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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 shadowmon on May 25, 2008, at 19:00:59
I'm getting scared because it seems like I'm backslipping more than I am making any progress... While I don't have the "churning" that I have with my GAD, I do feel very tense, I can't relax and overall feel miserable. I just increased my dosage on thursday and I am 4 days in to the new dosge,but not up where the dr ultimately wants me to be.
Posted by boltsdraggin on May 25, 2008, at 20:35:53
In reply to effexor not helping but making things worse?, posted by shadowmon on May 25, 2008, at 19:00:59
Hang in there shadowmon - give it another week or so, but definitely let your doctor know what you're feeling. Constant communication is the key, although many docs wouldn't want to make too much time for that. Did he consider giving you a PRN benzo for a 'break-through' episode of axiety? At any rate, after 4 days, my guess is you're only on 37.5 or 75mg per day - therapeutic is much more like 225. What other meds are you taking?
Posted by elanor roosevelt on May 25, 2008, at 22:34:28
In reply to Re: effexor not helping but making things worse?, posted by boltsdraggin on May 25, 2008, at 20:35:53
i took effexor for quite a while
looking back i realize i was in a borderline manic state the entire time which i enjoyedtried to go back to it and couldn't handle it
also, it made me very truthful which some people found to be extremely annoying
Posted by Phillipa on May 26, 2008, at 0:04:37
In reply to Re: effexor not helping but making things worse?, posted by elanor roosevelt on May 25, 2008, at 22:34:28
Yes do call you doc and if you don't have a benzo for the startup I'd request on and what other meds are you on? Phillipa
Posted by torachan on May 26, 2008, at 0:04:54
In reply to effexor not helping but making things worse?, posted by shadowmon on May 25, 2008, at 19:00:59
Shawdowmon, I'm pretty much in the same boat as you. I was on Effexor for many years, then dropped it and found I needed to increase my benzo usage which somewhat suggests that the Effexor did something for my anxiety, but I ultimately felt the same as you, constantly tense, so I dropped it. Trying it again because docs don't like prescribing higher doses of a benzo, if at all, but I'm finding out the reasons why I stopped it. The stuff just doesn't work for anxiety. I know I may get some flack for saying this but in my mind it's true. Those drugs are NOT FOR ANXIETY. And pretty soon I'm going to make this more than clear to any doctor I encounter in the future.
Now while I do agree that benzos are not an "ideal" long term treatment approach for GAD, they, the medical science establishment have yet to find an effective replacement. It's as simple as that. Unfortunately the research seems to be focussed on treating Depression, while largely ignoring Anxiety. There are reasons for this I'm sure. Here's another statement which may receive some flack; I'd much rather deal with Depression on a daily basis than Anxiety. In fact, I do deal with depression pretty much daily as a result of my constant anxiety. It's at a lesser degree, but still depression. Anxiety eats you from the inside out; chronic anxiety KILLS due to chronic stress. And don't say depression kills through suicide because I've contemplated suicide many, many times due to chronic anxiety.
I'm not demeaning the pain depressives go through, I'm just venting that anxiety is being looked over in the name of depression, and docs are pushing anti-depressants on us, which are not designed to treat anxiety properly, because they have no alternative. In a way, I'm pissed off at this whole Bipolar/Depression rage in the medical community. I'm suffering as a result and it's not fair. Anti-depressants are NOT effective for anxiety!!
End rant. Sorry if I offended anyone.
Posted by bleauberry on May 26, 2008, at 16:50:44
In reply to effexor not helping but making things worse?, posted by shadowmon on May 25, 2008, at 19:00:59
Any drug can make someone worse. Roughly speaking, based on a few scattered clinical studies that looked at this topic, and some subjective anecdotal evidence, I would estimate the percentage of people who get worse on any particular med is between 5% and 15%.
I think it is a common mistake for a doctor to have some predetermined target dose in mind when in fact he has absolutely no clue how this particular person will respond to the drug. That target is based on other people and generalities. Go to askapatient.com or search archives of various forums and you will see there are a good number of people who did very well with their starting dose of 37.5mg, or 75mg tops. Sure higher doses might be needed, but why go too far and possibly ruin a good thing. Go higher when a lower dose has had a fair shot.
One doc I saw somewhere on the web said something I agree with. That is, have the patient stay at the starting dose for a month before increasing it. Each increase needs another month. The idea is to get a good true reading of what the drug is doing. Too many dose changes in a short time, or too large of dose changes in a short time, makes evaluation of side effects and efficacy inaccurate. The drawback with this approach is it takes longer, if a higher dose is in the plans.
