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I'm 40 now. One time I was 22 and knew I needed help so I went to a therapist and she gave me herbal pills and acupuncture. Me, I still wanted to die and I knew there was SOMETHING out there but alas, moms insurance. Needless to say I became more depressed and sat in the cellar of a goth club staring at the wall for 5 years. Numb n drunk. Poverty did not enable me to seek meds but there was a clinical trial for Viibryd in 2012 which I did for three months along with Trazadone. It helped me get out of a dead end life im Seattle with a BPD type (you know how us codependants roll) and move to California. Must've not been a placebo since the withdrawal cold turkey was a week. Fast forward to Obamacare and asked for Citalopram. Big mistake. Called in sick to work,sweating like a crackhead and bipolar like behavior. Tried Buproprion. No side effects but didn't really *do* anything. Sooo....Cymbalta for 5 weeks and I just get more exhausted every second, take two naps a day on top of 8 hours of sleep. I dont have the fibro but do have back pain (DDD) I stuck with it, wouldn't you say? I even doubled the dosage to 120 which made sleepy times worse. I didn't suffer any side effects except the sleepy part. So go to shrink and he immediately wants to start me on generic Venalaxifine 35. whatever to 75 in two days. I asked about stimulants like Vyvanse or Adderall but he refused, though he was just fine prescribing Xanax and this Lorazapam. SO: Anyone had any luck doing this crossover. If it gives me at least more of a boost than Cymbalta, which just made me want to buy flowers and eat ice cream and pass out every three minutes, I would love to hear your experiences. Sorry so long, am newbie, and lonely in this waking dream🎃

 

 

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I also know of the Remeron and Abilify but this was my first real life shrink appointment, will ask of these later. would love to hear your experiences....

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Ahhh, I see. You're all a bunch of hardened pill poppers and this is one of those "see for yourself, kid." things. Okie doke.  I will report back from the otherside, posthaste.

Edited by Sleeeeeep77

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1 hour ago, Sleeeeeep77 said:

Ahhh, I see. You're all a bunch of hardened pill poppers and this is one of those "see for yourself, kid." things. Okie doke.  I will report back from the otherside, posthaste.

.Huh? Where the hell did that come from? You asked a very specific question about switching from Cymbalta to Effexor. You've got to wait a while until someone with that experience comes along. I certainly never made that switch.

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.....and sensitive too? I'm sorry brother my sarcasm tends to go under the radar or over the heads.  All apologies. Nice to meet you. 

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I've not had experience switching from Cymbalta to Effexor (had a couple of meds in between), but I must say, IMHO I think it's mighty foolish of your pdoc to switch you from Cymbalta 120 mg to 37.5-75 mg Effexor... I'm surprised you're not having withdrawal symptoms from hell from the Cymbalta.

To give you an idea of the "equivalency" of dosages between Cymbalta and Effexor, Effexor at 225 mg blocks > 80% SERT (serotonin transporters) and ~70% NET (norepinephrine transporters), while Cymbalta at 60 mg blocks 84% SERT and 67% NET. Not quite the same, but close enough. lol. Also, Effexor is essentially an SSRI at dosages below 150-225 mg depending on the patient. The norepinephrine reuptake part doesn't show up until around those dosages for most people. At even higher dosages (300-375 mg, maybe even 450 mg), weak dopamine reuptake inhibition starts to show up. Cymbalta is similar, but I don't have the numbers exactly... I think I remember reading somewhere that 60 mg is where it starts to become noradrenergic, anything below 60 mg is predominantly serotonergic, and 120 mg is significantly noradrenergic.

Anywho, what I'm trying to get at, is the approximate estimated equivalent dose of 120 mg Cymbalta is 300 mg Effexor. The least your pdoc could've done is start you on 225 mg rather than starting all over from the beginning and then going up from there, you know what I mean?

Also, it's odd that Cymbalta made you so sleepy, but you're certainly not the only one I've heard of who has made that complaint about it. I found it quite stimulating personally. But everyone is prone to paradoxical reactions.

I hope you do well on the Effexor! Good luck!

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7 hours ago, mikl_pls said:

I've not had experience switching from Cymbalta to Effexor (had a couple of meds in between), but I must say, IMHO I think it's mighty foolish of your pdoc to switch you from Cymbalta 120 mg to 37.5-75 mg Effexor... I'm surprised you're not having withdrawal symptoms from hell from the Cymbalta.

