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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Emmah on June 14, 2001, at 12:18:11
Hi everyone,
I am new here. Well new, I have been reading a lot of your messages over the past few months, but this is my first post.
I am from The Netherlands and am being treated by my family doctor for dysthymia. I have been taking Effexor XR 150 mg for a year and a half, and I consider myself very lucky that it kicked in from the first day and with no side effects whatsoever.
But now I am doing fine, my doc thinks my dysthymia is under control and I can do without meds because my body can do it on it's own again, so he lowered my dose from 150 mg XR to 75 mg XR last january, and it was hell. He was very surprised by that and let me go back to 150 mg XR. A few weeks later I had to try it again, in smaller steps, now from 150 mg XR to 1x 75 mg XR + 1x 37,5 mg non-XR. And it was hell again. Changing to 3x 37,5 mg non-XR made me feel a little better, which was not possible according to my doctor because the amount of mg was still 112,5, but it really did. Then I went from 3x 37,5 mg to 2x 37,5 mg and the misery started all over again. And I went back to 3 tablets a day again.
I feel so tired of all that trying and feeling miserable again. I had some capsules of 150 mg XR and 75 mg XR left and I decided I have had enough of this shit and 10 days ago I put myself on 150 mg XR a day again. And the day I did that, I started living again. So I have been wondering: could it be that I respond more to the noradrenalinic effect of Effexor than to the serotinergic effect? I have read somewhere on this board that with higher doses the noradrenalinic effect increases, so maybe that is why a decrease of just 37,5 mg already makes me feel so miserable? Do you know at what dosage the noradrenalinic effect starts to attribute to the effect of Effexor? And I would also like to know what treatment should be given after a doc considers your dysthymia under control. From what I've read about it, not much is known about dysthymia and it's treatment, let alone about maintenance treatment. I cannot seem to convince him that without these meds at a high enough dose I don't feel up to getting a job and having a socal life. My next appointment is on june 26th, and I hope you can help me with these questions because I really need to convince him. I am not prepared to spend any more time of my life feeling miserable than I have already, because I now know how much better I can feel with the right dosage of Effexor.
Thanks for listening to my long story,
Emmah
Posted by rmshed on June 14, 2001, at 17:54:44
In reply to positive on Effexor + don't want to stop!, posted by Emmah on June 14, 2001, at 12:18:11
> Hi everyone,
>
> I am new here. Well new, I have been reading a lot of your messages over the past few months, but this is my first post.
>
> I am from The Netherlands and am being treated by my family doctor for dysthymia. I have been taking Effexor XR 150 mg for a year and a half, and I consider myself very lucky that it kicked in from the first day and with no side effects whatsoever.
>
> But now I am doing fine, my doc thinks my dysthymia is under control and I can do without meds because my body can do it on it's own again, so he lowered my dose from 150 mg XR to 75 mg XR last january, and it was hell. He was very surprised by that and let me go back to 150 mg XR. A few weeks later I had to try it again, in smaller steps, now from 150 mg XR to 1x 75 mg XR + 1x 37,5 mg non-XR. And it was hell again. Changing to 3x 37,5 mg non-XR made me feel a little better, which was not possible according to my doctor because the amount of mg was still 112,5, but it really did. Then I went from 3x 37,5 mg to 2x 37,5 mg and the misery started all over again. And I went back to 3 tablets a day again.
>
> I feel so tired of all that trying and feeling miserable again. I had some capsules of 150 mg XR and 75 mg XR left and I decided I have had enough of this shit and 10 days ago I put myself on 150 mg XR a day again. And the day I did that, I started living again. So I have been wondering: could it be that I respond more to the noradrenalinic effect of Effexor than to the serotinergic effect? I have read somewhere on this board that with higher doses the noradrenalinic effect increases, so maybe that is why a decrease of just 37,5 mg already makes me feel so miserable? Do you know at what dosage the noradrenalinic effect starts to attribute to the effect of Effexor? And I would also like to know what treatment should be given after a doc considers your dysthymia under control. From what I've read about it, not much is known about dysthymia and it's treatment, let alone about maintenance treatment. I cannot seem to convince him that without these meds at a high enough dose I don't feel up to getting a job and having a socal life. My next appointment is on june 26th, and I hope you can help me with these questions because I really need to convince him. I am not prepared to spend any more time of my life feeling miserable than I have already, because I now know how much better I can feel with the right dosage of Effexor.
