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Mental Health (Expert Forum)
using effexor and paxil
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
using effexor and paxil
by kid watermelon, Feb 26, 2004 12:00AM
hello,
i have been on effexor 300 mgs for several months as treatment for my third major depressive episode. i partialy recovered but five days ago my depression reappeared (cognitive impairment, psychomotor retardation, crying, etc). i felt "intuitively" like i was not getting enough serotonin. i have been on paxil twice before and it worked quite well (though almost impossible to withdraw from) so i asked my p-doc if we could add paxil to the effexor. he said it seemed like it could work and is starting me with 10mgs, eventually hitting 20mgs in five days. i asked about serotonin syndrome and he said it was unlikely.
after speaking with a few psych friends and looking around on the web i have suspicions that this combo might be a bad idea.
i would like to know if effexor 225 + paxil 20 sounds like a recipe for disaster to you. also, if i do manage to get to 20 without experiencing the syndrome, does that mean i'm in the clear and it won't be triggered down the road (say, if i do something serotonergic like running or getting sun, etc)? would you prefer to see me weened of effex before or soon after adding the paxil, or would it be prudent to continue with the two, so long as the combo seems efective?
i'm getting to my last straw with this pharma-tinkering and am worried another setback will make me give up permanently. as i'm sure you know, depression of this scale is pure torture.
thanks for your help.
kw
i have been on effexor 300 mgs for several months as treatment for my third major depressive episode. i partialy recovered but five days ago my depression reappeared (cognitive impairment, psychomotor retardation, crying, etc). i felt "intuitively" like i was not getting enough serotonin. i have been on paxil twice before and it worked quite well (though almost impossible to withdraw from) so i asked my p-doc if we could add paxil to the effexor. he said it seemed like it could work and is starting me with 10mgs, eventually hitting 20mgs in five days. i asked about serotonin syndrome and he said it was unlikely.
after speaking with a few psych friends and looking around on the web i have suspicions that this combo might be a bad idea.
i would like to know if effexor 225 + paxil 20 sounds like a recipe for disaster to you. also, if i do manage to get to 20 without experiencing the syndrome, does that mean i'm in the clear and it won't be triggered down the road (say, if i do something serotonergic like running or getting sun, etc)? would you prefer to see me weened of effex before or soon after adding the paxil, or would it be prudent to continue with the two, so long as the combo seems efective?
i'm getting to my last straw with this pharma-tinkering and am worried another setback will make me give up permanently. as i'm sure you know, depression of this scale is pure torture.
thanks for your help.
kw
Doctor's Answer
by Roger Gould, M.D., Mar 01, 2004 12:00AM
, Mar 01, 2004 12:00AM
There is nothing wrong with that combination in general, but if you start getting serotonergic you will get a flush, and then you should decrease the dose of either or both.
Wyeth is a disgrace. To know that they were and are fully aware of the physiological addiction of Effexor XR and have not made such information publically available is sickening. When starting Effexor a year ago, I was brought up to a dose of 300mg/day. I was not told of any withdrawal syndromes or addictive potentials of this drug - I checked WebMD and of course that site says nothing because who sponsors it but the pharmecutial companies themselves. My pharmacist knew nothing of its addictive potential and had not heard of the effects of Effexor on simple things like circulation (blood pressure and 'tingling' extremeties). The fact simply remains : Effexor IS PHYSIOLOGICALLY ADDICTIVE. It may be 'non habit forming' because it does not provide the user with a feeling of euphoria - but studies have proven Effexor's addictive qualities. Mothers who took Effexor for brief periods of time during the pregnancy had neo-natal fetuses suffering from Withdrawal Syndrome. Who was on Effexor withdrawal but Andrea Yates herself when she drowned her children (supposedly, anyways). I have tried three times unsuccessfully to taper Effexor. The last time I tapered to 265 mg/day for a week and it was miserable - I know what it feels like now to be an addict going through rehab. I was crippled with nausea, vomiting, headaches, spinning head, vertigo, the 'electrical' impulse feeling (like I could sense my nervous system conducting action potentials when my eyes would move). Several lawsuits exist currently to fight this evil - some that involve sufferers who experience seizures and neuropathy because of this ****. SIGN THE PETITION, GET YOUR VOICE ACROSS. SOMETHING MUST BE DONE. We can not let the pharmeceutical companies reap the benefit of getting addicts to their medications. Is there no justice? I am 19 years old. In college and graduate school concurrently; I must take off my fall semester and find a way of support to get myself off this medication starting immediately this summer... after 3 days cold turkey one time I was about to physically die from the withdrawl effects - I could not get out of bed, kept hearing buzzing in my head, had a fever of over 102 and hot/cold spells. My breathing was depressed, and I was at my wit's end. THIS CAN NOT CONTINUE TO PLAGUE INNOCENT PEOPLE WHO WANT TO FIGHT DEPRESSION, NOT ADD A DRUG ADDICTION TO THEIR LIST OF WORRIES.
Effexor and Paxil is such a combination.
I have been on a combination of Prozac-Remeron for over a year, and it has helped a lot.
Unfortunately, many doctors are reluctant to prescribe this type of treatment, often for lack of knowledge, or simply because not many clinical studies have been conducted (sine each single antidepressant may be manufactured by a different pharmaceutical cie).
About the addiction:
1- Paxil: is a bit difficult to stop because of its limited "lifecycle" in the body. Other SRIs such as Prozac stay in the body much longer and are therefore easy to gradually stop taking
2- Effexor: have never taken personally. But some studies suggest that its action uses receptors similar to opioids.
So having difficulties getting off could be related.
3- However, if you are chronically severally depressed, I'd certainly take that chance rather than go back to the awful symptoms ! Bear in mind that for some, depression may very well require lifelong medication, like diabetes. You could perhaps reduce the addiction potential by asking your doctor to change from Paxil to another SRI like Prozac (or another "long-lasting" SRI) ???
Best wishes: there is always light at the end of the tunnel !!!