Jump to content
CrazyBoards.org

Sign in to follow this  
apsdecatur

what's the problem with switching from one SNRI to another?

Recommended Posts

After at least 10 good years on venlafaxine XR, it is definitely not working for me anymore.  

 

My psychopharmacologist seems to think that Brintellix is the next option for me, after trials on six different add-on medications.  Even with that, he expresses some doubt that Brintellix will work for me.  I asked why he's not looking at another SNRI (like Cymbalta) for me, but he said it doesn't make sense to go to a drug in the same class as venlafaxine.  

 

I'm so confused.  I mean, my history as well as some genetic testing shows that SSRIs won't be particularly helpful for me.  Brintellix is basically just a jazzed up SSRI, right?  Even though venlafaxine and Cymbalta are in the same class, my body could react differently to them, just like some people respond to some SSRIs and not to others.  
 

Any thoughts on how I can make my case to my doctor?

Share this post


Link to post
Share on other sites

How old are you?

When meds quit working, it's usually due to a change in the nature of your MI and not immunity or anything like that.  Those genetic tests are totally worthless.  All they can tell is how likely you are to have a handful of side effects and maybe help with dosing.  

What dose venlafaxine have you been on?  At doses around 300mgs a day it starts to have a much stronger effect on norepenephrine.  Cymbalta has a much stronger effect on norepenephrine than even the highest dose of Effexor, so if high dose Effexor was much more effective than it was at a lower dose, there is a chance that Cymbalta could be helpful.  We've had people around here on 450mgs Effexor a day, so you might be able to increase in some more.  It's an absolutely miserable drug to come off of, even if you're cross-tapering onto something else. so it might be prudent to totally max out the dose before going off it.  

The thing about Cymbalta is that it might eat your liver with some fava beans and a nice chianti.  

One of the most active threads on this site right now is one where people are comparing their experiences with Brintellix.  You might want to take a look at that.  

Most of the tricyclic ADs are also SNRIs.  Desipramine is almost a pure NRI.  They have a lot more potential side effects than newer ADs but are as cheap as shit and can really kick depression and anxiety in the ass.  

I'm personally rolling my own SNRI by taking Wellbutrin in conjunction with Luvox and some other stuff.  

 

Share this post


Link to post
Share on other sites
On 12/16/2015 at 7:39 PM, Velvet Elvis said:

How old are you?

When meds quit working, it's usually due to a change in the nature of your MI and not immunity or anything like that.  Those genetic tests are totally worthless.  All they can tell is how likely you are to have a handful of side effects and maybe help with dosing.  

What dose venlafaxine have you been on?  At doses around 300mgs a day it starts to have a much stronger effect on norepenephrine.  Cymbalta has a much stronger effect on norepenephrine than even the highest dose of Effexor, so if high dose Effexor was much more effective than it was at a lower dose, there is a chance that Cymbalta could be helpful.  We've had people around here on 450mgs Effexor a day, so you might be able to increase in some more.  It's an absolutely miserable drug to come off of, even if you're cross-tapering onto something else. so it might be prudent to totally max out the dose before going off it.  

The thing about Cymbalta is that it might eat your liver with some fava beans and a nice chianti.  

One of the most active threads on this site right now is one where people are comparing their experiences with Brintellix.  You might want to take a look at that.  

Most of the tricyclic ADs are also SNRIs.  Desipramine is almost a pure NRI.  They have a lot more potential side effects than newer ADs but are as cheap as shit and can really kick depression and anxiety in the ass.  

I'm personally rolling my own SNRI by taking Wellbutrin in conjunction with Luvox and some other stuff.  

 

Thanks for the feedback!  

So, I was experiencing some significantly lowered effectiveness of venlafaxine ER (I was taking 375 mg) prior to April 2014.  It was at that point that, due to my desire to become pregnant, the psychiatric nurse practitioner I was seeing decided to pull the Effexor rug out from under me and get me on Zoloft.  She decreased me from 375 mg to 225 mg without starting me on Zoloft first. She didn't even warn me about the withdrawal syndrome, even when I asked.  Her plan was to get me completely off Effexor in 6 weeks.  Needless to say, I thought I was dying.  I managed to get down to 75 mg Effexor and 150 mg Zoloft before I said "enough" and she titrated me back up to 375 mg and off Zoloft.