>
> Thanks for listening to my long story,
>
> EmmahI really can relate to what you are saying. If you are doing well on the Effexor and you are happy with the quality of life that you have with it and if the doctor that you are currently going to doesn't want you to be on it. Ask the doctor "WHY" and be persistent. If you feel that he has made a decision as to how he wants to treat you regardless of how you feel, you might want to get another opinion from another doctor. I have a doctor who has kept me on Xanax for 12 years, I had severe panic attacks then, but they are in remission. I know that I am addicted to xanax and it is very hard for me to cut down on it. If my doctor decided that he didn't want to prescribe it anymore, I would probably end up in drug rehab or something. I try not to worry about that. My argument with my doctor, is, I would rather have 5-10 decent years left of life, than 20-30 miserable years. This may sound extreme. But I get irritated when a doctor tells me that I don't need any medication for panic attacks. Let us know what happens. Best of Luck, I start effexor xr this weekend and I am terrified. I guess I have been reading too much on it. Becky
Posted by Cam W. on June 14, 2001, at 18:57:20
In reply to positive on Effexor + don't want to stop!, posted by Emmah on June 14, 2001, at 12:18:11
Emmah - Everyone's depressive symptoms seem to be unique to them, as is their response to medications. You may have responded to Effexor's noradrenergic effects, which gave you the increased energy. Also, Effexor's serotonergic effects may also have helped to alleviate your dysthymic symptoms.
It is generally accepted that Effexor's noradrenergic reuptake blocking ability seems to significantly kick in at around 225mg, but this will differ from person to person. You may have had enough noradrenergic effect at 150mg and this may have been enough to override Effexor's sedating side effects. The decrease of 37.5mg in dose may have been enough to take the noradrenergic effects away. As everyone is different, this is just a guess.
The best approach you can use is to tell the doctor what you have told us here. Some people with dysthymia need to stay on antidepressants for life; others can take drug holidays and the dysthymia may not return.
Then again, what you may have been experiencing with the decrease in dose may have been some serotonergic withdrawl symptoms. Your doc may want to wean you completely off Effexor, hoping that the symptoms you are feeling will go away once the withdrawl effects stop. If the depressive symptoms do not return at this point, you may be able to go drug free, at least until you relapse (if you do).
Talk candidly with your doc about stopping the Effexor. If you do not feel ready to stop, tell him/her. Explain the symptoms that you are experiencing and your fears that your depression is returning. Tell your doc about the lack of energy and ask what you should do about it. Your doc will know your disorder better than us. Both of you need to come to an agreement on how to treat your disorder.
Good luck and keep us posted. - Cam
Posted by Emmah on June 16, 2001, at 10:44:29
In reply to Re: positive on Effexor + don't want to stop!, posted by rmshed on June 14, 2001, at 17:54:44
> I really can relate to what you are saying. If you are doing well on the Effexor and you are happy with the quality of life that you have with it and if the doctor that you are currently going to doesn't want you to be on it. Ask the doctor "WHY" and be persistent. If you feel that he has made a decision as to how he wants to treat you regardless of how you feel, you might want to get another opinion from another doctor. I have a doctor who has kept me on Xanax for 12 years, I had severe panic attacks then, but they are in remission. I know that I am addicted to xanax and it is very hard for me to cut down on it. If my doctor decided that he didn't want to prescribe it anymore, I would probably end up in drug rehab or something. I try not to worry about that. My argument with my doctor, is, I would rather have 5-10 decent years left of life, than 20-30 miserable years. This may sound extreme. But I get irritated when a doctor tells me that I don't need any medication for panic attacks. Let us know what happens. Best of Luck, I start effexor xr this weekend and I am terrified. I guess I have been reading too much on it. Becky
Hello Becky,
It sounds so familiar to hear you talk about rather having less years left and feeling able to cope with life than feeling miserable till you're in your nineties. It feels good to know that it's not such a weird idea to stay on meds for years, after all you have been doing well on yours for 12 years now. So I will definitely ask my doctor why he persists on trying to lower my dose, while I feel it is not working at this moment. Thanks for your reaction, it makes me feel stronger to know other people too question their doc's decisions and we are entitled to that.
