Posted by Jay2112 on January 2, 2023, at 16:23:05
In reply to Re: TCA + Effexor Combo / Maximum Effexor Dosage » Jay2112, posted by SLS on January 2, 2023, at 11:46:21
> > Last time I tried Effexor at 300mg dose I ended up trying to cut my wrists.
> >
> > Jay
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> It is very frustrating to watch someone have a terrible reaction to a treatment that brings others to remission. However, any good doctor would titrate Effexor using a protocol accepted to be ideal for that drug. They consider dosage versus side effects versus therapeutic response. Some people respond to Effexor 75 mg/day, although my guess is that increased severity or treatment-resistance indicates the necessity for using higher dosages.
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> It's the doctor's responsibility not to blow past the lowest effective dosage for a given individual. With me, 225 mg/day didn't produce any improvement, but I found the drug tolerable. In this circumstance, it is critical to continue to a titrate the dosage to 300 mg/day or higher. If someone doesn't respond to 375 mg/day, it's probably time to reduce the dosage back to 300 mg/day, add Wellbutrin 150-300 mg, low-dosage lithium 300 mg/day +/- 150 mg/day, mirtazepine 45-90 mg/day, or anything else you have on your (or your doctor's) list that is beyond my knowledge.
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> If you don't respond to Effexor with augmenters, I would consider remaining on low-dosage lithium indefinitely, especially if you receive even the mildest of transient improvements over the first three days. According to published studies testing dosages of lithium 150-600 mg/day, 300 mg/day was the dosage most often found to be effective. For me, there is a narrow therapeutic window:
>
> 150 mg/day = No response.
> 300 mg/day = Remission.
> 450 mg/day = Relapse.
>
> Have you tried lamotrigine? If so, did you evaluate 300 mg/day before discontinuing it? This is another drug that can produce a mild response within the first week of treatment. However, its positive effect can become lost when polypharmacy is the mode of treatment. It is important to consider that lamotrigine might not have an all-or-nothing dosage-response curve. For me 200 mg/day gave me a partial improvement when added to my regime. The improvement was persistent and unabated over the course of 8 weeks. When the dosage was raised to 300 mg/day, it "popped". Big improvement. I have remained on both lithium and lamotrigine while continuing to trial other drugs. It has been my observation that the percentage of people responding to 200 mg is much higher than 150 mg/day.
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>
> - Scott
>I think it is important to keep a very wide range of options in mind, consideration for individual variables. I think you are missing out on the use of atypical antipsychotics, and other mood stabilizers. In particular, risperidone with it's 5ht2a blockade. 5ht2a is implicated as the 'activating' serotonin receptor. It may be likely responsible for mania, and the activating suicidal responses to serotonin drugs, in particular the SSRI's.(https://pubmed.ncbi.nlm.nih.gov/11870006/) Clozapine also has a strong 5ht2a blockade/antagonism.
I also think Wellbutrin can work well with propranolol...sort-of to balance out the norepinephrine stimulation. IMHO, for an antidepressant effect, there has to be some serotonin effect, and a TCA may be a better angle than Wellbutrin. I found amitriptyline quite effective, and low dose imipramine better than secondary amines. It seems "the more you muck around with (amines), the better the outcome".
You also have to take into consideration, as expert psychopharmacologist Dr. Peter Kramer explains, that psychiatry is still very much an art form, as no two individual psyche's are the same. We may respond in some ways similar to drugs and therapy, but no two exactly the same.
Jay
Humans punish themselves endlessly
for not being what they believe they should be.
-Don Miguel Ruiz-
poster:Jay2112
thread:1121427
URL: http://www.dr-bob.org/babble/20220917/msgs/1121469.html