I was never the same after that.  Effexor had become way less effective at that point.  She increased me to 450 mg, but about five weeks in, I was hit with some crazy side effects, insane dizziness, etc. that just wouldn't go away.  I then (finally) got in to see a different psychiatrist - a psychopharmacologist at another practice - who put me back on the 375 mg.  

Since November 2014, I have tried augmentation with Abilify, then Wellbutrin, then Deplin, then Buspar, then Remeron, and now Rexulti.  Some slight improvement only with Remeron and Rexulti, but combo side effects were way too much to handle, and with only limited success in making my depression and anxiety a little less bad.  I'm still on the Rexulti, but I'll have to go off it if I go on something else, says my doctor.

 

I should also note that I am in weekly CBT therapy, practicing daily mindfulness, exercising, etc.  I'm not hypo- or hyperthyroid, all my bloodwork checks out as normal, and no hormone issues.

Share this post


Link to post
Share on other sites
7 hours ago, apsdecatur said:

Thanks for the feedback!  

So, I was experiencing some significantly lowered effectiveness of venlafaxine ER (I was taking 375 mg) prior to April 2014.  It was at that point that, due to my desire to become pregnant, the psychiatric nurse practitioner I was seeing decided to pull the Effexor rug out from under me and get me on Zoloft.  She decreased me from 375 mg to 225 mg without starting me on Zoloft first. She didn't even warn me about the withdrawal syndrome, even when I asked.  Her plan was to get me completely off Effexor in 6 weeks.  Needless to say, I thought I was dying.  I managed to get down to 75 mg Effexor and 150 mg Zoloft before I said "enough" and she titrated me back up to 375 mg and off Zoloft.

I was never the same after that.  Effexor had become way less effective at that point.  She increased me to 450 mg, but about five weeks in, I was hit with some crazy side effects, insane dizziness, etc. that just wouldn't go away.  I then (finally) got in to see a different psychiatrist - a psychopharmacologist at another practice - who put me back on the 375 mg.  

Since November 2014, I have tried augmentation with Abilify, then Wellbutrin, then Deplin, then Buspar, then Remeron, and now Rexulti.  Some slight improvement only with Remeron and Rexulti, but combo side effects were way too much to handle, and with only limited success in making my depression and anxiety a little less bad.  I'm still on the Rexulti, but I'll have to go off it if I go on something else, says my doctor.

 

I should also note that I am in weekly CBT therapy, practicing daily mindfulness, exercising, etc.  I'm not hypo- or hyperthyroid, all my bloodwork checks out as normal, and no hormone issues.

If the 'fex was only helpful at higher doses, that would seem to indicate that serotonin imbalance isn't your only problem.  

What's your official diagnosis?

Which is worse, the depression or the anxiety?

 

Share this post


Link to post
Share on other sites

According to what I've read here and on other forums, the best way to come off Effexor is to moderately reduce the dose, start taking an SSRI with a long half-life such as prozac, stick with that for a while, then finish tapering off the 'fex, then taper off the prozac.  I've heard of nortryptiline being used for this as well.

I got off Cymbalta by cross-tapering onto celexa.   

 

Share this post


Link to post
Share on other sites

I had come off all meds, effexor had been switched to celexa, but since I felt pretty god with a low does of celexa, I discontinued it and went completely to the bad place, wanting to commit suicide but too scared. A wonderful doctor started me right away on 10 mg Brintellix and 10 mg latuda  and lorazapam for sleep. Worked ok for a week or two then back to not-quite-so-bad, but bad. So he upped the brintellix to 20 mg. and halved to latuda. God, I am so miserable. This heaviness. The fear. I really want to go back to what HAD worked, effexor or celexa! WHAT should I do? Should I experiment myself? Get permission from the doctor. What if he says no? 

