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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 Pandora on January 5, 2001, at 4:40:42
I've been on Effexor XR at 150 mgs/day for about a year. I've had similar bad experiences when missing doses. I've also recently developed acne around my scalp - never would have thought that this could be a side effect, but it's a good place to start!
My question is for those who have been on effexor for a while and/or those who have been on multiple ADs over time. I really don't feel that the effexor is working very well right now and wonder if my best course of action is to increase the dose (is 150 mg a "high" dose?) or to switch to another AD. I've experienced Prozac "burnout" and similar effects with tofranil and Zoloft. Unfortunately, I seem to be better informed than my pdoc on the effects of ADs and insurance prohibits me from shopping around for a new one... so I'm coming to other well-informed consumers for advice : ) (If anyone can recommend a good doc in the Houston area, I'd appreciate it!)
Posted by James Donivan Justice II on January 5, 2001, at 16:03:13
In reply to Increasing Effexor XR, posted by Pandora on January 5, 2001, at 4:40:42
> I've been on Effexor XR at 150 mgs/day for about a year. I've had similar bad experiences when missing doses. I've also recently developed acne around my scalp - never would have thought that this could be a side effect, but it's a good place to start!
> My question is for those who have been on effexor for a while and/or those who have been on multiple ADs over time. I really don't feel that the effexor is working very well right now and wonder if my best course of action is to increase the dose (is 150 mg a "high" dose?) or to switch to another AD. I've experienced Prozac "burnout" and similar effects with tofranil and Zoloft. Unfortunately, I seem to be better informed than my pdoc on the effects of ADs and insurance prohibits me from shopping around for a new one... so I'm coming to other well-informed consumers for advice : ) (If anyone can recommend a good doc in the Houston area, I'd appreciate it!)My advice would be to raise the dosage substantially before giving up. I have been on numerous ADs including the SSRIs and Serzone, Wellbutrin, Desyrel, Remeron, Anafranil, Sinequan, and also Effexor XR. In my case, nothing was nearly as effective as Effexor XR, but at a dose of 600mg/day. The higher the dose goes, the better effects you will have. This is because Effexor is a reuptake of serotonin, norepinephrine, and mildly dopamine. At low doses of Effexor, the prominent mechanism is through serotonin reuptake. However, as the dose increases, norepinephrine reuptake gets more and more predominant, and you receive the dual-action benefits of increasing both of these neurotransmitters. Try gradually increasing the dose to a maximum of 600mg/day, the dose I am on and pretty much a ceiling of dosage.
Hope This Helped.
Posted by Bob on January 6, 2001, at 18:23:04
In reply to Re: Increasing Effexor XR, posted by James Donivan Justice II on January 5, 2001, at 16:03:13
> > I've been on Effexor XR at 150 mgs/day for about a year. I've had similar bad experiences when missing doses. I've also recently developed acne around my scalp - never would have thought that this could be a side effect, but it's a good place to start!
> > My question is for those who have been on effexor for a while and/or those who have been on multiple ADs over time. I really don't feel that the effexor is working very well right now and wonder if my best course of action is to increase the dose (is 150 mg a "high" dose?) or to switch to another AD. I've experienced Prozac "burnout" and similar effects with tofranil and Zoloft. Unfortunately, I seem to be better informed than my pdoc on the effects of ADs and insurance prohibits me from shopping around for a new one... so I'm coming to other well-informed consumers for advice : ) (If anyone can recommend a good doc in the Houston area, I'd appreciate it!)
>
> My advice would be to raise the dosage substantially before giving up. I have been on numerous ADs including the SSRIs and Serzone, Wellbutrin, Desyrel, Remeron, Anafranil, Sinequan, and also Effexor XR. In my case, nothing was nearly as effective as Effexor XR, but at a dose of 600mg/day. The higher the dose goes, the better effects you will have. This is because Effexor is a reuptake of serotonin, norepinephrine, and mildly dopamine. At low doses of Effexor, the prominent mechanism is through serotonin reuptake. However, as the dose increases, norepinephrine reuptake gets more and more predominant, and you receive the dual-action benefits of increasing both of these neurotransmitters. Try gradually increasing the dose to a maximum of 600mg/day, the dose I am on and pretty much a ceiling of dosage.
