Posted by Molybdenum on July 11, 2008, at 22:21:41
In reply to Med to augment Effexor-XR; improve efficacy?, posted by Fivefires on July 11, 2008, at 16:36:13
Hi 5f, {add lots of "IMHO"s below - I just can't be stuffed typing it today} :)
Before I begin to waffle, I get the impression that you only started the Effexor a few weeks ago. It took a month for me to notice the AD effects at all & they steadily built up over several months. So maybe you need to wait it out. There - now that I've said that, let's ignore that idea & set the throttle to FULL....! ;)
OK, so notwithstanding my post 5 mins ago, the obvious choice to augment your venlafaxine (Effexor)is mirtazapine (Remeron). The combo is colloquially known as "California Rocket Fuel". If you google that you'll find a ton of hits - unfortunately they also make rocket fuel in California, so you have to ignore those ;)
In fact, search on that expression plus the word "Stahl" - he's the doc who is credited with the idea and he's apparently widely regarded as an authority on such matters. You only get a few hundred hits then but they're good.
I'm on 450mg venlafaxine & 180mg mirtazapine. I "was" on 600mg & 225mg...I cut back because my doc kept telling me it was too much. Plus my blood pressure went up a bit from the Effexor being so high... no prob though - just one more pill fixed that.
Anyway, it's a very common combination with a lot of anecdotal support and considered by some a "both barrels" heavy duty approach for treatment resistant depression. There have been studies done - just not by the manufacturers (Wyeth & Organon). I imagine they don't want to promote the combo out of fear that they'll discover a replacement in their existing product line which would negate the need for this "cooperation"... I dunno. ;) Point is it's a damn solid combo.
Dose-wise, mirt is a strange animal. 15mg is too low for AD effects but a fine sedative to help you sleep. AD effects start at 30-45mg and the odd thing is that the sedative quality actually REDUCES as the dose INCREASES. Some docs only add a small amount of mirtazapine while others go "pedal to the metal". Like I said I'm on 180mg and my head hasn't exploded yet. Mirtazapine tends to start working for you a lot sooner than most ADs too. Plus there's not a lot of the common AD side effects - the most common is weight gain, but from your post it sounds like that might be a good thing (!).
Mirt is a "noradrenergic and specific serotonergic antidepressant (NaSSA)". At lower doses it acts more on noradrenalin, at higher doses the serotonergic effects take the lead. So "in general", it's a calming AD at lower doses & a stimulating one at higher. BTW, higher probably means 45mg+ - not my 180mg. ;) So I suggest you start on 30mg & see how it feels. BTW, I found that it had a knock-out effect on me, so I take it at bedtime. It also tends to cause a little sedation next day but that definitely past in a week or so.
What else....oh yeah: Stahl's book is err..."available" at torrent sites if you are so enthused. It's 50MB & the file you need to search for is called "Stephen M. Stahl - Essential Psychopharmacology.pdf" - lotsa pretty pics too :)
Another thing, I too am taking modafinil (Provigil). I take it for narcolepsy but I believe it's a good augmenter for depression too. Nice & gentle...
BTW, Effexor made me feel very anxious initially & every time I increased the dose. It only lasted a week or so each time but it was pretty intense. I also take 150g moclobemide for angst. And I too don't get any anti-anxiety effects from Effexor. ;)
Take Care :)
Mr. M.
poster:Molybdenum
thread:839293
URL: http://www.dr-bob.org/babble/20080706/msgs/839354.html