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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by never2late on January 2, 2012, at 2:26:16
Just started effexor up to 75 mg. Been Diagnosed MDD,SAD,GAD, ADD.
Taking Effexor, Adderall IR 10 mg 2x, Klonopin .5 mg, Ambien to at night.
After getting past the sleepiness side effects the frist week I am not finding that I feel more emotionally blunted than before. I am also mentally and physically lethargic. I have no interest in sex even tho the equiptment works (barely). The positives is that I am now getting to sleep at night and having less anxiety than I did before.
What reamins is the lack of emotion, feeling happy about anything, and an increase in ADD symtoms even tho I am taking adderall.
I have read that SSRI/SNRI raise seretonin thereby reducing dopamine. The only thing that is getting me through the day is coffee and my adderall. But ithat gets me low level functioning. I have trouble counting (simple math), have been experiencing balance and coordination, slight shakiness in my hands at times.
I usually have a blank expression on my face and people are constantly telling me to smille more.Cigarettes, which I used to help me focus and relax myself when i felt overwhelmed do not work anymore. I have to smoke 3x more cigarettes in order to get the same effect.
Is the shot of seratonin fromt the effexor messing with my dopamine? Are the things I am describing due to a dopamine deficiiency? What options can I discuss with my Pdoc about fixing this?
Posted by Phidippus on January 2, 2012, at 16:20:48
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
You are on a low dose of Effexor, which may not be therapeutic and much of what you're feeling are the symptoms of your depression.
What you may be thinking is an increase in ADHD symptoms, may just be the lack of concentration that comes with untreated depression.
Not all SSRIs/SNRIs reduce dopamine. Some ADs actually increase dopamine. In fact, Effexor is a serotonin-norepinephrine-dopamine reuptake inhibitor, which means it increases dopamine.
The first thing I'd discuss is raising your Effexor dose with your doc. MAybe even increase your Adderal dose.
Eric
Posted by torrid2 on January 2, 2012, at 16:36:23
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
Quit the smoking for heven sake, if it's a stimulant you need go on the patch.
Posted by Christ_empowered on January 2, 2012, at 20:43:28
In reply to Re: Dopamine Fixes for Effexor, posted by torrid2 on January 2, 2012, at 16:36:23
Most antidepressants are like emotional novocaine. The blunting is part of their "therapeutic" effect. That's why they're so good for OCD--they make you care less.
Personally, I'd ditch the Effexor and up the Adderall a bit and do something non-medical about lingering symptoms--(group) therapy, exercise, supplements, art/writing, that kind of thing.
Posted by SLS on January 2, 2012, at 20:46:33
In reply to Re: Dopamine Fixes for Effexor, posted by Christ_empowered on January 2, 2012, at 20:43:28
> Most antidepressants are like emotional novocaine. The blunting is part of their "therapeutic" effect.
Are you projecting your own experiences to everyone else?
- Scott
Posted by poser938 on January 3, 2012, at 3:16:34
In reply to Re: Dopamine Fixes for Effexor, posted by Christ_empowered on January 2, 2012, at 20:43:28
> Most antidepressants are like emotional novocaine. The blunting is part of their "therapeutic" effect. That's why they're so good for OCD--they make you care less.
>
> Personally, I'd ditch the Effexor and up the Adderall a bit and do something non-medical about lingering symptoms--(group) therapy, exercise, supplements, art/writing, that kind of thing.i agree.
and SSRI's do indeed deplete dopamine. it seems that effexor is one of the more numbing antidepressants. it definitely blanked out my emotions and even gave me tardive dyskinesia in the muscles in my face. my mom took it a few years back and it made her feel emotionally blank too.
but every antidepressants i have tried has numbed my emotions to a certain extent.
