well, I've really gotten carried away, so I'll stop here. Below I've posted the latest from the scientific literature--I notice they don't metion withdrawal....
Clinical Therapeutics
Volume 25, Issue 8 , August 2003 , Pages 2138-2154
Venlafaxine (Effexor): A 2003 update
Mary A. Gutierrez BCPPa, , , Glen L. Stimmel BCPPb, a and Janet Y. Aiso MBAc
a School of Pharmacy, University of Southern California, Los Angeles, USA
b School of Medicine, University of Southern California, Los Angeles, USA
c JANEN Clinical Pharmacy Consultants, South Pasadena, California, USA
Accepted 29 May 2003. ; Available online 18 September 2003.
Abstract
Background: venlafaxine has been available for use as an antidepressant in the United States for a decade.
Objective: Comprehensive reviews of venlafaxine have been published elsewhere; thus, this update focuses on newer issues of treatment remission in depression, treatment-resistant depression, and extended-release venlafaxine for generalized anxiety disorder (GAD).
Methods: Relevant clinical literature from 1993 through 2003 was identified from database searches of MEDLINE and International Pharmaceutical Abstracts, and from manual searches of reference lists of the identified papers. Search terms included venlafaxine extended-release, venlafaxine XR, treatment-resistant depression, depressive disorders, anxiety disorders, generalized anxiety disorder, and antidepressive agents second generation.
Results: With its dual action of serotonin and noradrenergic reuptake inhibition, venlafaxine has been shown to be superior in efficacy to selective serotonin reuptake inhibitors for severe major depressive disorder, treatment-resistant depression, and depressive symptom remission. Its demonstrated efficacy for both short- and long-term treatment of GAD has led to its use for obsessive-compulsive disorder and chronic pain syndromes, although inadequate clinical literature currently exists to support these latter 2 uses. In the past decade, no new or unexpected adverse events have been identified with venlafaxine therapy, except a possibly greater risk of fatal overdose compared with other serotonergic drugs, suggesting the need for caution in patients with suicidal ideation. Because venlafaxine is a potent serotonin agonist, caution must also be exercised to prevent the possibility of serotonin syndrome when used with other serotonin agonists, and its dose should be tapered very gradually to minimize the risk of a serotonin withdrawal reaction.
Conclusion: Venlafaxine has emerged as a successful post-SSRI-era antidepressant with an expanded range of uses since it was first marketed.
poster:Caleb96
thread:276729
URL: http://www.dr-bob.org/babble/20031105/msgs/277749.html