To give you an idea of the "equivalency" of dosages between Cymbalta and Effexor, Effexor at 225 mg blocks > 80% SERT (serotonin transporters) and ~70% NET (norepinephrine transporters), while Cymbalta at 60 mg blocks 84% SERT and 67% NET. Not quite the same, but close enough. lol. Also, Effexor is essentially an SSRI at dosages below 150-225 mg depending on the patient. The norepinephrine reuptake part doesn't show up until around those dosages for most people. At even higher dosages (300-375 mg, maybe even 450 mg), weak dopamine reuptake inhibition starts to show up. Cymbalta is similar, but I don't have the numbers exactly... I think I remember reading somewhere that 60 mg is where it starts to become noradrenergic, anything below 60 mg is predominantly serotonergic, and 120 mg is significantly noradrenergic.

Anywho, what I'm trying to get at, is the approximate estimated equivalent dose of 120 mg Cymbalta is 300 mg Effexor. The least your pdoc could've done is start you on 225 mg rather than starting all over from the beginning and then going up from there, you know what I mean?

Also, it's odd that Cymbalta made you so sleepy, but you're certainly not the only one I've heard of who has made that complaint about it. I found it quite stimulating personally. But everyone is prone to paradoxical reactions.

I hope you do well on the Effexor! Good luck!

Hi mikl_pls:  Thank you so much for your response! So Cymbalta was an activator for you? I think I was so desperate for anything to work that maybe for the first two or three days I felt I had more energy. That quickly wore off and I started drinking three espressos a day which I never did before, and would still end up laid out.  Do you have fibromyalgia issues? I definitely believe it helps in physical pain issues, had relief there and I can see how it would be beneficial for people who are bedridden/ have limited mobility and the lack of discomfort would make them more active.....but in my case, its the dx'ed MDD and I am suspecting a bit of Bipolar 2 as well.

Yeah when he said start with the 37.5 I was like AAARGH TWINGE LOW DONCHA THINK but he's the professional.  Now here's what's interesting:  In the last three days, I have been getting up at around 8 or 9 as opposed to my usual drag out of bed at 11, definitely have more energy and no withdrawal effects whatsoever from the Cymbalta. Also, these are both generics and I'm not sure how that fits into the equation.  Haven't taken any unneeded naps,  I'm still tired of course but I feel kind of..wired?  Alert?  I'll take it, it's only been three days.. My next appt. is in 5 days and I will bring along the info you've shared with me and ask about any add ons he might recommend. I asked him why this particular drug and he said that in a study group between the two meds Effexor had a higher success rate for MDD than Cymbalta did. I also find it funny he wouldn't even think of prescribing a stimulant but was more than happy to prescribe Xanax without me asking for it, which may be because there may be a *high/wired effect from the switch of the two. 

Thanks again for the info, hopefully he just full on titrates me up to 300Mgs, HAHA! Any questions you and any others would have for the next appointment would be greatly appreciated. Thanks again

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Notes:

*this could also be a placebo effect, I am aware of the vast similarities between the two.

 *Anyone think 5 weeks was too short to give up on the Cymbalta? And if so, were you exhausted the whole time?

 

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On 3/21/2017 at 0:20 AM, Sleeeeeep77 said:

Fast forward to Obamacare and asked for Citalopram. Big mistake. Called in sick to work,sweating like a crackhead and bipolar like behavior. Tried Buproprion. No side effects but didn't really *do* anything. Sooo....Cymbalta for 5 weeks and I just get more exhausted every second, take two naps a day on top of 8 hours of sleep. I dont have the fibro but do have back pain (DDD) I stuck with it, wouldn't you say? I even doubled the dosage to 120 which made sleepy times worse. I didn't suffer any side effects except the sleepy part. So go to shrink and he immediately wants to start me on generic Venalaxifine 35. whatever to 75 in two days. I asked about stimulants like Vyvanse or Adderall but he refused, though he was just fine prescribing Xanax and this Lorazapam. SO: Anyone had any luck doing this crossover. If it gives me at least more of a boost than Cymbalta, which just made me want to buy flowers and eat ice cream and pass out every three minutes, I would love to hear your experiences. Sorry so long, am newbie, and lonely in this waking dream🎃