Posted by Phillipa on January 3, 2012, at 11:49:46
In reply to Re: Dopamine Fixes for Effexor, posted by poser938 on January 3, 2012, at 3:16:34
I wonder why they don't blunt my emotions as they sure could use some blunting. I escalate with anxiety with the drop of a hat. Maybe PTSD is it and not OCD? Does dopamine really become depleted on ssri's as that is the fun good feeling neurotransmitter isn't it? Jan/P
Posted by never2late on January 3, 2012, at 13:24:11
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
Im sticking with the effexor. I finally got a call back from my Pdoc last night and he said unless the effects are debilitating ( which they kind of are) I should stick with it until I get around the 4 week mark. Its been 2 and half weeks, I am concerned about the lack of mental concentration when I back to school in a few weeks.
I am just sick of feeling like crap all the time. Ive completely withdrawn from live socially and am trying to get back to being me. The problem is I have to redefine what that is after living my life undiagnosed for for so long. I will be going back to therapy after I get my meds worked out. I went before but I found myself talking more about how I was dealing with the side effects of taking AD than I did about dealing with real issues in my life.
Posted by creepy on January 3, 2012, at 15:59:43
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
Problem is, many of the side effects from AD's overlap those of depression itself. The apathy, the anhedonia, etc.
If this has really followed your med change Id ask about trying something else or adding wellbutrin.
Sometimes methylphenidate or dexedrine is helpful in place of adderall.
What else have you tried? Ive avoided the SNRIs like the plague since I have had discontinuation syndrome from old school SSRIs and it wasnt fun.
I find these drugs dont make me 'happy' so long as mute the depression like taking a 'psychic pain killer'.
TCAs may have a better chance of producing the effects you want.
Posted by emmanuel98 on January 3, 2012, at 19:47:14
In reply to Re: Dopamine Fixes for Effexor, posted by creepy on January 3, 2012, at 15:59:43
I never had this experience with any SSRI or SNRI and I tried a lot of them. Generally they had no effect at all. Except for lexapro. Lexapro didn't really affect my depression, but it made me much less angry and irritable, which had been a big problem for me. So if that is emotional blunting, it's a blunting that I found welcome and helpful.
Posted by Tony P on January 3, 2012, at 23:15:52
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
I have experienced both emotional blunting & anhedonia on various ADs, and the opposite: Serzone in particular freed me up to feel some feelings I'd buried for years.
Based on my own experience, I would agree that increasing your Adderal once you are stabilized on the Effexor might help; other stimulants such as methylphenidate or DexA would have basically the same effect.
I take Modafinil (100-200 mg/day) and find it very helpful mentally, emotionally & behaviourally (if that's a word???), with less jitteriness than the amphetamine family and absolutely no insomnia problems. It is also very helpful in getting over depression-induced "jet-lag", both from insomnia and hypersomnia, including resetting your biological clock. It gives me increased mental clarity and motivation. Unfortunately, it is mainly prescribed "on label" for narcolepsy, so it isn't covered by many drug plans. It is much safer & has lower side-effects than the amphetamine family (including Adderal), so I don't know why it's not much more widely prescribed.
If after a sufficiently long trial of Effexor you find it's not meeting your needs, ask your pdoc about Cymbalta. It has a had a somewhat negative press (or perhaps less effective marketing) compared to Effexor, but I find it both more effective and with far less side-effects (YMMV). The manufacturer claims it is a better-balanced SNRI than Effexor, and my experience bears this out, but it seems to be a very personal thing.
Posted by never2late on January 4, 2012, at 14:00:24
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
I notice that the only time I really feel well enough to function is after taking my adderall and klonopin. I have tried Nuvigil and it seemed to not not work the same everyday.
I recently got TEVA back. I had been on corepharma's adderall for 2 months. I like it a lot better. I am annoyed with the difference in my mood during the day. It seems to flucuate a a lot. Sometimes I feel calm and free from anxiety only to be dumped back into self doubt and anxious thought.
I would really like to stop taking Ambien at night fall asleep but I dont have enough klonopin left to take its placed. Klonopin seems to shut up my brain and allow me to fall asleep. The Ambien leaves me sluggish and not wanting to get out of bed in the morning (actually afternoon).
