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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Kreedi on April 16, 2005, at 9:10:51
I've recently stepped up my dose of Effexor XR from 112.5 to 150 and now 187.5. (I had been taking 112.5 as a maintentance dose for two-and-a-half years but six weeks ago depression returned.) My pdoc had suggested taking the 150 in two doses, morning and night, but since my waking times have lately been erratic, I've been doing what I've always done, taking the full dose after lunch. What should I do with the 187.5 dose? The doctor suggested taking the 37.5 with breakfast and the 150 with lunch. (I should emphasize that he didn't say that this was imperative.) I had much rather take the full 187.5 after lunch (as usual).
I don't want to create spikes and troughs in my body's levels of Effexor. I thought the XR formulation meant that, even with higher doses, once-daily dosing was fine. What has been the experience of people here? Do people on 225 (a dose to which I may move up to in 10 days or so) divide their doses or take it all at once? Which is preferable (insofar as an objective answer is possible in this case), my pdoc's suggestion or my usual practice?
Kreedi
Posted by nicky77 on April 16, 2005, at 10:46:20
In reply to Effexor: timing of dose(s) in the 150-225 range, posted by Kreedi on April 16, 2005, at 9:10:51
Yeah, I think it would be wise to take it all at once, provided it's all XR. Effexor 150mg quit on me after about a year and I am currently on 262.5mg. I take it all at once aswell. Supposedly it takes about a day to be eliminated, which would support this practice no?
I was just thinking, my shrink says it's best to take it all in the morning, as opposed to taking it in the afternoon or evening. Apparently thus making sure that your bloodcurve is highest during the time when you need it the most, i.e. daytime. Then again, this is just his professional opinion.
I'm curious though, has the increase in dose taken care of the depression?
Take care,Nicky
Posted by Kreedi on April 16, 2005, at 11:11:08
In reply to Re: Effexor: timing of dose(s) in the 150-225 range, posted by nicky77 on April 16, 2005, at 10:46:20
There seems to have been some improvement -- the previous two days have been pretty good -- but the depression certainly hasn't all gone. In the last six weeks, there have been a few isolated days when a feeling of relative "normalcy" returned; the next day I would feel like crap again. So I don't think I'm out of the woods yet.
Nicky, I'm curious whether you thought of augmenting with any other drug. Also, did the incidence of side-effects increase with the increased dose (particularly sexual)? I'm very reluctant to give up on Effexor RX, it's been great for nearly three years, the best "fit" of any antidepressant I've tried. So, for now, counting on the higher dose to "kick in."
I'm going to try getting up for a healthy breakfast every morning (I also have an insomnia problem), and I'll try taking the full dose at that time (after checking with my pdoc).
Posted by Colleen D. on April 16, 2005, at 14:29:24
In reply to Effexor: timing of dose(s) in the 150-225 range, posted by Kreedi on April 16, 2005, at 9:10:51
Posted by nicky77 on April 17, 2005, at 7:49:44
In reply to Re: Effexor: timing of dose(s) in the 150-225 range, posted by Kreedi on April 16, 2005, at 11:11:08
Hiya,
Before upping the dose of effexor I augmented it with Remeron 15mg. Now this worked for about a week and then it failed on me. I still take it though, as it has done wonders for my insomnia. You see, I too slept really lousy before, but not so after the Remeron augment. However, after upping the dose effexor, first to 225mg, then to 262.5mg, I still am not happy with the result. Strangely it works wonders for about a week, then it drops again. I dunno, bit tired of constantly looking for the right drug/combo but even more tired of not being able to carry a simple conversation because of the depression.
Do you have any ideas regarding possible combo's?
Take care,Nick
Posted by Kreedi on April 17, 2005, at 9:31:33
In reply to Re: Effexor: timing of dose(s) in the 150-225 range, posted by nicky77 on April 17, 2005, at 7:49:44
I've thought about augmenting with buspirone (Buspar) and pindolol and SAMe. Not bupropion (Wellbutrin) because of insomnia issues, and not mirtazapine (Remeron) because of sedation issues. I've also thought about switching to duloxetine (Cymbalta), which has apparently a more balanced serotonin/norepinephrine uptake action. But for now, sticking to Effexor XR.
For those of you with the psychopharmacological expertise: I've read that the SNRI action of venlafaxine (Effexor) only begins with doses above 150 mg. But as the norepinephrine action "kicks in" at 150+, does the serotonin reuptake inhibition continue to get stronger as the dose increases or does it plateau out at some point?
Kreedi
Posted by JH on April 17, 2005, at 16:01:21
In reply to Effexor: timing of dose(s) in the 150-225 range, posted by Kreedi on April 16, 2005, at 9:10:51
I take 225mg of Effexor XR and have for a number of years. I take it as soon as I get to work. One thing with Effexor XR is to be sure to take it as the same time every day. Otherwise, I would tend to get headaches, nausea, etc. I also take it at when I get to work because I found it making me drowsy while driving.
Posted by Colleen D. on April 17, 2005, at 21:11:05
In reply to Re: Effexor: augmentation... pharmacology question, posted by Kreedi on April 17, 2005, at 9:31:33
I believe it plateaus out at some point. I was on 150mg for several months and then went up to 225mg and really felt no difference. I currently take 75mg of Effexor which "acts" more like a mild SSRI with 300mg of Wellbutrin. My sleep is better and I don't always need a sleep-aid at bedtime like before I started any meds. MY GP gave me doxepin (a TCA) for sleep if needed and clonazepam for anxiety. I've been into this cocktail for 2 months now and it's my best combo to date. I haven't felt this good and normal around other people in years! I hope it stays this way.
Colleen
MDD, GAD, OCD and SP
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