Share this post


Link to post
Share on other sites

Experimenting (in the sense of taking leftover meds or getting them from someone or anything like that) is not a good idea.  It's not a long term solution in that even if it proves helpful, you're going to eventually have to admit it to your pdoc and ask for more.  It's not necessarily the exact same thing as self-medicating with benzos or opiates where it will keep most psychiatrists from being willing to prescribe it in the future, but it's still not good.  Also, there can be significant safety issues (whether to combine with what you are actually prescribed) and essentially makes your pdoc appointments useless (no way to tell if a side effect is due to a med he/she doesn't know about as an example).

i don't mean that as a lecture and I'm sorry if it comes off that way.  It can just really get you into a bad place in the blink of an eye.

your other idea--asking your psychiatrist--is much safer and sustainable.  You can even phrase it as a "this medication worked really well for me before and I thought it might makes sense to try it again.  Is there a reason why we aren't?"  If you get a no, you get to give it consideration--does the reason make sense even if it's not what you would have thought of or preferred?  Is he willing to try it if you stick the current regimen put a little longer and it's really not helping?  Do you want to try to get  a second opinion on this issue alone? (I think thats usually not done and it's reserved for bigger picture questions like whether you're even working to treat the right illness, but others here might think differently.)

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

  • Similar Content

    • By Blahblah
      First off, I'm aware people here sometimes have issues when switching from Brand med to Generic. My pdoc started me on a Generic Venlafaxine, (maybe she didn't want there to be an issue at a later date, in case I wasn't given the specific Effexor name brand everytime, I guess)? I started on 37.5mg Mylan tab, and as I increased, not sure if it changed. Last 4 months, I was taking 150mg (in 1 tab pill), (can't remember the name).
      Anyway, I am completely confused!! I've been on different generic manufacturers and different formulations (sometimes I go to a different pharmacy, due to stock, they sometimes give me 2 75mg doses, instead of 150mg). I'm not sure even which manufacturer/brand I've been taking the longest, as I don't save the packages. However, I have noticed this last week, I've been on a different pill than months prior. I am definitely feeling different (much more tired, LAZY, spacey and sweaty) I compared my current pill (Peach, 2 dose 75mg Pfizer Venlafaxine Capsules with individual beads) to a previous one (White, Mylan Venlafaxine, it's a hard tablet inside a capsule?). I've never been on the capsule with individual beads version (usually only the hard tab).
      I don't know the difference between these formulations (capsule with beads versus hard tabs)!! I'm assuming there would be a huge difference in the release mechanism and absorption of the drug right? I'm not sure what to do, or which specific manufacturer/name to request now....I also read that only XR formulation exists (no instant) so all of these should be extended, right? Which ones have the best reputation?
       