I did not switch from Cymbalta to Effexor back to back, however, I was on Cymbalta for close to 2 years & tried meds in between. Cymbalta initially worked ok, despite stomach upset. Over time, it made me agitated/irritable so I weaned off (to say the withdrawal was bad is a huge understatement.) Effexor was similar, but a bit more "speedy" and I stopped quickly because it immediately made me more agitated/irritable than Cymbalta and I read that the half-life is much shorter (hence leading to more abrupt withdrawals)

I don't want to scare you (plenty of people do not experience withdrawals at all, but Effexor is sort of known to have one of the worst if you are on it longterm..IMO) don't ever miss doses! Again I do not  want to discourage you, meds really do affect everyone differently (ex: Citalopram made me lethargic, was good for anxiety tho) Also, even when you take a break from a med and do a 2nd trial, the effect can be different!

Edited by Blahblah
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4 hours ago, Sleeeeeep77 said:

Hi mikl_pls:  Thank you so much for your response! So Cymbalta was an activator for you? I think I was so desperate for anything to work that maybe for the first two or three days I felt I had more energy. That quickly wore off and I started drinking three espressos a day which I never did before, and would still end up laid out.  Do you have fibromyalgia issues? I definitely believe it helps in physical pain issues, had relief there and I can see how it would be beneficial for people who are bedridden/ have limited mobility and the lack of discomfort would make them more active.....but in my case, its the dx'ed MDD and I am suspecting a bit of Bipolar 2 as well.

Yeah when he said start with the 37.5 I was like AAARGH TWINGE LOW DONCHA THINK but he's the professional.  Now here's what's interesting:  In the last three days, I have been getting up at around 8 or 9 as opposed to my usual drag out of bed at 11, definitely have more energy and no withdrawal effects whatsoever from the Cymbalta. Also, these are both generics and I'm not sure how that fits into the equation.  Haven't taken any unneeded naps,  I'm still tired of course but I feel kind of..wired?  Alert?  I'll take it, it's only been three days.. My next appt. is in 5 days and I will bring along the info you've shared with me and ask about any add ons he might recommend. I asked him why this particular drug and he said that in a study group between the two meds Effexor had a higher success rate for MDD than Cymbalta did. I also find it funny he wouldn't even think of prescribing a stimulant but was more than happy to prescribe Xanax without me asking for it, which may be because there may be a *high/wired effect from the switch of the two. 

Thanks again for the info, hopefully he just full on titrates me up to 300Mgs, HAHA! Any questions you and any others would have for the next appointment would be greatly appreciated. Thanks again

7

You're welcome! Yep Cymbalta stimulated me, but it kinda leveled out until I increased the dose from 60 mg to 90 mg, then from 90 mg to 120 mg. No, I don't think I have FM issues, but I've suspected at times that I might have FM... Yeah it definitely helped me with my anergic, bedridden depression, at least for a little while.

I would've definitely questioned him and interrogated him about why he started you on 37.5 mg... that's just me. I'm very adamant when it comes to medication, but I'm usually a very soft spoken and quit and shy guy who doesn't speak up about things... That is interesting how you're reacting to the Effexor, because at that dose, it's essentially just an SSRI—no effects on norepinephrine to speak of.

I don't get why he won't prescribe you a stimulant. If it were me, I would figuratively corner him with questions about why he isn't willing to prescribe a stimulant until he either invites me to find a new psychiatrist or until he caves in and tells me. You can even include "you had no problem prescribing me Xanax yet..." When my psychiatrist is being shady, shifty, and sheisty about something I ask her about and gives vague answers that are a sack of words that basically say nothing, I repeat the question again or change the wording of the question and keep doing it until I get an answer. It's the only way you'll get any answers from doctors, unfortunately... If you really want to know something, you have to be very direct and persistent with your question. That's just my experience anyway. Take all that with a grain of salt or sugar or whatever you like. lol (that's one of the things that pisses me off is when a doctor absolutely refuses to do something and doesn't say why or gives a vague reason why, or the reason the give seems almost made up...)

