![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by JGm on April 2, 2002, at 10:04:47
Hi dr. Kramer and Others.
I'm suffering of pure unipolar depression.
Was on 225 mg/d of Effexor xr (under the control of my med specialist) but i was terribly sedated, (dizzy, drowsy...). At the end i couldn't stand it!
Otherwise, at the dosage of 75 mg/d, i could tolerate it very well without any side effects.
I think i could tolerate even 150 mg/d!
Are these dosage (75 or 150 mg/d) enough for a real antidepressant effect or should i increase to 225 mg/d?
Which is the difference between a antidepressant cure using 75 instead of 225 (or more) mg/d of effexor? It should be a longer cure?
Thanks very much indeed
Posted by Dr. Kramer on April 2, 2002, at 20:00:30
In reply to dr. Kramer - EFFEXOR XR's adequate dosage., posted by JGm on April 2, 2002, at 10:04:47
Hey, whatever works is the right dosage! Different people react differently.
Effexor is an interesting drug. Below 150mg/d, it's basically an SSRI. At 150-225, it seems to have both SSRI and SNRI properties. At around 300 mg, it becomes mostly noradrenergic.
Posted by Tye on April 2, 2002, at 20:41:31
In reply to Re: dr. Kramer - EFFEXOR XR's adequate dosage., posted by Dr. Kramer on April 2, 2002, at 20:00:30
> Hey, whatever works is the right dosage! Different people react differently.
>
> Effexor is an interesting drug. Below 150mg/d, it's basically an SSRI. At 150-225, it seems to have both SSRI and SNRI properties. At around 300 mg, it becomes mostly noradrenergic.At dose above 300 mg, venlafaxine acquires dopamineric activity. It still retains serotonin and norepinephrine qualities at this dose range, and does *not* become mostly noradrenergic. If the medication did become mostly noradrenergic, the serotonergic benefits/side effect would dissipate.
Tye
Posted by Zo on April 3, 2002, at 1:28:26
In reply to That is incorrect Dr. Kramer, posted by Tye on April 2, 2002, at 20:41:31
with, um, "Tye." I believe in this case he's right.
Zo
Posted by Elizabeth on April 4, 2002, at 22:46:48
In reply to That is incorrect Dr. Kramer, posted by Tye on April 2, 2002, at 20:41:31
> At dose above 300 mg, venlafaxine acquires dopamineric activity. It still retains serotonin and norepinephrine qualities at this dose range, and does *not* become mostly noradrenergic. If the medication did become mostly noradrenergic, the serotonergic benefits/side effect would dissipate.
Not necessarily. I'm not sure what Dr. Kramer meant, but it could equally mean that the NE effect continues increasing while the 5-HT effect plateaus, so that the NE effect dominates at higher doses. It could even just mean that the rate at which the NE effect increases surpasses the rate of increase of 5-HT effects. It certainly doesn't imply that the 5-HT effect *decreases* as the dose increases -- just that it decreases *relative* to the NE effect.
BTW -- are you sure that 300 mg/day is about where the DA effect starts kicking in? I had been looking for that info, and I wasn't able to find out the answer. Can I ask where you found that out?
-elizabeth
Posted by Zo on April 5, 2002, at 5:06:09
In reply to Effexor dose-dependent effects » Tye, posted by Elizabeth on April 4, 2002, at 22:46:48
Elizabeth, I believe "Tye" was another blocked person, since re-blocked. . .but I do recall that the DA effects do not kick in until 375mg/day level.
Zo
Posted by Elizabeth on April 5, 2002, at 9:11:50
In reply to Re: Effexor dose-dependent effects » Elizabeth, posted by Zo on April 5, 2002, at 5:06:09
> Elizabeth, I believe "Tye" was another blocked person, since re-blocked
Yeah, I read that in another thread after I posted this.
> . . .but I do recall that the DA effects do not kick in until 375mg/day level.
Can you tell me where you read/heard that? I'd like to have something to show my pdoc (I was taking 375, dropped to 337.5 because of jitters).
