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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 Lorraine on February 13, 2001, at 15:54:11
I have a long history of failed meds:
Almost all SSRI's, except effexor--which caused me to gain 35 lbs and lose all interest in sex
I have also failed on Wellbutrin (caused panic attacks)
Low dose selegiline (caused panic attacks)
Trazadone (too activating--back aches)
Serzone (with the Wellbutrin trying to knock it back down a bit)
Moclobemide (panic attacks)
Even the amino acids l-tyrosine and glutamine cause panic attacks
Pdoc wants to put me on Effexor and stimulant--using Effexor to counteract the anxiety and panic attacks caused by activating agents and stimulant to counter-act the weight and sexual side effects of Effexor.
I'm a bit leary of going back on Effexor because I had a devil of a time getting off of it
Posted by Lorraine on February 13, 2001, at 16:24:28
In reply to Med change--need help AndrewB, JohnL, CamW, posted by Lorraine on February 13, 2001, at 15:54:11
Sorry, after I post saw that I didn't say that my diagnosis is major depression (5years) and now I seem to have this anxiety component. Also, reason pdoc thinks I need a stimulant is because my QEEG shows low alpha activity.
Posted by Cam W. on February 13, 2001, at 16:35:57
In reply to Med change--need help AndrewB, JohnL, CamW, posted by Lorraine on February 13, 2001, at 15:54:11
Lorraine - Give your doc's regimen a try. Yes, many people have some problem coming off of Effexor, there are several ways to minimize the withdrawl symptoms. First and foremost, be sure that your doc prescribe the XR (long-acting) version of Effexor, as it has less propensity for causing withdrawl symptoms (lasts longer in the body).
Consult with your doctor on the following weaning program when discontinuing the Effexor XR. To minimize withdrawl symptoms, taper to the smallest dose you can (to the point of intolerable side effects). Then add 10mg of Prozac daily for a week or two, tapering and then stopping the Effexor XR during this period. Then continue taking Prozac 10mg for another week or two (during the second week you may want to take the Prozac every second day) and then stop the Prozac. This greatly diminishes the withdrawl symptoms caused by the Effexor.The are other methods, but I have seen the best results with this one. There is a lot of misinformation about Effexor in the lay press, usually because studies are interpreted with some bias, rather than with a neutral perspective. It is true that Effexor is the worst offender for causing withdrawl symptoms, but this is because the body eliminates it too quickly. To a lesser extent the same syndrome can be seen with Paxil and sometimes even Zoloft. Many doctors are not aware of the severity of the withdrawl symptoms of Effexor and this is another reason improper weaning from the drug occurs (thankfully this problem is now being eradicated as docs are being educated on this topic).
Approached properly, weaning from Effexor can be done with minimal discomfort.
Hope that this helps - Cam
Posted by Lorraine on February 13, 2001, at 22:29:13
In reply to Re: Med change--need help AndrewB, JohnL, CamW » Lorraine, posted by Cam W. on February 13, 2001, at 16:35:57
Cam: I really appreciate your taking the time to post. I notice that you tend to do a lot of service for the group. My hat is off to you.
Posted by JohnL on February 14, 2001, at 2:06:44
In reply to Med change--need help AndrewB, JohnL, CamW, posted by Lorraine on February 13, 2001, at 15:54:11
Hi Lorraine,
This is just off the top of my head, but the first thing that seemed obvious to me when I read your post was that drugs that increase neurotransmitter levels didn't work out for you, with the possible exception of Effexor.If Effexor worked real good for you (not just so-so, but real good), then definitely I think it is worth returning to it and dealing with the weight gain and sexual matters. If it worked a little, but not really impressive, then I personally would probably not bother returning to it.
In the SSRI category, have you tried good ole Prozac? Just curious.
I think your doc should be trying you on Zyprexa, or Risperdal. It just seems to me that when people have a hard time with a long list of antidepressants (like me, or like you), then for some reason the neuroleptic class of drugs can be magic. Especially considering the panic attack thing, I would forget the antidepressants for now (except maybe Prozac or Effexor) and instead look at drug class categories that have not yet been tried. They represent various brain chemistries that as of yet have not been addressed, or only made worse, by antidepressants. The amino acid thing is a powerful clue. That implies that certain neurotransmitter levels need to be tamed, not increased. Neuroleptics could do the trick.