I know I am just starting to take effexor and it needs time to work right but I dont know if my experience is positive so far. Meaning, is this drug going to work for me or am I going to have to start all over with something else in a few months and go thru all this crap all over again with something else.
I have been at 37.5 for a week, 75 for another week. I dont see my Pdoc until MLK day. Is it too early to increase again? Should I call him and ask if I can increase to the dosage again to see if it helps?
Posted by SLS on January 4, 2012, at 14:20:37
In reply to Re: Dopamine Fixes for Effexor, posted by never2late on January 4, 2012, at 14:00:24
150 mg seems to be minimum dosage at which people with MDD respond to.
- Scott
Posted by bleauberry on January 5, 2012, at 10:25:40
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
The phenomenon you are referring to....emotional blunting....has been reported here so many times over the months and years. I have seen it happen with myself and others and I think it is far more common than doctors are willing to admit. I'm sure they see it, but they somehow explain it away with some ridiculous reasoning or they just blow it off or add wellbutrin or something.
Anyway, what meds have been involved in the emotional blunting? Here are ones I remember people commenting about....
SSRIs....all of them, zoloft and prozac being less guilty but still guitly.
Nortriptyline. Reboxetine. Adderall. Ritalin. Antipsychotics.So you see, while we tend to think of this phenomenon as a serotonin/dopamine thing, it happens with pure or dopamine sometimes too norepinephrine too. How can a potent stimulant like ritalin cause someone ADD to become calm and grounded? Kind of the same phenomenon we are talking about here....boosting a certain neurotransmitter can have an opposite effect depending on the sensitivities of the receptors involved. Depending on how the dopamine circuits are set up, one person may become stimulated and euphoric while another may become calm and focused and yet another will become anxious and depressed, all from the same drug.
That said, serotonin is usually the more guilty party I believe. Effexor happens to be a very potent serotonin med with very little effect on norepinephrine or dopamine. Why it is called a SNRI instead of a SSRI is a mystery to me because it really doesn't have much effect on norepinephrine....30 parts serotonin to 1 part norepinephrine....not exactly an equal balance and actually not even close....almost pure serotonin. I think it is a marketing thing to call it a SNRI but isn't really supported much by the facts.
So what to do? Well, adding something dopamine does make sense. Me personally, any motivation/pleasure issues respond much better to norepinephrine strategies than dopamine strategies. I find NE much more involved than dopamine, but understand we are all different.
Probably the most common strategy I am aware of is to add wellbutrin. I am not a fan of that drug, but it is a common strategy. Whether it works or not, I don't know, haven't seen it happen very much. Other options would include adding a med to balance out NE, which would mean either nortriptyline, desipramine, or savella.
Now here is the problem.....you are already taking a dopamine/norepinephrine med....adderall. But you are still flat. Maybe it is itself involved in the flatness? Dunno, maybe, maybe not. But for sure, it is not helping to undo negative effects of effexor.
Gut instincts. Mine tell me effexor is probably not a good choice for you because if it is causing that kind of flatness this early in the game at that low of a dose, well, that doesn't predict a great future. It predicts you may likely be dealing with that problem for a long time. On the other hand, maybe some would claim the flatness will slowly go away as the body gets accustomed to the med over months. I've just hardly ever seen that happen so I tend not to agree.
Anyway, some stuff to think about.
If it were me, what would I do?
I would lower effexor to 37.5mg (that dose works great for a lot of people) and I would add the herb Rhodiola Rosea to it. Both of those moves are directed at antidepression and antiflat with minimal side effects.
Posted by novelagent on January 5, 2012, at 19:23:19
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
you're experiencing neurological symptoms of toxicity, including ataxia. Stop taking it. klonopin isn't so bad it's worth trying drugs that cause brain damage, jeez.
> Just started effexor up to 75 mg. Been Diagnosed
MDD,SAD,GAD, ADD.
>
> Taking Effexor, Adderall IR 10 mg 2x, Klonopin .5 mg, Ambien to at night.
