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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by PCB on September 9, 2020, at 20:56:01
So Im off Nardil and still on 450 Lithium. I was planning on trying Effexor to replace Nardil. But after reading Dr Preskorns website, he mentioned a TCA with a SSRI allows you to adjust the serotonin and norepinephrine reuptake.
What do you guys think? Effexor vs Zoloft + Desimpramine? (Will use low dose desipramine and blood levels of desipramine because of the CYP2D6 inhibition by Zoloft)
Posted by rjlockhart37 on September 10, 2020, at 0:27:53
In reply to Effexor vs TCA+SSRI?, posted by PCB on September 9, 2020, at 20:56:01
Effexor is more tolerated its more activating than zoloft, and less side effects than desipramine ....low doses it works on serotonin, but the high dose like taking 2 150mg XR capsules is common, its an acitvating med, and from what i've read its more effective than SSRI's, but the withdrawl....from it is bad
Low dose - serotonin, high dose - serotonin, norephinprhine, and slightly dopamine. Thats why its a effexor activate effect. People who take 300mg usally are stimulated and less depressed
Posted by rjlockhart37 on September 10, 2020, at 0:32:33
In reply to Re: Effexor vs TCA+SSRI?, posted by rjlockhart37 on September 10, 2020, at 0:27:53
effexor higher doses is california rocket fuel
prozac just keeps a serotonin, warm feeling, and does hit NE receports provides activating effect, prozac morning lift from depression if i take a rest or wake up the morning horribly depressed, after fluoxetine is taken, it goes away, i take 80, the max dose. It works but its not speed like effexor
Posted by Christ_empowered on September 10, 2020, at 10:20:18
In reply to Re: Effexor vs TCA+SSRI?, posted by rjlockhart37 on September 10, 2020, at 0:32:33
I'd avoid tca if possible.
Posted by undopaminergic on September 10, 2020, at 11:56:27
In reply to Re: Effexor vs TCA+SSRI?, posted by Christ_empowered on September 10, 2020, at 10:20:18
> I'd avoid tca if possible.
From the point of view of side effects, it is generally a good idea to avoid TCAs. However, the TCAs (not to mention MAOIs) are often more effective than (especially) SSRIs.
Trimipramine (a TCA) by far more effective than the SSRIs I've tried (most of them). It does have disturbing anti-histamine side-effects, but I've not noticed any sexual adverse effects. And the sedative (anti-histamine) effects can be exploited to facilitate sleep.
-undopaminergic
Posted by linkadge on September 10, 2020, at 17:17:10
In reply to Re: Effexor vs TCA+SSRI?, posted by undopaminergic on September 10, 2020, at 11:56:27
I'm going to take the opposite position. Effexor can be effective, but it's kind of hit or miss. Also, Prescorn mentions that it's not really dual acting. You need really high doses to get meaningful norepinephrine action (at which point it can be somewhat activating). Also the TCAs have many other AD mechanisms (5-ht2, 5-ht7, M1, H1) which may contribute to their effects.
Clomipramine for me was significantly more effective for anxious depression than effexor (by a wide margin). Amitriptyline + cipralex was also good. If you do augment sertraline, I would recommend nortriptyline over desipramine, but it's your call.
Linkadge
Posted by PCB on September 10, 2020, at 20:45:00
In reply to Re: Effexor vs TCA+SSRI?, posted by linkadge on September 10, 2020, at 17:17:10
So you would try nortriptyline + sertraline over Effexor? Im sure clomipramine would work for me if I had 450 lithium, 0.5 clonazepam with it. But the memory loss would be considerable for me.
Posted by SLS on September 11, 2020, at 11:15:53
In reply to Re: Effexor vs TCA+SSRI? » linkadge, posted by PCB on September 10, 2020, at 20:45:00
Effexor + Wellbutrin can be magic.
- Scott
Posted by linkadge on September 12, 2020, at 5:57:22
In reply to Re: Effexor vs TCA+SSRI? » linkadge, posted by PCB on September 10, 2020, at 20:45:00
Have you taken clomipramine? Was memory loss an issue? I took up to 75mg and only experienced a bit of morning haziness. I remember at the time I was first on sertraline (which wasn't cutting it) and was really depressed which caused me to fail a midterm exam in university (first time ever). We switched to clomipramine and the improvement was dramatic (although, in hindsight, the norepinephrine action may have improved ADHD like straterra is now - the sertraline wasn't helping in this regard). Long story short I aced the final exam and the prof replaced my midterm mark with the final mark (got an A+ in the course).
To answer your question, I know that (for me) nortriptyline + sertraline would work better than effexor. It's hard to say what would work better for you. I found nortriptyline + lithium worked better than SSRI + lithium. The latter seemed to amplify the serotonergic side effects (i.e. spacieness and apathy). On nortriptyline I started to develop some 'passions' again (i.e. deep interests in certain activities that gave me a reason to wake up in the morning). Now I'm on effexor (looking to switch off). It's ok, but I just feel kind of bla (although the straterra is improveing this). So my answer may be colored by the fact that the TCAs were treating undiagnosed ADHD.