Chances are he will not want you to go above 225 mg if I had to guess, based on his conservative approach to prescribing (not wanting to prescribe stimulants), in which case I would google for the Effexor XR official PI sheet and print out just the page that talks about the dosing and says the max dose of Effexor XR is 375 mg, and find some papers online that discuss high dose Effexor (450-600 mg). Stephen Stahl (a very famous psychopharmacologist who has written psychopharmacology textbooks) has talked about Effexor dosing and described 600 mg as a "heroic dose." If I'm not mistaken, he said you can go even higher as long as you do blood work and monitor the levels of venlafaxine, desvenlafaxine, and the minor metabolites, and as long as they're within normal range, you can keep increasing the dose if you need to (like if the current dose poops out). For instance, if you're a rapid metabolizer or an ultra-rapid metabolizer of one of the enzymes Effexor is metabolized by. For example, I'm a CYP2D6 rapid metabolizer, and that's one of the main enzymes that Effexor is metabolized by, and I would increase my dose and it would last for about a week and a half. Increase it, same thing would happen. I got to 825 mg before I called it quits on Effexor.

Anyway... back to your titration... chances are he will want to titrate you by 37.5 mg or 75 mg every week, or if he's conservative then every 2-4 weeks (the PI sheet says every 4-7 days...)

Since if he just ABSOLUTELY WILL NOT YIELD and prescribe you a stimulant, then Wellbutrin is a good alternative for some. That way once you get up to about 150+ mg of Effexor, you'll get triple reuptake inhibition.

Remeron goes well with Effexor too, but it'll make you sleepy (you take it at night) and make you hungry and gain weight. The higher the dose though the less those side effects are present because it becomes more noradrenergic in higher doses.

Trazodone is another good adjuvant medicine. It reduces anxiety and helps you sleep. Most people start out with 25-50 mg but some will develop a tolerance to it rather quickly and need higher doses.

If you suspect bipolar 2, a good mood stabilizer would be lamotrigine (Lamictal). It's one of the only mood stabilizers that truly treats depressive states and stabilizes from below and prevents mania (albeit not as good as some of the other mood stabilizers). It's used in unipolar depression too in treatment-refractory cases.

That's about all my brain can throw out on my keyboard right now, if I think of anything else I'll let you know. :) 

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18 hours ago, Dphxa said:

So did I.  Cymbalta did little to nothing for me both times I tried it.

I more or less went straight from Cymbalta to Pristiq, which is desvenlafaxine, the active metabolite of Effexor, and the difference was like night and day.  The Pristiq almost immediately began to put my agitated depression episode into complete remission for about 3 years.  The only other thing I've taken that had such a strong effect was Paxil.  It was a real wonder drug until early last year when it mostly stopped working.  I suspect I may be bipolar 2 and that is just what happens with that illness.

  Now I'm stuck with two boxes of these pills. I wonder if my back starts to hurt I can just pop one for the physical effect, I mean the fuck else am I gonna do with 'em?  How much Cymbalta were you on and how long when you switched to Pristiq?  I'll google the differences between the P and the E. I'll ask for that since it looks like we had the same reaction to the Cymbalta.  I'm suspecting Bipolar 2 as well but I can't tell if it's just one of those "hey I don't feel like utter shit right this second I feel like cleaning my room and laughing for a couple hours" than back to the sweaty bed.  I definitely would be lower on the mania scale. What are you taking now that the Pristiq pooped out?

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11 hours ago, Blahblah said:

I don't want to scare you (plenty of people do not experience withdrawals at all, but Effexor is sort of known to have one of the worst if you are on it longterm..IMO) don't ever miss doses! Again I do not  want to discourage you, meds really do affect everyone differently (ex: Citalopram made me lethargic, was good for anxiety tho) Also, even when you take a break from a med and do a 2nd trial, the effect can be different!

You know, by far the worst withdrawal effects were from Viibryd but that was because it was  clinical trial and I didn't do any research whatsoever on it. Only lasted 3 days though and it wasn't that horrible.  I'm pretty obsessed with getting out of this shit so I can live a  healthy life and not be a burden to anyone.  WILL NOT BE MISSING ANY DOSES. When you mean a break, do you mean the Cymbalta?  Thats interesting I wonder why that would be, though 5 weeks doesn't sound too long. The longest I've been on any med is 3 months. Psychotic really to suffer for no reason but you know, poverty.   And how do we feel about taking a little Cymbalta with the 75 mgs of Effexor?  Can I get those brain zaps I've heard so much about because they sound charming. 

