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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Ray on March 10, 2000, at 15:28:24
In 1995 I started taking paxil for depression & anxiety. After a year The Paxil was working well except I could not stay awake. So I switched to Effexor and that seemed to work well, but not as well as the Paxil. I have stayed with the Effexor because I don't feel as sleepy as I did with the Paxil. However now I have trouble staying asleep. My question is does anyone have any experience with taking Effexor during the day and Paxil in the evening. Recently I have read alot about augmentation, however I haven't seen this combo talked about
Thanks for any feedback
Ray
Posted by Cam W. on March 11, 2000, at 18:56:27
In reply to Effexor + Paxil, posted by Ray on March 10, 2000, at 15:28:24
Ray - We probably need to know the dose of Effexor you are presently taking. Unlike the SSRIs (like Paxil) Effexor has linear dose-dependent antidepressant activity. This means that it keeps working better as you increase the dose. The SSRI's activity plateaus after a certain dose (everyone is different). Talk to your doctor and ask about an increase in Effexor dose. I wouldn't do it on you own because the antidepressant activity of Effexor changes at increasing dosages (changes from an SRI to an SRI + NRI and eventually, at very high doses, to a SRI + NRI + DRI). S = serotonin; N = norepinephrine; D = dopamine; and RI = reuptake inhibitor. Also, when incresing the dose, you can temporarily get some of the side effects back that you would have noticed when you started the Effexor. I haven't seen Paxil used in conjunction with Effexor, but maybe someone else in babbleland has. Hope this helps - Cam W.
Posted by medlib on March 11, 2000, at 19:42:21
In reply to Re: Effexor + Paxil, posted by Cam W. on March 11, 2000, at 18:56:27
Cam-
Depending on doses of each, isn't TSS a possibility with this combo? My one brush with that (I took a Paxil not realizing I still had a little Prozac onboard) convinced me that's something I NEVER want to see again!
medlib
> Ray - We probably need to know the dose of Effexor you are presently taking. Unlike the SSRIs (like Paxil) Effexor has linear dose-dependent antidepressant activity. This means that it keeps working better as you increase the dose. The SSRI's activity plateaus after a certain dose (everyone is different). Talk to your doctor and ask about an increase in Effexor dose. I wouldn't do it on you own because the antidepressant activity of Effexor changes at increasing dosages (changes from an SRI to an SRI + NRI and eventually, at very high doses, to a SRI + NRI + DRI). S = serotonin; N = norepinephrine; D = dopamine; and RI = reuptake inhibitor. Also, when incresing the dose, you can temporarily get some of the side effects back that you would have noticed when you started the Effexor. I haven't seen Paxil used in conjunction with Effexor, but maybe someone else in babbleland has. Hope this helps - Cam W.
Posted by Cam W. on March 11, 2000, at 21:47:51
In reply to Re: Effexor + Paxil=TSS?, posted by medlib on March 11, 2000, at 19:42:21
medlib - Quite frankly, I wouldn't use Paxil with Effexor, but some of the combinations I have seen on this bulletin board would have scared the hell out of me 2 months ago. Serotonin syndrome is a possibility, but if the dose of both are kept low, this shouldn't be a problem. Anything that is done, should be done through the doctor (let him/her assume liability of this). This board is quite a learning experience, which is why I am happy to impart any knowledge I have, but I try to stay out of anything I am not sure about. - Cam W.
Posted by Scott L. Schofield on March 11, 2000, at 22:45:34
In reply to Effexor + Paxil, posted by Ray on March 10, 2000, at 15:28:24
> In 1995 I started taking paxil for depression & anxiety. After a year The Paxil was working well except I could not stay awake. So I switched to Effexor and that seemed to work well, but not as well as the Paxil. I have stayed with the Effexor because I don't feel as sleepy as I did with the Paxil. However now I have trouble staying asleep. My question is does anyone have any experience with taking Effexor during the day and Paxil in the evening. Recently I have read alot about augmentation, however I haven't seen this combo talked about
>
> Thanks for any feedback
> Ray
I think you may want to explore other alternatives for dealing with the changes in sleep other than combining these two antidepressants. If Paxil was so helpful, you may consider adding Wellbutrin, Ritalin, or some other alerting drug to conteract the somnolence (fancy word for sleepiness). Such an addition might also help to prevent the "SSRI poop-out" sometimes seen when using Paxil-like drugs, in which the antidepressant response begins to fade with the passage of time. As a side benefit, these drugs can also help minimize the sexual side effects that often accompany the use of SSRIs.As far as Effexor is concerned, it might be interesting to increase the dosage. It may foster a greater improvement of your depression, and possibly normalize sleep at the same time. Sometimes, sleep disturbances are primary symptoms of depression, and may resolve upon the successful treatment of the depression itself. If the depression gets better and the sleep gets worse, it may be necessary to add some sort of sleep aid.
Good luck.
- Scott
Posted by Cindy W on March 12, 2000, at 1:25:08
In reply to Re: Effexor + Paxil=TSS?, posted by medlib on March 11, 2000, at 19:42:21
> Cam-
> Depending on doses of each, isn't TSS a possibility with this combo? My one brush with that (I took a Paxil not realizing I still had a little Prozac onboard) convinced me that's something I NEVER want to see again!
