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Mental Health  (Expert Forum)
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Effexor, Lexapro.....Help
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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.
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Effexor, Lexapro.....Help

by emeraldeyes1646, Nov 03, 2003 12:00AM
I have been on Effexor XR for the past 2 years.  I was taking 300 mg a day with Lamictal 200mg/day and Seroquel 100mg to sleep.  The Effexor wasn't working so my psychiatrist wanted to drop the Effexor and replace it with Lexapro 10mg/day.  He told me to "just" drop my Effexor dose by one 75 mg pill a day and I would be "off" of the Effexor in 4 days.  Yeah, right!!!  

Having once before attempted to "stop" Effexor, I knew it wasn't going to be that easy.  A very close family member is a supervisor for the company that makes Effexor.  He gave me "advice" on how to "quit" by gradually decreasing the dose by 37.5mg over every 2 days.  The last week I should break open the 75 mg caps and take fewer and fewer granuales until I was "weaned".  I thought I had done everything to a T until yesterday when I had gone without my "fix" for 2 days and hurled all over my kitchen after staying in bed all day.  The only thing that made me feel better was taking a few granuales of Effexor.  I have almost a week off soon and plan on "detoxing" during my vacation.

I had been researching Lexapro to see the side effects and wonder if this drug is even worse that Effexor (which I would NEVER recommend to anyone)?  I read the testaments and have found several even going as far as saying they (or a loved one) were suicidal after taking Lexapro when they had never been before.  HELP...now what do I do.
Doctor's Answer

by Roger Gould, M.D., Nov 04, 2003 12:00AM
What you described seems to be true of all the antidepressant medications, and especially those ssri's.  You have to wean carefully once you have been taking them as long as you have, and at the dose you have.  And you have to make sure your underlying depression is resolved, not just dampened down, so that does not reappear.  Its best to be in therapy and take mediations, and gradually diminsih your medications.  Lexapro is a little less likely but you will stay have to wean yourself carefully.
Member Comments (26)

by StupidMe, Nov 04, 2003 12:00AM
To: emeraleyes1646
You had been on a high dose of Effexor XR for 2 years and you should taper it off over 3 weeks time instead of 8 days and watch out for discontinuation symptoms even after the withdrawal. Anyway you are over with Effexor XR. Effexor is an SNRI while Lexapro is SSRI. But they are more or less the same with regards to classification, efficacy and side effects. Lexapro claims to be an improved formula of Celexa, which is another SSRI. The pharmaceutical companies that launches these products tends to include an exhaustive list of possible side effects from the established papers to safeguard themselves from possible litigation. Remember each paper reveals its own profile of untoward effects from its set of patients. If you look at that list, one will probably be scared and shy away from the drugs. By and large, SSRI are much saver than older antidepressants like tricyclics and tetracyclics. If you know how to use your drugs or take them according the advice of a psychiatrist, these drugs work wonders. If you quit it in 8 days instead of 3 weeks it makes you hate it. And everyone has a idiosyncratic interaction with a certain drug which may not be in the literature. So, step up Lexapro slowly and taper off in 3 weeks time for stopping it. Or if you are scare of SSRI, you can try another class, e.g. Wellbutrin.

by emeraldeyes1646, Nov 04, 2003 12:00AM
To: stupidme
thanks for the advice.  i am just so scared of having to go this withdrawl again.  i have been on prozac and zoloft before but they didn't see to do much.  was also on wellbutrin but it made my blood pressure too high.  still felt crappy yesterday on about 37.5mg of effexor.  took about 50 last night.  let's see how this works.  i just hopre lexapro makes me feel more energy that effexor.  all i do now is work and sleep.  again, thanks for your advice.

by Try_to_be_social, Nov 04, 2003 12:00AM
To: emeraldeyes1646
I quitted my Luvox (an SSRI) 50mg without any problem after 10 years. I reduced my Klonopin (an addictive Benzo) very slowly from 2mg to 1.25mg after 10 years. I read a lot about cognitive-behavioral therapy and its help me a lot. Why don’t you go for psychotherapy, which will lessen the dosage on your medications? Here is another choice for you in case Lexapro did not work-mobclobemide, which is a reversible MAOI and totally different from SSRI.

by emeraldeyes1646, Nov 05, 2003 12:00AM
Will taking the Lexapro before I am completely off of the Effexor ease the withdrawls efects of the Effexor?

by StupidMe, Nov 05, 2003 12:00AM
Yes, you can step up Lexapro while taper off Effexor at the same time. That is most people do.

by emeraldeyes1646, Nov 06, 2003 12:00AM
am thinking of just not taking anything for awhile....

1st.....are there any withdrwal effects from lamictal?