Nevertheless, I do think that nortriptyline is a superior antidepressant. However, you could always start with effexor. I have never gone beyond 75mg (as it increased anxiety at that stage for me), but apparently it can become more effective at higher doses. Actually, I took effexor + nortriptyline too which, for depression, was very good. My sleep was a bit broken on that combo however. I replaced the nortriptyline with mirtazapine which improved sleep somewhat, but isn't as good for depression.
Linkadge
Posted by PCB on September 12, 2020, at 14:22:25
In reply to Re: Effexor vs TCA+SSRI?, posted by linkadge on September 12, 2020, at 5:57:22
Never tried clomipramine but did do well with impramine, lithium and klonopin. It made me feel confident, authentic and in a way more like a man. I did have mild memory problems which affected my job and needed 900 mgs of lithium which could cause long term kidney damage.
Nardil makes me feel a little too talkative, less authentic. The first MAOI had tuberculoses patients clapping and dancing despite being ill. I dont like that disingenuous happy feeling of Nardil. I always think about going back to imipramine and being the real me, but end up staying on Nardil due to the imipramine combos side effects.
God I wish we could talk/email just once Linkage!
Posted by linkadge on September 13, 2020, at 16:04:24
In reply to Re: Effexor vs TCA+SSRI? » linkadge, posted by PCB on September 12, 2020, at 14:22:25
Hey, I'm open to a conversation any time. I'm not sure how to share my contact info though in a private way. Thinking ...
Linkadge
Posted by PCB on September 13, 2020, at 17:04:46
In reply to Re: Effexor vs TCA+SSRI? » PCB, posted by linkadge on September 13, 2020, at 16:04:24
There is Babblemail which is private. Just click on my posting name PCB on any of my posts. It should be highlighted blue and underlined. That takes you to the babblemail form to privately email me or anyone.
The only thing is you have to have babblemail settings turned on. Babblemail is off by default. To turn your babblemail on, just go to Psychobabble settings at the link ..... http://www.dr-bob.org/cgi-bin/pb/settings.pl.
Posted by linkadge on September 14, 2020, at 6:25:34
In reply to Re: Private Babblemail » linkadge, posted by PCB on September 13, 2020, at 17:04:46
That's right. I forgot about babblemail. I haven't used it in 15 years. Anyhow. I sent you a message with my email. Feel free to email me.
Linkadge
Posted by creepy on September 27, 2020, at 19:30:20
In reply to Effexor vs TCA+SSRI?, posted by PCB on September 9, 2020, at 20:56:01
for me, venlafaxine was pure hell. it didnt do much of anything for my symptoms and when I raised it to max all it did was become very difficult to quit.
I had nausea, vomiting, dizziness, brain zaps.
Personally I liked sertraline + desipramine combo much better but everyone is different.
Posted by linkadge on September 30, 2020, at 15:12:07
In reply to Re: Effexor vs TCA+SSRI?, posted by creepy on September 27, 2020, at 19:30:20
Low dose effexor helps me, but anything over 37.5mg and I get palpitations.
Linkadge
Posted by Lamdage22 on October 1, 2020, at 13:53:38
In reply to Re: Effexor vs TCA+SSRI?, posted by linkadge on September 30, 2020, at 15:12:07
37.5 ftw. I take the same dosage. More than that makes me anorgasmic, which I don't appreciate.
> Low dose effexor helps me, but anything over 37.5mg and I get palpitations.
>
> Linkadge
Posted by SLS on October 4, 2020, at 14:23:19
In reply to Re: Effexor vs TCA+SSRI?, posted by linkadge on September 30, 2020, at 15:12:07
> Low dose effexor helps me, but anything over 37.5mg and I get palpitations.
>
> LinkadgeSorry to hear that. If you begin to think that Effexor at therapeutic dosages might be worth trying, what about working with beta-blockers to take along with it? I have experienced palpitations early in the titration process that later resolved as the dosage was increased. Palpitations might actually be a sign that Effexor will work - in my experience.
How high have you been on Effexor and for how long?
Which other drugs have you experienced palpitations with? What happened? Did they go away with continued treatment? Did you experience any kind of improvement with these drugs at full therapeutic dosages - even if only transiently?
Pristiq (desvenlafaxine)?Trintellix (vortioxetine)?
- Scott
Posted by linkadge on October 4, 2020, at 18:45:22
In reply to Re: Effexor vs TCA+SSRI? » linkadge, posted by SLS on October 4, 2020, at 14:23:19
I suppose I could take beta blockers, but there's something about raising peripheral / cardiac norepinephrine then blocking it that leaves me a little uneasy. The highest I went on effexor was 75mg. At this dose I had an almost constant feeling of chest tightness as well as high heart rate and blood pressure. This resolved within 24 hours of switching to sertraline. I don't quite understand effexor. I didn't get this on nortriptyline 75mg (which should have had a much more potent effect on the norepinephrine transporter). I am in the camp that says there are yet undiscovered properties of effexor which lead to BP elevations at relatively low norepinephrine transporter inhibition.
Linkadge
This is the end of the thread.
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