California Rocket Fuel+General Effexor talk.

[AugmentedReality]

Hi everyone,

 

I used to consume Methylphenidate for years to my adhd/add and needed to go to the highest possible dosages I`ve heard, 18+56mg extended release (Concerta)+around 30-40mg Ritalin a day. The side effects of MF has always been an issue regarding the nausea and "comedown". My dream medication would be Dexamphetamine+additional medication for my depression and sleeping problems. I had to quit the stimulants year a go as I had a congenital heart condition which was operated successfully.

 

I`ve been moderately depressed since I can remember, always feeling insecure and anxious especially on public and never feel totally comfortable around people though I`m socially talented and so have always been able to cope somehow. I`ve never missed a day of work because my depression because I`m way too stressed to do everything perfectly what I`m up to and have the fear that I would lose my job.etc

 

In the end of last year I realized that I have never actually enjoyed life at all and have been the last 15 years in a state that nothing satisfies me and acted so recklessly that really would`nt have cared if I would die in the age of 28. My wife was quite unhappy with the situation and so I decided to start medicating myself and know that this will be the case for the rest of my life, I`m going to be pumped with all the psychoactive medication until the fat lady sings..

 

I started with Mirtazapine which I have been very familiar for years to aid me get the normal 8-9 hours of continuous sleep I require, it works wonders for this and never makes me feel bad the next day as I`m used to it. I upped the dosage to 30mg/d hoping that it would help in my depression but after a few weeks I was disappointed as first I was having the time of my life but then I felt zero relief with it. I got up to 45mg and still nothing, I went to the doc being somewhat self-educated on pharmacology and requesting Effexor augmentation which was started on the ridiculous 37.5mg/d dose. It did help a lot right from the beginning but then after 3-4 weeks I had a relapse and increased to 75mg/d. I`ve never been so calm and comfortable with me and the world around as I was then until the next relapse in four weeks.. I increased to 150mg/d and "Oh, the time of my life and I finally enjoy it after 15 years of darkness and hell" just to realize the same thing happened to me after four weeks.. I was at the doc updating my prescription two weeks ago and my dosage was 225mg effexor/45mg of mirt a day and she screamed at me: "That is a huge dose" which it actually is`nt as even in a strict country I live in the cold north europe, I`ve heard psych-docs prescribing 375mg/d effexor during CRF treatment with tolerable side effects.

I`ve had minimal sides so far, some anorgasmia&erectile dysfunction in the beginning which was really a pain in the ass but subsided in a month, night sweats though dont much bother me and have also disappeared..

 

The problem is that its been four weeks again and I`m having a relapse again.. I`ve always felt the effects of venlafaxine during the next 24 hours of dose increasement and life is perfect  for the next month, I can concentrate perfectly, I never yell at anyone or lose my nerves, I enjoy life and forget all the past and present stress + darkness. But then I step in to the hell and get the feeling that I would like to cry although I cant, yell at everyone and cant concentrate at all. Today I was really tired and fucked up the whole day I know that when you start AD:s, symptoms can get worse but how come I feel great for a month and then it poops out.

 

I personally think that I have some strange overactive metabolism on especially all the medication that concerns the  CYP2D6 enzyme/cytocrome of the liver. I get ZERO sides now when I`m taking 225/45 California Rocket Fuel and the doc insisted that I should feel them heavily by now. 

What should I do, increase the dose AGAIN or request some augmentative medication such as Wellbutrin? The doc is already anal on my medication which I personally have no problem as we have the tools to make our life better, I think we should use them The CRF is a dream to me when it works but a world of pain when this happens. While it works, I`m the person I would like to be for the rest of my life, calm and stable human being able to enjoy this so called once in a lifetime opportunity of living in this planet.

Thanks everyone

Edited April 5, 2014 by AugmentedReality

[Wooster]

Honestly, what you should do is stop tweaking your meds without working actively with your doctor.

 

While you may know some things about psychopharmacology, you are not a trained and licensed medical provider who has had exposure to all the information that you need to know about safely prescribing and changing doses of medications. 

 

There is a reason some medications require prescriptions, thus requiring doctor visits.

 

Does your doctor know about ALL the supplements you are taking? Some of them may be interfering with the meds you are taking.

 

There is also the option of psychotherapy in addition to pharmacotherapy. Learning skills to manage times when you feel  insecure and anxious in public, or feel like you're going to yell at people, and to improve your concentration, etc might reduce the amount of medication you need over time.

 

You've asked what you should do... and I have rendered my opinion.

[vanderk]

What she said. 

 

You have listed a dizzying array of complaints, concerns and hypotheses.  These need to be addressed, face to face, with a medical professional.  I hope this can all be sorted out and resolved satisfactorally.

[AugmentedReality]

Thanks, umm.. And sorry for giving an image that I`m "self medicating" myself without any medical assistance.

