![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by cb776 on June 13, 2010, at 12:46:19
Been treated with venlafaxine for several years. I am going off this slowly because I get paradoxical depression and apathy.
I read that longterm SSRI (cymb, EFxr) down-regulates dopamine-receptors possibly causing this.
Would L-tyrosine be able to restore dopamine that VEN lowers.
Or maybe any better alternative?
I am thinking 5-HTP at night with L-tyrosine in the morning?
Any suggestion would be very appreciated.
/chris
Posted by Lao Tzu on June 13, 2010, at 15:15:01
In reply to help; Post longterm treatment w/ Venlafaxine L-tyr, posted by cb776 on June 13, 2010, at 12:46:19
I don't want to give advice because Effexor is a very strong antidepressant and withdrawal can be bad if you don't substitute with another type of antidepressant. Definitely, if you're going to go off it, do it with a doctor's help, not on your own. I switched from Effexor XR to Zoloft, and I like the Zoloft a lot better. Effexor is a good drug, though. But you're saying you have paradoxical depression. Do you mean Treatment-Resistant Depression, that the Effexor is not really helping you with your depression? Then you might ask your doctor about other antidepressant options. For example, some people get better on MAOIs. Another one is Wellbutrin SR, which works more on increasing dopamine and norepinephrine in the brain. Maybe that would help you better. I'd talk to your doctor about your options. There's also Abilify or Risperdal which helps to regulate your dopamine receptors. Some people get relief when using these medications, especially if you have a severe anxiety disorder or you have bipolar disorder. If you don't have an anxiety disorder or are bipolar, then I don't think you would need Abilify or Risperdal. As far as L-Tyrosine or L-Phenylalanine, I've tried them and they don't seem to affect mood very well, but they could help you a little, I guess. I believe there are some good herbs that affect dopamine, but you have to be careful with these if you are taking medication. There could be drug interactions with the herbs. Post a query on this site about herbs that affect dopamine. Somebody here is bound to know about them and can give you some suggestions. Pass that information on to your doctor and see what he says, but I would definitely ask him about other antidepressants if Effexor isn't working for you and also ask about Abilify or Risperdal if you have an anxiety disorder or have bipolar disorder. Good luck!!
Posted by cb776 on June 15, 2010, at 15:22:39
In reply to Re: help; Post longterm treatment w/ Venlafaxine L, posted by Lao Tzu on June 13, 2010, at 15:15:01
Thanks for reply! I know venlafaxine is troublesome to get off. I am taking it very slow.
Some aspects of depression is gone but others are still persistent. Ability to focus during day, sexual performance, lack of interest, apathy ..I am gonna try talk to my dr about wellbutrin.
Gonna look for info about some herbs.
Posted by Hombre on June 15, 2010, at 20:21:29
In reply to Re: help; Post longterm treatment w/ Venlafaxine L, posted by cb776 on June 15, 2010, at 15:22:39
http://www.itmonline.org/shen/chap8.htm
Withdrawing from SSRIs:
"APPENDIX 1: Guipi Tang and SSRI Withdrawal Syndrome
The problem of adverse reactions to withdrawing from the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) is important to patients, especially since they already may suffer from problems of anxiety and fear which can exacerbate their concerns about symptoms that arise. A Chinese herbal therapy for this condition has not been established, but can be suggested from the typical symptoms of withdrawal. A listing of symptoms that have been repeatedly observed in patients withdrawing from SSRIs is arranged in the left column of the following table by general type, and paired with a potential TCM interpretation of the symptoms in the right column.
.
.
.