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16 minutes ago, Sleeeeeep77 said:

You know, by far the worst withdrawal effects were from Viibryd but that was because it was  clinical trial and I didn't do any research whatsoever on it. Only lasted 3 days though and it wasn't that horrible.  I'm pretty obsessed with getting out of this shit so I can live a  healthy life and not be a burden to anyone.  WILL NOT BE MISSING ANY DOSES. When you mean a break, do you mean the Cymbalta?  Thats interesting I wonder why that would be, though 5 weeks doesn't sound too long. The longest I've been on any med is 3 months. Psychotic really to suffer for no reason but you know, poverty.   And how do we feel about taking a little Cymbalta with the 75 mgs of Effexor?  Can I get those brain zaps I've heard so much about because they sound charming. 

By break in between, i meant that I did not titrate straight from Cymbalta to Effexor. I was on numerous medications in between those two meds.

5 weeks on a medication is barely enough time to see whether it will work or not. Some meds like Lamictal take 2 months to get to adequate blood levels & benefit...Also If you are only on a med for 3 months and then titrate down, it is less likely you will have major withdrawals. It depends on the dosage + the length of time you were on the med. I was on 90-100mg Cymbalta for 2 years, so this is no doubt why I had such a rough withdrawal.

Edited by Blahblah
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7 hours ago, mikl_pls said:

I don't get why he won't prescribe you a stimulant. If it were me, I would figuratively corner him with questions about why he isn't willing to prescribe a stimulant until he either invites me to find a new psychiatrist or until he caves in and tells me. You can even include "you had no problem prescribing me Xanax yet..." When my psychiatrist is being shady, shifty, and sheisty about something I ask her about and gives vague answers that are a sack of words that basically say nothing, I repeat the question again or change the wording of the question and keep doing it until I get an answer. It's the only way you'll get any answers from doctors, unfortunately... If you really want to know something, you have to be very direct and persistent with your question. That's just my experience anyway. Take all that with a grain of salt or sugar or whatever you like. lol (that's one of the things that pisses me off is when a doctor absolutely refuses to do something and doesn't say why or gives a vague reason why, or the reason the give seems almost made up...)

Well I'm in France in a town of 8000 people.  Maybe the stimulants aren't doled out because of the abuse or whatever the fuck BUT I HAVE SHIT TO DO not to mention living in a new country.  Also Viibryd is not on the market here for some damn reason which sucks but there are only 300 other alternatives to try. Savella is very popular.  I wouldn't say the man is shifty but I'm payin out of pocket for this and I can be VERY DIRECT hehe.  This  only be my second appt with him and I assume he wants to see how its going.  

7 hours ago, mikl_pls said:

Chances are he will not want you to go above 225 mg if I had to guess, based on his conservative approach to prescribing (not wanting to prescribe stimulants), in which case I would google for the Effexor XR official PI sheet and print out just the page that talks about the dosing and says the max dose of Effexor XR is 375 mg, and find some papers online that discuss high dose Effexor (450-600 mg). Stephen Stahl (a very famous psychopharmacologist who has written psychopharmacology textbooks) has talked about Effexor dosing and described 600 mg as a "heroic dose." If I'm not mistaken, he said you can go even higher as long as you do blood work and monitor the levels of venlafaxine, desvenlafaxine, and the minor metabolites, and as long as they're within normal range, you can keep increasing the dose if you need to (like if the current dose poops out). For instance, if you're a rapid metabolizer or an ultra-rapid metabolizer of one of the enzymes Effexor is metabolized by. For example, I'm a CYP2D6 rapid metabolizer, and that's one of the main enzymes that Effexor is metabolized by, and I would increase my dose and it would last for about a week and a half. Increase it, same thing would happen. I got to 825 mg before I called it quits on Effexor.

Whoa!! Have you thought about going into this as a career path? I don't know how to find out if I'm a rapid metabolizer I do know of the test that figures out what meds work best for one but I'll have to research the french version.  Also will look into Stephen Stahl, thank you!

 

7 hours ago, mikl_pls said:

Since if he just ABSOLUTELY WILL NOT YIELD and prescribe you a stimulant, then Wellbutrin is a good alternative for some. That way once you get up to about 150+ mg of Effexor, you'll get triple reuptake inhibition

 I may have to get some of that shipped. I think you can buy it online.....believe it or not its only prescribed as a smoking cessation tool and its not used for depression in France. I really think, to my limited knowledge, that Effexor and Vyvanse would work out really well for me. I do not suffer from anxiety (small miracles)  and I already have the Xanax as well as Loprazelam for sleep.  