>
> Hope This Helped.My God, man! That is a high dosage, with a doubt! How are you able to withstand side-effects? I would think that you are no longer able to feel your crotch at all, that you would be experiencing insomnia to some extent, and that you would be very sleepy in the mornings.
Posted by Bob on January 6, 2001, at 18:24:55
In reply to Re: Increasing Effexor XR, posted by James Donivan Justice II on January 5, 2001, at 16:03:13
> > I've been on Effexor XR at 150 mgs/day for about a year. I've had similar bad experiences when missing doses. I've also recently developed acne around my scalp - never would have thought that this could be a side effect, but it's a good place to start!
> > My question is for those who have been on effexor for a while and/or those who have been on multiple ADs over time. I really don't feel that the effexor is working very well right now and wonder if my best course of action is to increase the dose (is 150 mg a "high" dose?) or to switch to another AD. I've experienced Prozac "burnout" and similar effects with tofranil and Zoloft. Unfortunately, I seem to be better informed than my pdoc on the effects of ADs and insurance prohibits me from shopping around for a new one... so I'm coming to other well-informed consumers for advice : ) (If anyone can recommend a good doc in the Houston area, I'd appreciate it!)
>
> My advice would be to raise the dosage substantially before giving up. I have been on numerous ADs including the SSRIs and Serzone, Wellbutrin, Desyrel, Remeron, Anafranil, Sinequan, and also Effexor XR. In my case, nothing was nearly as effective as Effexor XR, but at a dose of 600mg/day. The higher the dose goes, the better effects you will have. This is because Effexor is a reuptake of serotonin, norepinephrine, and mildly dopamine. At low doses of Effexor, the prominent mechanism is through serotonin reuptake. However, as the dose increases, norepinephrine reuptake gets more and more predominant, and you receive the dual-action benefits of increasing both of these neurotransmitters. Try gradually increasing the dose to a maximum of 600mg/day, the dose I am on and pretty much a ceiling of dosage.
>
> Hope This Helped.Just out of curiousity... how long were you on Effexor XR, before you ramped up to 600mg levels, and how long have you been at levels that high?
Posted by Havenator on January 8, 2001, at 13:43:35
In reply to Re: Increasing Effexor XR, posted by Bob on January 6, 2001, at 18:24:55
> > > I've been on Effexor XR at 150 mgs/day for about a year. I've had similar bad experiences when missing doses. I've also recently developed acne around my scalp - never would have thought that this could be a side effect, but it's a good place to start!
> > > My question is for those who have been on effexor for a while and/or those who have been on multiple ADs over time. I really don't feel that the effexor is working very well right now and wonder if my best course of action is to increase the dose (is 150 mg a "high" dose?) or to switch to another AD. I've experienced Prozac "burnout" and similar effects with tofranil and Zoloft. Unfortunately, I seem to be better informed than my pdoc on the effects of ADs and insurance prohibits me from shopping around for a new one... so I'm coming to other well-informed consumers for advice : ) (If anyone can recommend a good doc in the Houston area, I'd appreciate it!)
> >
> > My advice would be to raise the dosage substantially before giving up. I have been on numerous ADs including the SSRIs and Serzone, Wellbutrin, Desyrel, Remeron, Anafranil, Sinequan, and also Effexor XR. In my case, nothing was nearly as effective as Effexor XR, but at a dose of 600mg/day. The higher the dose goes, the better effects you will have. This is because Effexor is a reuptake of serotonin, norepinephrine, and mildly dopamine. At low doses of Effexor, the prominent mechanism is through serotonin reuptake. However, as the dose increases, norepinephrine reuptake gets more and more predominant, and you receive the dual-action benefits of increasing both of these neurotransmitters. Try gradually increasing the dose to a maximum of 600mg/day, the dose I am on and pretty much a ceiling of dosage.
