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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by flygirl on March 27, 2004, at 9:49:41
Help me please! My husband has been taking 300mg zoloft for 4-5 months and over the last 4 weeks has been tapered off it and replaced with 150 of effexor. For the last week he has been having horrible side effects...mostly what seems to be from effexor withdrawl...but could it be the zoloft withdrawl even though he's still taking an SSRI? The horror stories I have read scare me to the point of wanting him to get off all meds period! (and he wants to anyhow, only on his terms, without seeing a Pdoc...he's very angry that the medical world could ever let anyone take something like these drugs with such side effects)
At any rate, ultimately he has to be off all anti depressant meds in order for him to return to work as he has a safety senstive job....so why not try and start now?! HOW??? and what can a "depressed" person do to fight this without meds...he barely has any "umph" to get out of bed...or do anything that is good for him...doesn't eat right, no exericse, no social activity, no spirituality etc....(he used to have all of these...) Please help me with some ideas or support or something as he has been out on disability from his job now for over a year and is convinced now that his brain has been "so damaged" by the meds, that he will never be able to go back to work.
Posted by King Vultan on March 27, 2004, at 11:48:11
In reply to HELP..effexor/zoloft side effects ARGH!, posted by flygirl on March 27, 2004, at 9:49:41
What type of side effects is he suffering? Both Zoloft and Effexor are strongly serotonergic and may not be the best choice for some people. I've taken both of them and had insomnia problems on both, for instance. Both of them also seemed to make me emotionally aloof, but this went away after discontinuing the meds.
Todd
Posted by flygirl on March 27, 2004, at 13:36:02
In reply to Re: HELP..effexor/zoloft side effects ARGH!, posted by King Vultan on March 27, 2004, at 11:48:11
> What type of side effects is he suffering? Both Zoloft and Effexor are strongly serotonergic and may not be the best choice for some people. I've taken both of them and had insomnia problems on both, for instance. Both of them also seemed to make me emotionally aloof, but this went away after discontinuing the meds.
>
> Todd
He's having sweats/chills, dizziness, (my head is swimming, is what he calls it), tremors or twitchs...that won't stop or go away. So much so that he can't sleep...where as before he was getting pretty "dozy" off and on throughout the day...now he can't seem to fall asleep and wants to so that he can experience some sleep. I'm wondering about toxicity....beuause as he was building up on the effexor he had about 2 solid weeks of doing great and feeling good...much better than he ever had on the zoloft too.
Any more ideas on this would greatly be appreciated.
I have called in to his pdoc but no return call yet. last night he took 3 37.5 pills and today he has taken only 2....we're thinking the toxicity thing...and yet wanting to avoid the withdrawl...
I have thought about giving him some of my prozac, but don't want to do that without speaking with pdoc first.
Posted by JoannaC on March 27, 2004, at 19:09:28
In reply to HELP..effexor/zoloft side effects ARGH!, posted by flygirl on March 27, 2004, at 9:49:41
Hi, I've just been doing some research in my nursing books here. I think your husbands pdoc has given him too high of a dose of Effexor to start out with. I may be wrong of course. But the starting dose is 37.5 up to 225mgs. Now I think when you start any new medication you should start on the lowest dose possible, so that you don't experience all of the brutal side effects he's experiencing. He should still have some of the Zoloft left in his blood stream, but the 150mgs of Effexor is too much. My pdoc put me on 75mgs, because he had 75mg caps in his office, and I took one, within 1.5 hours I had blurred vision, I was nauseated, and so dizzy and sweaty that my boyfriend had to carry me to bed, where I laid for about 8 hours, and never took it again. I really think the doc started him too high to start. I'll tell you I felt the same way as your husband that I was brain damaged from the medications. I'm 33 years old, and laid in a bed for 4 years, not able to shower, or cook for myself. I couldn't remember what happen 5 minutes ago. Medications do that, make everything foggy. No SSRI, or SNRI or any Benzodiazepine (which by the way impaires your memory the worst), ever worked for me. However they do work for alot of people, I just didn't respond, and the side effect are horrible. Remeron or Mirtazipine which is an antidepressant that is totally different than any other ones, helped with the depression, anxiety and sleep. I have never slept so well in my life, and wake up refreshed, it does take time to get used to the sedation at first, because it comes on quickly after taking the pill. And I didn't have to take any other medication, just the remeron. My family and friends say they haven't seen me this well since high school. I hope I've helped and given you a possible other option to talk to your doc about. I wish you the best.
Posted by flygirl on March 27, 2004, at 19:22:18
In reply to Re: HELP..effexor/zoloft side effects ARGH!, posted by JoannaC on March 27, 2004, at 19:09:28
> Hi, I've just been doing some research in my nursing books here. I think your husbands pdoc has given him too high of a dose of Effexor to start out with. I may be wrong of course. But the starting dose is 37.5 up to 225mgs. Now I think when you start any new medication you should start on the lowest dose possible, so that you don't experience all of the brutal side effects he's experiencing. He should still have some of the Zoloft left in his blood stream, but the 150mgs of Effexor is too much. My pdoc put me on 75mgs, because he had 75mg caps in his office, and I took one, within 1.5 hours I had blurred vision, I was nauseated, and so dizzy and sweaty that my boyfriend had to carry me to bed, where I laid for about 8 hours, and never took it again. I really think the doc started him too high to start. I'll tell you I felt the same way as your husband that I was brain damaged from the medications. I'm 33 years old, and laid in a bed for 4 years, not able to shower, or cook for myself. I couldn't remember what happen 5 minutes ago. Medications do that, make everything foggy. No SSRI, or SNRI or any Benzodiazepine (which by the way impaires your memory the worst), ever worked for me. However they do work for alot of people, I just didn't respond, and the side effect are horrible. Remeron or Mirtazipine which is an antidepressant that is totally different than any other ones, helped with the depression, anxiety and sleep. I have never slept so well in my life, and wake up refreshed, it does take time to get used to the sedation at first, because it comes on quickly after taking the pill. And I didn't have to take any other medication, just the remeron. My family and friends say they haven't seen me this well since high school. I hope I've helped and given you a possible other option to talk to your doc about. I wish you the best.