 

8 hours ago, mikl_pls said:

 

If you suspect bipolar 2, a good mood stabilizer would be lamotrigine (Lamictal). It's one of the only mood stabilizers that truly treats depressive states and stabilizes from below and prevents mania (albeit not as good as some of the other mood stabilizers). It's used in unipolar depression too in treatment-refractory cases

 Yep been interested in that too,  I wonder why it's not prescribed more for depression. What I do find funny with the shrink is I said I suspect I MAY have Bipolar 2 and he was pretty unresponsive about it. I wonder if thats why he was so quick to refuse the stimulants.  

 

Thank you for the life helping advice, my brother.  I refuse to accept defeat and I will continue to find a solution and I will go in to that next appointment with a briefcase  full of info like a lawyer in court. Bless you!!!!!!

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Day 5 or so? Not sure but I am WIRED, y'all. And I'm only on 75 mgs 😁 Been fighting some tiredness, for example forcing myself to get up after 6 hours of sleep in the morning BEFORE 11 😜 and no naps and say, a coffee. Went out last night and had a few drinks nothing nuts but I will take a two hour nap which is my reward for appearing to be a normal human being HAHA anyway. Never happened with Cymbalta, this. I will keep updating for all my fellow Cymbalta sleepers.

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Welllll....that didn't last long. Have been on 75 Effexor and I started to get that sleepy feel again for the past week. So went to pdoc, he just doles out the pills, right? So I tell him I've been doing research on meds to take in conjunction with the Effexor with a bit more mmph, I just moved (ok I moved back six months ago and I have MDD so it takes me longer to do live the day to day) to France where my sister and mother live, my only family live, after living in California for 8 years. It's going like hell thank you for asking should improve once I move out. So he advises to raise the dosage to 112.5, which I have done for two days and no major changes in the tired dept, but I was on 60 of Cymbalta for 60 weeks and aside from the sleepy part, I'm thinking of going straight to 150 starting tonight. Two in the morn, two in the night with the Alprozolam and Xanax which AGAIN, he has no problem prescribing but I want some Vyvanse I think it would really help..so ask thee, should I up the dosage tonight or just wait three more days? Thank you for your insight.

um that should read six weeks on Cymbalta great for body pains crap for depression unless you like being a zombie

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If your doctor told you to wait the three days, then I would if I were you. Three days isn't long. Just be aware that Effexor doesn't begin to act on norepinephrine until you to 150 mg or so.

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I personally see no reason why you shouldn't be able to go straight from 75 mg to 150 mg of Effexor—that's what I did in the beginning... 1 week of 75 mg and then up to 150 mg. The titration instructions for MDD say you may increase by 75 mg every 4-7 days. I'll include a screen cap from Epocrates to back that up.

What you want to make sure you do is make sure your pdoc is on board with this, and make sure you have enough Effexor to last you until next time so you don't run out before you're able to refill or able to get back to your pdoc. I'm no one to say anything about this as I've done it plenty of times myself lol, but the less things you do behind your pdoc's back without him/her knowing, the better, because you'll build better rapport with them that way. Or if you DO do something on your own, be sure to straight up tell them at your next appointment and tell them why. But 37.5 mg increments, unless you're having issues tolerating Effexor, are baby steps... 75 mg increments are generally better suited for titration for a depressed patient. Next time he wants to increase it and recommends a 37.5 mg increase, you could just flat out ask if you can increase by 75 mg increments since that's what's indicated.

Strange that he has no problems prescribing Xanax but has issues with prescribing stimulants... I mean in the US they are 2 schedules away from each other (benzos schedule IV and stimulants schedule II) but still, Vyvanse has been shown to be the least abusable stimulant. I would keep pressing him for that, and actually ask questions directly to him about why he isn't willing to prescribe it. You're paying him to prescribe you medicine. If there's something that you think will help you, you have a right to ask about it, and if the doctor declines, you have a right to know why they are declining it, in detail.

Back to the Effexor, I personally wouldn't take any Effexor at night. If you split doses, it's probably best to take the second dose in the afternoon due to Effexor's stimulating nature (but then again you're getting tired from it so take that advice with a grain of salt. Just a heads up for when/if it does become stimulating).

