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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by gromit on March 24, 2005, at 1:46:25
I'm wondering if anybody here has had trouble with Effexor withdrawals but had no trouble stopping other meds. My new pdoc suggested Effexor but there are so many threads about nightmare problems tapering down that I'm a little hesitant to commit to a trial. I've never had to really taper an AD before, I've just stopped with no really bad effects but I'm possibly a mutant.
Thanks
Rick
Posted by SLS on March 24, 2005, at 11:17:29
In reply to Effexor, posted by gromit on March 24, 2005, at 1:46:25
Hi Rick.
> I'm wondering if anybody here has had trouble with Effexor withdrawals but had no trouble stopping other meds. My new pdoc suggested Effexor but there are so many threads about nightmare problems tapering down that I'm a little hesitant to commit to a trial. I've never had to really taper an AD before, I've just stopped with no really bad effects but I'm possibly a mutant.
What other alternatives have you been presented with? Perhaps it isn't time to move on to Effexor just yet. I would consider Effexor a first or second line treatment, though. Other SSRIs can produce withdrawal syndrome when discontinuing.
Effexor is probably the most effective AD that physicians currently choose as a first line antidepressant. It gets more people well and gets each person more well than any of the SSRIs.
Personally, I wouldn't sacrafice the possibility of getting well for the potential for difficulties discontinuing the drug. I guess I am less afraid of it now that I've found a discontinuation taper strategy that works well for me. If you respond well to it, there will be no reason to come off of it for quite some time. The drug pipeline does not contain any antidepressants that are to be imminently approved by the FDA. JB Becker would know better than I, though.
If you are afraid of Effexor, then review your remaining alternatives and decide under what circumstances you would choose it.
I use a flexible dosing strategy to discontinue antidepressants and benzodiazepines. I remain hopeful that this strategy can be generalized to others, but I need to see more people try it.
- Scott
Posted by miracles on March 25, 2005, at 0:16:35
In reply to Effexor, posted by gromit on March 24, 2005, at 1:46:25
Hi Gromit,
I had a horrible time when I stopped taking Effexor, and I had never had any sort of problems before. Granted, I never took any other AD.
In my humble opinion Effexor is way overprescribed. If there is any way that you can avoid taking it, I would. It made me very sick.
I am not exactly sure if someone really heals from having taken it cause it seems to me like so many people who take Effexor need to take some kind of AD to feel okay for the rest of their lives even if they weren't depressed when they started to take it. It doesn't seem like there are a lot of people that just stop taking it and never take another AD afterwards. I asked my pharmacist about this, and he said that he rarely sees people that stop taking Effexor.
Good luck with whatever you decide.
Posted by gromit on March 25, 2005, at 3:59:08
In reply to Re: Effexor » gromit, posted by SLS on March 24, 2005, at 11:17:29
Hi Scott,
> What other alternatives have you been presented with? Perhaps it isn't time to move on to Effexor just yet. I would consider Effexor a first or second line treatment, though. Other SSRIs can produce withdrawal syndrome when discontinuing.
We didn't have much time to talk about meds since it was my first visit. He gave me the selegiline I asked for after trying to steer me towards Wellbutrin which I've taken. He also mentioned Cymbalta which I didn't really give a fair trial but at a higher dose.
> Effexor is probably the most effective AD that physicians currently choose as a first line antidepressant. It gets more people well and gets each person more well than any of the SSRIs.That's good to know, I've only tried Zoloft and Lexapro but they made me feel worse.
> I use a flexible dosing strategy to discontinue antidepressants and benzodiazepines. I remain hopeful that this strategy can be generalized to others, but I need to see more people try it.
I think that makes a lot of sense, if it's too fast for you then it's too fast. OTOH maybe you don't need to prolong it just to be on a schedule.
Thanks,
Rick
Posted by gromit on March 25, 2005, at 4:06:27
In reply to Re: Effexor » gromit, posted by miracles on March 25, 2005, at 0:16:35
Hi,
Thanks for responding, I'm sorry to hear about your bad experience stopping Effexor. This is exactly what worries me though, so many people with such a strong opinion about Effexor.
Rick
Posted by SLS on March 25, 2005, at 7:44:20
In reply to Re: Effexor » SLS, posted by gromit on March 25, 2005, at 3:59:08
> > I use a flexible dosing strategy to discontinue antidepressants and benzodiazepines. I remain hopeful that this strategy can be generalized to others, but I need to see more people try it.
