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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Shell on October 22, 2000, at 20:46:42
I have an appointment with my doctor later this week to assess how well I am doing with Effexor XR for depression and OCD. She has said that she is open to trying different things until we find what works for me. I am hoping that perhaps some of you that have personal experience can give me some ideas of a possible next step we might take.
When I started seeing this doctor (I changed doctors due to a move), I was already taking 40 mg Prozac daily for OCD, which she agreed to continue. The Prozac seemed to work well for the OCD (and I even managed to lose 15 pounds!), but I disliked the sexual side effects. She then switched me to Luvox, 50 mg/day. The side effects were not as bad as with the Prozac (but still noticeable), but the OCD symptoms returned. I discontinued the Luvox since it didn’t help me at all. I didn't go back to Prozac because I decided I'd rather live with the OCD than the side effects (I’ve lived most of my life with OCD, maybe I am used to it).
After a year with no medication, the OCD symptoms were still there, but then I began to have other, more troubling symptoms. I returned to my doctor, who diagnosed me with depression. For me, at least, the depression has been much more difficult to live with than the OCD and just ignoring it is no longer an option.
My doctor started me on 75 mg Effexor XR once a day. After a month of this with no improvement (but no side effects either), she increased it to 150 mg once a day. This is the dose I have been taking for the last four weeks. I still have no side effects, but I have not seen any improvement in my depression symptoms; in fact, they seem to be worse. At my last visit, she told me that if this dosage of Effexor XR (150 mg) didn't work for me, she would try something else.
I am somewhat perplexed by her stance on the Effexor dosage. If I am having no side effects, why would she be reluctant to increase the dosage to see if that will make a difference? Is 150 mg really such a high dose? From what I have read on here, it does not seem so to me. If she wants me to switch to a different medication, would I be better off to go to a different SSRI (Celexa, Paxil, Zoloft) or perhaps to Serzone, Remeron or Anafranil? I had asked her about Wellbutrin because of its lack of sexual side effects and its nonsedating qualities, but she doesn't want to use that because it is not helpful for OCD. At this point, I truly don't care too much about the OCD; I just want to take care of the depression and worry about the OCD later.
I would deeply appreciate any advice you could give me. As I have gained 20 pounds in the last six months with no change in diet (gained before I started taking Effexor), live in a constant brain fog, and am always tired, I would prefer something that didn't cause weight gain or sedation (is that attainable?). I am open to about anything, switching medications, doing a medication combination, anything to feel better.
Thanks,
Shell
Posted by stjames on October 22, 2000, at 21:06:30
In reply to Need Your Advice for an Upcoming Doctor Visit , posted by Shell on October 22, 2000, at 20:46:42
Given that you have no side effects on Effexor and the
PDR stated higest dose is 300 mgs I think you should go higher
before you call it quits. For me 150 mgs is the smallest dose
that does anything. If you start another meds you will be back to square one
with a 1 to 2 month waiting period to get positive effects but upping the dose
of effexor could bring on positive effects very quickly.james
Posted by Cindy W on October 22, 2000, at 21:11:01
In reply to Re: Need Your Advice for an Upcoming Doctor Visit , posted by stjames on October 22, 2000, at 21:06:30
> Given that you have no side effects on Effexor and the
> PDR stated higest dose is 300 mgs I think you should go higher
> before you call it quits. For me 150 mgs is the smallest dose
> that does anything. If you start another meds you will be back to square one
> with a 1 to 2 month waiting period to get positive effects but upping the dose
> of effexor could bring on positive effects very quickly.
>
> jamesShell, I have OCD and depression, and take Effexor-XR 375 mg/day in the early morning (along with 75 mg Serzone) and l50 mg/night of Seroquel. The dose of an AD needs to be higher for OCD. Check out the great article by Michael Jenike, MD, at www.ocfoundation.org (article about meds with adults). Effexor-XR seems to be curbing the OCD quite a bit and doesn't interfere much with sexual functioning, for me. Hope this helps.
Posted by MK1 on October 23, 2000, at 2:15:00
In reply to Need Your Advice for an Upcoming Doctor Visit , posted by Shell on October 22, 2000, at 20:46:42
Shell,
It sounds like a combination might be helpful.
for the OCD you'll probably need an SSRI.
If this helps but the depression is still there
you could add another antidepressant. Sound like the Effexor isn't the right fit for you, you've given it a fair chance. I would switch to another
SSRI first and see if helps.Best of Luck, MK1
Be
Posted by noa on October 23, 2000, at 8:02:54
In reply to Re: Need Your Advice for an Upcoming Doctor Visit , posted by MK1 on October 23, 2000, at 2:15:00
> Shell,
The Effexor xr dose is not high, as others have indicated. Although the official high dose is supposedly 300, I have taken 375, and there was someone who posted early that he/she takes 450.Since you have no side effects, I would ask the doc to go higher on the effexor xr. If you have partial AD effect from that, or a good AD effect but start to have side effects, it may be worth staying on it and adding a second med to augment it, rather than switching altogether.
Posted by MK1 on October 24, 2000, at 19:47:28
In reply to Need Your Advice for an Upcoming Doctor Visit , posted by Shell on October 22, 2000, at 20:46:42
The Effexorites know more about this med than I do. Based on their experience maybe an increase would help.
MK1
Posted by Shell on October 24, 2000, at 23:04:57
In reply to Re: Need Your Advice for an Upcoming Doctor Visit , posted by MK1 on October 24, 2000, at 19:47:28
Thanks to all who responded to my question. I am going to see my doctor on Friday and I am going to ask her to consider increasing my Effexor dosage. I'll let you know what she decides to do.
Thanks again,
Shell
Posted by laural on October 26, 2000, at 15:41:55
In reply to Need Your Advice for an Upcoming Doctor Visit , posted by Shell on October 22, 2000, at 20:46:42
haven't read this thread but zoloft seemed to help me stop my picking and hair pulling while wellbutrin added to this might lesson the sexual side affects--this combo might work if it doesn't make you a spaz case, both are rather stimulating ADs, at least for me.
i have the decreased ability to orgasm. before i ever got on meds, sex was amazing for me and now less of a sensation (try almost none) but more of a shared intimate experience. there are pills you can take to help but it takes the spontanaeity and fun out of the act. what i find most effective and i hope this is okay to say, is direct oral contact. laural
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