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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 Fathe on April 13, 2008, at 19:10:55
I was on Effexor a few years back. I had mild depression and the Effexor was effective in treating it. After two year4s, I felt much better and also felt I hit a plateau as to the overall effectiveness of the Effexor. I slowly withdrew and after several weeks of bothersome withdrawal, I was able to stop. I have been off any kind of meds for several years.
I now find that my sadness is returning and had been trying to see if I will feel better in time without medication, but decided now that I should try medis again. I do not want to take Effexor because of the withdrawal symptoms. Is there another medication that others have used here that are effective and have milder withdrawal symptoms? Thanks in advance.
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Posted by Phillipa on April 13, 2008, at 19:15:46
In reply to Which Antidepressant, posted by Fathe on April 13, 2008, at 19:10:55
If effexor worked for you before and a few years have gone by it might work again. Maybe a lower dose???? Phillipa
Posted by med_empowered on April 13, 2008, at 20:33:38
In reply to Re: Which Antidepressant » Fathe, posted by Phillipa on April 13, 2008, at 19:15:46
Maybe Cymbalta? Effexor withdrawals suck, but some pdocs are really skillful in managing them, so maybe if you go for the effexor again your doc will be better about managing the tapering process this time around...
A pdoc will probably select an AD (or other drug) by targeting symptoms, not just "depression." It might be helpful to make a list of specific areas that you think need improvement, like concentration, drive, energy, sleep, agitation, etc. With that info., you can have an idea of what a pdoc might do before you hit their office...you might also want to think over what you liked about effexor and what you didn't.
If Effexor worked, then I'd think (as a non-professional) that Cymbalta, Wellbutrin, or even a tricyclic might be helpful. If you have good insurace, the EMSAM patch might be an option...you might even consider a combo, like Wellbutrin and an SSRI. Thinkig about the downsides of your Effexor experience might make gettig things as perfect as possible easier this time around. Like, if Effexor was sometimes too energizing, you might need an occasional tranquilizer or BuSpar, or if you had lingering concentration probs then you might want to look for co-existing ADD/ADHD, that kind of thing.
It's also sad but true that lots of people don't get good results in round 1 with antidepressants; lots of people end up switching or they end up on additional med(s) like tranquilizers, antipsychotics, stimulants, additional antidepressants, etc. I'm not tryig to scare you, I'm just saying: medical treatment of depression can be tricksy, so do be patient.Good luck with everything.
Posted by Dopamine123 on April 13, 2008, at 22:10:57
In reply to Which Antidepressant, posted by Fathe on April 13, 2008, at 19:10:55
You could try a supplement. A few of them have been shown to have good antidepressant efficacy, like SAM-E and omega 3 fatty acids. Both can be bought over the counter.
Omega 3 fatty acids (EPA)
>1000 mg eicosapentaenoic acid (EPA), Fluoxetine and EPA appear to be equally effective in controlling depressive symptoms.
http://www.ncbi.nlm.nih.gov/pubmed/18247193?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumThis website has some good info about supplements for depression.
http://www.qualitycounts.com/fpdepression.html
Posted by jms600 on April 14, 2008, at 7:02:42
In reply to Re: Which Antidepressant, posted by Dopamine123 on April 13, 2008, at 22:10:57
Have you thought of Prozac? It has a much longer half-life than the other SSRIs and Effexor and so stays in the body longer. Therefore you don't get the withdrawal effects that are common with other antidepressants. I successfully came off Prozac last year without any withdrawal effects at all (I still had to taper it though).
Another thing you could try is to take an SSRI or maybe Effexor, then - when you are ready to come off the drug - switch straight onto Prozac and stop the SSRI/Effexor that you are on. Then just taper the prozac.
I found Prozac really easy to come off without any withdrawal problems at all.
Good luck!
Posted by Amigan on April 14, 2008, at 8:55:11
In reply to Which Antidepressant, posted by Fathe on April 13, 2008, at 19:10:55
As already been said, cymbalta. A SNRI like effexor but with a longer half-life. Alternatively, Prozac.
Posted by Fathe on April 14, 2008, at 8:57:55
In reply to Re: Which Antidepressant, posted by jms600 on April 14, 2008, at 7:02:42
Thank you all for the great suggestions. I am going to decide which to try. I heard that Prozac is much easier to stop so I will suggest that to my doctor when I see him. I will check out all the links provided here and make sure I am knoweldgable before deciding with my doctor the best medicine to try this time.
Thank you again.
Posted by bleauberry on April 14, 2008, at 18:33:31
In reply to Which Antidepressant, posted by Fathe on April 13, 2008, at 19:10:55
You might want to try Kira brand or Nature's Way Perika brand St Johns Wortsfirst. For mild to medium depression they have as good a track record as heavy drugs. Those 2 brands are the ones used in the majority of worldwide clinical studies, with Kira being most common (can buy a month of it Rite-Aid pharmacy for about $12).
Give it a couple months. If that doesn't cut it, and any drug you choose might not cut it either, then try SAMe 200mg to 600mg for a week (if it is going to work you should feel it quickly).
Choosing drugs is really hard. Some people respond to the same drug they once took, and others don't. Biochemistry may have changed enough since back then to alter the whole scenario. And really, looking at it generally, no matter whether you choose effexor, lexapro, prozac, sertraline, duloxetine, remeron or wellburin, the odds of success just shooting blindly are about the same.
It can help somewhat to aim the medication at specific symptoms. Someone fatigued with lack of joy might put Wellbutrin at the top of the trial list for example. Someone with intense insomnia might go for Remeron. But it is still guesswork.
In reviewing user comments at askapatient.com, it is obvious that Duloxetine has harsh withdrawal effects similar or worse than Effexor in many, but not all, people. The way to lessen withdrawals is to wean off slowly in small steps. Capsules can be opened up and you can count how many "beads" to take each day, slowly decreasing. Going from 37.5mg effexor to zero is huge. But you can go from 37.5 to 35.0 to 33.0 to 30.00 and so on all the way to zero. Same with duloxetine. With prozac you do it by mixing the capsule contents in orange juice and drink a custom sized amount. As long as tablets are not extended release they can be broken into whatever sizes, chunks, chips, or dust you want for custom doses. A switch from extended release to regular release can help that. In any case, doctors do not educate us how to minimize pain of withdrawing. But you now know how.
Posted by Molybdenum on April 15, 2008, at 6:30:02
In reply to Which Antidepressant, posted by Fathe on April 13, 2008, at 19:10:55
Hi,
citalopram (Celexa) worked for me for years until it pooped out. I had very mild withdrawl effects considering I was on 80mg when I quit. I tapered it down by 20mg each week. In a month I was off it entirely.
I had the most fantastic dreams on citalopram. Really gloriously entertaining ones. I woke up most days feeling like I'd seen a great sci-fi movie. Weird but it sure worked for me.
Of course, it then took me another few months to realise I really needed something. So now I'm on venlafaxine & mirtazapine.... and methylphenidate .....and modafinil and melatonin ;)
This is the end of the thread.
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