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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Franz on April 1, 2011, at 11:57:17
Hello, I would liek to know in your experiencea, not the literature, is venlafaxine stimulant.
Is duloxetine better?.
Thanks
Posted by Phillipa on April 1, 2011, at 12:47:47
In reply to From which dose venlafaxine is stimulant?, posted by Franz on April 1, 2011, at 11:57:17
Are you looking for the one most stimulant like? That would vary from person to person and over time in their bodies as once they were stimulating for me but not now. Phillipa
Posted by Conundrum on April 1, 2011, at 12:50:04
In reply to From which dose venlafaxine is stimulant?, posted by Franz on April 1, 2011, at 11:57:17
> Hello, I would liek to know in your experiencea, not the literature, is venlafaxine stimulant.
>
> Is duloxetine better?.
>
> ThanksI've never tried venlafaxine but I tried desvenlafaxine. It certainly was stimulating and I couldn't sleep the first night and had some trouble the 2nd night, but from then on I could sleep fine. I tried cymbalta recently and felt it blunted my feelings too much, although it is stimulating as well, I prefered Pristiq(desvenlafaxine) to Cymbalta. Only way to know which one will help you is to try them.
Posted by mtdewcmu on April 1, 2011, at 14:57:23
In reply to Re: From which dose venlafaxine is stimulant? » Franz, posted by Conundrum on April 1, 2011, at 12:50:04
>
> I've never tried venlafaxine but I tried desvenlafaxine. It certainly was stimulating and I couldn't sleep the first night and had some trouble the 2nd night, but from then on I could sleep fine. I tried cymbalta recently and felt it blunted my feelings too much, although it is stimulating as well, I prefered Pristiq(desvenlafaxine) to Cymbalta. Only way to know which one will help you is to try them.A study ranked the available antidepressants by side effects and efficacy, and Cymbalta was among the worst, and Effexor was among the best. So it's not totally random. Cymbalta came off looking like junk.
Posted by Franz on April 1, 2011, at 15:34:26
In reply to Re: From which dose venlafaxine is stimulant?, posted by mtdewcmu on April 1, 2011, at 14:57:23
> A study ranked the available antidepressants by side effects and efficacy, and Cymbalta was among the worst, and Effexor was among the best. So it's not totally random. Cymbalta came off looking like junk.
I thought escitalopram ranked as the best.
Also, I believe I read in this website a review saying SSRNIs where not better than SSRIs.
Posted by mtdewcmu on April 1, 2011, at 16:24:11
In reply to Re: From which dose venlafaxine is stimulant? » mtdewcmu, posted by Franz on April 1, 2011, at 15:34:26
> > A study ranked the available antidepressants by side effects and efficacy, and Cymbalta was among the worst, and Effexor was among the best. So it's not totally random. Cymbalta came off looking like junk.
>
> I thought escitalopram ranked as the best.
> Also, I believe I read in this website a review saying SSRNIs where not better than SSRIs.
>
>Escitalopram ranked the best, but Effexor was among the best. The study also failed to show an advantage for SNRIs as a class.
Posted by linkadge on April 1, 2011, at 16:25:39
In reply to Re: From which dose venlafaxine is stimulant? » mtdewcmu, posted by Franz on April 1, 2011, at 15:34:26
There are tons of studies all of which paint different antidepressants out to be the best.
Linkadge
Posted by mtdewcmu on April 1, 2011, at 16:48:00
In reply to Re: From which dose venlafaxine is stimulant?, posted by linkadge on April 1, 2011, at 16:25:39
> There are tons of studies all of which paint different antidepressants out to be the best.
>
> LinkadgeThere are lots of head-to-head studies funded by the drug companies showing their own antidepressant to be the best. But this was a large meta-analysis that pooled all of the available data, and the medical community seems to be taking it seriously. I'm not saying that I have complete faith in it, but it seems like the best we have.
