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300 mgeffexor, 450 mg wellbutrin, 45mg remeron


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I went on meds back at the end of Nov.  I had been taking 300mg wellbutrin, 45 mgs remeron, and then a mix of antisychotics along with effexor and zoloft.  Right now I've been on 300 mg wb and 150 mg effexor with 45mg remeron after dinner.  We both work full time.  We have a daughter and I am the primary caregiver, so i can't be too out of it.  The remeron for sleep has worked for my anorexia and insomnia, but my  depression and  anxiety have gotten worse at points and not better for more than a day or so.  Yesterday boosted wb to 450 mgs and effexor to 300 mgs kept remeron the same.  Still hyper in evenings after getting home having dinner and puting the kid to sleep.  If this dosen't work they are talking about adderall.

what are your thoughts on the subj

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my  depression and  anxiety have gotten worse at points
You're on THREE?!?! SSRIs at exceptionally high doses??  Honestly, I'm not remotely surprised that your anxiety levels are going through the roof.  Effexor is especially (and 300mg is HIGH) notorious for screwing with anxiety.  Trust me on this - I have a BP2 dx with excessive anxiety and have only recently found a pdoc who recognised that it was BAD NEWS for someone with anxiety issues.  I've just spent the past 6 weeks or so titrating off the stuff from 225mg.

My thoughts on this -- what exactly are they treating you for?  Depression? ADD? Bipolar? GAD? Have they actually settled on a diagnosis at all?  From the little you say, it seems like a case of random meds being thrown at you in the hope that something might miraculously do the job.  Geez... so many anti-depressants, including the devilspawn drug from hell (Effexor, and yes I know it works for some people, and yes I am somewhat biased etc)

If this dosen't work they are talking about adderall.

err... are they considering ADDING the adderall to the above cocktail?  Argh!

Are any of these working for your depression? Or just making you screamingly anxious and then down -- it's pretty inevitable to feel a slump after a screaming anxiety swing. 

I know I'm not a doc... but my husband and I have dealt endlessly with so much crap from pdocs and between us have been through an absurd number of diagnoses and meds, and your post just let off warning signals all over the place.

Is it possible for you to get another opinion?  If so, please do! As fast as you can! RUN to another pdoc.

PS my husband says that if his new pdoc saw a med cocktail like that he would just have screamed in horror!

Also -- if your dx is anxiety and depression, and the SSRI-type meds are just making you more anxious, perhaps consider asking your (next) doc about MAOIs.  Yes, I know they have a bad name, but that's largely due to misinformation, and can be surprisingly effective for stubborn anxiety/depression. (not saying YOU are stubborn; referring to your illness)

Good luck, and keep us updated if you can... I'd be interested to read what happens next.

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Actually the weird thing is that since they upped the wellbutrin and effexor doses I'm a little calmer.  I still have racing thoughts and I tend to get hyper in the evenings.  My main diagnosis is depression, I also am anorexic, have had chronic insomnia for over 20 yrs, and hyper.  The zyprexa, and resperdal where off label attempts to help the antidepressants, and to calm me in the evenings.  They didn't do either.  Zoloft had also been tried before the effexor, but w/ no effect.  The remeron has done wonders for my insomnia and has helped me to finally gain 5lbs.  Up until now I was losing weight even w/ the remeron, zyprexa, and resperdal.  I'm am stil in a bit of a hyper mode, so hopefully I'll calm down a little more.

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I know ADs can tend to make bipolar folks have more anxiety, but I'm also sure that some are used for anxiety.  Some ppl get revved up on Effexor, some get anxiety relief.

What I don't understand is adding Adderal...  Adderal, as far as I know (and I don't really know anything about Adderal) is a stimulant.  Stimulants tend to cause anxiety.

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What I don't understand is adding Adderal...  Adderal, as far as I know (and I don't really know anything about Adderal) is a stimulant.  Stimulants tend to cause anxiety.

I'm also puzzled about the Adderall suggestion.  BUT if there is genuine ADD there the stimulant can calm the anxiety level.  Again, just going on what I've seen from my SO, who can be bouncing off the ceiling, take his ADD meds and suddenly calm down enough to fall asleep.  Maybe he's atypical? Not sure.  If there isn't ADD there, then I'd be asking serious questions about what the pdoc is doing.  Perhaps it's an attempt to deal with the racing thoughts?

Numbone -- wishing you well; hoping that something is figured out soon.  I know how horribly frustrating the whole med-go-round is. 