How are you doing on the Effexor you started this weekend? I hope you will experience no side effects; it is possible you know. In spite of all the horrible stories you read about it I have only felt flu-like for a day and I immdediately noticed a change in my mood. I hope it will work for you too.Take care,
Emmah
Posted by Emmah on June 16, 2001, at 11:22:45
In reply to Re: positive on Effexor + don't want to stop! » Emmah, posted by Cam W. on June 14, 2001, at 18:57:20
Hi Cam,
Thanks for your great suggestions. I will talk to my doctor if it is possible that I am responding to the noradrenergic effects of Effexor at a dosage of just 150 mg XR. I don't know if the symptoms I had when lowering the dosage from 150 mg to 112,5 mg were from serotonergic wthdrawal. I tend to think not, because I don't seem to relate much to all the withdrawal stories I have read. What happens when I have to lower is that I start feeling sad without no reason, nothing feels fun anymore and I can sleep all day. Just about what Effexor was prescribed for in the first place.
Oh, and when I am on 3x 37,5 mg non-XR a day (1 tablet with each meal) I can't sleep all night because my head feels terrible. I have tried to put more time between the tablets to spread them more equally over the day, taking them around 9 am, 4 pm and 11 pm, and then I sleep much better, but from 2 hours before I have to take the next tablet till about 2 hours after I have taken it I have such a miserable feeling in my head. I just feel short of one tablet, when I only have 3 tablets a day.You said my doc will now my disorder better than you do but I am not so sure of that. I have been suffering from dysthymia for 15 years already and have been treated by him for feeling down and having no energy and more of those symptoms, but I myself had to discover what it was I am actually suffering from. I found some info on the internet and took it with me to ask him if I could be suffering from dysthymia. He looked through what I had printed for him and then agreed that the diagnosis dysthymia is most likely.
I really like this man, he has helped me very well with some major stuf the past 11 years, and I feel that most of the time he really listens to me and what I have come to know about it. But I think in general family physicians in my country don't know very much about all the different mental problems people can have. And they are still not happy to accept the biological-cause-theory. I am very sure that in my case it is a biological problem and with that my doc does not agree completely. He says mind and body are very much interconnected, so you cannot clearly seperate the causes.Since I don't respond as well to lowering the dosage as he had expected he now wants me to see a psychiatrist. I really don't want to do that, because I am so sure it is a biochemical problem and I feel I can feel great with the proper dose of Effexor, and because I don't want to talk about anything with a mental health professional. Sure I have to deal with some issues, but it's nothing big and I feel I have come to terms with that during the talks I had with my family doc the past 2 years. I feel there is really nothing to talk about, so I would only have to see that psychiatrist for my medication. Well, I cannot believe that he will let me just take meds and not talk about anything going on in my life. But the months I have taken 150 mg of Effexor XR I felt good enough to deal with everything myself. No sad feelings or feelings of insecurity or hopelesness, I simply enjoyed life and I didn't encounter any problems that would made me need to see a psychiatrist.
So it is not just that I have to convince my doc to let me stay on 150 mg as long as I feel I need that, I also need to convince him that he is qualified enough for that maintenance treatment, that I really don't need a psychiatrist.Wow, when I started typing I had no idea it would be such a long story, sorry for that.