>
> After getting past the sleepiness side effects the frist week I am not finding that I feel more emotionally blunted than before. I am also mentally and physically lethargic. I have no interest in sex even tho the equiptment works (barely). The positives is that I am now getting to sleep at night and having less anxiety than I did before.
>
> What reamins is the lack of emotion, feeling happy about anything, and an increase in ADD symtoms even tho I am taking adderall.
>
> I have read that SSRI/SNRI raise seretonin thereby reducing dopamine. The only thing that is getting me through the day is coffee and my adderall. But ithat gets me low level functioning. I have trouble counting (simple math), have been experiencing balance and coordination, slight shakiness in my hands at times.
> I usually have a blank expression on my face and people are constantly telling me to smille more.
>
> Cigarettes, which I used to help me focus and relax myself when i felt overwhelmed do not work anymore. I have to smoke 3x more cigarettes in order to get the same effect.
>
> Is the shot of seratonin fromt the effexor messing with my dopamine? Are the things I am describing due to a dopamine deficiiency? What options can I discuss with my Pdoc about fixing this?
>
Posted by novelagent on January 5, 2012, at 19:46:19
In reply to Re: Dopamine Fixes for Effexor » never2late, posted by Phidippus on January 2, 2012, at 16:20:48
> The first thing I'd discuss is raising your Effexor dose with your doc. MAybe even increase your Adderal dose.
>
> EricThe old don't blame the obvious, and vaguely cite the depression itself as the culprit for symptoms of drug toxicity (in his case-- some fare well on Effexor).
Here's what's going on, Eric: your Adderall is the problem, and the Effexor is causing the movement imbalance (ataxia). Amphetamine is a beautiful adjunct for MILD depression, as it has been understood since the 1930's.
Its greatest promoter, Dr. Abraham Myerson at Harvard, even admitted it didn't fare well with severe depression states
And here's why: you have low depression stores, all from being worn thin by your depression. You don't have many tours of duty left in your troops battling it out in dopamine land,so your reserve troops are actually being used as your everyday troops. Amphetamine is coming along and telling your men they can't go home to their families, because there's too few men to cover for them when amphetamine hangs out and fires on all cylinders.
so that paradoxially means your amphetmamine, which is in a lighter case of anhedonic, atypical depression brilliant at restoring vigor and zest for life, is actually DEPRESSING your serotonin and dopamine stores by over-taxing it.
Raising your emphetamine dose is going to excaccerbate this, and I lived through this for a year before finally taking what now is sold as EmSam. That restores dopamine stores, giving your men up there a nice rested feeling. I went from craving sleep every day to realizing two weeks from taking it I hadn't the least bit of interest in taking a single nap since starting. And yes, when combined with PEA hcl, it can act this fast.
another treatment for your depression, concentration, anhedonia, and so on to consider is memantine. It resets the clock on amphetamine stores, and user reports claim each day of taking Adderall is "like the first day."
But take an SSRI-- ditch the Effexor, and don't do what I did-- don't let yourself over-think things until you find yourself on high doses of the very things worsening your depression. Good luck!
oh, and high doses of fish oil, which I also took during my road to recovery. Lovaza is a pharmaceutical, synthetic fish oil you can try if you'd like to try it from your doc.
Posted by SLS on January 6, 2012, at 6:45:31
In reply to Re: Dopamine Fixes for Effexor » Phidippus, posted by novelagent on January 5, 2012, at 19:46:19
When I tried d-amphetamine, my depression became mildly worse after a few days of feeling better. I was taking Parnate and desipramine at the time.
That's just me, though.
- Scott
Posted by never2late on January 8, 2012, at 2:41:07
In reply to Dopamine Fixes for Effexor, posted by never2late on January 2, 2012, at 2:26:16
Well I got the bump from my P doc. I am now taking 3 37.5 pills per day. He also increased my klonopin to 2 .5's per day one for the day one before bed to shut up my brain to fall asleep ( in place of god awful ambien).
