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Re: Going with Venlafainxe + Bupropion

Posted by SLS on November 17, 2022, at 11:22:40

In reply to Going with Venlafainxe + Bupropion, posted by linkadge on November 16, 2022, at 14:20:43

> I saw my psychiatrist today. We're going to go with venlafaxine 37.5mg + bupropion 150mg (also taking lithium 300mg and mirtazapine 7.5mg).
> Fingers crossed.
> Linkadge

Hi, Linkadge.

I like your choice - a lot.

I think you will come close to receiving an acceptable improvement that you can build on.

So that you not be spooked by side effects and flinch as a knee-jerk reactions to them when they first appear, I think you should make addressing potential side effects a crucial and necessary part of your trial protocol.

A few thoughts.

1. A *very* gradual titration of Effexor. It might be appropriate to allow 6 weeks to reach a therapeutic dosage. Start at one half of a 37.5 mg capsule. If you reach a dosage that produces side effects, decrease the dosage for two weeks and try increasing again.

2. I don't think it is in your best interest to stop at 37.5 mg/day. I doubt anyone improves robustly at dosages lower than 75 mg/day. I didn't reach my optimal response to Effexor until I reached a dosage of 300 mg/day. 225 mg/day didn't cut it. I had side effects early in treatment, but I eventually was able to establish a dosage of 300 mg/day without side effects.

3. You must begin thinking that you are going to try each treatment only ONCE. Be thorough, and try not to abort the trial unless side effects, including psychiatric side effects, are intolerable. By this time, you will already have in place a strategy to treat side effects. Be creative when developing strategies. Benzodiaepine? Beta-blocker? Buspar? Anti-psychotic? I am absolutely sure that you are more competent than me in designing palliative treatments for the side effects that you expect.

4. If you find the psychiatric side effects (anxiety, etc.) of Effexor (venlafaxine) to be intolerable and refractory to mitigation, I implore you to try Pristiq (desvenlafaxine) afterwards, regardless of expense. Drug company financial aid? Regardless, this should be considered am imperative in order to perhaps give you the motivation and functionality to work and pay for the Pristiq. Employee benefits?

Good luck. No more circles.

- 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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