Posted by linkadge on April 1, 2011, at 17:03:45
In reply to Re: From which dose venlafaxine is stimulant?, posted by mtdewcmu on April 1, 2011, at 16:48:00
Yeah, but the meta-analysis are simply comprised of the individual head to head studies.
I remember a mata analysis about 7 years back suggesting that mirtazapine was at the top, in terms of efficacy, speed of onset, tollerability, yadi, yada. I don't believe it for a second.
Linkadge
Posted by Conundrum on April 1, 2011, at 17:39:40
In reply to Re: From which dose venlafaxine is stimulant?, posted by mtdewcmu on April 1, 2011, at 16:24:11
Effexor and remeron were the most effective. However more dropped out than with zoloft and lexapro which had high efficacy and patient acceptability, but not as potent as those two particular dual acting drugs. Cymbalta did not do well.
Posted by linkadge on April 1, 2011, at 20:27:46
In reply to Re: From which dose venlafaxine is stimulant?, posted by Conundrum on April 1, 2011, at 17:39:40
Thats what I don't understand. Remeron is not really dual acting (at least in the way effexor is). I also continually see people quit remeron for lack of sustained efficacy.
The statistical methods for comparing antidepressant efficacy is highly controversial.
Drug A might beat B and B might beat C, yet C also beats A. It depends on what weighting factors you give to efficacy and tollerability in your overall rating. It also depends on what studies you include and how you rate the study's overall believability. I.e. if you remove studies funded by the drug company, would you get the same results? Yes, escitalopram is rated highly, but most of the positive studies are industry funded.
Linkadge
Posted by mtdewcmu on April 1, 2011, at 20:50:47
In reply to Re: From which dose venlafaxine is stimulant?, posted by linkadge on April 1, 2011, at 20:27:46
> Thats what I don't understand. Remeron is not really dual acting (at least in the way effexor is). I also continually see people quit remeron for lack of sustained efficacy.
>Remeron is multiply-acting. It blocks alpha2 adrenergic, 5-ht2a, 5-ht2c, and 5-ht3 receptors. I don't know if that makes it as effective as they say, but why would Remeron's makers be better at influencing the scientific publications than anyone else?
> The statistical methods for comparing antidepressant efficacy is highly controversial.
> Drug A might beat B and B might beat C, yet C also beats A. It depends on what weighting factors you give to efficacy and tollerability in your overall rating. It also depends on what studies you include and how you rate the study's overall believability. I.e. if you remove studies funded by the drug company, would you get the same results? Yes, escitalopram is rated highly, but most of the positive studies are industry funded.I think when they do those meta-analyses, they reinterpret the raw data, rather than relying on the interpretations of the original authors. Not completely sure though.
Posted by Conundrum on April 2, 2011, at 5:09:50
In reply to Re: From which dose venlafaxine is stimulant?, posted by linkadge on April 1, 2011, at 20:27:46
> Thats what I don't understand. Remeron is not really dual acting (at least in the way effexor is). I also continually see people quit remeron for lack of sustained efficacy.
>
> The statistical methods for comparing antidepressant efficacy is highly controversial.
> Drug A might beat B and B might beat C, yet C also beats A. It depends on what weighting factors you give to efficacy and tollerability in your overall rating. It also depends on what studies you include and how you rate the study's overall believability. I.e. if you remove studies funded by the drug company, would you get the same results? Yes, escitalopram is rated highly, but most of the positive studies are industry funded.
>
>
> LinkadgeThat is a good point. If the studies used were those funded by drug companies then it seems that the companies that did the greatest number of studies would come out on top. It would be interesting to see if that was the case.
Anyway regarding remeron, for me it was one of the few drugs that had any effect, but it did poop out in record time. Pristiq and prozac have been the only drugs that have had any effect on me. Pristiq is an active metabolite of venlafaxine so perhaps there is something to this study. By dual acting, I meant the drug is antagonist in the serotonergic and adrenergic systems. However one could argue Zoloft is a dual acting drug.
