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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 jms600 on February 2, 2009, at 16:36:11
Are dosages of Efexor above 150mg suitable for the treatment of anxiety disorders? Or, at such doses (and above), is it likely to exacerbate anxiety?
At higher doses Efexor blocks the re-uptake of dopamine - is this something to avoid when anxiety problems are an issue??
Posted by SLS on February 2, 2009, at 18:18:10
In reply to High dosages of Efexor for anxiety??, posted by jms600 on February 2, 2009, at 16:36:11
> Are dosages of Efexor above 150mg suitable for the treatment of anxiety disorders? Or, at such doses (and above), is it likely to exacerbate anxiety?
>
> At higher doses Efexor blocks the re-uptake of dopamine - is this something to avoid when anxiety problems are an issue??
Good questions. I have no definitive answers. For me, reaching dosages of 300mg and higher did not precipitate anxiety. Anxiety - especially social anxiety - is a component of my illness. I would not stop at 150mg if I were you. So far, I have not encountered a recommendation of dosing differently for depression and anxiety disorders. Perhaps someone else has.
- Scott
Posted by Jay_Bravest_Face on February 2, 2009, at 22:31:01
In reply to Re: High dosages of Efexor for anxiety?? » jms600, posted by SLS on February 2, 2009, at 18:18:10
> > Are dosages of Efexor above 150mg suitable for the treatment of anxiety disorders? Or, at such doses (and above), is it likely to exacerbate anxiety?
> >
> > At higher doses Efexor blocks the re-uptake of dopamine - is this something to avoid when anxiety problems are an issue??
>
>
> Good questions. I have no definitive answers. For me, reaching dosages of 300mg and higher did not precipitate anxiety. Anxiety - especially social anxiety - is a component of my illness. I would not stop at 150mg if I were you. So far, I have not encountered a recommendation of dosing differently for depression and anxiety disorders. Perhaps someone else has.
>
>
> - ScottYes, I agree with Scott. Especially if you are taking generic Efexor XR, and especially during tough times, a good high dose can help. The mechanism in which dopamine is affected is largely unknown, and for me, helped with anxiety, but only in combination with benzo's. ****But*****..let me add a few things as a footnote here. First, if you are having any 'bad' feelings, even VERY 'mild', either suicidal or just feeling really strung out, I might suggest taking high dose meds..especially an antidepressant..*in a hospital setting*. Better, would be if you have good access to a good benzodiazepine. These are critical for anxiety. Thirdly, and you should be cautious and reserved with this option, is asking your doc if you can add a small dose of an antipsychotic.(I know..people here that word and go..WAAIITT!) This is the option that brought me from 'cycling' through to better, calmer days and nights.(even after going through most 'mood stabilizing' meds.)
I hope our info helps a bit, and maybe you can get some info elsewhere too. Just be careful, because like my suggestions, it's all IMHO, FWIW, YMMV, etc. Hang on...hang on really tight....
Best,
Jay
Posted by Phillipa on February 3, 2009, at 12:41:30
In reply to Re: High dosages of Efexor for anxiety?? » jms600, posted by Jay_Bravest_Face on February 2, 2009, at 22:31:01
For me at the time was going though menopause so could have made a difference but effexor with my benzos did make my anxiety worse at 37.5 mg. Think took it for two weeks. I know old babblers who did great with anxiety and klonopin on effexor. Good luck!!!! Phillipa
Posted by jms600 on February 3, 2009, at 15:36:51
In reply to Re: High dosages of Efexor for anxiety?? » jms600, posted by SLS on February 2, 2009, at 18:18:10
> > Are dosages of Efexor above 150mg suitable for the treatment of anxiety disorders? Or, at such doses (and above), is it likely to exacerbate anxiety?
> >
> > At higher doses Efexor blocks the re-uptake of dopamine - is this something to avoid when anxiety problems are an issue??
>
>
> Good questions. I have no definitive answers. For me, reaching dosages of 300mg and higher did not precipitate anxiety. Anxiety - especially social anxiety - is a component of my illness. I would not stop at 150mg if I were you. So far, I have not encountered a recommendation of dosing differently for depression and anxiety disorders. Perhaps someone else has.
>
>
> - Scott
Thanks Scott. I live in Britain and, for some reason, Effexor is not indicated here for social phobia or panic disorder (it's only indicated for depression and GAD). I'm currently tapering off amitriptyline and starting 75mg of generic Venlafaxine XR next week.Interestingly, the patient information leaflet states that the maximum dose for anxiety is 225mg, but for severe unresponsive depression the dose can go up to 375mg. Not sure why this is. My psychiatrist mentioned that I could go up to 375mg if necessary - and he is obviously fully aware of my anxiety problems. Guess I just need to start the 75mg next week and take it from there!
I also need to bear in mind that I don't have another Remeron situation, where the higher doses always made my anxiety worse.
Posted by jms600 on February 3, 2009, at 15:45:06
In reply to Re: High dosages of Efexor for anxiety?? » jms600, posted by Jay_Bravest_Face on February 2, 2009, at 22:31:01
> > > Are dosages of Efexor above 150mg suitable for the treatment of anxiety disorders? Or, at such doses (and above), is it likely to exacerbate anxiety?
> > >
> > > At higher doses Efexor blocks the re-uptake of dopamine - is this something to avoid when anxiety problems are an issue??
