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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by zonked on July 14, 2009, at 22:21:36
Hi all:
I finally discontinued Nardil (and had the two week washout) because it was no longer effective at 90mg, and my doctor wouldn't prescribe me a higher dosage.
I asked her about Vivactil, because it looked promising for my symptom set (and can start to work in as quickly as a week) but she was pushing Effexor XR and I agreed.
I've been on it two weeks (first week 75mg, second week 150mg) and feel sick as a dog. Anxiety is through the roof, stomach ache all day long...
Should I give it the six week try or get off it now and try something else? SSRIs quit working for me years ago... I am wondering if I am just making myself sick with this med or if the side effects will go away and it will begin to work.
Posted by floatingbridge on July 14, 2009, at 23:54:12
In reply to Started Effexor XR - nightmare! advice needed, posted by zonked on July 14, 2009, at 22:21:36
Hey Zonked, sorry your having a rough time. Someone else here is currently posting about terrible start up on pristiq. Have you asked your pdoc about these symptoms--they sound extreme. When I started, I had flu-like symptoms for a few days that began to dissipate. No two people are alike--maybe this drug isn't the one for you, but I don't know.... I do know the withdrawal can be a protracted nightmare. Hope this is more helpful than alarming.
fb
Posted by zonked on July 15, 2009, at 0:19:44
In reply to Re: Started Effexor XR - nightmare! advice needed » zonked, posted by floatingbridge on July 14, 2009, at 23:54:12
I am thinking about asking about Remeron, Vivactil or Marplan...
I forgot to mention: I am also taking Lamictal 200mg and Klonopin 1mg b.i.d.; my former psychiatrist would NOT give me xanax (Klonopin worsens my depression) even though it works better than anything, and I had been on the same dose for years .. Hopefully my new doc (who I meet tomorrow) will switch me back.
I don't understand why Xanax is such a dirty word to some doctors - it doesn't make me high, just literally takes the anxious edge away without making me more depressed. Ativan also makes me more depressed.
I appreciate this board more than you can imagine.
> Hey Zonked, sorry your having a rough time. Someone else here is currently posting about terrible start up on pristiq. Have you asked your pdoc about these symptoms--they sound extreme. When I started, I had flu-like symptoms for a few days that began to dissipate. No two people are alike--maybe this drug isn't the one for you, but I don't know.... I do know the withdrawal can be a protracted nightmare. Hope this is more helpful than alarming.
>
> fb
Posted by Phillipa on July 15, 2009, at 0:39:15
In reply to Re: Maybe Remeron, Vivactil or Marplan instead.., posted by zonked on July 15, 2009, at 0:19:44
Hi Zonked I don't know why xanax is seen that way either just relaxed me enough to function normally for many years now take valium used to do the same for me have you asked about it as klonopin is the only benzo that severly depressed me. Sorry but it's true another babbler having horrible experience with effexor or pristiq same arent they except for time release. Maybe change the med before you would have withdrawals. Good luck Phillipa
Posted by rvanson on July 15, 2009, at 8:43:28
In reply to Re: Maybe Remeron, Vivactil or Marplan instead.., posted by zonked on July 15, 2009, at 0:19:44
> I am thinking about asking about Remeron, Vivactil or Marplan...
>
> I forgot to mention: I am also taking Lamictal 200mg and Klonopin 1mg b.i.d.; my former psychiatrist would NOT give me xanax (Klonopin worsens my depression) even though it works better than anything, and I had been on the same dose for years .. Hopefully my new doc (who I meet tomorrow) will switch me back.
>
> I don't understand why Xanax is such a dirty word to some doctors - it doesn't make me high, just literally takes the anxious edge away without making me more depressed. Ativan also makes me more depressed.
You need to find a new Pdoc. The lastest fad with newer docs is some paranoia about Dxing Xanax, one of the best benzodiazapines made. I can't take Ativan or Klonopin as they are depressive to me and effect my memory which xanax does not do. You can't make the doc give you a med that helps do what I do: Dump the Doc!
Posted by Phil on July 15, 2009, at 17:50:32
In reply to Re: Maybe Remeron, Vivactil or Marplan instead.. » zonked, posted by rvanson on July 15, 2009, at 8:43:28
Posted by Phil on July 15, 2009, at 17:53:26
In reply to Started Effexor XR - nightmare! advice needed, posted by zonked on July 14, 2009, at 22:21:36
Gave me myoclonic jerks.
Posted by bleauberry on July 15, 2009, at 19:23:28
In reply to Started Effexor XR - nightmare! advice needed, posted by zonked on July 14, 2009, at 22:21:36
I don't know, it's a tough call. Some people gut it out through real nasty side effects to see if there is something good on the other side, some people like me don't.
I think the primary problem is not the medication but rather the dosage. It should have been 37.5mg for perhaps 3 to 4 weeks, or until side effects diminished, before even contemplating an increase. There are people at askapatient.com and revolutionhealth.com that ended up with either 37.5mg or 75mg as their final therapeutic dose, where higher doses made them feel worse or gave them unbearable side effects or both, or where they never found it necessary to venture into higher doses because the low ones worked great.
I strongly despise the common strategy of choosing preconceived dosing strategies. The patient's reactions should be the guiding factor, without any preconceived notion of where things are going, starting with the lowest possible dose. The side effects and the emotions are the steering wheel, not a pen and paper and not clinical studies on cherrypicked samples that are not representative of you and me and of which the results are so intricately flawed it could write an entire book. So I disagree with your doses. They are obviously out of control and way too high.
I would have already bailed out. Or at least reduced the dose way back to the starting line. But that's just me. I look at it like a boxing match. I'm in it to win. I don't want to get knocked out in the early rounds. It's already hard enough to win that I don't want to get bruised up any harder than I have to. The punishment you are experiencing is avoidable or bearable with proper dose management.
If we are to get well, we need access to all options. If a doctor rules out a reasonable option, such as xanax, it might be wise to seek a second opinion from someone with wider therapeutic boundaries.
It is a tough call. Some of the ideas that roamed through my head...
1. Reduce the dose to minimum, give this thing some time.
2. Reduce the dose to minimum, add nortriptyline.
3. Reduce the dose to minimum, add desipramine.
4. Stop completely and go to Nort or Desip.
5. Stop completely and go to Nort+Zoloft (specific pharmacological reasons)
It's just me, someone else will see it different, but notice my options did not include staying at my current dose or Vivactil.Vivactil does look good on paper. In the real world it has some really powerful sides. I couldn't even handle one day of the lowest dose. Rat poison. Nort or Desip so much friendlier, and in my book better options than any newer med.
Posted by sowhysosad on July 16, 2009, at 6:00:52
In reply to Re: Started Effexor XR - nightmare! advice needed, posted by bleauberry on July 15, 2009, at 19:23:28
> I strongly despise the common strategy of choosing preconceived dosing strategies. The patient's reactions should be the guiding factor, without any preconceived notion of where things are going, starting with the lowest possible dose. The side effects and the emotions are the steering wheel, not a pen and paper and not clinical studies on cherrypicked samples that are not representative of you and me and of which the results are so intricately flawed it could write an entire book.
I heartily agree. I recently asked my junior pdoc to prescribe fluoxetine liquid so I could start at 10mg and titrate when ready.
He sounded completely baffled by this and protested that they never start anyone on less than 20mg! No wonder a lot of people quit before getting any potential benefit because of intolerable startup effects.
This is the end of the thread.
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