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Re: Are maximum doses more effective?

Posted by bleauberry on April 23, 2009, at 16:36:57

In reply to Are maximum doses more effective?, posted by matt sanz on April 21, 2009, at 20:35:57

I know a girl who's therapeutic dose of Lexapro is 3mg (liquid).

A clinical study showed low dose Milnacipran was just as effective as high dose, with the only difference being that the low dose took longer.

Personally, I seem to get significant benefit out of a mere 5mg Parnate once every 3 days. Maybe someone else needs 100mg every day. But how does one know if they shoot right to the top in a hurry?

And there are many other examples.

At or you'll find people who did well with just 37.5mg or 75mg effexor.

I think it is absurd for a doctor to somehow have a magical target in mind without a clue where things are going to go.

I like my doctor's way of doing it. That is, start very conservative, judge what has happened, and don't make any plans on anything until then. If he were to start me on Lexapro for example, and him knowing my history, I know his strategy would be 2.5mg every other day for a couple weeks. He would not even speculate on what to do after that until he had assessed every detail of that two weeks. And we would have no preconceived notion whether the final dose I end up on being well is that same dose or 40mg per day or anything inbetween.

Let your reactions make the decision making. Maybe you need a high dose, maybe you only need a tiny dose. You'll never know if you shoot right to the highest doses as fast as possible. That just sets the patient up for more side effects, more expensive, worse withdrawals, than they might have needed to be exposed to.

I tend to agree wtih Dr Gillmans beliefs that in really severe depression, ssris and snris should be avoided completely, unless combined with a TCA. He just has not seen them having enough power or staying power to treat severe depression. Patients get somewhat better, but hardly ever really well (on ssris/snris). That's his take, his experience, not mine, though I do tend to agree. It takes a ssri+tca, or an maoi, to get the job done.

Effexor though does have something different about it that the others don't, so that is in your favor.




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