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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Lamdage22 on October 27, 2015, at 9:04:00
What can i do?
Posted by Lamdage22 on October 27, 2015, at 9:14:46
In reply to HELP. Bad case of Effexor poop out!!, posted by Lamdage22 on October 27, 2015, at 9:04:00
How high is the risk of Nortriptyline psychosis???
Would you take it if you were me?
Posted by Christ_empowered on October 27, 2015, at 10:13:02
In reply to Nortiptyline psychosis, posted by Lamdage22 on October 27, 2015, at 9:14:46
hmmmm...i dunno. any AD can cause psychosis, mania, agitation, akathisia, etc. I think TCA drugs are supposed to be worse about mania and psychosis, not as bad w/ akathisia, compared to SSRI/SNRI drugs.
Ever tried wellbutrin? Maybe...Cymbalta or Pristiq?
That said, TCA drugs can be very helpful. If you're severely depressed and all, they can help w/ numerous core symptoms, better than many more modern drugs.
I don't know that I'd take a TCA w/ the seroquel and the zyprexa, personally. You're not on very much Effexor. Why not try to increase that, or switch over to Pristiq, Cymbalta, etc. ?
Posted by Lamdage22 on October 27, 2015, at 10:25:52
In reply to Re: Nortiptyline psychosis, posted by Christ_empowered on October 27, 2015, at 10:13:02
What about TCA vs MAOI, psychosis?
Posted by Christ_empowered on October 27, 2015, at 12:37:20
In reply to Re: Nortiptyline psychosis, posted by Lamdage22 on October 27, 2015, at 10:25:52
I have no clue. TCAs have been around forever, so have MAOIs. My wild *ss guess would be that MAOIs would be more problematic than TCAs, but I could easily be wrong.
Posted by Lamdage22 on October 27, 2015, at 13:20:12
In reply to Re: Nortiptyline psychosis, posted by Christ_empowered on October 27, 2015, at 12:37:20
ok.
I will need to call my dr.
I think i am trying.
I like that Nortiptyline doesnt cause anorgasmia frequently.
Posted by Jeroen on October 27, 2015, at 14:34:21
In reply to Re: Nortiptyline psychosis, posted by Lamdage22 on October 27, 2015, at 13:20:12
be carefull for weird reactions Lamdage!
Posted by Lamdage22 on October 28, 2015, at 13:30:38
In reply to Re: Nortiptyline psychosis, posted by Jeroen on October 27, 2015, at 14:34:21
will do
Posted by Lamdage22 on October 28, 2015, at 14:36:24
In reply to Re: Nortiptyline psychosis, posted by Jeroen on October 27, 2015, at 14:34:21
I mean, MAOI have god dopamine action which nortriptyline does not
Posted by linkadge on October 28, 2015, at 16:19:14
In reply to Re: Nortiptyline psychosis, posted by Lamdage22 on October 28, 2015, at 14:36:24
I would say that nortriptyline definitely has a lower risk of inducing any psychotic like side effects.
I say this from 1) having taking both 2) literature suggests that nortriptyline monotherapy can actually be effective for psychotic depression 3) nortriptyline typically improves sleep while MAOI's disrupt it. Phenelzine metabolizes to PEA, which is essentially amphetamine. The MAO-B blocking effects of nardil will enhance this action.
I remember taking parnate and feeling like I was in a different world. Sure beats anhedonia, but by the end of the trial, I was begging to be bored again.
Linkadge
Posted by SLS on October 28, 2015, at 19:03:58
In reply to Re: Nortiptyline psychosis, posted by linkadge on October 28, 2015, at 16:19:14
> I would say that nortriptyline definitely has a lower risk of inducing any psychotic like side effects.
Except for maybe in bipolar disorder type 1 and schizoaffective disorder, bipolar type.
- Scott
Posted by Lamdage22 on October 29, 2015, at 6:19:36
In reply to Re: Nortiptyline psychosis, posted by SLS on October 28, 2015, at 19:03:58
Thanks guys.
I am not bipolar or bipolar type.
Posted by Lamdage22 on October 29, 2015, at 14:27:49
In reply to Re: Nortiptyline psychosis, posted by Lamdage22 on October 29, 2015, at 6:19:36
Posted by Lamdage22 on November 2, 2015, at 1:41:01
In reply to When should i expect to see results? (nm), posted by Lamdage22 on October 29, 2015, at 14:27:49
I was up and awake at 7!! am...
So maybe it is working
Posted by Lamdage22 on November 2, 2015, at 1:42:05
In reply to When should i expect to see results? (nm), posted by Lamdage22 on October 29, 2015, at 14:27:49
I was up and awake at 7!! am...
So maybe it is working
Posted by Lamdage22 on December 2, 2015, at 6:21:28
In reply to Re: When should i expect to see results?, posted by Lamdage22 on November 2, 2015, at 1:42:05
So now again. This time not at 37.5mg but at 75mg.
Posted by SLS on December 2, 2015, at 7:35:51
In reply to Effexor poops out at the higher dosage., posted by Lamdage22 on December 2, 2015, at 6:21:28
> So now again. This time not at 37.5mg but at 75mg.
