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Re: Venlafaxine is not an SSRI linkadge

Posted by SLS on August 17, 2022, at 12:18:44

In reply to Venlafaxine is not an SSRI, posted by linkadge on August 17, 2022, at 10:19:15


> This being said, I hate the assertion that venlafaxine is just an SSRI in low doses. I can't express how wrong this viewpoint is (especially for me). 5mg of escitalopram feels nothing like 37.5 -75mg of effexor.
> On paper they should be "the same" but they're not . Even though effexor is purportedly devoid of noradrenergic action below 150mg, it is much more activating for me. It doesn't produce the spaciness or confusion that escitalopram does.

I agree with your thesis statement. Effexor is not an SSRI according to how SSRIs are defined.

I'm going to reiterate for you, Linkadge, that Pristiq might be a better drug for you than Effexor. You might react adversely to the parent drug, venlafaxine (Effexor) but not the active metabolite, desvenlafaxine (Pristiq). These two drugs "feel" different to me. Effexor must have at least one property that Pristiq does not. I experience some improvement with Effexor, but none at all with Pristiq, although I found Pristiq to be a smoother drug with respect to mental and physical side effects.

I used to push an idea here over the years that different is different. It is a simple concept, but too often ignored. Many people make treatment decisions based upon the faulty notion that all SSRIs are alike and interchangeable. We now know that this is not true.

Another consideration is that humankind has likely not yet elucidated all of the pharmacological properties of every psychotropic drug. Scientists discover new properties of old drugs all the time, as is demonstrated by the repurposing of old drugs for new indications.

I made it a general rule for myself that I not be too smart and predict my reactions to drugs based upon what little man understands about the brain, and physiology in general. For the most part, I did not eliminate any drug from consideration based upon what I believed to be true about the pharmacological properties of a drug. Even if I did, I would not be able to explain the interindividual differences in the responsiveness to the same drug without understanding much more about the structure and function of the brain.

If Paxil and Zoloft were identical simply because some human being dubbed both drugs as being "SSRIs", then why will someone respond to one and not the other? That's all you need to know in order to make rational treatment decisions if your mental illness is difficult to treat.

Different is different.

Don't exclude any possibilities by being "too smart". Linkadge, you are plenty smart, but scientists have not provided you with sufficient information to put the puzzle together.

Two last thoughts...

1. Don't "pulse" antidepressants.Your brain doesn't know what the hell is going on. It can't find anything resembling homeostasis from which to navigate gradually towards a true and persistent remission. Your brain is lost. It has no familiar starting point from which to begin its journey. I think you would be better off to no longer make frequent and abrupt changes to what you are assaulting the brain with. That includes herbs and nutriceuticals. Stop taking them. They will only confound the biological dynamics between drug and brain. Besides, they don't do sh*t for you. Try to find a combination of drugs that leaves you with a bearable depression as you give the brain time to establish a homeostasis - any kind of homeostasis. It would be great if you can do this without using an antidepressant in the interim. Taking a "drug holiday" for perhaps 2-3 months might make you much more responsive to the same drugs that had failed to produce an improvement previously.

2. You should expect that the journey from baseline depression to remission will be frustratingly gradual. Expect the journey to take a year or more once you begin to feel the beginnings of an improvement. Give a treatment 3 months to demonstrate the robustness of a response after you begin to improve. If you feel no improvement at all - zero - after 1 month, or you feel worse and can't tolerate side effects, you might be better off aborting the trial at that point. Wait at least two weeks before beginning a new treatment.


- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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