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Thread: Increasing Venlafaxine to 300mg

  1. #21

    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by panic_down_under View Post
    Your psychiatrist will likely recommend adding a mood stabilizer, Andy. Imho, it isn't the best option, but it is the easiest, least disruptive and quickest option.
    Can I ask why you think this might not be the best option?


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  2. #22

    Re: Increasing Venlafaxine to 300mg

    My GP tells me that the psychiatrist noted on my record that the next thing to try could be to switch from Venlafaxine to Sertraline. Basically, I need to decide if I want to try this.

    Any views on whether this could be a good switch? I assume if I go ahead I’m going to need to cross taper very slowly. I’m wary given my already high anxiety and low mood.


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  3. #23
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    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by Cornish Andy View Post
    Can I ask why you think this might not be the best option?
    Firstly, because it is adding another med in an attempt to make up for the deficiencies of the current one. It mostly results in taking two ineffective drugs. Secondly, mood stabilizers can have unpleasant ongoing side-effects.

    My GP tells me that the psychiatrist noted on my record that the next thing to try could be to switch from Venlafaxine to Sertraline. Basically, I need to decide if I want to try this.

    Any views on whether this could be a good switch?
    I'm not convinced going to another SSRI is the best option given one, paroxetine pooped-out and another venlafaxine isn't working that well. In these circumstances an AD from another class such as a TCA can be a better bet. However, some psychiatrists (and even more GPs) have little experience of TCAs these days and cross tapering from venlafaxine to a TCA can be tricky so many psychiatrists are wary of initiating it.
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  4. #24

    Re: Increasing Venlafaxine to 300mg

    Thanks again PDU. I’m going to take a little while to think it over. Seems like there are pros and cons to every option. If an SSRI would be an smoother switch perhaps that’s not a bad thing in my current condition.

    I would say that Paroxetine worked for a long while, 15 years or so, before pooping out. Not sure if that makes any difference.

    It’s been really helpful bouncing thoughts off of you panic_down_under. How are you, anyway? I hope life is good for you at the moment.


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  5. #25
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    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by Cornish Andy View Post
    Seems like there are pros and cons to every option.
    This is true of just about everything in life and often we don't really understand which are the true pros and the cons until much later, Andy. But just think how boring life would be if everything was clear cut and predictable.

    If an SSRI would be an smoother switch perhaps that’s not a bad thing in my current condition.
    Perhaps. But don't just accept what your psychiatrist recommends. Make him to earn his fee by asking him what your options are and have him justify his choice.

    I would say that Paroxetine worked for a long while, 15 years or so, before pooping out. Not sure if that makes any difference.
    Hard to say though if poop-out happens it most often occurs much earlier. Was anything significant happening in your life around the time it began to fail?

    How are you, anyway?
    I'm okay, just tired. Today was the second time this week I've driven from one end of the state to the other and back again, round trips of about 450 miles which have me feeling my age even with the car doing most of the driving.
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  6. #26

    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by panic_down_under View Post
    This is true of just about everything in life and often we don't really understand which are the true pros and the cons until much later, Andy. But just think how boring life would be if everything was clear cut and predictable.



    Perhaps. But don't just accept what your psychiatrist recommends. Make him to earn his fee by asking him what your options are and have him justify his choice.



    Hard to say though if poop-out happens it most often occurs much earlier. Was anything significant happening in your life around the time it began to fail?



    I'm okay, just tired. Today was the second time this week I've driven from one end of the state to the other and back again, round trips of about 450 miles which have me feeling my age even with the car doing most of the driving.
    Thinking back, I changed from Paroxetine not long after my second child was born, so a pretty significant time you could say!

    I don’t know your history PDU, but if you have any history of panic or anxiety, just being able to drive that far is amazing! Sounds like you should put your feet up over the weekend though


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  7. #27
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    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by Cornish Andy View Post
    Thinking back, I changed from Paroxetine not long after my second child was born, so a pretty significant time you could say!
    That would account for an increase in anxiety/stress. Did you try upping the dose, Andy?

    I don’t know your history PDU, but if you have any history of panic or anxiety, just being able to drive that far is amazing!
    Fortunately, ADs control my PD+agoraphobia almost completely and they don't often restrict me from doing what I please.

    Sounds like you should put your feet up over the weekend though
    The place is often overrun by tourists clogging up the roads and hogging the best fishing spots so I usually take it easy on weekends anyway.
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  8. #28

    Re: Increasing Venlafaxine to 300mg

    Hi everyone. I’m back again!

    So it’s not been going that well. More bad days than good. My mood has been low and anxiety and agoraphobia much higher.

    To cut a long story short, I’ve now gone to a private psychiatrist to try to get some more detailed advice and move things forward.

    He has recommended adding the tricyclic Lofepramine at a starting dose of 70mg twice daily to my existing Venlafaxine 300mg. He doesn’t want to lower the Venlafaxine yet so that no withdrawal effects get in the way of progress. He’s also prescribed a beta blocker Atenolol to help bring down the physical symptoms of the anxiety.

    This is all against the advice of a GP who recently wanted to lower the Venlafaxine as I was experiencing palpitations and raised blood pressure, and wouldn’t prescribe a beta blocker as I previously had mild asthma, which I don’t really suffer with any more.

    As you can imagine, all these changes and differences of opinion are a lot to take in. I’m mainly worried about taking two antidepressants side by side while the dose of Venlafaxine is still so high. But the psychiatrist seems more knowledgeable than the GP so I have to trust him and go with it for now. I just need to relax and stop worrying so it has a chance to start working. Easier said than done.

    Any similar experiences or words of advice would be welcome. As always, hoping you are all having a good day and taking care.


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  9. #29
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    Re: Increasing Venlafaxine to 300mg

    Quote Originally Posted by Cornish Andy View Post
    He has recommended adding the tricyclic Lofepramine at a starting dose of 70mg twice daily to my existing Venlafaxine 300mg. He doesn’t want to lower the Venlafaxine yet so that no withdrawal effects get in the way of progress. He’s also prescribed a beta blocker Atenolol to help bring down the physical symptoms of the anxiety.
    So he is essentially creating a bespoke SNRI. Not sure venlafaxine is the best SRI for that, but you have to work with what you've got and maybe that will be addressed once the lofepramine kicks-in.

    This is all against the advice of a GP who recently wanted to lower the Venlafaxine as I was experiencing palpitations and raised blood pressure, and wouldn’t prescribe a beta blocker as I previously had mild asthma, which I don’t really suffer with any more.
    Is the psychiatrist fully aware of this?

    As you can imagine, all these changes and differences of opinion are a lot to take in. I’m mainly worried about taking two antidepressants side by side while the dose of Venlafaxine is still so high.
    Creating bespoke SNRIs was very popular back in the day and often produce very good outcomes in treatment resistant cases. Lofepramine is only a weak serotonin reuptake inhibitor and venlafaxine a weak noradrenaline reuptake inhibitor so on that score there shouldn't be any issues. There may be other potential problems, but you have to defer to his expertise.
    __________________
    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  10. #30

    Re: Increasing Venlafaxine to 300mg

    Panic_down_under I knew (hoped!) you’d be the first to reply.

    I did make the psychiatrist fully aware of what the GP had said, but he said it shouldn’t be a problem. Apparently, Atenonol is less likely to cause problems with asthma as it targets the heart as opposed to both heart and lungs like Propananol.

    As for the Venlafaxine, if the new AD does start to work I think my preference would be to maybe get back to 225mg it as I do worry about being on such a high dose, which might not be needed with the combination approach.

    What other problems do you foresee?


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