Thanks for the help and best wishes,
Emmah
Posted by rmshed on June 16, 2001, at 13:11:30
In reply to Re: positive on Effexor + don't want to stop! » rmshed, posted by Emmah on June 16, 2001, at 10:44:29
> > I really can relate to what you are saying. If you are doing well on the Effexor and you are happy with the quality of life that you have with it and if the doctor that you are currently going to doesn't want you to be on it. Ask the doctor "WHY" and be persistent. If you feel that he has made a decision as to how he wants to treat you regardless of how you feel, you might want to get another opinion from another doctor. I have a doctor who has kept me on Xanax for 12 years, I had severe panic attacks then, but they are in remission. I know that I am addicted to xanax and it is very hard for me to cut down on it. If my doctor decided that he didn't want to prescribe it anymore, I would probably end up in drug rehab or something. I try not to worry about that. My argument with my doctor, is, I would rather have 5-10 decent years left of life, than 20-30 miserable years. This may sound extreme. But I get irritated when a doctor tells me that I don't need any medication for panic attacks. Let us know what happens. Best of Luck, I start effexor xr this weekend and I am terrified. I guess I have been reading too much on it. Becky
>
> Hello Becky,
>
> It sounds so familiar to hear you talk about rather having less years left and feeling able to cope with life than feeling miserable till you're in your nineties. It feels good to know that it's not such a weird idea to stay on meds for years, after all you have been doing well on yours for 12 years now. So I will definitely ask my doctor why he persists on trying to lower my dose, while I feel it is not working at this moment. Thanks for your reaction, it makes me feel stronger to know other people too question their doc's decisions and we are entitled to that.
> How are you doing on the Effexor you started this weekend? I hope you will experience no side effects; it is possible you know. In spite of all the horrible stories you read about it I have only felt flu-like for a day and I immdediately noticed a change in my mood. I hope it will work for you too.
>
> Take care,
> Emmah
I started my effexor last night. I had no side effects last night, I took it as I got into bed. I had a small snack, which the pharmicist suggested that I eat something before taking my effexor. This morning I woke up and perhaps it is all in my head, but I haven't had this much energy on a Saturday morning in over a year. I will have to wait and see what happens once my body begins to adjust to the medication. I hope it works. My life is a flat line. I get up every day and go to work and I love my job. I don't do very well mentally on weekends and when I am under alot of stress. I forgot to add something to my inital post to you. Ask your doctor what the rush is on getting you off of the medication? In my opinion, unless you are experiencing a medical problem from being on the medication, you should be able to maintain some type of dose until you feel you want to come off of it. I am not a doctor, but have seen enough of them in my lifetime to know how some of them think.Take Care.
Becky
Posted by Zo on June 16, 2001, at 21:56:45
In reply to positive on Effexor + don't want to stop!, posted by Emmah on June 14, 2001, at 12:18:11
Agendas, agendas. What's with these guys? I have to question, in general, the intelligence of any doc who pushes for something that makes no intrinsic sense. And 150mg is not even a therapeutic dose.
There are docs who have a program. . and there are docs who actually listen to their patients, and actually want to help. If you're stuck with the former, it often works to get assertive, to study up on your own and insist on the right dose.
Best of luck,
Zo
Posted by Emmah on June 17, 2001, at 11:49:54
In reply to Re: positive on Effexor + don't want to stop!, posted by Zo on June 16, 2001, at 21:56:45
> Agendas, agendas. What's with these guys? I have to question, in general, the intelligence of any doc who pushes for something that makes no intrinsic sense. And 150mg is not even a therapeutic dose.
Hi Zo,
I already noticed that most people at Psycho-Babble seem to be taking doses of 225 mg / 375 mg. But I always thought 150 mg was the minum amount of mg to be considered a therapeutic dose, if it is working for you that means. I do feel a lot better when I am on 150 mg XR, but I keep feeling that I am just a little short. I asked to be put on 225 mg or 187,5 mg, but my doc said that I was doing good enough already, so he would consider lowering my dosage rather than up it. Do you know where I could find more info about what is considered a therapeutic dose?