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I guess I need to tell a little more about myself.  I'm 34 married and we have a 22 month daughter.  I have had insomnia since childhood, never really slept more than 3-5 hrs. a night.  I was in a major depression and was beginning to self sabotage myself at work and home.  The remeron was for the insomnia, I now get 6-7 hrs a night and was also supposed to help me add some weight back.  Instead I lost 10 lbs over the next 2 months.  Wellbutrin had been tried with zoloft and then resperdal, and then zyprexa.  The zoloft did nothing, and neither did the antipsichotics.  I haven't had a lapse into psochisis since college, and I've always tested high for add.  Right before the last visit to pdoc, i was almost fired, my thoughts were racing, I was in constant fight or flight, and the depression was worse than ever.  We have tried all different doses and flavors of the wellbutrin and effexor.  He upped me to the max doses about 2 weeks ago.  Mornings i take the 450 wellbutrin and the 300 effexor, the remeron I take at 9 ish 10 ish.  I know that these drugs are supposed to act like stimulants, but I've been gaining weight, able more to focus on one task at a time, instead of racing and multitasking.  I am a little lethargic here and there.  I see the doc in 2 weeks we'll see what he says.  The weird thing is that in college I did a little drug experimentation.  I tried coke a couple of times.  The last time I tried it I did an 1/8 gram before heading out to the clubs w/ some freinds.  They were all zooted, but I became instantly lethargic and had the munchies like a mutherfucker.  Orgered a shitload of food, ate it all and pass out.  I know some of you will say that maybe it wasn't coke, but it was about 80% pure.  Maybe I am one of those people that an upper helps calm.

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Well, the phrase "Your Mileage May Vary" pops up a lot around here, and it sounds to me like you yours varies a lot from typical metabolizers!  I'm just impressed that your pdoc has been willing to work with that fact.  It'll be interesting to hear if the Adderall helps you - I hope you post an update if you try it.  (BTW have you posted on the ADD board to see if anyone else has this type of med response?)

I also wanted to add that I consider myself "stable" on my med cocktail and yet still have occasional problems with depression and anxiety, and especially lethargy and lack of motivation.  (Even though many of our other symptoms don't match up, and our med responses definitely don't.) Some of it's leftover symptoms, some of it I think is actually side effects.  The lethargy/focus thing I fight with a little coffee each day.  Which unfortunately lowers my anxiety threshold.  And I end up taking 1mg of Ativan usually at some point each day.  I talked to my doctor about an ADHD med for this because I've *always* had a busy brain with a short attention span, but she seems reluctant.  Probably because of my BP2 diagnosis.  We're keeping it on the table though.  My depression episodes are usually hormone related, which probably isn't helpful to you.  Anyhow ... I was just wondering if there are any lifestyle tweaks that might help your cocktail on the last leg to stability.  Being the primary caregiver for a toddler can be psychically exhausting - do you need some time for yourself?  Getting any exercise?  Eating healthy?  Getting any quality downtime with your partner?  (Do I sound like your mother yet, LOL?  Sorry.  Sometimes it does help to have someone else remind you of the little things.)

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numbone -  I was very interested to read your last post, especially about your reaction to coke.  From what I know, it does sound as if there are ADD issues involved in there somewhere.  Ditto gretl's suggestion above about checking out the ADD board; may be a helpful thing to do, and I'll also be interested to hear if the Adderall makes a difference should they decide to put you on it.

Hope these issues are resolved soon for you!

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Paradoxically, Remeron can be more sedating at lower doses. I've read several posts here that talk about Remeron being really sedating at 15 mgs, much less so at 30 or 45 mgs. I don't know if it works the same way if you're dropping down from a higher dose. Worth a google, though.

Greeny

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Numbone, you're on several meds at very high doses. Maybe the meds are part of the problem, not of the solution ?

That cocktail of yours looks like something that should only be used in extreme situations.

If you need something to calm you down you should consider benzodiazepines, maybe seroquel would not be a bad alternative either. Antipsychotics (yes, I know seroquel is an antipsychotic, but since it's so sedating it's sometimes used instead of a benzo) don't seem to be necessary in your case. And keep in mind, antipsychotics can be harmful, at least as much as benzodiazepines. If the problem is really "racing thoughts" benzos could work. For as far as I know regular antipsychotics should work against that, but you may need a high dose.

I'd like to suggest that if you're gonna take anything for/against depression, then only take one antidepressant. Find one that works. All that elaborate tweaking of your brain chemistry looks like asking for trouble. And I can't imagine you like being dependant on so many meds.

Of course, your doctor mayknow more than me, but I'd question that cocktail.

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So the increase in meds was starting to pay off until last week when my wife told me she is preggers again.  It dropped me into a major depression.  Today I saw my pdoc, and he wants to keep the wellbutrin effexor and remeron at this level, but now he wants me to start provigil.  Any thoughts?

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