Posted by West on November 16, 2009, at 18:56:41
In reply to Need help choosing a new SSRI/SNRI, posted by jerrypharmstudent on November 16, 2009, at 12:05:45
It's true that effexor doesn't represent a balanced effect on both norepinephrine and serotonin, for some this may be an advantage, myself included.Despite duloxetine's greater affinity for NE I found it to cause a great deal of fatigue with its serotonergic effect being quite prominent, warranting the addition of modafinil. My advice would be to forget neurotransmitter hypotheses altogether and go with a realistic list of drugs with known efficacy in treating each disorder. More often than not they serve only to bolster drug marketing data and distinguish it from existing molecules. Many find the NRI reboxetine a horrible drug, adding stress or worsening anxiety and sleep. Duloxetine as with other second generation NRIs does precipitate sleeplessness . In my experience this was more serious than with Effexor XR, which I feel is a much easier drug to live with all round. I second bleaberrry's concerns about adderall perhaps being a culprit. I suggest lowering the dose and assessing any changes with each drop. A lower dose might represent a better alternative to stopping altogether.
5mg of clonazepam is certainly enough to cause depression and I would repeat the same sentiments as above with the aim of perhaps halving this dose.Finally I don't know if adding a tricyclic to lexapro would do much for all round vim (though yes, technically you would be raising Ne levels).I suggest: a painless switch to Effexor XR from Lexapro, titrating up to no <225mg, and leaving no more than 3 weeks per dose escalation. Aiming to halve clonazepam and adderall doses by 6 months time, perhaps with a view to crossing over to a long acting methyphenidate preparation in the long term, and adding a hypnotic/sedating antidepressant/promethazine to replace the 2mg klonopin dose at night. Keep the Geodon if it's of help.
West
poster:West
thread:925936
URL: http://www.dr-bob.org/babble/20091107/msgs/925969.html