I don't think Effexor pooped-out on you. I think you just need a higher dosage. It is not unusual for someone to feel better briefly upon dosage increases. This is a VERY good sign that a higher dosage will "stick" and remain effective. These drugs generally don't produce a lasting improvement so quickly. You really need to be patient, continue to raise the dosage, and be prepared for a trial lasting longer than four weeks at a higher dosage. If you can tolerate Effexor, I would not give up on it until you reach a dosage of 300 mg/day. (Much easier said than done).
Check this out:
http://www.dr-bob.org/babble/20151119/msgs/1084330.html
- Scott
Posted by Lamdage22 on December 2, 2015, at 10:40:28
In reply to Re: Effexor poops out at the higher dosage. » Lamdage22, posted by SLS on December 2, 2015, at 7:35:51
Will do, Scott.
I am not happy to be almost anorgasmic, but i guess its a necessity for me to feel better mentally. I am in quite the distress.
If i feel better mentally, i may not be as dependent anymore on sex to make me feel better.
Posted by SLS on December 2, 2015, at 18:52:42
In reply to Re: Effexor poops out at the higher dosage., posted by Lamdage22 on December 2, 2015, at 10:40:28
> Will do, Scott.
>
> I am not happy to be almost anorgasmic, but i guess its a necessity for me to feel better mentally. I am in quite the distress.
>
> If i feel better mentally, i may not be as dependent anymore on sex to make me feel better.You are being very logical about all of this. Still, your situation is terrible. I have had a few drugs impair my ability to achieve orgasm. However, Effexor wasn't one of them. I hope this side effect goes away for you with continued treatment. You can always discontinue Effexor if you deem the benefits to be inadequate. However, if it works magic at the cost of sexual side effects, you can then tackle these side effect with drugs like the buspirone you chose. I forget what your experience with Wellbutrin was, but it might reduce sexual side effects and make the Effexor work better. I'm hoping that when you respond to Effexor, the reduction in depressive symptoms will include an improvement in sexual function. The higher the dosage of Effexor, the more that norepinephrine (NE) becomes available as a result of reuptake inhibition. A rush of NE is necessary for orgasm to occur.
There is a drug that might be approved soon for depression and anxiety called gepirone. It has come up for consideration by the FDA several times and has been rejected. Perhaps it will pass this time. It appears to be safe, though. Gepirone is in the same family of drugs as buspirone. It is reported by some to be pro-sexual and has been suggested to be a good remedy for SRI-induced sexual side effects.
- Scott
Posted by Lamdage22 on December 3, 2015, at 3:12:50
In reply to Re: Effexor poops out at the higher dosage. » Lamdage22, posted by SLS on December 2, 2015, at 18:52:42
I wonder if i could try Bupropion instead. It is reported to be pro psychotic though especially in high dosages.
Posted by SLS on December 3, 2015, at 7:12:25
In reply to Re: Effexor poops out at the higher dosage., posted by Lamdage22 on December 3, 2015, at 3:12:50
> I wonder if i could try Bupropion instead. It is reported to be pro psychotic though especially in high dosages.
Yes. That was my concern as well. Having two antipsychotics on board would minimize this risk. There is no guarantee, though. Ever since I have been taking Abilify (which I know causes akathisia in you), I have not had a manic/psychotic reaction to the drugs that I sometimes have. Supposedly, Wellbutrin is one of the least likely to cause a switch to mania, but I don't know about psychotic depression.
I would stay with the Effexor for now and establish the minimum effective dosage through a methodical titration. Stay on that dosage for a few more weeks to see in what direction your sexual side effects go. If they still bother you, you can then add Wellbutrin (or other drugs) to try to recapture your ability to reach orgasm. Remember, this is really nothing more than an experiment. You can discontinue the experiment whenever you would like. I know it would be a great relief to you to imagine having another option to switch to instead of taking Effexor. But for right now, I think it makes sense to continue the Effexor experiment. You are already taking it, albeit at a subtherapeutic dosage. Don't sacrifice the time you have already invested and the potential for obtaining a strong response with continued titration. Your brief improvements at such low dosages beg that you give Effexor a chance.
Three ideas:
1. Add Remeron (mirtazapine) to Effexor - increase the potential for a good response to Effexor. I have always wondered if Remeron might help reduce sexual side effects because of its overlap with cyproheptadine. I never pursued a literature search to test my hypothesis (until now). *See below.
2. Switch to Viibrd (vilazodone) - Low potential for sexual side effects.
3. Switch to Brintellix (vortioxetine)
4. Switch from Seroquel to Saphris (asenapine)
* Mirtazapine Augmentation for Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: A Retropective Investigation
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079186/
- Scott
Posted by Lamdage22 on December 3, 2015, at 7:14:32
In reply to Re: Effexor poops out at the higher dosage. » Lamdage22, posted by SLS on December 3, 2015, at 7:12:25
What about Mianserin?
Posted by Lamdage22 on December 3, 2015, at 7:18:37
In reply to Re: Effexor poops out at the higher dosage., posted by Lamdage22 on December 3, 2015, at 7:14:32
Id rather try vilazodone right away.
I get alot from sexual encounters. It relaxes me. It makes me happy.
This is the end of the thread.
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