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Is there anything stronger than Effexor?


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#1 PSmith4630

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Posted 08 March 2006 - 12:15 PM

I don't even know the difference between SSRI or Non-SSRI and which are supposed to be stronger.  But I've read at crazymeds that if Effexor won't bring you out of the deepest darkest depression, nothing will.  But my pdoc took me off of it (slowly) because it worked great for me the 1st 2 weeks or so I was on it, then I never got that back.  Pdoc has since put me on 20mg of Lexapro and 300mg of Wellbutrin.  Along with 100mg of Trazodone, which is mainly for sleep but it also seemed to help the Effexor work better cause Effexor did fuck all for me without the Trazodone. 

I've never gotten back to that point where I was the 1st couple weeks on Effexor, where I truly felt like literally whatever happened I could handle it.  It wasn't that nothing bothered me, but shit was a LOT easier to cope with because it didn't bother me anywhere near as much as it has before those 2 weeks or since.

So my question is: is there anything out there stronger than Effexor?  Or would one need to be on a combination of antidepressants to get a stronger effect than Effexor?


#2 ~nestling~

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Posted 08 March 2006 - 01:22 PM

remeron and efexor in combo have been my way through. but, mainly therapy.....

In the Dark and the Deep there are truths that can always heal~Ken Wilber
[Recurrent (Chronic Major) Depression - Complex Trauma&Borderline]


#3 mrsloony

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Posted 08 March 2006 - 02:54 PM

I've never really thought of one AD being "stronger " than another. Everyone responds so differently to different chemicals and combinations. for me its been years of trial and error. ( btw effexor did Nothing for me) omg i've been on prozac, zoloft, effexor, paxil, etc etc
Sometimes i find one AD will work for 1-2 years and then kind of poops out and doesn't work anymore. I even came full circle going back to prozac after15 years since the first go round, and then it helped again.
ssri and non- ssri are different in how they effect the chemicals in your brain.
Actually the best antidepressant i've found personally is lithium. I guess in low doses ( and for me in combination with prozac and wellbutrin) it can work well for some people as an AD.
I hope you have a pdoc you like who is willing to always work to make you feel better than you do. Also, if you feel a pdoc isn't helping- i hope you can change to another.

Edited by mrsloony, 08 March 2006 - 02:55 PM.

dx: bp II, ptsd, ocd, ibs, hypothyroid
rx: wellbutrin, lithium, seroquel, ativan, levoxl


take all I say with a big grain of salt as I am crazy and i know not what i say.
if it is professional advice you seek, go elsewhere, you will find none here.
pay no attention to the (wo)man behind the curtain. (s)he's a very good (wo)man, but a very bad wizard. Use any of my words at your own risk. i warned you ,ok?

#4 Loon-A-TiK

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Posted 08 March 2006 - 08:08 PM

I'm BP1 and have been prescribed many, many, many meds for various reasons over the years (20 years now). The most potent AD for me was Paxil. Effexor was like candy compared to Paxil. First it made me manic and then physical addiction made me a slave (which is why I finally had to quit), but nothing else saved my life.

I owe Paxil my life.

As far as "stronger", adding Lithium or Lamictal, but especially Lithium to an AD will make it more potent. At least according to my pdocs, who love to add on meds for this reason.
DX-BP1 w/psychotic symptoms, PTSD, ADD (Inattentive), and body dysmorphic disorder
Daily RX- WB 300mg, Lamictal 400mg, Abilify 20mg, Adderall XR 30mg, Inderal 10mgx2, Nuvaring
a multi-vitamin, hair/skin/nails vitamin, super 50-b complex vitamin, flax oil

prn- Zyprexa 10-20mg for emergencies

In memory of my dad, BP1 suicide. I love you and miss you!

EX RX- Seroquel, Risperdal, Geodon (master of all that is evil), Zyprexa (the good stuff), Zyprexa Zydis, Trazadon, Depakote, Lithium, Serzone, Paxil, Effexor, Lexapro, Haldol, Strattera, Topamax, Symmetrel, other old school ACs, and more I can't remember now

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#5 Greenyflower

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Posted 09 March 2006 - 12:05 AM

If Effexor won't do it alone, using Remeron as an add-on is frequently spectacularly effective. I've heard it referred to as "California Rocket Fuel."

