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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Fivefires on July 11, 2008, at 16:36:13
I've gone through the worst major depressive episode of my life these past months.
I am on Provigil, but even this doesn't seem to be enough to conquer the malaise, fatigue.
I'm on a benzo, must since incident of 2005 which I believe must have done some damage to my nervous system.
Eff-XR decreased anxiety in the past; doesn't seem to be working the same way this time; had a couple panic attacks last couple days.
No appetite. I've lost 10-12lbs in last few mos.
Anyyyyywaaayyyy ....
Has any1 had long-lasting or even 3-4month-lasting success w/ a medication to serve as an augmentor, to take alongside E-XR, and increase it's effectiveness; an awake, sense of well-being?
Began wk1 75mg, wk2 150mg, now wk3 225mg, and next wk4 go to 300mg.
I've never been on this high a dose; 300mg!
I would say nervousness, fatigue, and agoraphobia are my most bothersome probs'.
Much thanks to any1 for their suggestions or sharing their experiences!
bestwishes, 5f
Posted by Phillipa on July 11, 2008, at 16:53:43
In reply to Med to augment Effexor-XR; improve efficacy?, posted by Fivefires on July 11, 2008, at 16:36:13
Wellbutrin might add energy. Have you ever tried this med? Sorry you're feeling so poorly. How long have you been on the effexor as it takes a while with start up effects. Good luck. Phillipa
Posted by Molybdenum on July 11, 2008, at 22:21:41
In reply to Med to augment Effexor-XR; improve efficacy?, posted by Fivefires on July 11, 2008, at 16:36:13
Hi 5f, {add lots of "IMHO"s below - I just can't be stuffed typing it today} :)
Before I begin to waffle, I get the impression that you only started the Effexor a few weeks ago. It took a month for me to notice the AD effects at all & they steadily built up over several months. So maybe you need to wait it out. There - now that I've said that, let's ignore that idea & set the throttle to FULL....! ;)
OK, so notwithstanding my post 5 mins ago, the obvious choice to augment your venlafaxine (Effexor)is mirtazapine (Remeron). The combo is colloquially known as "California Rocket Fuel". If you google that you'll find a ton of hits - unfortunately they also make rocket fuel in California, so you have to ignore those ;)
In fact, search on that expression plus the word "Stahl" - he's the doc who is credited with the idea and he's apparently widely regarded as an authority on such matters. You only get a few hundred hits then but they're good.
I'm on 450mg venlafaxine & 180mg mirtazapine. I "was" on 600mg & 225mg...I cut back because my doc kept telling me it was too much. Plus my blood pressure went up a bit from the Effexor being so high... no prob though - just one more pill fixed that.
Anyway, it's a very common combination with a lot of anecdotal support and considered by some a "both barrels" heavy duty approach for treatment resistant depression. There have been studies done - just not by the manufacturers (Wyeth & Organon). I imagine they don't want to promote the combo out of fear that they'll discover a replacement in their existing product line which would negate the need for this "cooperation"... I dunno. ;) Point is it's a damn solid combo.
Dose-wise, mirt is a strange animal. 15mg is too low for AD effects but a fine sedative to help you sleep. AD effects start at 30-45mg and the odd thing is that the sedative quality actually REDUCES as the dose INCREASES. Some docs only add a small amount of mirtazapine while others go "pedal to the metal". Like I said I'm on 180mg and my head hasn't exploded yet. Mirtazapine tends to start working for you a lot sooner than most ADs too. Plus there's not a lot of the common AD side effects - the most common is weight gain, but from your post it sounds like that might be a good thing (!).
Mirt is a "noradrenergic and specific serotonergic antidepressant (NaSSA)". At lower doses it acts more on noradrenalin, at higher doses the serotonergic effects take the lead. So "in general", it's a calming AD at lower doses & a stimulating one at higher. BTW, higher probably means 45mg+ - not my 180mg. ;) So I suggest you start on 30mg & see how it feels. BTW, I found that it had a knock-out effect on me, so I take it at bedtime. It also tends to cause a little sedation next day but that definitely past in a week or so.
What else....oh yeah: Stahl's book is err..."available" at torrent sites if you are so enthused. It's 50MB & the file you need to search for is called "Stephen M. Stahl - Essential Psychopharmacology.pdf" - lotsa pretty pics too :)
Another thing, I too am taking modafinil (Provigil). I take it for narcolepsy but I believe it's a good augmenter for depression too. Nice & gentle...
BTW, Effexor made me feel very anxious initially & every time I increased the dose. It only lasted a week or so each time but it was pretty intense. I also take 150g moclobemide for angst. And I too don't get any anti-anxiety effects from Effexor. ;)
Take Care :)
Mr. M.
Posted by Fivefires on July 14, 2008, at 15:01:51
In reply to Re: Med to augment Effexor-XR; improve efficacy?, posted by Molybdenum on July 11, 2008, at 22:21:41
I'm supposed to go up to 300mg Weds and the next week I see my pdoc. At this time, we will talk (I hope!) of what med or meds to add in; this is what I want. Often pdoc looks to me for direction.(?)
TY for all your sharing above. I am discussing the same issue above in a thread about California Rocket Fuel.
I fear I'm misdiagnosed; more than borderline, feel atypical. Fear caregivers are not looking deeply enough into my hx. Not sure if said, but no pdoc ever, ever dx'd borderline. One of many caseworkers where I'd lived before now, just casually asked me if I'd ever been told I was borderline. I repeated it to the pdoc I was seeinhg then and NOW wish I'd not.
pls keep in touch ... all knowledge appreciated
tks .. try get back online in a bit .. wear out .. tire so easily
Fear I'm in the longest major depressive 'episode', an 'episode' can last ...
5f
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