Summing up the notes about TCM interpretation, the withdrawal syndrome may revolve around the problems of qi and blood deficiency, which may be accompanied by qi stagnation and dampness accumulation (and, in rare cases, also by internal wind). These deficiency syndromes of Chinese medicine are attributed primarily to the spleen (for qi) and liver (for blood); a Western interpretation of the same pattern might be a relative deficiency in serotonin availability or an imbalance of neurotransmitters that occurs when the drugs are removed.Key herbs that might be considered for SSRI withdrawal syndrome based on the symptom analysis include:
Atractylodes (white atractylodes): tonifies qi, resolves damp
Peony (white peony): nourishes blood, vitalizes blood circulation
Tang-kuei: nourishes blood, vitalizes blood circulation
Zizyphus: nourishes liver and heart blood and clams shen
Saussurea: circulates qi, calms shen
Ginseng: tonifies qi, calms shen
Astragalus: tonifies qi, raises yang qi
Polygala: resolves phlegm, calms shen
Fu-shen or Hoelen: resolves damp, calms shen
Pinellia: resolves damp, lowers stomach qi
Citrus: resolves damp, circulates qiA formula with these ingredients can be constructed from the traditional formula Gupi Tang, which includes most of the herbs. According to Giovanni Maciocia, who is widely respected for his knowledge of TCM, this formula is itself used for treating depression (11). He noted that: "The formula Guipi Tang tonifies spleen-qi and heart-blood and calms the mind: it is ideally suited to treat post-natal depression and insomnia. This formula is also recommended by Wu Qian in his Golden Mirror of Medicine for post-natal depression from worry, pensiveness, and sadness." The ingredients may be provided as a decoction ( Guipi Tang ), dried decoction, or in tablet form (Guipi Wan).
.
.
.
While there have not been studies providing clinical evidence for efficacy of Gui Pi Tang, or any of the herbs mentioned, to alleviate SSRI discontinuation symptoms, it is a characteristic of modern Chinese medicine practices to select herbs on the basis of symptom patterns, with the expectation of attaining some level of effect. The symptoms are understood to be a manifestation of an underlying imbalance, whether described in ancient terms (e.g., qi and blood deficiency) or modern terms (e.g., neurotransmitter release and reuptake). That imbalance generates symptoms via common mechanisms that can be affected by the herbs. Starting an herbal formula along with gradual drug dose reductions may prevent or minimize the withdrawal symptoms."(continued)
*Gui Pi Wan is easily found online for usually less than $5. I've taken it. It strengthens digestion and is calming. I have not tried it for Effexor withdrawal, but I take Effexor and will definitely use herbs if I ever decide to withdraw. A trained herbalist could probably help you with the symptoms if the are too bothersome or persist for too long.
Posted by janejane on June 15, 2010, at 22:03:36
In reply to Re: help; Post longterm treatment w/ Venlafaxine L, posted by cb776 on June 15, 2010, at 15:22:39
If you have a partial response from effexor and you'd like to stick with Rx meds, you might want to continue with it and add something to tackle your remaining symtoms. Wellbutrin sounds like a good choice. If you want to discontinue, I believe it's the serotonin part of the equation that causes problems, not the catecholamines. (This is why few people have trouble getting off wellbutrin relative to say, paxil.)
If you switch to another SNRI (or SSRI), I don't think withdrawal is likely to be a problem if you cross-taper. If you don't transition to something else serotonergic, 5-HTP or tryptophan might be useful. (Benadryl is also good for relieving withdrawal-related nausea.) Adding tyrosine or phenylalanine makes sense for your symptoms. (Note that if you use tryptophan, you'd have to take it at a separate time than the others. It may be safer for your heart than 5-HTP, though.) Personally, I didn't have consistent results with aminos. Other people seem to like them, though.
If you're interested in herbs, try looking into rhodiola rosea.
Posted by janejane on June 16, 2010, at 5:33:18
In reply to help; Post longterm treatment w/ Venlafaxine L-tyr, posted by cb776 on June 13, 2010, at 12:46:19
I forgot to say, if you use aminos, start with really small doses. Like maybe just 1/4 of a 500 mg tryptophan tablet. (Pill cutters are handy here.)
I like Hombre's advice too. (I'm trying TCM myself, right now.)
Posted by 49er on June 21, 2010, at 10:56:17
In reply to help; Post longterm treatment w/ Venlafaxine L-tyr, posted by cb776 on June 13, 2010, at 12:46:19
> Been treated with venlafaxine for several years. I am going off this slowly because I get paradoxical depression and apathy.