Since we are only changing meds one at a time to gauge what is causing what. I will have to wait till the next appoinment to get off the adderall and try a different stim.
I am curious about adding the mematiine or requip or whatever ts called. For the last year I have had really tight uscles and joint pain. Some of which had gone away since starting the effexor ( sertonin increased pain threshold?)
I would really like to get something for energy/motivation and something that will help me fell positive about things that I accomplish. From tis threat it is either a NE or DA problem.
Effexor supposedly startes to hit NE at doses past 150 so we will see how it pans out.
The problem is I start school aain in a week and dont want to get stuck with something that isnt going to help me concentrate. I am not oing to waste my tuition money to struggle in school because I am not on the right meds.
Another thought that I had breifly spoke to my doctor about was abilify. I heard at low doses it block D2 receptor which frees up the DA to atach tot he other ones which can benefit adhd.
I think the requip or mematine could work as well. I have a had time expressing myself to doctors and requesting meds.
What would be a good way to ask him about either trying Abilify, or requip to help boost y dopamine levels?
Posted by alfie on January 12, 2012, at 14:11:42
In reply to Re: Dopamine Fixes for Effexor, posted by never2late on January 8, 2012, at 2:41:07
I think you should stick with the adderall, but just at a lower dose
> Well I got the bump from my P doc. I am now taking 3 37.5 pills per day. He also increased my klonopin to 2 .5's per day one for the day one before bed to shut up my brain to fall asleep ( in place of god awful ambien).
>
> Since we are only changing meds one at a time to gauge what is causing what. I will have to wait till the next appoinment to get off the adderall and try a different stim.
>
> I am curious about adding the mematiine or requip or whatever ts called. For the last year I have had really tight uscles and joint pain. Some of which had gone away since starting the effexor ( sertonin increased pain threshold?)
>
> I would really like to get something for energy/motivation and something that will help me fell positive about things that I accomplish. From tis threat it is either a NE or DA problem.
>
> Effexor supposedly startes to hit NE at doses past 150 so we will see how it pans out.
>
> The problem is I start school aain in a week and dont want to get stuck with something that isnt going to help me concentrate. I am not oing to waste my tuition money to struggle in school because I am not on the right meds.
>
> Another thought that I had breifly spoke to my doctor about was abilify. I heard at low doses it block D2 receptor which frees up the DA to atach tot he other ones which can benefit adhd.
>
> I think the requip or mematine could work as well. I have a had time expressing myself to doctors and requesting meds.
>
> What would be a good way to ask him about either trying Abilify, or requip to help boost y dopamine levels?
Posted by creepy on January 13, 2012, at 20:15:04
In reply to Emotional blunting, posted by emmanuel98 on January 3, 2012, at 19:47:14
Prozac and lexapro/celexa both made me really really irritable. sometimes Id feel good but not abnormally good. But my control of my anger was really poor. Stupid little things would really piss me off.
Theres some debate as to whether this is mixed/dysphoric hypomania or just the depression itself. Depression can manifest with irritability too.zoloft (and high doses of lexapro) acted much like what you mention. It dampened the anger but with it came apathy and anhedonia. Lexapro was worse in this regard and lowering it just allowed the anger to come back.
Probably an AED like lamictal would work better for this sort of thing. But my cognitive function is bad enough already with depression.
Posted by never2late on January 14, 2012, at 2:12:19
In reply to Re: Dopamine Fixes for Effexor » never2late, posted by alfie on January 12, 2012, at 14:11:42
The effexor is definitely making me feel flat. I just recently have realized that I dont have any desire to have sex. When I do get aroused I have trouble staying with the thought that got me aroused.
I am pretty unimpressed with the Effexor so far. I have had a dramatic decrease in anxiety but that could be due to the klonopin I take twice a day. I really hope my doc switches me to ritalin or focalin when I see him. I am really unmotivated and tired all the time. The only thing that gets me through the day is coffee and cigarettes. Not exactly where I want to be.
