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Thread: Desvenlafaxine anyone?

  1. #1
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    Desvenlafaxine anyone?

    Hi here in Oklahoma also known as the opioid state, its impossible to get MAOI or TCA antidepressants.

    Ive tried most SSRI without success. Leaves just SNRI and duloxetine was good for 8 years. Venlafaxine pooped out so looking at desvenlafaxine now. Im sure most people have never heard of it and its not on the medication list on this forum.

    I never goovle stuff and prefer to ask other users direcrly

  2. #2
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    Re: Desvenlafaxine anyone?

    Quote Originally Posted by lebonvin View Post
    Hi
    Welcome to No More Panic,

    I've combined your two posts and rearranged the order a little

    Ive tried most SSRI without success.
    How long ago was this, which ones did you try and what was the highest dose of each taken and how long were you on that dose?

    Ive been on 150mg of venlafaxine for depression and anxiety. Did well for 3 months then crashed. I dont think this is normal. So raised to 225mg a month ago but no improvement.
    If you didn't respond to any of the SSRIs then it's no surprise venlafaxine has failed because despite what it says on the box, it is really only a SSRI, not a SNRI. The SSRI paroxetine is a more potent inhibitor of noradrenaline (NA), aka norepinephrine, albeit still only a weak one. It's possible that you might see some improvement at 225mg, but I wouldn't count on it. The good result for 3 months may have had more to do with the placebo effect than the med.

    looking at desvenlafaxine now. Im sure most people have never heard of it and its not on the medication list on this forum.
    Desvenlafaxine is the active metabolite of venlafaxine and actually does most of the work so if venlafaxine isn't working then the chances of its metabolite doing so are not great, even though it does inhibit NA reuptake a little more strongly than the parent compound.

    its impossible to get MAOI or TCA antidepressants.
    Which is a great pity because they are superior to SSRIs and SNRIs in the opinion of many of the older psychiatrists who practised during the MAOI and TCA eras. While the newer ADs now dominate the market it's not because they are more effective, but because they are perceived to be safer in overdose which isn't actually true for all of them, including venlafaxine.

    If they are available, the SNRIs milnacipran (Savella), or its metabolite levomilnacipran (Fetzima) may be your best bet. Milnacipran has been around for decades and is a pretty good AD, but isn't approved in the U.S. for anxiety, or depression so will need to be prescribed off-label. Levomilnacipran is approved, but is, I think, still in patent so may be more expensive therefore you need to check whether your insurance will pay for it. Milnacipran is slightly biased toward serotonin (5-HT) reuptake, approx 5-HT:NA 1.5:1, while levomilnacipran has a ratio of 1:2 (venlafaxine is 30:1, desvenlafaxine 14:1, duloxetine 10:1), so given your lack of success with SSRIs, levomilnacipran might be the better bet though in practice there's likely not going to be much difference. Certainly, both are more worthy of the SNRI tag than the others.

    here in Oklahoma also known as the opioid state,
    I'm in Tasmania where most of the opium poppies from which those opiods are made is grown.

    Is this the reason TCAs and MAOIs aren't available?

    Ian

  3. #3
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    Re: Desvenlafaxine anyone?

    Hello panic

    Thanks for your detailed and lengthy reply.

    I'd never heard of Milnacipran. It's good to know I have an alternative now.

    In Oklahoma physicians are scared now to prescribe anything which can be abused or used for OD because of lawsuits

  4. #4
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    Re: Desvenlafaxine anyone?

    Quote Originally Posted by lebonvin View Post
    In Oklahoma physicians are scared now to prescribe anything which can be abused or used for OD because of lawsuits
    And yet they prescribe venlafaxine which is the most cardio-toxic (and pro convulsant) of the SSRIs/SNRIs and much more so than the noradrenergic/norepinephrinergic TCA nortriptyline you're being denied because of a blanket rule based on group generalities, not med specifics. The other issue is only about 5% intentionally OD on their prescribed antidepressant. Most use other medications, prescription or illicit, or other means such as guns which are apparently by far the biggest risk factor in Oklahoma.

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