If I were in your shoes, top drugs on my priority list would be:
Zyprexa
Risperdal
Prozac
Ritalin
Adderall
Lithium (small dose)
Depakote
Amisulpride
AdrafinilSorry, I'm rambling. Basically, look where you haven't yet looked. Turn over some rocks that haven't yet been turned over. Do something completely different. Even though all the drugs you've tried were quite different, they all still fell into a common theme. That theme didn't work, and only made things worse. Time to try a completely different angle.
John
Posted by Lorraine on February 14, 2001, at 15:21:43
In reply to Re: Med change--need help AndrewB, JohnL, CamW, posted by JohnL on February 14, 2001, at 2:06:44
John: Thanks for your response. Here are some other drugs I've tried but left off the list
Prozac: Didn't support my mood enough
Depakote: Made me druggy and sleepy
Lomictol: Panic attacksThe Effexor worked really well, but the sexual and weight side effects just about destroyed a good marriage. I suspect the amphetimine will help with the weight gain. I just don't know about the sexual side effects or how they would benefit from amphetimine. Plus, I wonder if dopamine oriented drugs are a problem for me, given my reactions to Wellbutrin, Selegiline and Moclobimide.
Posted by Lin on February 14, 2001, at 17:00:27
In reply to Re: Med change--need help AndrewB, JohnL, CamW, posted by Lorraine on February 14, 2001, at 15:21:43
Lorraine: I agree with John that Zyprexa would be a good next step. I know that I am just one person, but I took Effexor + Dexadrine and the Dexadrine did not change the sexual side effects at all. Zyprexa, luckily, has no sexual side effects for most people. The unfortunate part of Zyprexa is the possibility of weight gain. --Lin
> John: Thanks for your response. Here are some other drugs I've tried but left off the list
>
> Prozac: Didn't support my mood enough
> Depakote: Made me druggy and sleepy
> Lomictol: Panic attacks
>
> The Effexor worked really well, but the sexual and weight side effects just about destroyed a good marriage. I suspect the amphetimine will help with the weight gain. I just don't know about the sexual side effects or how they would benefit from amphetimine. Plus, I wonder if dopamine oriented drugs are a problem for me, given my reactions to Wellbutrin, Selegiline and Moclobimide.
Posted by Lorraine on February 17, 2001, at 15:30:23
In reply to Re: Med change--need help AndrewB, JohnL, CamW » Lorraine, posted by Lin on February 14, 2001, at 17:00:27
Lin, thanx for your response. The die is cast. I'm back on Effexor but just 12.5 mg 2x day. The plan is to add a small amount of amphetamine and see what happens. I appreciate your feedback on the sex part. I've never been anorgasmic, just lack desire and interest. I'm hoping the low dose of the Effexor will help with that. If it doesn't I'll add 250 mg of gingko a day. I don't know if I could substitute l-deprenyl for the amphetamine. If I can, that is a sexual activator for me.
> Lorraine: I agree with John that Zyprexa would be a good next step. I know that I am just one person, but I took Effexor + Dexadrine and the Dexadrine did not change the sexual side effects at all. Zyprexa, luckily, has no sexual side effects for most people. The unfortunate part of Zyprexa is the possibility of weight gain. --Lin
>
>
>
> > John: Thanks for your response. Here are some other drugs I've tried but left off the list
> >
> > Prozac: Didn't support my mood enough
> > Depakote: Made me druggy and sleepy
> > Lomictol: Panic attacks
> >
> > The Effexor worked really well, but the sexual and weight side effects just about destroyed a good marriage. I suspect the amphetimine will help with the weight gain. I just don't know about the sexual side effects or how they would benefit from amphetimine. Plus, I wonder if dopamine oriented drugs are a problem for me, given my reactions to Wellbutrin, Selegiline and Moclobimide.
This is the end of the thread.
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