Posted by linkadge on April 2, 2011, at 13:23:57
In reply to Re: From which dose venlafaxine is stimulant?, posted by mtdewcmu on April 1, 2011, at 20:50:47
>Remeron is multiply-acting. It blocks alpha2 >adrenergic, 5-ht2a, 5-ht2c, and 5-ht3 receptors. >I don't know if that makes it as effective as >they say, but why would Remeron's makers be >better at influencing the scientific >publications than anyone else?
Remeron can produce faster improvement in certain depressive symptoms (anxiety, insomnia, loss of appetite etc). However, many of the studies I have read, seem to suggest that S/NRIs improvement lags, but is often superior after about 4 weeks. I don't know how the data was anaylsed.
I really don't know how to answer the question. However, there are a lot of good psychiatrists out there that don't think much of remeron. I personally think that remeron is great at masking symptoms of depression (not that any antidepressant does much more), but people I talk to seem to think its great at improving symptoms of deprssion without actually improving depression (if that makes any sense).
>I think when they do those meta-analyses, they >reinterpret the raw data, rather than relying on >the interpretations of the original authors. Not >completely sure though.
That may be so, but I think its like comparing apples to oranges. There are many subtle, but powerful things that can influence the outcome of a trial. I just don't think its possible to compare two different trials done on two different dates, in two different locations, funded by two different parties, on two different groups of people.
With a lot of these trials, if the wind blows a different way, you'd get different results IMHO. Unless its industry funded, then you know what results to expect.
Linkadge
Posted by mtdewcmu on April 2, 2011, at 15:49:21
In reply to Re: From which dose venlafaxine is stimulant?, posted by linkadge on April 2, 2011, at 13:23:57
> >Remeron is multiply-acting. It blocks alpha2 >adrenergic, 5-ht2a, 5-ht2c, and 5-ht3 receptors. >I don't know if that makes it as effective as >they say, but why would Remeron's makers be >better at influencing the scientific >publications than anyone else?
>
> Remeron can produce faster improvement in certain depressive symptoms (anxiety, insomnia, loss of appetite etc). However, many of the studies I have read, seem to suggest that S/NRIs improvement lags, but is often superior after about 4 weeks. I don't know how the data was anaylsed.
>The nice thing about Remeron, though, is that it can be combined with S/NRIs. So you don't have to choose. The premise that you have to take one and only one antidepressant isn't realistic.
> I really don't know how to answer the question. However, there are a lot of good psychiatrists out there that don't think much of remeron. I personally think that remeron is great at masking symptoms of depression (not that any antidepressant does much more), but people I talk to seem to think its great at improving symptoms of deprssion without actually improving depression (if that makes any sense).
>There's a saying in self-help: Fake it till you make it!
> >I think when they do those meta-analyses, they >reinterpret the raw data, rather than relying on >the interpretations of the original authors. Not >completely sure though.
>
> That may be so, but I think its like comparing apples to oranges. There are many subtle, but powerful things that can influence the outcome of a trial. I just don't think its possible to compare two different trials done on two different dates, in two different locations, funded by two different parties, on two different groups of people.
>
> With a lot of these trials, if the wind blows a different way, you'd get different results IMHO. Unless its industry funded, then you know what results to expect.
>I'm sure that whoever did the study was aware of these problems and did their best. It's still better than intuition and hearsay.
Posted by linkadge on April 2, 2011, at 20:29:54
In reply to Re: From which dose venlafaxine is stimulant?, posted by mtdewcmu on April 2, 2011, at 15:49:21
>It's still better than intuition and hearsay.
Maybe better than hearsay, but not intuition IMO.
Linkadge
Posted by mtdewcmu on April 3, 2011, at 0:29:09
In reply to Re: From which dose venlafaxine is stimulant?, posted by linkadge on April 2, 2011, at 20:29:54
> >It's still better than intuition and hearsay.