Screenshot_2017-04-05-13-02-41.png

Edited by mikl_pls
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7 hours ago, jt07 said:

If your doctor told you to wait the three days, then I would if I were you. Three days isn't long. Just be aware that Effexor doesn't begin to act on norepinephrine until you to 150 mg or so.

Actually the doc wants me to stay on 112.5 for a month. It sounds ludicrous to me bu then again, I'm not a doctor.

 

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Is there any way you can contact him and ask if you can go straight to 150 mg?

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mikl_pls you are the med whisperer here. Any idea why it doesn't stimulate as it is its general nature? I have no anxiety issues, no self harm. Insomnia without action not bipolar. How common is it to be so damn tired??'bipopar........

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13 minutes ago, Sleeeeeep77 said:

mikl_pls you are the med whisperer here. Any idea why it doesn't stimulate as it is its general nature? I have no anxiety issues, no self harm. Insomnia without action not bipolar. How common is it to be so damn tired??'bipopar........

 

Haha I just do a lot of reading on meds is all.

Lemme break open Stahl's Essential Psychopharmacology for this, as I can't exactly remember the explanation off the top of my head.

In one section he says that "at modest levels, norepinephrine (NE) can improve prefrontal cortical function by stimulating postsynaptic α2A receptors, but will lead to impaired working memory at high levels when α1 and β1 receptors are also recruited." 

I can't seem to find exactly where he says it, but I'm pretty sure it has something to do with moderate levels or norepinephrine stimulating the postsynaptic α2A receptors is stimulating, but if you have too much norepinephrine, it can also stimulate the α2B and α2C adrenergic receptors, and stimulating the α2C receptors is what causes fatigue in some people with a high basal amount of norepinephrine, say if you have a mutation in your COMT genes or MAOA genes that slow their function down in degrading norepinephrine and dopamine.

However, what I don't get is why you're feeling sleepy at such a low dose without the NRI kicking in yet. Maybe it's the SRI part that's making you sedated? Maybe if you get to a high enough dose (150-225 mg) you'll feel more stimulated? Then again, you had this problem with Cymbalta at 60 mg, and Cymbalta 60 mg is about like 150-225 mg Effexor. I think it's worth waiting it out to give it a shot, and if it doesn't attenuate or go away, to plead with your pdoc for a stimulant.

If Effexor is a dud for you, though, you live in France, so I think you have some options available to you that aren't available for us... You could either replace or augment with reboxetine (if you have it there), or switch to milnacipran (if you have it there too). Reboxetine is a pure norepinephrine reuptake inhibitor, and milnacipran is unlike the other SNRIs, which are predominantly serotonergic and then noradrenergic—it's noradrenergic primarily then serotonergic, so you'll definitely get the noradrenergic part along with the serotonergic part. Same for Fetzima (levomilnacipran), but I don't know if that's available there. There's also Strattera if you can't add reboxetine, another NRI, but it's actually been shown to be another SNRI, just way more noradrenergic than serotonergic. You could augment the Effexor with Strattera/reboxetine (very similar meds). If that doesn't work, then you could add a secondary amine tricyclic like desipramine (Norpramin) (my favorite!), protriptyline (Vivactil) (my second fav!), or nortriptyline (Pamelor) (it's okay). Their brand names may be different where you live, but I went ahead and listed their brand names in the US. Desipramine especially is very stimulating, at least for most, as it's the most potent norepinephrine reuptake inhibitor, even more than Strattera and reboxetine, and more selective even at that, so that there's hardly any serotonergic activity until you reach the much higher doses.

If he refuses to go for that, you could probably try adding lamotrigine (Lamictal)... I know it's a bipolar mood stabilizer, but it does help with unipolar depression, and it tends to be stimulating for most, especially in the lower doses. You might not need a full therapeutic dose of 100-200 mg, you might get by with just 25-50 mg/day.

Another possibility is aripiprazole (Abilify), which tends to be stimulting for most. Some get tired from it, but most are stimulated from it, especially in the lower doses. Some bipolar folks are even triggered into hypo/mania in the lower doses. Same for Geodon, just not as much I don't think.

Good luck!

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thank you! No disrespect to my bipolar brothers and sisters, but I should could use some mania to clean my damn room 😘

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1 hour ago, Sleeeeeep77 said:

thank you! No disrespect to my bipolar brothers and sisters, but I should could use some mania to clean my damn room 😘

Just not the dysphoric mania. lol

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