Posted by Racer on July 17, 2008, at 18:36:19
In reply to years on a effexor and it stopped working, posted by copper on July 13, 2008, at 15:37:47
Hi! Welcome to Babble. It's a place where I've gotten a lot of good support and information over the years, and I hope you find the same is true for you.
As for the Effexor, it's not uncommon for the serotonin reuptake inhibitors to lose their effectiveness over time. No one seems to know why this is, but it's a phenomenon which has been noted anecdotally for a long time -- and which psychiatrists have also been acknowledging for some time now. It seems that may have happened for you. For what it's worth, 10 years is actually a long time for it to continue working, so you're ahead of the curve. Not, I suspect, that that will make you feel any better!
And about the anxiety and the anti-psychotics: there are two schools of thought on this. Some doctors now say that when depression and anxiety are both present, it's a sign of bipolar disorder. Others say that it is sometimes a sign of bipolar -- and sometimes just a sign that someone has both depression and anxiety. Since there's no definitive answer on that one, I say it's probably best to concentrate on whether or not the treatment works, instead of what label gets applied to the disorder.
If Effexor was effective for you for so long, my own inclination -- and keep in mind that I am not a doctor, just a garden variety crazy person -- would be to try another serotonin reuptake inhibitor, whether or not it also inhibits the reuptake of norepinephrine as Effexor does. Options might be Cymbalta, which is also a dual reuptake inhibitor, although it hasn't seemed to be quite as effective for some people as Effexor has been; one of the SSRIs, like Prozac, Zoloft, Celexa, or Lexapro; a combination of an anti-depressant and an anti-anxiety agent, which it sounds as though your new doctor has been trying; or one of the older antidepressants with a broader range of actions.
Taking the last of those first, the older medications tend to have more side effects, and many people find them less tolerable. They're very effective drugs, and it's worth keeping them in mind. Tolerability is a question, though, and my advice in considering them is to think about what side effects you're most willing to tolerate, and see if there's one that might meet your criteria.
The SSRIs have been effective for many people against both depression and anxiety, so they're worth looking at. They share serotonin reuptake inhibition with Effexor, and if you respond to one without reaching remission, you can add on something to effect norepinephrine and see if that boosts your response. Since you did have such a good run on Effexor, that's actually where I would start. Cymbalta is more balanced than Effexor in its effects, and is well worth a try. Of the two, I found it more tolerable than Effexor, although ultimately neither worked very well for me. An SSRI combined with Wellbutrin might be a good option, though -- aside from boosting the effects of the SSRI, the Wellbutrin might counter some of the more common side effects of SSRIs.
Remeron does have serotonergic effects, and it's hugely effective for a lot of people. Depending on your dose and how long you've been on it, it might be that you're just not one of those people. If that's the case, it's worth looking at options.
And finally, I know for me, the relationship with the psychiatrist makes a difference. If you aren't comfortable with your new pdoc, it might be that a lack of rapport is interfering with your response. You probably know whether or not you have that sort of reaction, so I'll just leave you with that thought...
Best luck to you, and welcome to Babble! Medication related questions often get great responses over on the Medications board, which you can find at http://www.dr-bob.org/babble/
poster:Racer
thread:839584
URL: http://www.dr-bob.org/babble/newbs/20080507/msgs/840259.html