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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by g_g_g_unit on August 11, 2010, at 10:11:20
the psychologist i see (who's in the process of referring me to a psychiatrist and who lectures on psychopharmacology) has suggested i look into Effexor for ADD/OCD and severe, anergic depression. right now my most bothersome symptoms are cognitive + physical slowing. i'm less anxious in this state, but it's making engaging in CBT for my OCD difficult because i have very little cognitive control or mental capacity to redirect my attention.
i tried effexor once for a week and could barely stay awake, so have been scared to revisit it, though i'm guessing (hoping?) that's a transient side-effect.
has anyone here found that Effexor had any effect on their ADD symptoms outside of relieving their depression? or did you require augmentation? responses in the archives seem to be pretty mixed .. some people report feeling spacier on Effexor, and there seem to be some undocumented anticholinergic side-effects?
while i'm at it, does anyone with ADD have any positive experiences with the NRIs (Reboxetine, Strattera)? do they exacerbate anxiety? might they be useful for a co-morbid OCD guy like myself?
i've been wondering if i'd be better off trying a clean SSRI like Zoloft (the one SRI i have yet to try) with an NRI or low-dose AP (there are a couple of reports in the archives from people who found Geodon at low doses particularly useful).
thanks :>
Posted by ed_uk2010 on August 11, 2010, at 16:53:09
In reply to effexor for ADD/anergic depression?or augment SRI?, posted by g_g_g_unit on August 11, 2010, at 10:11:20
Effexor is not normally used to treat ADHD. Since Effexor frequently causes more severe side effects (and withdrawal symptoms when stopped) compared with SSRIs such as Zoloft, it might be best to try Zoloft initially. You can combine Zoloft with an NRI or stimulant if appropriate.
> the psychologist i see (who's in the process of referring me to a psychiatrist and who lectures on psychopharmacology) has suggested i look into Effexor for ADD/OCD and severe, anergic depression. right now my most bothersome symptoms are cognitive + physical slowing. i'm less anxious in this state, but it's making engaging in CBT for my OCD difficult because i have very little cognitive control or mental capacity to redirect my attention.
>
> i tried effexor once for a week and could barely stay awake, so have been scared to revisit it, though i'm guessing (hoping?) that's a transient side-effect.
>
> has anyone here found that Effexor had any effect on their ADD symptoms outside of relieving their depression? or did you require augmentation? responses in the archives seem to be pretty mixed .. some people report feeling spacier on Effexor, and there seem to be some undocumented anticholinergic side-effects?
>
> while i'm at it, does anyone with ADD have any positive experiences with the NRIs (Reboxetine, Strattera)? do they exacerbate anxiety? might they be useful for a co-morbid OCD guy like myself?
>
> i've been wondering if i'd be better off trying a clean SSRI like Zoloft (the one SRI i have yet to try) with an NRI or low-dose AP (there are a couple of reports in the archives from people who found Geodon at low doses particularly useful).
>
> thanks :>
>
>
Posted by olivia12 on August 11, 2010, at 21:45:19
In reply to effexor for ADD/anergic depression?or augment SRI?, posted by g_g_g_unit on August 11, 2010, at 10:11:20
I find Effexor to be side effect free and it has helped me with both depression and ADD at 75 mg. Hope this helps:)
Posted by g_g_g_unit on August 11, 2010, at 23:11:12
In reply to Re: effexor for ADD/anergic depression?or augment SRI?, posted by ed_uk2010 on August 11, 2010, at 16:53:09
> Effexor is not normally used to treat ADHD. Since Effexor frequently causes more severe side effects (and withdrawal symptoms when stopped) compared with SSRIs such as Zoloft, it might be best to try Zoloft initially. You can combine Zoloft with an NRI or stimulant if appropriate.
>thanks ed. the effexor wasn't recommended as a primary treatment for ADD; rather, the intention was to treat the depression, anxiety and OCD.
i've tried SSRI's as monotherapy before - specifically Prozac, Lexapro, Luvox and Paxil - for anxiety before with mixed results; they seem to help the OCD at the expense of worsening other conditions (social anxiety and certain aspects of the ADD such as anhedonia/dysthymia). do you think that Zoloft is atypical enough to warrant a trial where other SSRI's failed me?
Posted by linkadge on August 12, 2010, at 8:18:52
In reply to Re: effexor for ADD/anergic depression?or augment SRI? » ed_uk2010, posted by g_g_g_unit on August 11, 2010, at 23:11:12
Why not just go to clomipramine? It was far more tollerable than SSRIs or Effexor (for me) and also worked better.
