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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Phoebe on December 8, 2000, at 5:50:57
I have been on 800mg of Lithium plus 150mg of Effexor, for the past six months (after a time of six weeks in hospital) -- for the past few weeks I have been very down, which I first thought was just my period, but it got worse and I still feel very down and sad. My husband took me back to see my psychiatrist and he has now changed my medication. I now am to take double the amount of Lithium (1600mg) plus a different medicine called "Stablon" - 12.5mg three times a day. I am concerned about just making a sudden change from the Effexor. The reason I am worried is that a couple of times I forgot Effexor and felt quite strange (shakey and dizzy). Does anyone have some advice?
Posted by JohnL on December 11, 2000, at 5:23:01
In reply to Effexor to Stablon? Advice please?, posted by Phoebe on December 8, 2000, at 5:50:57
> I have been on 800mg of Lithium plus 150mg of Effexor, for the past six months (after a time of six weeks in hospital) -- for the past few weeks I have been very down, which I first thought was just my period, but it got worse and I still feel very down and sad. My husband took me back to see my psychiatrist and he has now changed my medication. I now am to take double the amount of Lithium (1600mg) plus a different medicine called "Stablon" - 12.5mg three times a day. I am concerned about just making a sudden change from the Effexor. The reason I am worried is that a couple of times I forgot Effexor and felt quite strange (shakey and dizzy). Does anyone have some advice?
Sorry, no easy answers here. This must be very difficult and frustrating for you.
Ten different pdocs would probably have ten different ways of approaching your situation. I'll offer my perspective, and you can either use it or discard it at your discretion.
Generally these are issues I have a problem with:
1. One thing at a time. Otherwise one won't know what's doing what. In other words, doubling Lithium and changing the other meds simultaneously is bound to cause problems and confusions.
2. I don't like doubling the Lithium dose. For depression, if it is going to work, it will usually work within a range of 300mg to 1200mg. If it's not, then it's probably not the right treatment. I don't like higher doses because of the longterm wear-and-tear on the kidneys and the side effects. Severe manics have no choice. High dose Lithium in those cases is more appropriate than in your case.
3. Stopping Effexor too fast is begging for trouble. The weening process for this drug should probably be at least 4 weeks and maybe as much as 12.
4. Stablon works just the opposite of Effexor...it is a serotonin reuptake enhancer instead of inhibitor. The transition from one to the other is likely to involve some 'weirdness', and it will be hard to tell the difference between the drug's action, side effects, withdrawals, or all combined.Other things to consider before switching completely to a different drug:
1. Try Ritalin and then Adderall for one week each with a one day washout inbetween. Choose a favorite, if there is one, to continue for a longer trial.
2. Try Zyprexa and then Risperdal for two weeks each with a one day washout inbetween. Choose a favorite, if there is one, to continue for a longer trial.
3. Add Prozac. Theoretically this doesn't make a whole lot of sense. Yet several people here over the last couple years experienced profound improvement rather quickly when Prozac was added to ongoing Effexor. It is something specific to Prozac, and might not be the same with other SSRIs.
4. Try mailorder Amisulpride and/or Adrafinil.
5. And of course, the easiest of all, increase the dose of Effexor and/or Lithium, but one at a time. If that doesn't make a difference after two weeks or so, forget it. Other drug trials would then be warranted as I see it.Just some thoughts and ideas. Hope something here might be helpful. I guess you could say I disagree with your doctor's strategy for a variety of reasons, most of which have your wellbeing as the top priority.
John
Posted by Phoebe on December 12, 2000, at 9:10:05
In reply to Re: Effexor to Stablon? Advice please?, posted by JohnL on December 11, 2000, at 5:23:01
Thank you so much for your advice. i am going to discuss the situation with my doctor on friday when i have to go for a blood test. I was also considering ringing the pdoc I saw when I went home to Australia after my hospital episode.
Anyway - one more question - do you have any idea WHY my doc would change me from Effexor to Stablon? Is it a more aggressive antidepressant?
regards karen
Posted by JohnL on December 13, 2000, at 4:25:43
In reply to Thankyou so much, posted by Phoebe on December 12, 2000, at 9:10:05
> Thank you so much for your advice. i am going to discuss the situation with my doctor on friday when i have to go for a blood test. I was also considering ringing the pdoc I saw when I went home to Australia after my hospital episode.
>
> Anyway - one more question - do you have any idea WHY my doc would change me from Effexor to Stablon? Is it a more aggressive antidepressant?
>
> regards karenKaren,
I don't know why the doctor wants you to switch from Effexor to Stablon. I would suspect that the reason is because it is of a totally different mechanism. Neither one is more, or less, effective than the other in any given random sample of people. Actually, if anything, Effexor is probably usually a little more effective statistically. Of course, that doesn't mean anything in individual cases.For some of us, the reuptake inhibition mechanism of antidepressants is not the appropriate way to go. Simply increasing the level of neurotransmitters is kind of a false roundabout way to fix something that may not be related to neuro levels, especially if the levels are fine to begin with. Some other mechanism, such as reuptake enhancement, receptor agonism, or receptor antagonism may more accurately address the real underlying chemical problem if reuptake inhibition doesn't.
Hang in there. Wishing you the best!
John
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