I was hoping for some advice or someone who had success on effexor with some type of add on to help me figure out a plan with my Pdoc. But there are no magic solutions. Ill see what he comes up with. I was thinking about asking him to order a blood test for prolactin and testoserone as I my self esteem motivation and focus are all 0 (unless I chain smoke and drink coffee all day which is sick).
Posted by SLS on January 14, 2012, at 7:00:00
In reply to Re: Dopamine Fixes for Effexor, posted by never2late on January 14, 2012, at 2:12:19
Some people have success gaining energy and mitigating sexual side effects by adding Wellbutrin to Effexor. Adding Ritalin rather than switching might be worth a try. I just hate to see you lose the anxiolytic effect of the Effexor. Did you start the Effexor after the Klonipin? If so, how long was it before you noticed a significant reduction in anxiety.
- Scott
Posted by never2late on January 14, 2012, at 23:18:09
In reply to Re: Dopamine Fixes for Effexor » never2late, posted by SLS on January 14, 2012, at 7:00:00
I was on the Klonopin before the effexor. If I do not take klonopin it is not exactly anxiety in the sense of panic, but a real restlessness that just feels awful. I feel like I have to have to do something but I dont have any energy or motivation to do it. LIke when I was driving today I felt really listless and just uncomfortable. I smoked alot of cigarettes which kind of helps because I am doing something. At work at I was drinking a lot of coffee, because I felt like it helped calm me down. I switched to mint tea because I dont feel that drink 8 cups of coffee in a day is good for me.
The klonopin kind removes my feelings of listlessness and feeling restless but I am still left with no motivation and lack of concentration, which is not being helped ( I feel ) by the adderall. Before I started effexor and used to take my add drugs their effects were noticeable. I could sit and study and concentrate on things and was more productive but had anxiety driving my behavior. Now the anxiety is removed and this uncomfortable restless feeling remains and the adderall dosn't really work as well.
I am returning to school next week. I already sat down in a quiet room with my headphones on with my white noise playing (which really helps if you have ADD and are trying to read) . I had a really hard time getting through the material. I also felt absolutely no sense of satisfaction from completing the case studies.
Emotional blunting works well to blunt sad thoughts but having no pleasure or enjoyment in anything is depressing in itself. The anxiety is getting taken care of but the other problems still remain.
Posted by Tony P on January 17, 2012, at 12:26:30
In reply to Re: Dopamine Fixes for Effexor, posted by never2late on January 14, 2012, at 2:12:19
At risk of repeating myself, if Effexor continues to not be satisfactory, try Cymbalta. It's a better balanced SNRI than Effexor & for me has far less side-effects. By better balanced I mean it is more motivating & I am in good touch with my feelings most of the time.
Cymbalta stimulates much more NE than Serotonin and (paradoxically) that energizes me without making me anxious. I have been able to cut my klonopin (now switched to diazepam) to 1/3 of what I was taking 9 months ago (3 mg/day), and hope to get off the benzos in the next 3 months.
Re the sexual side-effects, I don't know what the active half-life of Effexor is, but I can skip one dose of Cymbalta without any noticeable distress, but the sexual S/E decrease considerably.
TP
===
> The effexor is definitely making me feel flat. I just recently have realized that I dont have any desire to have sex. When I do get aroused I have trouble staying with the thought that got me aroused.
>
> I am pretty unimpressed with the Effexor so far. I have had a dramatic decrease in anxiety but that could be due to the klonopin I take twice a day. I really hope my doc switches me to ritalin or focalin when I see him. I am really unmotivated and tired all the time. The only thing that gets me through the day is coffee and cigarettes. Not exactly where I want to be.
>
> I was hoping for some advice or someone who had success on effexor with some type of add on to help me figure out a plan with my Pdoc. But there are no magic solutions. Ill see what he comes up with. I was thinking about asking him to order a blood test for prolactin and testoserone as I my self esteem motivation and focus are all 0 (unless I chain smoke and drink coffee all day which is sick).
This is the end of the thread.
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