Linkadge
Posted by g_g_g_unit on August 12, 2010, at 8:45:59
In reply to Re: effexor for ADD/anergic depression?or augment SRI?, posted by linkadge on August 12, 2010, at 8:18:52
> Why not just go to clomipramine? It was far more tollerable than SSRIs or Effexor (for me) and also worked better.
>
> Linkadgei've been thinking about that. my only hesitancy was that TCA's are less effective in atypical depression (supposedly?) and i don't think i could bare any more cognitive dysfunction; i'm trying to return to college to complete a masters degree, and it seems like clomipramine is very effective at inducing brain fog :)
Posted by ed_uk2010 on August 12, 2010, at 10:21:30
In reply to Re: effexor for ADD/anergic depression?or augment SRI? » ed_uk2010, posted by g_g_g_unit on August 11, 2010, at 23:11:12
>do you think that Zoloft is atypical enough to warrant a trial where other SSRI's failed me?
Difficult to say. Zoloft can cause all of the typical SRI side effects... but so can Effexor.
How do you respond to stimulants such as Concerta?
Posted by linkadge on August 12, 2010, at 12:30:16
In reply to Re: effexor for ADD/anergic depression?or augment SRI?, posted by ed_uk2010 on August 12, 2010, at 10:21:30
I would say that clomipramine would be more effective than effexor for atypical depression.
Effexor only has weak effects on norepinephrine. It takes massive doses before noradrenergic effects are pronounced.
Although clomipramine is preferentially a SSRI, its metabolite, is essentially a selective norepinephrine reuptake inhibitor. I noticed that clomipramine dramatically improved my energy levels as compared to either an SSRI or effexor.
Clomipramine also improves sleep. The sleep disturbance from effexor or SSRI's can adversely effect daytime energy levels.
Linkadge
Posted by Phillipa on August 12, 2010, at 13:00:24
In reply to Re: effexor for ADD/anergic depression?or augment SRI?, posted by linkadge on August 12, 2010, at 12:30:16
Why do some say all they do is sleep on SSRI's? Seems like now that don't disturb my sleeping either but take low dose of benzos with SSRI Phillipa
Posted by linkadge on August 12, 2010, at 18:52:55
In reply to Re: effexor for ADD/anergic depression?or augment SRI? » linkadge, posted by Phillipa on August 12, 2010, at 13:00:24
SSRIs esp in high doses just eventually put me in zombie land. I can't get deep sleep, yet I'm tired all the time. Tired but can't sleep.
Linkadge
Posted by olivia12 on August 12, 2010, at 18:55:03
In reply to Re: effexor for ADD/anergic depression?or augment SRI?, posted by linkadge on August 12, 2010, at 12:30:16
Link--are you a doctor? You sound like one. Just curious.
Posted by g_g_g_unit on August 12, 2010, at 20:23:54
In reply to Re: effexor for ADD/anergic depression?or augment SRI?, posted by ed_uk2010 on August 12, 2010, at 10:21:30
> How do you respond to stimulants such as Concerta?
>
um, ritalin SR made me really irritable, but did improve energy/cognitive energy levels (and made my OCD worse). i wasn't on an AD though. the plan was to trial the reputably gentler dexamphetamine once i was on an AD.
Posted by g_g_g_unit on August 12, 2010, at 20:25:28
In reply to Re: effexor for ADD/anergic depression?or augment SRI?, posted by linkadge on August 12, 2010, at 12:30:16
> I would say that clomipramine would be more effective than effexor for atypical depression.
>
that's interesting. i thought TCA's were as a rule generally ineffective in atypical depression.why didn't you stay on clomipramine? how did it find its effects on cognition?
> Effexor only has weak effects on norepinephrine. It takes massive doses before noradrenergic effects are pronounced.
>
> Although clomipramine is preferentially a SSRI, its metabolite, is essentially a selective norepinephrine reuptake inhibitor. I noticed that clomipramine dramatically improved my energy levels as compared to either an SSRI or effexor.
>
> Clomipramine also improves sleep. The sleep disturbance from effexor or SSRI's can adversely effect daytime energy levels.
>
>
> Linkadge
>
>
>
Posted by linkadge on August 12, 2010, at 20:56:24
In reply to Re: effexor for ADD/anergic depression?or augment SRI?, posted by g_g_g_unit on August 12, 2010, at 20:25:28
Well, I don't want to talk about my own reasons for discontinuing clomipramine (to not disuade anyone). They were not related to medication efficacy or tollerability though.
This is the end of the thread.
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