2nd.....am i making a mistake?  don't want to have same thing happen to me with lexapro.

3rd.....have been to a couple of therapists.  last one (only one covered by my insurance) stunk.  is insurance required to have more than one in an area?

by StupidMe, Nov 06, 2003 12:00AM
I don’t know the condition you are suffering from. Correct me if I am wrong, it is my conjecture that you have Bipolar. That may be the reason why you need Lamictal and Seroquel as a mood stabilizers. And I don’t know how long you have bee taking them. The best way is to discuss your wish with your psychiatrist, who knows you much better. It is dangerous to stop Lamictal abruptly because it is an anticonvulsant. You may have fits. Quitting both Lamictal and Seroquel may cause relapse of you condition and insomnia. Unless your condition was in complete remission for a long time, discontinuing all drugs would invite relapse. Even after a period of complete remission, you have to taper off each drug carefully in the correct order while watching out for signs of relapse during and after such process. The correct order depends on the exact nature of your problem. I think you are extremely angry about the unexpected withdrawal effect of Effexor and it is difficult for you to accept it. It is not a message to end all drugs but a point for you to quit your drugs slowly after complete recovery and find out as much as you can about your drugs and your condition from psychiatrists and people who are taking the same drugs with the same condition. This is the very purpose of this forum and other forums and other sources of information in the net.

by emeraldeyes1646, Nov 08, 2003 12:00AM
To: stupid me
thnaks for taking the time you have with me.  i was diagnosed with depression not bipolar.  i have been on the effexxor for 2 years, the lamictal for about 10 months, and the seroquel for about 2 months.  the seroquel is for the insomnia and i don't take that on a regular basis.

you are right...i am angry about the effexor withdrawl. had i known about this from the beginning i NEVER would have taken it.  right now, i, also, don't have much faith in my psychiatrist, who told me to wean myself off of the effexor over 3-4 DAYS.  while i know, i am not "cured", since i have cut down the effexor to about 50 mg daily (just to function) i feel better emotionally/mentally.  i am not as tired, sad, solemn.  am thinking very strongly about going to an accupuncturist.  a friend tried it (for other reasons) and asked if it worked for depression.  the dr. said yes...along with joint pain, headaches, fatigue, insomnia, asthma, weight loss and smoking cessation.  i figure what the heck.  right now am still on 200 mg hs and the occasional seroquel.  have appt. with psych. in 2 weeks.

by StupidMe, Nov 09, 2003 12:00AM
To: emeraldeyes1646
No body is perfect, including a psychiatrist, who is human and is therefore bound to err. Forgive your psychiatrist, who may have seen many patients without withdrawal symptoms after a quick discontinuation. Your psychiatrist has been helping you for more than 2 years. First, grieve. This includes your anger, mistrust, dissuading other not to take Effexor, turning to acupuncturist, disregarding traditional psychiatry. … You lost faith in your psychiatrist and this may extend to other psychiatrists, psychotherapists, other professional helpers, .… You lost faith in Effexor XL and you may generalize to distrust other drugs, including Lexapro, Lamictal, Seroquel, …. Second, take comfort for your loss. Talk to others about your feeling on such medical mishap. Air your grievances. Do that until you come to terms with such medical misfortune. Once you resolve such conflict, you can go all the way to recovery because you understand.

Client-therapist relationship is the most crucial factor that determines the outcome of the psychotherapy and is very important for the success of management from your psychiatrist.

Coming back to your medications, 10 months ago Lamictal 200mg was added because Effexor XR alone was not adequate? 2 months ago, you had to add Seroquel 100mg for sleep if required as Effexor XR and Lamictal were not controlling your insomnia? Recently, Effexor XR was found to be not working anymore and it was planned that Lexapro is to replace Effexor, indicating that your depression has not been fully controlled by the said medications together with psychotherapy from 2 psychotherapists. And Prozac and Zoloft had failed you while Wellbutrin gave you hypertension. It sounds that your depression, which started about 2 years ago, is not in remission for at least the last 10 months. I sincerely believe that by trial and error you can find the antidepressant and its adjuvant that will give you a complete recovery, of course, with psychotherapy.  You may try Lexapro or Luvox or another class of antidepressant, e.g. Trazodone. After complete recovery, continue the antidepressant for at least the length of your episode of depression that is not fully remitted. For resistant or relapsing depression maintenance takes even longer to prevent recurrence.



All the best

by StupidMe, Nov 09, 2003 12:00AM
To: emeraldeyes1646
Please refer to the link below, paying particular attention to the key points in red, italic and big print.



http://www.psychiatrist.com/audiograph/nemeroff/jcpbook.pdf