Wellbutrin XL at 450 mgs and 50 mgs Zoloft is working well for me (the Effexor wasn't working well and when my pdoc raised the dosage to 300 it made my blood pressure shoot up).

There really is no strongest antidepressant. It's all about what works for you. Your pdoc will take various symptoms of yours into consideration when choosing the next AD for you to try. Are you anxious or slowed down? Do you have insomnia or want to sleep all the time? Have you lost your appetite or crave sweets all day long? It can get *really* frustrating finding the one(s) that are going to work.

To help the pdocs and us through the process, both Harvard and Texas have developed treatment algorithms for depression. Here's the URL for the Harvard site. It's an incredibly interesting site (if you're into that kind of thing), and it will give you an idea of just how many medications and combinations there are.

Good luck. I hope you find your magic potion soon.

Greeny
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#6 angeldivax

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Posted 09 March 2006 - 01:37 AM

Zoloft is known to be one of the more potent ADs. Personally, I think it may have been TOO strong for me-- I found it highly sedating!

I think I've heard Cymbalta is highly potent as well, but I'm not that familiar with it myself.

#7 username

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Posted 09 March 2006 - 02:02 AM

In Anti-depressant land, more potent does not = better (for some seemingly odd reason).

Effexor can work on both noradrenaline/norepinephrine serotonin, and even dopamine, so one may consider it potent.

But Paxil is more potent than Zoloft and Prozac, and yet I had a better response to the latter two.

The medicine that I am on at the moment - Cymbalta - is more potent than effexor I believe.  For ME, it is excellent.

But my advice is not to get bogged down in which AD is the most potent.

Instead consider the neurotransmitters that the AD works on, and whether or not it is good for YOU.

#8 TheNewFlesh

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Posted 10 March 2006 - 05:04 AM

Hmm.  You might want to look into the whole BP II/III direction.  Talk to your pdoc and check out the stuff up on psycheducation.org.  It's a decent possiblity.  AD poop-out is a big soft sign for that.  I may or may not be BP II/III, but the only drug that I found tolerable for that and actually worked, Lamictal, gave me a nasty hive reaction.  But then I usually get fucked with that kind of stuff.  If you're desperate, and you don't have mood issues, it can even be used at the sub-mood stabilizing dose.

I'm about to give the SSRI/WB combo a try myself.  If anxiety isn't a big issue for you or you're on some kind of benzo, I would recommend bumping up the WB to 450 mg.  This is what my pdoc and a pdoc relative of mine both suggested before I try throwing an SSRI into the mix.  Of course, you should consult your pdoc before making any changes to the dosages, as I am not a medical professional (at least not yet).  One other thing that you might want to try if bumping up the WB doesn't help things is to go real experimental and try out one of the anti-Parkinsonians (e.g. Mirapex).  They work by increasing the levels of dopamine (DA) in your brain, whereas the WB causes your brain to utilize it better.  This would be essentially doing the same thing as Remeron, only working on DA instead of norepinephrine (NE) and seretonin (5-HT)

That's a very, very simplified explanation, but it is essentially what is going on.  It may be a lack of DA that's your problem, although the fact that Effexor was effective for you would lead one to believe it's not a DA, as Effexor only works on 5-HT and NE.  The suggestion of Cymbalta, which works on the same neurotransmitters as Effexor, is an interesting one, but there's a good likelyhood you'd have a poop out isssue with that one as well.

The trazadone is a novel AD, which is probably why it's boosting the effects of the other ADs you're on.  Basically it does some SRI work, along with some other stuff that psychopharmacologists aren't too sure about. Hope all this helps.
dX: ADD-Inattentive Subtype, PTSD, GAD, dysthmia w/ MDD (poss. BPSD), social phobia, PLMD w/ multiple arousals (>16), chronic insomnia (delayed sleep onset), asthma/allergies, and IBS w/constipation

Psych rX: Adderall IR 25-30 mg qam, Clonazepam 1.75 mg bid, Wellbutrin XL 300 mg qam, Sonata 20 mg prn, Mirapex 0.5 mg qpm, Remeron 7.5 mg qpm, lorazepam 1-2mg prn, propranolol 5 mg prn

Other rX: Zelnorm 6mg bid, Allegra 180mg qam, Singulair 10 mg qpm, Maxaire prn

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