> medlib
>
>
>
> > Ray - We probably need to know the dose of Effexor you are presently taking. Unlike the SSRIs (like Paxil) Effexor has linear dose-dependent antidepressant activity. This means that it keeps working better as you increase the dose. The SSRI's activity plateaus after a certain dose (everyone is different). Talk to your doctor and ask about an increase in Effexor dose. I wouldn't do it on you own because the antidepressant activity of Effexor changes at increasing dosages (changes from an SRI to an SRI + NRI and eventually, at very high doses, to a SRI + NRI + DRI). S = serotonin; N = norepinephrine; D = dopamine; and RI = reuptake inhibitor. Also, when incresing the dose, you can temporarily get some of the side effects back that you would have noticed when you started the Effexor. I haven't seen Paxil used in conjunction with Effexor, but maybe someone else in babbleland has. Hope this helps - Cam W.
Cam, at what doses does Effexor-XR affect l) serotonin, 2) norepinephrine, and 3) dopamine? what changes does this have on feelings of depression and/or OCD? Thanks!
Posted by Cindy W on March 12, 2000, at 22:43:02
In reply to Re: Effexor + Paxil=TSS?, posted by Cindy W on March 12, 2000, at 1:25:08
>... the antidepressant activity of Effexor changes at increasing dosages (changes from an SRI to an SRI + NRI and eventually, at very high doses, to a SRI + NRI + DRI). S = serotonin; N = norepinephrine; D = dopamine; and RI = reuptake inhibitor. Also, when incresing the dose, you can temporarily get some of the side effects back that you would have noticed when you started the Effexor. I haven't seen Paxil used in conjunction with Effexor, but maybe someone else in babbleland has. Hope this helps - Cam W.
> Cam, at what doses does Effexor-XR affect l) serotonin, 2) norepinephrine, and 3) dopamine? what changes does this have on feelings of depression and/or OCD? Thanks!Still didn't get an answer (question got archived) and am still curious about Effexor-XR's effects on various neurotransmitters--Thanks!
Posted by Cam W. on March 13, 2000, at 7:27:23
In reply to For Cam, re: Effexor effects?, posted by Cindy W on March 12, 2000, at 22:43:02
Cindy - Sorry. When you block reuptake of the neurotransmitters in the synaptic cleft (gap between neurons) this leaves more neurotransmitter (NT) in the cleft, as it is not taken up by the neuron it came from. The reuptake pump is one of nature's ways of conserving neurotransmitters. If most of the NT is recycled, the body doesn't have to make more. By blocking the reuptake pump it is essentially like releasing (or leaving) more NT into the cleft and also forcing the body to make more NTs (NTs = serotonin, norepinephrine, dopamine and others). Since we are lacking serotonin and possibly norepineprine in depression, we want the body to make more.That said, at lower doses Effexor increases serotonin in the synaptic cleft. At moderate doses it increases serotonin and norepinephrine and at high doses (not really used clinically) it increases serotonin, norepinephrine and dopamine in the synaptic cleft. In depression scientists have noticed a decrease in the breakdown products (metabolites) of serotonin in the cerebral spinal fluis (CSF). This CSF bathes the brain, so concentrations of metabolites in it reflects the amount of neurotransmitter in the brain. Norepinephrine seems not to be decreased, but when you block it's reuptake you seem to normalize the flow of norepinephrine between nerve cells that contain it (esp. in the locus cereuleus - major site of norepinephrine transmission in the body). I know this is a lot more than you asked for, but I hope this is a little clearer. - Cam W.
Posted by Cindy W on March 13, 2000, at 9:18:31
In reply to Re: For Cam, re: Effexor effects?, posted by Cam W. on March 13, 2000, at 7:27:23
>
> Cindy - Sorry. When you block reuptake of the neurotransmitters in the synaptic cleft (gap between neurons) this leaves more neurotransmitter (NT) in the cleft, as it is not taken up by the neuron it came from. The reuptake pump is one of nature's ways of conserving neurotransmitters. If most of the NT is recycled, the body doesn't have to make more. By blocking the reuptake pump it is essentially like releasing (or leaving) more NT into the cleft and also forcing the body to make more NTs (NTs = serotonin, norepinephrine, dopamine and others). Since we are lacking serotonin and possibly norepineprine in depression, we want the body to make more.
>
> That said, at lower doses Effexor increases serotonin in the synaptic cleft. At moderate doses it increases serotonin and norepinephrine and at high doses (not really used clinically) it increases serotonin, norepinephrine and dopamine in the synaptic cleft. In depression scientists have noticed a decrease in the breakdown products (metabolites) of serotonin in the cerebral spinal fluis (CSF). This CSF bathes the brain, so concentrations of metabolites in it reflects the amount of neurotransmitter in the brain. Norepinephrine seems not to be decreased, but when you block it's reuptake you seem to normalize the flow of norepinephrine between nerve cells that contain it (esp. in the locus cereuleus - major site of norepinephrine transmission in the body). I know this is a lot more than you asked for, but I hope this is a little clearer. - Cam W.Cam, thank you for explaining how this works. Do you have any comments on the article Medscape posted (http://psychiatry.medscape.com/18571.rhtml) about changes in neurons from high dosage SSRI's? Hope I'm not eventually left with no serotonergic sensitive neurons, or my body making no more serotonin!
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