> >
> >
> > Good questions. I have no definitive answers. For me, reaching dosages of 300mg and higher did not precipitate anxiety. Anxiety - especially social anxiety - is a component of my illness. I would not stop at 150mg if I were you. So far, I have not encountered a recommendation of dosing differently for depression and anxiety disorders. Perhaps someone else has.
> >
> >
> > - Scott
>
> Yes, I agree with Scott. Especially if you are taking generic Efexor XR, and especially during tough times, a good high dose can help. The mechanism in which dopamine is affected is largely unknown, and for me, helped with anxiety, but only in combination with benzo's. ****But*****..let me add a few things as a footnote here. First, if you are having any 'bad' feelings, even VERY 'mild', either suicidal or just feeling really strung out, I might suggest taking high dose meds..especially an antidepressant..*in a hospital setting*. Better, would be if you have good access to a good benzodiazepine. These are critical for anxiety. Thirdly, and you should be cautious and reserved with this option, is asking your doc if you can add a small dose of an antipsychotic.(I know..people here that word and go..WAAIITT!) This is the option that brought me from 'cycling' through to better, calmer days and nights.(even after going through most 'mood stabilizing' meds.)
>
> I hope our info helps a bit, and maybe you can get some info elsewhere too. Just be careful, because like my suggestions, it's all IMHO, FWIW, YMMV, etc. Hang on...hang on really tight....
> Best,
> Jay
>
>Hi Jay, thanks for the info.
As mentioned to SLS, I'm tapering amitriptyline and starting 75mg generic venlafaxine XR next week. I'm also taking 40mg buspirone and 600mg lithium, whether that will help I really don't know. Guess I will have to keep the Valium near me.
Just out of interest which antipsychotic do you take? I've tried a few but they were generally ineffective (apart from high doses of Zyprexa).
Posted by Pete1968 on February 3, 2009, at 20:19:44
In reply to Re: High dosages of Efexor for anxiety?? » jms600, posted by Jay_Bravest_Face on February 2, 2009, at 22:31:01
OK, I have the answers to your question. ; )
For anxiety GAD or Panic I cannot recommend Olanzapine in a low dose (5mg ish at night) highly enough, it was a literal life saver for me when I was totally debilitated by 'the fears' during a period of MDD. I have also been on Venlafaxine for over a year and I went right up to 300mg a day for Depression and found that the higher doses made me more agitated than a lower dose, around 150mg. thats not to say that you are the same as me, we are all different in metabolising these drugs, but I will say, in my humble opinion NOTHING beats an Atypical Anti Psychotic such as Olanzapine for chronic anxiety, it literally removes it as a factor in ones life and in my opinion should be first line treatment for anxiety and anxiety related illness over Benzos and SSRI/SNRIs. DOnt be put off by the 'stigma' of taking an AAP (Atypical Anti Psychotic) they are The Bomb for putting a stop to agitation, anxiety and panic, end of story. Believe me I have been there seen it and done it with the anxiolytic meds and NOTHING worked (yes Benzos did but theyre habit forming and short term)apart from Olanzapine for me. On the down side it makes you want to sleep for 12 hours a night and you will put on weight as it makes you crave carbs, but I can live with that and it makes a nice change from being unable to eat or sleep!! Good luck mate.
Posted by Pete1968 on February 3, 2009, at 20:49:01
In reply to Re: High dosages of Efexor for anxiety??, posted by Pete1968 on February 3, 2009, at 20:19:44
I went up to 300mg Venlafaxine in a quest to achieve remission from depression and it made me agitated bordering on Akathisia, when I reduced it I calmed down, and thats with the augmentation of Olanzapine 5mg!! If its relief from anxiety youre after and not concomitant depression youre on the wrong drug! Despite what big pharma says SSRIs and SNRIs should not be prescribed for GAD! A stimulating med isnt the answer for people who are 'highly strung' the reason theyre indicated is because of the falling out of favour of Benzos in the 80s, the drugs companies stood to lose money so promoted SSRIS. I have been playing this game for a decade and can say that the 'cure' for anxiety lies on a neuroleptic not an SSRI. But then thats just my humble opinion. The problem with these forums is that there is a lot of disinformation out there.. Everybody has their ten pence to add and a lot of it is irrational. My advice is if you are dealing with anxiety rather than depression, quit the Venlafaxine and go with an anti psychotic. I only wish i had had somebody point this out to me back in 1999, perhaps then I could have saved two major relationships and a decade of 'imbalance'.
Posted by jms600 on February 4, 2009, at 17:21:54
In reply to Re: High dosages of Efexor for anxiety??, posted by Pete1968 on February 3, 2009, at 20:49:01
Posted by SLS on February 4, 2009, at 17:34:50
In reply to Re: High dosages of Efexor for anxiety??, posted by Pete1968 on February 3, 2009, at 20:49:01
Everyone is different - trite, I know.
Anxiety is a feature of my untreated depression. Effexor 300mg helped with both the depression and the anxiety. Adding nortriptyline to it really boosted these effects.
- Scott
Posted by Garnet71 on February 4, 2009, at 21:30:06
In reply to High dosages of Efexor for anxiety??, posted by jms600 on February 2, 2009, at 16:36:11
Hi there Pete,
That much Effexor might destroy your sex life--Wellbutrin completely mitigates this though, for some.
Speaking from someone with severe anxiety - and I've had a 3 day straight panic attack before - SSRIs/Effexor/Wellbutrin (NOT the generic for Wellbutrin) all worked for the anxiety I suffered from. For me, it's being able to tolerate the side effects of those kinds of drugs. I can't.
Good luck in whatever you do!!
This is the end of the thread.
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