I need to clarify that he has built up over the last 4 weeks to the 150mg of effexor...37.5mg at a time. BUT, I agree with what you have said...it must be done slowly...both on and off of it! Plus, I have done some research today on serotonin syndrome (ie:too much serotonin) and it can be lethal...and I'm wondering if that is not what is going on with him. Today he has only taken 2 pills (yesterday 3) and we are just waiting to see what may happen next....Monday we will be visitin his pdoc ASAP!!! In the mean time, I am keeping a close eye on him...too many scarey stories out there as to what AD's can cause people to do...just today the FDA announced that SSRI's must carry a warning about possible suicidal side effects!!!! Check out the FDA's website and you will see!
Posted by Camille Dumont on March 27, 2004, at 20:53:04
In reply to Re: HELP..effexor/zoloft side effects ARGH!, posted by flygirl on March 27, 2004, at 19:22:18
Even four weeks its quite quick ... I waited a month between every change ... 37.5, 75, 150, 225 and then 300.
The cold sweats I've had but not the twiches and what not ... I got those from antipsychotics ... I don,t think ADs can give diskinesia so it sounds like a serotonin syndrome. Go see a doctor ASAP please.
Posted by King Vultan on March 28, 2004, at 10:02:02
In reply to Re: HELP..effexor/zoloft side effects ARGH!, posted by flygirl on March 27, 2004, at 13:36:02
I had also considered the possibility that he might be experiencing some symptoms of serotonin syndrome. I also agree that the potential build up of the drug to toxic levels is a concern. Depending on one's ethnicity, a certain percentage of people are what is called "poor 2D6 metabolizers," meaning that they lack sufficient levels of the CYP-450 2D6 enzyme to properly metabolize certain drugs. Almost all antidepressants, including both Zoloft and Effexor, are metabolized by this enzyme.
What happens with people who are poor 2D6 metabolizers is that when they take a drug metabolized by this enzyme, the drug can build up to dangerously high levels, as the body is not able to properly get rid of it. I note that your husband seemed to be doing better on the lower dosages and question if lowering the dosage might not be a prudent thing to try.
Of course, there is also the issue of Effexor withdrawal to throw a monkey wrench in the works, but from everything you've said, it sounds like he likely would be better off on a lower dosage of this drug. Withdrawal symptoms from lowering the dosage of Effexor are not as bad as eliminating it entirely, if my own experience is any indication.
FWIW, 3%-8.9% of caucasians are poor 2D6 metabolizers, as are 1%-4.5% of hispanics and 0%-2.4% of east Asians. The only antidepressants that are not metabolized by the 2D6 enzyme are the SSRIs Celexa and Lexapro, and the MAO inhibitors Nardil and Parnate. It is worth pointing out that Celexa and Lexapro are both metabolized by the 2C19 enzyme, another enzyme that exhibits genetic polymorphism (2.5%-6.7% of caucausians are poor metabolizers, but I'm assuming there is no relationship to being a poor 2D6 metabolizer). Nardil and Parnate are not metabolized by the CYP-450 enzyme system.
Todd
Posted by zo out on March 28, 2004, at 14:10:50
In reply to Re: HELP..effexor/zoloft side effects ARGH! » flygirl, posted by King Vultan on March 28, 2004, at 10:02:02
Thank you, King Vulcan, for the information on 2D6. You had replied to an earlier message of mine where I stated I was on 150 mg of Zoloft and experiencing 5 wks of diarrhea. But the previous year and a half I was on 20 mg of celexa and felt great.(too great sometimes) Foolishly I went off Celexa for a month and fell into a deep depression. I looked forward to zoloft and I have to come to the conclusion it is not working? Do you think I should go back to Lex or Celexa and put somethink like zypreza with itif I get to feeling too good? Is there something to take to block the 2D6
Posted by flygirl on March 28, 2004, at 16:49:12
In reply to Re: HELP..effexor/zoloft side effects ARGH! » flygirl, posted by King Vultan on March 28, 2004, at 10:02:02
Todd- Thanks soooo much for the info. I and my husband were literally "dumbfound" that someone out there was aware of it and that we weren't imagining things. Also, your info on the enzymes was very interesting...I have printed up the responses and will be taking them into the pdoc this week when we see him!!! I have also just made another post titled "serotonin syndrome" just to see if anyone else has had exp. with it!
thanks again. He is feeling better today and again, has only had 2 37.5 effex. pills today.
Posted by flygirl on March 28, 2004, at 17:21:08
In reply to Re: HELP..effexor/zoloft side effects ARGH!, posted by Camille Dumont on March 27, 2004, at 20:53:04
> Even four weeks its quite quick ... I waited a month between every change ... 37.5, 75, 150, 225 and then 300.
>
> The cold sweats I've had but not the twiches and what not ... I got those from antipsychotics ... I don,t think ADs can give diskinesia so it sounds like a serotonin syndrome. Go see a doctor ASAP please.>>Camille-
Thanks to you also for your info.... It helps so much to not feel alone in this battle!
Karol
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