Psycho-Babble Medication Thread 910235

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Fluoxetine or venlafaxine?

Posted by tensor on August 4, 2009, at 13:23:29

My Lexapro trial is coming to an end. I have taken 20mg along with 30mg of Remeron for depression and panic attacks. The panic anxiety is under control but the depression is not lifting. Have no energy, no motivation or interest. I have to make a decision what to try next. I would like to try one newer antidepressants before resorting to TCAs (not that they are guaranteed to work.), it's either fluoxetine or venlafaxine as I can see.
I'm a bit confused over the noradrenergic properties of venlafaxine, but I guess at high enough dose it's there. Venlafaxine is possibly stronger, but as I can recall fluoxetine has a more favorable s/e profile. Oh, I'm keeping Remeron at 30mg.

Please come with ideas, or pros and cons.

Kind regards,
Mattias

 

Re: Fluoxetine or venlafaxine? » tensor

Posted by SLS on August 4, 2009, at 14:22:47

In reply to Fluoxetine or venlafaxine?, posted by tensor on August 4, 2009, at 13:23:29

> My Lexapro trial is coming to an end. I have taken 20mg along with 30mg of Remeron for depression and panic attacks. The panic anxiety is under control but the depression is not lifting. Have no energy, no motivation or interest. I have to make a decision what to try next. I would like to try one newer antidepressants before resorting to TCAs (not that they are guaranteed to work.), it's either fluoxetine or venlafaxine as I can see.
> I'm a bit confused over the noradrenergic properties of venlafaxine, but I guess at high enough dose it's there. Venlafaxine is possibly stronger, but as I can recall fluoxetine has a more favorable s/e profile. Oh, I'm keeping Remeron at 30mg.
>
> Please come with ideas, or pros and cons.
>
> Kind regards,
> Mattias

I would first try adding Wellbutrin to the Lexapro if it is not too late to do so. Then, if you get no response, but feel no worse, you could leave the Wellbutrin in place and switch from Lexapro to Effexor. If you still don't respond, I would then consider swapping the Wellbutrin for nortriptyline and continue with the Effexor. If you get a partial response at any point, you can try adding Lamictal, Abilify, or Geodon.


- Scott

 

Re: Fluoxetine or venlafaxine? » SLS

Posted by tensor on August 4, 2009, at 14:31:09

In reply to Re: Fluoxetine or venlafaxine? » tensor, posted by SLS on August 4, 2009, at 14:22:47

Scott, you're the best ;)

I assume that means quitting Remeron, however, I'm a bit reluctant to do so, because everytime I've done it I get worse. So I would like to keep Remeron. I tried Wellbutrin a couple of years ago but I just felt like I have smoked too much cigarettes, no improvement at all. What do you think of Effexor+Remeron? I tried Lamictal for several months before but it just made me tired.

regards,
Mattias

 

Re: Fluoxetine or venlafaxine? » tensor

Posted by SLS on August 4, 2009, at 15:14:49

In reply to Re: Fluoxetine or venlafaxine? » SLS, posted by tensor on August 4, 2009, at 14:31:09

> I tried Wellbutrin a couple of years ago but I just felt like I have smoked too much cigarettes, no improvement at all.

I wouldn't rule it out for future treatments. What exactly did it feel like? I don't smoke, so I wouldn't know how that would feel.

> What do you think of Effexor+Remeron?

Good idea. I overlooked that one. Yes, Effexor + Remeron has been said to be a powerful treatment - dubbed California Rocket Fuel. You probably knew that already. I think the mistake that is too often made with Remeron is to use dosages that are too low. I consider the therapeutic range to include dosages between 45-75mg.

One thought. With Remeron, withdrawal rebound depression is a possibility. Just like other withdrawal symptoms, this additional depression can disappear with time. The occurrence of a rebound depression does not necessarily mean that Remeron was helping your depression at all. I don't know of any way to discriminate between rebound depression and relapse.


- Scott

 

Re: Fluoxetine or venlafaxine? » SLS

Posted by tensor on August 5, 2009, at 1:01:18

In reply to Re: Fluoxetine or venlafaxine? » tensor, posted by SLS on August 4, 2009, at 15:14:49

Yes, thank you. I have been thinking about rebound depression and quitting Remeron, I just haven't had the patience to wait and see, so I've kept it. IMHO Remeron is the "smartest" AD there is.

> What exactly did it feel like? I don't smoke, so I wouldn't know how that would feel.

As a non-smoker, smoke one cigarette fast and you will get a nicotine kick, that's how it felt for me. Although not as nauseous.

Yeah, Effexor is probably the next one to try, I will discuss this with my pdoc tomorrow. Will also consider raising Remeron to 45mg prior to switching to Effexor.

Thanks,
Mattias

 

Re: Fluoxetine or venlafaxine?

Posted by zana on August 5, 2009, at 9:24:13

In reply to Re: Fluoxetine or venlafaxine? » SLS, posted by tensor on August 5, 2009, at 1:01:18

Remeron is fine with Pristiq so I assmume it would be fine with Effexor. I am also taking Wellbutrin with it so there's plenty of room to augment with other ADs.


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