>
> I read that longterm SSRI (cymb, EFxr) down-regulates dopamine-receptors possibly causing this.
>
> Would L-tyrosine be able to restore dopamine that VEN lowers.
>
> Or maybe any better alternative?
>
> I am thinking 5-HTP at night with L-tyrosine in the morning?
>
> Any suggestion would be very appreciated.
>
> /chrisHi Chris,
Having just finished a successful taper of a 4 med psych cocktail, I would advise you to proceed very carefully with supplements.
I tried many of them during my taper and I feel in the end, that most of them caused more harm than helped. The one major exception was spirulina which helped me cold turkey Wellbutrin XL. But generally, because your system is very delicate during withdrawal, they are going to cause more harm than be helpful.
The issue is time, not restoring various chemicals. Your brain needs time to adjust to having less Effexor in your body. Adding supplements simply causes confusion to your brain.
Personally, I would not use another med to taper off of Effexor unless your intention is to stay on meds. You will simply be trading one poison for another.
By the way, when I read similar type advice while tapering, my attitude was people were too entrenched in their views and they didn't know what they were talking about. I now realize they actually did.
And when you say you are tapering slowly, are you doing 10% of current dose every 3 to 6 weeks? With Effexor, you might need to go more slowly.
For those of you who claim this will take forever, well, after getting off of psych meds last week, I am doing great in spite of being on meds for 15 years. I am even sleeping without taking anything 2 out of 3 days. I credit that to a slow taper.
I hope this helps.
49er
PS - Another exception is fish oil. I definitely recommend that.
Posted by cb776 on June 23, 2010, at 3:38:05
In reply to Re: help; Post longterm treatment w/ Venlafaxine L-tyr » cb776, posted by 49er on June 21, 2010, at 10:56:17
> > Been treated with venlafaxine for several years. I am going off this slowly because I get paradoxical depression and apathy.
> >
> > I read that longterm SSRI (cymb, EFxr) down-regulates dopamine-receptors possibly causing this.
> >
> > Would L-tyrosine be able to restore dopamine that VEN lowers.
> >
> > Or maybe any better alternative?
> >
> > I am thinking 5-HTP at night with L-tyrosine in the morning?
> >
> > Any suggestion would be very appreciated.
> >
> > /chris
>
> Hi Chris,
>
> Having just finished a successful taper of a 4 med psych cocktail, I would advise you to proceed very carefully with supplements.
>
> I tried many of them during my taper and I feel in the end, that most of them caused more harm than helped. The one major exception was spirulina which helped me cold turkey Wellbutrin XL. But generally, because your system is very delicate during withdrawal, they are going to cause more harm than be helpful.
>
> The issue is time, not restoring various chemicals. Your brain needs time to adjust to having less Effexor in your body. Adding supplements simply causes confusion to your brain.
>
> Personally, I would not use another med to taper off of Effexor unless your intention is to stay on meds. You will simply be trading one poison for another.
>
> By the way, when I read similar type advice while tapering, my attitude was people were too entrenched in their views and they didn't know what they were talking about. I now realize they actually did.
>
> And when you say you are tapering slowly, are you doing 10% of current dose every 3 to 6 weeks? With Effexor, you might need to go more slowly.
>
> For those of you who claim this will take forever, well, after getting off of psych meds last week, I am doing great in spite of being on meds for 15 years. I am even sleeping without taking anything 2 out of 3 days. I credit that to a slow taper.
>
> I hope this helps.
>
> 49er
>
> PS - Another exception is fish oil. I definitely recommend that.Thanks for reply. Iam gonna take that advice and dont start wtih any suppl. during venlafaxine-taper.
I jumped fron 375 mg to 150 mg in one day which wasnt clever and it gave me headzapps for 10 days.
But no increase anxiety/depression.Now i taper opening capsule and releasing 10 corns. Feels much better ans safer.
Maybe my anxiety-level gonna rise when i am off venlafaxine completely so i am thinking 5-htp in for sleep.
Is spirulina activating?
/chris
This is the end of the thread.
Psycho-Babble Alternative | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.