After reading all your responses I think I will tell him that how I feel is more important than what he is thinking about how I am doing. And I will ask him why it is such a big deal to get off the Effexor as soon as possible. After all, this whole therapy is meant to make me feel better than I used to, so why should I accept feeling bad again with a lower dosage or no meds at all? That just makes no sense. I am definitely going to be more assertive from now on. Thanks to you guys!
Take care,
Emmah
Posted by Emmah on July 1, 2001, at 12:19:37
In reply to positive on Effexor + don't want to stop!, posted by Emmah on June 14, 2001, at 12:18:11
Hi everyone,
I thought I might give you an update.
I saw my doc last tuesday and I told him I had felt very bad with only 3 tablets of 37,5 mg a day. And that I therefor had decided to raise my dose to 4x 37,5 mg. I expected him to be upset about me not contacting him about that, but he just nodded and let me continue my story. So I told him about the noradrenergic effect of Effexor with higher doses and my suspcion that I might be suffering from noradrenaline deficiency. I had found a checklist about the deficiency symptoms at:
http://www.healthsmith.com/hsweb/htm/mood_inventory.htm
My symptoms are mainly in the noradenaline category. He was very interested in what I told him about that and he nosed through the things I had printed for him about it (and asked if he could keep them!). And when I said I didn't want to try anymore to lower my dose, but instead wanted to raise it to maybe 225 mg a day to see if I really need some noradrenalergic medication, he just said "Ok, we could try that for a month." And without any arguing about it he handed me a prescription for 2 months, till my next appointment. I know he is a reasonable person and he really listens to me, but this I had not expected. I expected that I had to persuade him to let me give it a try, but he seemed willing to let me set the course now that I want to go. And he never even mentioned the possible referral to a psychiatrist.
And the good news is: I feel so much better since I went from 150 mg to 225 mg! I have much more energy, I feel like doing lots of things and I can really enjoy being with friends again. Just the second day I already felt good enough to go shopping, on my own! And I had a great time. I didn't even get annoyed when the bus was late and my feet were sore from the hot weather. I hope that this feeling will last and that my doc will let me stay on this meds till I feel I am ready to try to get off them.
Thanks for your advise and all the other info on this board!
Take care,
Emmah
Posted by Emmah on July 1, 2001, at 12:30:20
In reply to Re: positive on Effexor + don't want to stop!, posted by rmshed on June 16, 2001, at 13:11:30
> I started my effexor last night. I had no side effects last night, I took it as I got into bed. I had a small snack, which the pharmicist suggested that I eat something before taking my effexor. This morning I woke up and perhaps it is all in my head, but I haven't had this much energy on a Saturday morning in over a year. I will have to wait and see what happens once my body begins to adjust to the medication. I hope it works. My life is a flat line. I get up every day and go to work and I love my job. I don't do very well mentally on weekends and when I am under alot of stress.
> Take Care.
>
> BeckyHi Becky,
How are you doing on the Effexor? Still feeling good and so side effcts? I just wish everybody could feel as good on Effexor as I feel now. I just pray to God that the effect will last as long as I need it. And I pray for all those people feeling miserable and hopeless, who haven't found a drug yet that does the trick for them. I truely believe no one should have to feel the way many of us do feel or have felt.
Take care,
EmmahPS I take my meds with some food too, and I never felt nauseated after taking them.
Posted by rmshed on July 2, 2001, at 18:34:00
In reply to Re: positive on Effexor + don't want to stop! » rmshed, posted by Emmah on July 1, 2001, at 12:30:20
> > I started my effexor last night. I had no side effects last night, I took it as I got into bed. I had a small snack, which the pharmicist suggested that I eat something before taking my effexor. This morning I woke up and perhaps it is all in my head, but I haven't had this much energy on a Saturday morning in over a year. I will have to wait and see what happens once my body begins to adjust to the medication. I hope it works. My life is a flat line. I get up every day and go to work and I love my job. I don't do very well mentally on weekends and when I am under alot of stress.
> > Take Care.