> >
> > Hope This Helped.
>
> Just out of curiousity... how long were you on Effexor XR, before you ramped up to 600mg levels, and how long have you been at levels that high?How long have you been on 600mg? Thought that 225mg was a safe cap. I was on 300mg for last two years. Went cold turkey...severe side effects on withdrawl. Any suggestions? Haven
Posted by MarkinBoston on January 8, 2001, at 16:57:23
In reply to Increasing Effexor XR, posted by Pandora on January 5, 2001, at 4:40:42
> My question is for those who have been on effexor for a while and/or those who have been on multiple ADs over time. I really don't feel that the effexor is working very well right now and wonder if my best course of action is to increase the dose (is 150 mg a "high" dose?) or to switch to another AD. I've experienced Prozac "burnout" and similar effects with tofranil and Zoloft. Unfortunately, I seem to be better informed than my pdoc on the effects of ADs and insurance prohibits me from shopping around for a new one... so I'm coming to other well-informed consumers for advice : ) (If anyone can recommend a good doc in the Houston area, I'd appreciate it!)
150XR was the starting dose for me and last week I jumped to taking 2/day without too much difficulty with side effects and good mood improvements. A more gentle approach is to get a script for 75mg tabs and step to 225 first. At 150 I already had anorgasmia and sweating, so the only new thing is a little insomnia and constipation. Before XR, I think I had taken up to 375 on previous episodes, and never have experienced withdrawl symptoms (I titrate up and down usually). My pdoc advocates high doses for the treatment resistant, and drugs like Effexor and especially Serzone work better at high doses. I dropped Serzone because of memory difficulties - I'd be in the shower not remembering if I had washed my hair a second time or not. Not now.
The acne may be due to sweating.
600 sounds like a lot to me too. How's your blood pressure?
Posted by Noa on January 8, 2001, at 17:22:54
In reply to Re: Increasing Effexor XR, posted by James Donivan Justice II on January 5, 2001, at 16:03:13
I thought I had posted a response to this a few days ago, but don't see it here, so....
150, imho, is not a high dose. I am on 300, and was up to 375. I have read here about others up higher than that, and my pdoc also told me he has had patients up to 600.
I think it is possible to raise the dose, or to try an augmentation strategy, such as adding another AD, a stimulant, thyroid meds, mood stabilizers, and others. Keep this in mind if you do try a higher dose and experience side effects, or don't get the results you want---sometimes a combo works well.
Good luck.
Posted by medlib on January 8, 2001, at 21:26:16
In reply to Increasing Effexor XR, posted by Pandora on January 5, 2001, at 4:40:42
I've been on EffexorXR for over a year (plus various and sundry augmenting meds). I, too, would suggest increasing the Effexor before giving up on it. However, don't be surprised if whatever side effects you experienced with initial doses return with each increase in doseage. I had nausea and some lightheadedness each time I went up on E.--ranging from several days to 2 weeks. The manufacturer recommends no more than 375mg/day--the level I'm at now; I was unsuccessful in increasing my level beyond that point ("rubbery" legs, etc.).
There are many meds which successfully augment Effexor if you find that it's working, but not quite well enough. Few people on this board have experienced complete remission of their symptoms with just one med.
Well wishes---medlib
>I've been on Effexor XR at 150 mgs/day for about a year. I've had similar bad experiences when missing doses. I've also recently developed acne around my scalp - never would have thought that this could be a side effect, but it's a good place to start!
> My question is for those who have been on effexor for a while and/or those who have been on multiple ADs over time. I really don't feel that the effexor is working very well right now and wonder if my best course of action is to increase the dose (is 150 mg a "high" dose?) or to switch to another AD. I've experienced Prozac "burnout" and similar effects with tofranil and Zoloft. Unfortunately, I seem to be better informed than my pdoc on the effects of ADs and insurance prohibits me from shopping around for a new one... so I'm coming to other well-informed consumers for advice : ) (If anyone can recommend a good doc in the Houston area, I'd appreciate it!)
This is the end of the thread.
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