    • By dumbdoo
      Hello there,
      I'am taking Duloxetine 120mg for Depression and Pure O (OCD) since Feb. 2017. Unfortunately, I still have intrusive thoughts and some symptoms of depression (low mood, no energy etc.), although I can handle my everyday life somehow. However, the whole situation is not satisfying for me and my family. I'm constantly tired, lethargic, grumpy, hungry and unhappy. So what's next? I've already tried to augment with Seroquel (300mg; horrible, horrible experience) and Abilify (2,5mg-5mg, quit working after two months).
      What's about switching the baseline med? Can I go back to SSRIs like Citalopram, Fluvoxamine or Paroxetine?* Or is it pointless, since the doctors kept telling me that Duloxetine and Venlafaxine were far more potent than the SSRIs...
      *Lexapro did considerably well in the past, but it unfortunately pooped out after two years. Sertraline did nothing for me (I'm an ultra rapid metabolizer).
    • By inconsequinntial
      Psych Dx: treatment resistant depression (major + persistent), generalized anxiety, adhd
      Psych Rx: bupropion 450 qd, buspirone 15 bid, adderall 20 am 10pm, clonazepam .5 prn
      Other Dx: celiac, gerd, vulvodynia/vulvar vestibulitis, oab, seasonal allergies, idiopathic chronic nausea, neuropathy, myalgia, & arthralgia
      Other Rx: myrbetriq 50 qd, pantoprozole 20 bid, topical estrogen qd, topical clobetasol prn, topical lidocaine prn
      OTC:  mucinex 12-hour bid, vitamin D3 qd, fish oil qd, probiotic qd, zyrtec qd, nasacort qd, saline spray bid, melatonin prn
      Previous Psych Rx: seroquel, depakote, lamictal, remeron, trazadone, lithium, ambien, sonata, zyprexa, lexapro, prozac, temazepan, xanax, rozerem
      So I've clearly been on a lot of meds over the years (since first being put on seroquel in early 2013) partially because I was initially misdiagnosed with bipolar disorder. I've been on my current cocktail for quite awhile, and I had been doing pretty well with my depression but it's gotten significantly worse lately due to some life events + unyielding chronic pain that has been getting worse for the last two years.
      For the neuropathy I tried gabapentin for several months and it did absolutely nothing. I've been suggested Lyrica (which even with my good insurance is still $100 a month or $200 for 3 months with a mail order pharmacy which is a lot more than I can reasonably afford) and Cymbalta.
      Does anyone with depression and/or neuropathy have any experience with taking Cymbalta and Wellbutrin together? The two SSRIs I've taken (lexapro & prozac) in the past both gave me severe gastrointestinal side effects and I wasn't able to stay on them long enough to see if they even helped. It would be great to have a cheap, generic drug improve my nerve pain and depression, but I'm nervous about trying another SSRI.
      I'm also fairly uncomfortable with the idea of going off bupropion, bc it's been pretty damn  effective if not adequately so. Because when I wasn't on bupropion I was a MESS and I'm afraid of going back to that level of depressed.
      Also curious if anyone has any success with using any med, Cymbalta or otherwise, as an adjunct treatment for depression?
      I have recently gotten back to therapy so I'm hoping that will help some but it's hard to follow through on anything from my therapist (or from my physical therapists, doing anything besides going to work & sleeping) bc of executive dysfunction, constant fatigue, pretty severe anhedonia, general feeling of emptiness.
    • By KnickNak
      So, I am not 100% better.. I still have some weird side effects, but I am no longer taking Cymbalta! I have been wanting to come off this drug for awhile now , I tried once, failed. Then another time, Nope. And 3rd time , well I guess this was the charm. Let me tell you... the withdrawal , terrible. My pdoc increased the Seroquel to level it out..and it was ok for a few days then all of sudden bam... it began. I sweated, it wasn't even like sweating it was a damp cold clammy sweat when after you get sick or have the shits. My moods were terrible. The crying spells, I had to be watched. I was very Manic Depressive. I was sick to my stomach, vomiting etc. I couldn't sleep, I stayed up until 4am and had sleep paralysis. I honestly wanted to give in and go back on it, just so I could not have these side effects. I pushed thru it. It took me about 2 weeks of hell and now it's tolerable, I am starting to feel better where I can actually drive again with out getting sick. 
      I am getting a little worried tho..because now that I am no longer on any SSRI, or SRNI.. I am starting to feel a lil wound up and agitated. Very hyper too. Hoping this will pass. 
      Anyway just wanted to express that I made it (so far), even tho I wanted to go to in-patient and my t doc wanted me to go to, I didn't. I fought thru this. 
      If any of you came off this drug , how long did it take you to sort of feel balanced again and get off that rocky boat. 
    • By Blahblah
      Since Trintillex had absolutely no effect (on my anhedonia), my pdoc suggested Effexor. I'm very wary about Effexor due to the horrible withdrawals I had with Cymbalta 10 years ago. I don't remember it helping me much, not worth the withdrawals. If I missed 1 dose by mistake, I would be a trembling mess with full-on brain zaps, anxiety, crying spells, the works...
      I have tried all of the SSRI's and most make me numb, tired & kill libido. These meds help acute depression, but what about for stable-ongoing low mood-anhedonia? Like when you feel no excitement/joy in anything?
      Effexor has an even shorter half-life than Cymbalta, which worries me. Question: Will Effexor help symptoms of anhedonia, low mood, low motivation? What was the main difference you felt between the two? (did they feel relatively the same, or did one work much better with less/different side effects??)
×
×
  • Create New...