I have discovered that meds for me have a therapeutic window. Higher than my window and I feel worse.
Nortriptyline may be an exception, as it has a verified blood level that relates to efficacy. But with any other drug, personal opinion here, I say don't try to copy drug trials, don't try to be somebody else, find the dose that you personally agree with. There should be no predetermined dose target in mind.
But that's just me. I would go back down to the previous dose and stay there a while before making another move.
Posted by Phillipa on May 26, 2008, at 19:14:13
In reply to Re: effexor not helping but making things worse?, posted by torachan on May 26, 2008, at 0:04:54
I can't believe someone else feels exactly the same way I do and reacts the same way too. Thank-you for not thinking something is wrong with me cause they just don't work for me and make me feel worse. Love Phillipa
Posted by shadowmon on May 26, 2008, at 22:29:04
In reply to Re: effexor not helping but making things worse?, posted by boltsdraggin on May 25, 2008, at 20:35:53
I'm also taking trazodone, so I can sleep at night. I crashed in all ways, I'm depressed and I'm anxious,although the anxiety is not as bad as I imagined it would be.
Funny tho, when I take the trazodone at night, I feel actually normal....
Posted by shadowmon on May 26, 2008, at 22:39:09
In reply to Re: effexor not helping but making things worse?, posted by torachan on May 26, 2008, at 0:04:54
> Shawdowmon, I'm pretty much in the same boat as you. I was on Effexor for many years, then dropped it and found I needed to increase my benzo usage which somewhat suggests that the Effexor did something for my anxiety, but I ultimately felt the same as you, constantly tense, so I dropped it. Trying it again because docs don't like prescribing higher doses of a benzo, if at all, but I'm finding out the reasons why I stopped it. The stuff just doesn't work for anxiety. I know I may get some flack for saying this but in my mind it's true. Those drugs are NOT FOR ANXIETY. And pretty soon I'm going to make this more than clear to any doctor I encounter in the future.
>
> Now while I do agree that benzos are not an "ideal" long term treatment approach for GAD, they, the medical science establishment have yet to find an effective replacement. It's as simple as that. Unfortunately the research seems to be focussed on treating Depression, while largely ignoring Anxiety. There are reasons for this I'm sure. Here's another statement which may receive some flack; I'd much rather deal with Depression on a daily basis than Anxiety. In fact, I do deal with depression pretty much daily as a result of my constant anxiety. It's at a lesser degree, but still depression. Anxiety eats you from the inside out; chronic anxiety KILLS due to chronic stress. And don't say depression kills through suicide because I've contemplated suicide many, many times due to chronic anxiety.
>
> I'm not demeaning the pain depressives go through, I'm just venting that anxiety is being looked over in the name of depression, and docs are pushing anti-depressants on us, which are not designed to treat anxiety properly, because they have no alternative. In a way, I'm pissed off at this whole Bipolar/Depression rage in the medical community. I'm suffering as a result and it's not fair. Anti-depressants are NOT effective for anxiety!!
>
> End rant. Sorry if I offended anyone.
Torachan,I agree with you about the anxiety kills you from the inside out. I could manage the depression by itself. Sometimes all I want is to just Rest. and REST and not have these thoughts racing around in my head. My anxiety makes it so I can't eat, I'm afraid to go out and do things to help myself.I'm surprised though because normally my depression manifests itself very badly with GAD. The effexor at 75 has stopped the incessant churning of thoughts (meaning I can stop them) but it overall has not stopped the edgy anxious feeling nor has it stopped the body from freaking out yet. And, of course, I have a very depressed mood. I'm going to go up on it because right now, I'm without pdoc (changing health plans, have yet to get new health card and transfer records) so I'm going with what my last doc wanted me to get to to at least have something be hopefully therapeutic.
Part of me kinds of wishes I didnt go off of paxil... I had a lot of stress in the last 6 months, and I at least knew what to expect from it...
Posted by shadowmon on May 26, 2008, at 22:43:17
In reply to Re: effexor not helping but making things worse?, posted by Phillipa on May 26, 2008, at 0:04:37
> Yes do call you doc and if you don't have a benzo for the startup I'd request on and what other meds are you on? Phillipa
I'm only taking trazodone 50 mg for sleep. Believe it or not it actually makes me not depressed when I take it. It makes it tolerable, and I feel normal. And I eat, and I can fall asleep.
Believe it or not, since my diagnosis of depression, I have never had a benzo. Before I was diagnosed, I had a dr put me on clorazepam for anxiety, but I didnt have depression at that time and man, I couldn't function even on the littlest dose.
This is the end of the thread.
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