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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 1 of 1. This is the beginning of the thread.
Posted by LouisianaSportsman on February 21, 2014, at 2:30:35
Hey, everybody!
Due to a variety of reasons, I am discontinuing Effexor XR (venlafaxine) 150mg.; however, I am looking for another antidepressant to help bridge the gap during the tapering and withdrawal process. Additionally, I am looking for this antidepressant to serve as a maintenance medication within my cocktail. My cocktail is currently:
Adderall IR (amphetamine salts) 60mg.;
Aplenzin (bupropion hydrobromide) 522mg.;
Effexor XR (venlafaxine) 150mg.;
Lamictal (lamotrigine) 200mg.;
Latuda (lurasidone) 80mg.;
Nuvigil (armodafinil) 250mg.;
Neurontin (gabapentin) 1,200mg.;
Topamax (topiramate) 100mg.------
I am contemplating an alternative SNRI or perhaps a TCA (or atypical AD with NE properties) as I postulate that it would make discontinuation of venlafaxine smoother; currently, I have my eyes set upon Fetzima (levomilnacipran).
My analysis shows:
1. Reports of elevated energy levels. Notice: I take amphetamine salts, armodafinil, and buproprion; obviously, I have a dilemma with fatigue and lethargy.
2. 5-HT7 receptor antagonism. Scott (SLS) has pointed this out to me, and he has made note of it here on the forum. Medications with this property have been successful for me (Abilify [aripiprazole] and Latuda [lurasidone]). This unique property of levomilnacipran is very attractive. It would be intriguing to be prescribed two 5-HT7 receptor antagonists; perhaps, they would be cohesive in alleviating symptoms?
Lamentably, there are also many calamitous reports. Also, in some clinical trials levomilnacipran was hardly superior than placebo.
Regardless, I still want to give it a shot, but I wanted to hear the advice of this forum first especially from those with experience with this pharmacon who can advise me about dosage, etc.
I'm open to hear advice of alternative routes from venlafaxine besides levomilnacipran.
------
BONUS
I want to suggest the following changes in my cocktail to the forum. I am suggesting to my PDOC the next visit:
Neurontin (gabapentin) 1,200mg. --> dosage increase as high as the PDOC is willing to go. I find that 2,400mg. is essential which is double my current dose; I'm not sure if she is willing to go for that or not. I want #90 800mg. I'd say it's a 50/50 shot.
Topamax (topiramate) 100mg. --> Trokendi XR 200mg.
This is an extended-release topiramate. Topiramate was prescribed for weight control concomitantly with AAPs. There was also hope that it would be propitious for mood stabilization. Regrettably, it is losing effectiveness in both indicated areas where it helped a little bit in the past.
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Scott, I wanted to let you know that I read your follow-up reply to my post about your Latuda trial. I am solicitous about asenapine therapy for you based on your analysis; I can see reverberation to aripiprazole. But, what are your thoughts on this topic?
Everyone else, I look forward to your input! This is my choice place for intelligent discussion about psychiatric medications.
Thanks, everybody!
This is the end of the thread.
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