> >
> > Becky
>
> Hi Becky,
>
> How are you doing on the Effexor? Still feeling good and so side effcts? I just wish everybody could feel as good on Effexor as I feel now. I just pray to God that the effect will last as long as I need it. And I pray for all those people feeling miserable and hopeless, who haven't found a drug yet that does the trick for them. I truely believe no one should have to feel the way many of us do feel or have felt.
>
> Take care,
> Emmah
>
> PS I take my meds with some food too, and I never felt nauseated after taking them.Emmah: I am so happy for you. I am glad that you have your doctor's support, that is so very important. It makes me happy when I know that for some of us, medication does work. As for my effexor xr, I increased my dose on Friday night 6/29 from 37.5 to 75mg. I noticed that I am a little dizzy at times, but then I have always felt this way, just a little more now. I am finally able to nap, on my first 10 days of being on effexor xr, I wasn't able to nap, and really that was ok. I have been napping excessively for over a year. I don't have much of a social life because of the depression. I just feel that there are not many people that I feel comfortable with and who understand me. I want to be able to share all of my experiences with a friend, just not the good times, and if I am truly a friend, I feel that they deserve to know that I suffer from depression and anxiety. I am really careful who I tell this too. I actually got up early last Saturday morning, and went and ate breakfast out and then did some shopping. It was great to be motivated to do something. If effexor is going to help me, it will take awhile for me to get used to planning on doing activities on the weekends. For almost a year, I did nothing but sleep, play games on the computer and eat on the weekends. I feel kind of lost since now I feel motivated and haven't felt that way in over a year. I hope that only good things come to you in the future and BTW let me know how things are going.
Take Care.
Becky
Posted by DebbieLynn on July 8, 2001, at 11:21:19
In reply to Re: positive on Effexor/don't want to stop! UPDATE » Emmah, posted by Emmah on July 1, 2001, at 12:19:37
> Hi everyone,
>
> I thought I might give you an update.
>
> I saw my doc last tuesday and I told him I had felt very bad with only 3 tablets of 37,5 mg a day. And that I therefor had decided to raise my dose to 4x 37,5 mg. I expected him to be upset about me not contacting him about that, but he just nodded and let me continue my story. So I told him about the noradrenergic effect of Effexor with higher doses and my suspcion that I might be suffering from noradrenaline deficiency. I had found a checklist about the deficiency symptoms at:
>
>
> http://www.healthsmith.com/hsweb/htm/mood_inventory.htm
>
> My symptoms are mainly in the noradenaline category. He was very interested in what I told him about that and he nosed through the things I had printed for him about it (and asked if he could keep them!). And when I said I didn't want to try anymore to lower my dose, but instead wanted to raise it to maybe 225 mg a day to see if I really need some noradrenalergic medication, he just said "Ok, we could try that for a month." And without any arguing about it he handed me a prescription for 2 months, till my next appointment. I know he is a reasonable person and he really listens to me, but this I had not expected. I expected that I had to persuade him to let me give it a try, but he seemed willing to let me set the course now that I want to go. And he never even mentioned the possible referral to a psychiatrist.
>
> And the good news is: I feel so much better since I went from 150 mg to 225 mg! I have much more energy, I feel like doing lots of things and I can really enjoy being with friends again. Just the second day I already felt good enough to go shopping, on my own! And I had a great time. I didn't even get annoyed when the bus was late and my feet were sore from the hot weather. I hope that this feeling will last and that my doc will let me stay on this meds till I feel I am ready to try to get off them.
>
> Thanks for your advise and all the other info on this board!
>
> Take care,
> EmmahHELLO--
Thank you for the link. I too printed this for my doc, I have an appointment with him tomorrow. I am on Effexor XR 225mg, have been for about 6 weeks. It works very well for me also. I just have anorgasmia-- :-0 Maybe Wellbutrin is the answer!Debbie
Posted by SalArmy4me on July 10, 2001, at 3:03:54
In reply to Re: positive on Effexor/don't want to stop! UPDATE, posted by DebbieLynn on July 8, 2001, at 11:21:19
This is the end of the thread.
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