> I think that makes a lot of sense, if it's too fast for you then it's too fast.Yup. That's the advantage to dosage flexibility. It discourages you from going any faster than your body is ready for.
> OTOH maybe you don't need to prolong it just to be on a schedule.
Or worse - be on a schedule that allows for the precipitation of a significant withdrawal syndrome. I am beginning to believe that the longer you allow for a withdrawal state to continue, the worse it will get and the longer it will last after discontinuing the drug altogether.
Please post of your progress with selegiline on the Meds board. I'd be very curious to see how well you do with it and what alternative augmenting strategies you and your doctor come up with.
GOOD LUCK!!!
- Scott
Posted by SLS on March 25, 2005, at 8:05:34
In reply to Re: Effexor » SLS, posted by gromit on March 25, 2005, at 3:59:08
The results of the following meta-analysis reflect the experiences of the clinicians I have seen since 1992 when venlafaxine (Effexor) was still investigational. Harvard has been working with this drug for over 20 years.
I am not advocating that you choose to try Effexor right now. There is much to consider. However, if you get "stuck", you might reach the point at which the higher probability treatments would be using one of the older MAOIs or Effexor or Effexor + Remeron.
I am not a salesman for Effexor.
:-)
- ScottFrom Medline:
--------------------------------------------
Br J Psychiatry. 2001 Mar;178:234-41. Related Articles, Links
Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors.Thase ME, Entsuah AR, Rudolph RL.
University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213-2593, USA.
BACKGROUND: It had been suggested that the antidepressant venlafaxine, which inhibits reuptake of both serotonin and (at higher doses) noradrenaline, may result in better outcomes than treatment with selective serotonin reuptake inhibitors (SSRIs). AIMS: To compare remission rates during treatment with SSRIs or venlafaxine. METHOD: Data from eight comparable randomised, double-blind studies of major depressive disorder were pooled to compare remission rates (Hamilton Rating Scale for Depression score < or = 7) during treatment with venlafaxine (n = 851), SSRIs (fluoxetine, paroxetine, fluvoxamine; n = 748) or placebo (four studies; n = 446). RESULTS: Remission rates were: venlafaxine, 45% (382/851); SSRIs, 35% (260/748); placebo, 25% (110/446) (P: < 0.001; odds ratio for remission is 1.50 (1.3-1.9), favouring venlafaxine v. SSRIs). The difference between venlafaxine and the SSRIs was significant at week 2, whereas the difference between SSRIs and placebo reached significance at week 4. Results were not dependent on any one study or the definition of remission. CONCLUSIONS: Remission rates were significantly higher with venlafaxine than with an SSRI.
Publication Types:
Meta-AnalysisPMID: 11230034 [PubMed - indexed for MEDLINE]
J Clin Psychiatry. 1999;60 Suppl 22:7-11. Related Articles, Links
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Evolution of remission as the new standard in the treatment of depression.Nierenberg AA, Wright EC.
Depression Clinical and Research Program, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston 02114, USA.
Epidemiologic and clinical data support the goal of treating depressed patients to wellness or full remission. Many patients improve but fail to achieve full remission with antidepressant treatment and continue to have residual symptoms, which cause distress and dysfunction. These residual symptoms may meet criteria for subsyndromal and minor depression. Patients who have these milder syndromes after treatment have a greater risk of relapse and recurrence than do those who remain symptom-free. Clinical trials of antidepressants have shown lower rates of remission than of responses that fall short of remission, although some dual-acting antidepressants (e.g., serotonin-norepinephrine reuptake inhibitors) may have higher remission rates than other agents. Treatment with such robust dual-acting antidepressants may result in higher rates of remission and fewer residual symptoms than treatment with selective serotonin reuptake inhibitors.
Publication Types:
Review
Review, TutorialPMID: 10634349 [PubMed - indexed for MEDLINE]
Posted by gromit on March 26, 2005, at 1:16:00
In reply to Re: Effexor » gromit, posted by SLS on March 25, 2005, at 7:44:20
Posted by Dr. Bob on March 28, 2005, at 4:15:37
In reply to Re: Effexor » gromit, posted by miracles on March 25, 2005, at 0:16:35
> I had a horrible time when I stopped taking Effexor, and I had never had any sort of problems before...
When you're blocked, you're not supposed to post, so I'm going to double its duration and delete your other posts here.
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Thanks,
Bob
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