-elizabeth
Posted by Zo on April 7, 2002, at 5:20:13
In reply to Re: Effexor dose-dependent effects » Zo, posted by Elizabeth on April 5, 2002, at 9:11:50
I got kinda jittery on the upper end too, was relieved to drop.
Where I heard it is from my pdoc, who is a behavioral med expert in Sonoma County. Where are you? Maybe your doc has some connection to him? I know he sees Bob all over the place! Bob the precise note-taker, that's what I hear--and don't think Brent isn't grateful!
So. . how can I help?
And, I posted a subject line above--but am curious, is the incidence of Bupe provoking mania small? Miniscule? Does anybody know?!
For so many years, my illness went undiagnosed, therefore unmedicated, in large part because of this FICTION (!) that med-induced cycling isn't "real" bipolar!
I count on you to set the world straight!Zo
Posted by Elizabeth on April 7, 2002, at 22:13:15
In reply to Re: Effexor dose-dependent effects » Elizabeth, posted by Zo on April 7, 2002, at 5:20:13
> Where I heard it is from my pdoc, who is a behavioral med expert in Sonoma County.
Damn. I was hoping for something more empirical.
> Where are you? Maybe your doc has some connection to him?
Not a chance!
> And, I posted a subject line above--but am curious, is the incidence of Bupe provoking mania small? Miniscule? Does anybody know?!
I've heard of exactly one case, which you're already familiar with. <g>
> For so many years, my illness went undiagnosed, therefore unmedicated, in large part because of this FICTION (!) that med-induced cycling isn't "real" bipolar!
I've experienced medication-induced mania without being (becoming?) bipolar, but cycling? (I'm assuming that means being on a drug, becoming manic, going off it, and continuing to switch back and forth...?)
-elizabeth
Posted by Zo on April 8, 2002, at 22:28:11
In reply to Re: Effexor dose-dependent effects » Zo, posted by Elizabeth on April 7, 2002, at 22:13:15
> Damn. I was hoping for something more empirical.
Well, with him, he's got something empircal. If it's important, I can ask what the ref is, am going up there
Thursday, email me. zozo1029 at mac dot com.> I've heard of exactly one case, which you're already familiar with. <g>
very funny <g>
>
> I've experienced medication-induced mania without being (becoming?) bipolar, but cycling? (I'm assuming that means being on a drug, becoming manic, going off it, and continuing to switch back and forth...?)
Sorry, meant rapid cycling, like pretty much every day. Since it was soft bipolar, nobody caught it. . until it was caught, if you get my meaning.Tho in the larger sense, your description applies to the *years*. . .!
Zo
Posted by Elizabeth on April 10, 2002, at 11:35:00
In reply to Re: Effexor dose-dependent effects » Elizabeth, posted by Zo on April 8, 2002, at 22:28:11
> Well, with him, he's got something empircal. If it's important, I can ask what the ref is, am going up there
> Thursday, email me. zozo1029 at mac dot com.Cool. I'm cybersquid_400 at yahoo.
> > I've heard of exactly one case, which you're already familiar with. <g>
> very funny <g>Well jeez, I *hope* you're familiar with it!
> Sorry, meant rapid cycling, like pretty much every day. Since it was soft bipolar, nobody caught it. . until it was caught, if you get my meaning.
You mean until bipolar disorder became a trendy diagnosis. :-} Seriously -- I'm curious about all these "ultrarapid cycling" bipolar disorders I keep hearing about (I just met a woman yesterday who says she cycles daily, too -- seems you guys are everywhere!). It appears to be the real thing, as far as I can tell. It's curious because DSM-IV defines rapid cycling as anything more frequent than 4 mood episodes per year! Also, I believe that manic or hypomanic episodes are defined as lasting a certain amount of time, so things like what you have aren't really acknowledged by DSM-IV. Hopefully the next edition will recognize this type of thing.
> Tho in the larger sense, your description applies to the *years*. . .!
My description...? Sorry, what was that referring back to?
-elizabeth
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.