>
> Maybe better than hearsay, but not intuition IMO.
>
> Linkadge
>
>After I pushed send on that, I wished I had written "speculation and hearsay" if it makes a difference. Intuition is good as long as you can go back and justify it with good reasons.
I put some weight on my own impression of meds I've taken, but I recognize that my physiology is not quite the same as everyone's.
Posted by ed_uk2010 on April 3, 2011, at 15:38:15
In reply to From which dose venlafaxine is stimulant?, posted by Franz on April 1, 2011, at 11:57:17
> Hello, I would liek to know in your experiencea, not the literature, is venlafaxine stimulant.
>
> Is duloxetine better?.
>
> ThanksIf by stimulant you mean amphetamine-like, venlafaxine is not stimulant at any dose. Like most ADs it can sometimes cause agitation and insomnia, but it is not like a stimulant.
Posted by desolationrower on April 4, 2011, at 1:40:59
In reply to Re: From which dose venlafaxine is stimulant?, posted by ed_uk2010 on April 3, 2011, at 15:38:15
i think over 150mg it made me too sleepy to stay awake over ~6 hours.
if you want stimulation, i'd just pick another drug.
-d/r
Posted by bleauberry on April 4, 2011, at 5:03:33
In reply to From which dose venlafaxine is stimulant?, posted by Franz on April 1, 2011, at 11:57:17
I wouldn't count on effexor for stimulation. I mean, sure, it could give some of that stimulation that some people feel from boosted serotonin, which is usually a short term phenomenon.
The best med is the one that feels best to you. No study is going to tell us which one that is. In the studies determining which is superior, they are naturally biased depending on who sponsored and wrote the study. All meds at one time or another have been deemed superior to others. But even the ones that were superior...were only superior by a few percentage points...nothing to celebrate about.
All that said, I've heard effexor begins to get more stimulating about 225mg, and more so around 350mg. Those doses are where its very small effect on norepineprhine and dopamine begin to have some slight relevance compared to serotonin.
Posted by ed_uk2010 on April 5, 2011, at 14:37:34
In reply to Re: From which dose venlafaxine is stimulant?, posted by bleauberry on April 4, 2011, at 5:03:33
>All that said, I've heard effexor begins to get more stimulating about 225mg, and more so around 350mg. Those doses are where its very small effect on norepineprhine and dopamine begin to have some slight relevance compared to serotonin.
But in reality, very high doses of Effexor cause considerable fatigue extremely frequently.
Posted by Conundrum on April 5, 2011, at 14:42:25
In reply to Re: From which dose venlafaxine is stimulant?, posted by bleauberry on April 4, 2011, at 5:03:33
> I wouldn't count on effexor for stimulation. I mean, sure, it could give some of that stimulation that some people feel from boosted serotonin, which is usually a short term phenomenon.
>
> The best med is the one that feels best to you. No study is going to tell us which one that is. In the studies determining which is superior, they are naturally biased depending on who sponsored and wrote the study. All meds at one time or another have been deemed superior to others. But even the ones that were superior...were only superior by a few percentage points...nothing to celebrate about.
>
> All that said, I've heard effexor begins to get more stimulating about 225mg, and more so around 350mg. Those doses are where its very small effect on norepineprhine and dopamine begin to have some slight relevance compared to serotonin.I agree everyone will respond differently. When I started desvenlafaxine I found it immediately stimulating and could not sleep the first night. I never experienced this with lexapro or prozac, so I'm guessing it had to do with its effect on norepinephrine, which is *claimed* to be 10:1 in favor of serotonin as opposed to the venlafaxine molecule which is 30:1 in favor of serotonin, which when couple with the metabolite in the blood must be somewhere in between those ratios. I was able to sleep fine on this drug over time though. I never found it sedating though. Some people find adrenergic drugs tiring so YMMV.
This is the end of the thread.
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