[Psychmajor]

Okay, so I'm on 200 mg of sertraline and 150 mg (twice daily) of wellbutrin. meaning im on an SSRI and NDRI (<- only put on this to ease my anxiety problems since zoloft completely took care of my depression), my doctor wants to switch me to an SNRI (effexor is likely) if wellbutrin doesn't work out. How would this be different from what im currently on besides the dopamine aspect and the actual drug thats inside the med.

Also how is giving anything that increases the amount of Norepinephrine in the nervous system going to help with anxiety? With it being so related to adrenaline it seems like it would only increase anxiety through its excititory processes (cant find understandable info on the little inhibitory functions it has). I would assume that since the SSRI took care of the depression so well that the anxiety must be a comorbid disorder that isnt effected on the seritonin, noipinephrine (on the NDRI), and dopamine systems... which only leaves gaba related drug options and antipsychotics which would lower dopamine which is bad for an unmotivated person (yes im going to therapy on a weekly basis and practicing it but less dopamine would be a horrible idea), and noripinephrine (less anxiety but BAD side effects possible, i think i might rather be addicted than have tartive dysconisia [spelt wrong im pretty sure])
I dont want to have to go through 50 meds before finding the right thing (if i find it), i lived with anxiety for too long already. (frequent panic attacks (associated with agoraphobia) which interfere with creating any relationships romantic and platonic)

it would be awesome If anyone can answer my above questions, you would and more help than a Neuroscience teacher (bio psychology) and an arrogent Psychiatrist.

[just_a_mom]

Psychmajor,

I debated for a long time about whether or not to respond to your post. I *think* I have something of worth to say - but I guess that is really for you to decide.

First, I think you and I are probably fairly similar. I suffer from depression/anxiety (claustrophia which manifests itself in odd ways) and I finally got on top of it with Lexapro/Wellbutrin. Secondly, I am an over-educated scientist that has worked for 10 years in big pharma. A disclaimer, I have never worked directly on a CNS project, so while I am very familiar with issues that face CNS targets in drug discovery, I do not consider myself an "expert". So with all that in mind... you can decide whether or not to give credence to anything I say.

When I first went on medication for my depression/anxiety, I researched EVERYTHING I could about SSRIs - original literature in peer-reviewed journals, prescribing information, raw data, etc. I really geeked out on it. So when Celexa didn't work for me, I sort of freaked out. I was convinced I would have to be on the older tricyclics (ugh). I was convinced to try a different SSRI (lexapro) which didn't really make sense to me - why would one SSRI work when another didn't - the mechanism of action is the SAME. However, I had to eat my words b/c it did work. It worked well and quickly. Adding Wellbutrin helped more with the anxiety and some other lingering issues.

Sooooo. What had I learned from all this? I still research my meds and look at the literature to make sure I like the data from the studies, BUT I also realize that the human body is just too damn complicated/unique for us to completely rationalize drug interactions based on in vitro, animal or even human trials. Sometimes you just have to make an informed decision, take the meds and hope that they work with your own unique body - and ignore all the *known* science behind it. Unfortunately, it is entirely possible that there is some other pathway that one drug in a class affects that another one does not - that could be enough to make the difference between one drug working and another in the same "class" not. Trust me, I have seen some FREAKY things in my time in the industry (I worked in upstream drug discovery, we never got beyond animal testing before things were handed off to a different department) - most of them were never explained and some couldn't even be rationalized.

Again, just my experience and my 2 cents. I really wish you the best - I have been in your shoes where you just want to feel "normal".

just a mom

[salpal]

Dear Just a mom: (i am impressed with your knowledge!!)

I am just a mom too, with anxiety and nerve pain issues. I was on Lexapro for several years and my dr. switched me to Pristiq thinking I would benefit from the Norepinephrine for my pain issues. I took 50mg. with evening meal. It took some time to get used to but it really worked for my pain issues even thou I felt very hyper on this drug. I was on Pristiq since last March, but have had dry mouth, bitter taste issues. The only thing anyone can figure out it it must be the Pristiq.( Many dr./dentist, ENT visits.) Just to let you know I try to take charge and figure things out, but this taste thing is just strange.

My dr. recently recommended I switch to Effexor XR 37.5 once a day. The thought was maybe this would help my dry mouth and I would still get the pain benefit too. I liked the idea of taking less of a drug and depression is not a huge issue for me. I tell you, after 5 days I had terrible withdrawal symptoms, panic attack I did not know what the heck hit me. My dr. did not expect this to happen either. Gosh, is the Pristiq that powerful? Now I am taking two Effexors XR 37.5 and I am as dry as ever. I feel so frustrated. I think I should have just stayed on the Pristiq but I suppose just because they are cousins they are somewhat different.

I will be contacting my dr. after the holiday to discuss further, but I do not know what to think. I do think the norepinephrine does help with my issues. I just do not want to have to take MORE now.

So, what is my question. Does anyone know if 50mg Pristiq = two 37.5mg xr of Effexor. Dosing is tricky I suppose. Also, reading other posts on here about effexor scares me with all these people warning about withdrawal problems from effexor. I think to myself, how did I get started on this roller coaster and I feel scared about what I am doing to my body.

I really should not read all these posts but I feel knowledge is power. I am impressed with how you have taken charge of your situation. GOOD FOR YOU. Any thoughts would be appreciated. Happy Thanksgiving. gosh, am i going to gain weight on effexor too. HELP SALPAL