Posted by bleauberry on July 15, 2009, at 19:23:28
In reply to Started Effexor XR - nightmare! advice needed, posted by zonked on July 14, 2009, at 22:21:36
I don't know, it's a tough call. Some people gut it out through real nasty side effects to see if there is something good on the other side, some people like me don't.
I think the primary problem is not the medication but rather the dosage. It should have been 37.5mg for perhaps 3 to 4 weeks, or until side effects diminished, before even contemplating an increase. There are people at askapatient.com and revolutionhealth.com that ended up with either 37.5mg or 75mg as their final therapeutic dose, where higher doses made them feel worse or gave them unbearable side effects or both, or where they never found it necessary to venture into higher doses because the low ones worked great.
I strongly despise the common strategy of choosing preconceived dosing strategies. The patient's reactions should be the guiding factor, without any preconceived notion of where things are going, starting with the lowest possible dose. The side effects and the emotions are the steering wheel, not a pen and paper and not clinical studies on cherrypicked samples that are not representative of you and me and of which the results are so intricately flawed it could write an entire book. So I disagree with your doses. They are obviously out of control and way too high.
I would have already bailed out. Or at least reduced the dose way back to the starting line. But that's just me. I look at it like a boxing match. I'm in it to win. I don't want to get knocked out in the early rounds. It's already hard enough to win that I don't want to get bruised up any harder than I have to. The punishment you are experiencing is avoidable or bearable with proper dose management.
If we are to get well, we need access to all options. If a doctor rules out a reasonable option, such as xanax, it might be wise to seek a second opinion from someone with wider therapeutic boundaries.
It is a tough call. Some of the ideas that roamed through my head...
1. Reduce the dose to minimum, give this thing some time.
2. Reduce the dose to minimum, add nortriptyline.
3. Reduce the dose to minimum, add desipramine.
4. Stop completely and go to Nort or Desip.
5. Stop completely and go to Nort+Zoloft (specific pharmacological reasons)
It's just me, someone else will see it different, but notice my options did not include staying at my current dose or Vivactil.Vivactil does look good on paper. In the real world it has some really powerful sides. I couldn't even handle one day of the lowest dose. Rat poison. Nort or Desip so much friendlier, and in my book better options than any newer med.
poster:bleauberry
thread:906796
URL: http://www.dr-bob.org/babble/20090709/msgs/906935.html