 

I meet my doc every 8-12 weeks but my current doctor is not a psych-doc and she was`nt even aware that Venlafaxine has any other dose-dependent properties than serotonergic activity. Neither she was aware of the Mirtazapine having a  paradoxal diminished effect on the histamine receptor with larger dosages. At first she gave me 37.5mg/d of effexor to my significant depression and made me fill the usual self-evaluation chart used to diagnose depression. How the hell should I trust her at all then? Not to mention I`ve had even more spectacular history on incompetent doctors which have nearly killed me before, when for a decade, they did`nt believe me when I told that I`ve had episodes of Supraventricular Tachycardia. (Which it actually was when the WPW-syndrome was finally diagnosed and I was told I`m living on the edge until operated)

 

In my country, its far easier to get medication than any other aid not to mention we have the highest suicide rates in the world.. Im on my way to get a (private) specialist soon, which is going to cost me an arm and a leg, I used to have one before, very pharma-liberal and the most competent money can buy but he unfortunately retired three years ago and I`ve been in the hands of the casual occupational healthcare (free) since that which seems to possess only doctors that are capable of giving you three days of sick-leave if you got the flu. I`m not flying entirely solo here though, I have several friends who are seemingly competent doctors. And by the way, I`ve been assessed since I was a kid and so have been several times in my adulthood too, my loss was not admitting I need help and that is still the largest obstacle I have at the moment, I dont feel comfortable to share my life with absolutely anyone except a few people I trust. I remind that it took me 15 years to even tell a doctor I`m depressed at all (Though I was diagnosed mildly depressed along my ADD/ADHD 7-8 years ago)

 

Second, what comes to all supplements, they are a big no no for every single member of the medical community here, excluding representatives of the functional medicine. I am using l-theanine and l-tyrosine+the obvious multivitamin/omega3/d-vit but thats a limited amount of psychotropic holistic supplements, though I did calculate that I`m eating a way over gram per day of tryptophan due to my high-protein diet. No signs of serotonin syndrome and l-tyrosine could according to my knowledge push you towards mania more than dig you deeper in the depression. Actually it helped me concentrate and improved my cognitive skills when I started it while on CRF therapy.

 

 

 

What comes to any therapy, I`m perfectly aware that it is extremely efficient on achieving remission combined with medication, but I`m completely comfy with the fact that I`ll be using psychotropic medication forever as I believe in the theory that ADD.etc is born from "malfunctional" dopaminergic activity in the brain which cant be fixed with therapy. Insisting that you could learn to think differently is the same thing as you sometimes hear people say to depressed people: "Chill out, dont be so negative" I`m far more happy popping AD:s(With dopaminergic activity) than stimulants for the rest of my life though, methylphenidate was more less "side effects in a bottle" for me aside of helping me live a normal life.

 

I`m still eager to hear any experiences on the similar issue, have you had the medication pooping out monthly?

Edited April 5, 2014 by AugmentedReality

[Wooster]

I'm not saying you can fix everything with therapy, but you certainly can learn to manage it better and making environmental modifications. Learning tips and tricks to create an environment that better fits your needs means less medication, which is less taxing on your body, and will cause fewer problems down the road.

 

Nobody here is a medical professional capable of answering your questions. You need face to face time with a REAL psychiatrist who is qualified to address your concerns about your cardiac condition as well as all of the symptoms. Comorbid depression and ADD is treatable, but it takes some persistence to get the right combination of things.

 

You are asking very complex pharmacological questions that are beyond the scope of an internet-based peer support site.

 

Please give yourself the treatment you deserve and work with a professional in person.

 

ETA: The doc you are seeing every 8-12 weeks is a generalist who doesn't have the specialized knowledge you need. I hope you get to see your specialist soon.

[jt07]

You are asking a question that I don't think even most doctors could answer, but they are far more qualified to answer (or speculate) than we are. I don't think that any of us are neurochemists or neurobiologists much less psychopharmocologists.

[AugmentedReality]

 You are right. The congenital heart condition is luckily past life now. I will figure why Effexor poops out one way or another. I`ve seen other quite complex questions here and realized that there are enlightened people reading this forum and that`s why I posted here in the first place. I am going to book an appointment with a competent psych-doc and pay 500 dollars for it, for the sake of my life which should be somewhat enjoyable in the future as I`ve lost too many years so far being unsatisfied. In the meanwhile while waiting for my appointment for a month, I`m increasing my dose by one 37.5mg Venlafaxine in the evening too to battle the relatively short half life and active metabolism and hope it helps me to remain functional. One thing needs to be pointed out though, doctors dont use medications and sometimes good experience based information is acquirable from forums like this.. When I was prescribed Ritalin, the most competent doc I`ve ever had, told me to take six a day.. I was stoned for the next two weeks until my friend who has been using the drug for years, told me to split them in two or four and take them evenly. And it worked like a miracle! That is something doctors won`t necessarily tell you. California Rocket Fuel is not too common here after all and usually people get just the usual SSRI:s so I`ve been gathering my information internationally so far. (Including Stahl`s essential psychopharmacology)

 

I'm not saying you can fix everything with therapy, but you certainly can learn to manage it better and making environmental modifications. Learning tips and tricks to create an environment that better fits your needs means less medication, which is less taxing on your body, and will cause fewer problems down the road.

 

Nobody here is a medical professional capable of answering your questions. You need face to face time with a REAL psychiatrist who is qualified to address your concerns about your cardiac condition as well as all of the symptoms. Comorbid depression and ADD is treatable, but it takes some persistence to get the right combination of things.

 

You are asking very complex pharmacological questions that are beyond the scope of an internet-based peer support site.

 

Please give yourself the treatment you deserve and work with a professional in person.

 

ETA: The doc you are seeing every 8-12 weeks is a generalist who doesn't have the specialized knowledge you need. I hope you get to see your specialist soon.

 

 

Edited April 5, 2014 by AugmentedReality