I have been treated for depression for over 20yrs and now have severe major depression for last 6 months. I take 150 mg Effexor XR and it doesn't seem to be working. I also have anxiety and panic attacks.
What is a good medication for severe major depression?
Question posted by PNHHM2 on 30 May 2012
Last updated on 28 October 2024 by sveikas
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97 Answers
sveikas
28 Oct 2024
I'm sorry to hear you’re struggling with this. When someone has been on an antidepressant for a long time and experiences a return or worsening of depressive symptoms, it’s a common issue called "antidepressant tachyphylaxis" or "poop-out," where the medication gradually loses effectiveness. Here are a few approaches that may be helpful:
1. Medication Adjustments and Alternatives
Effexor XR Dose Increase: For some people, adjusting the dose of Effexor (Venlafaxine) can help, as this medication’s effect on norepinephrine increases at higher doses (150–225 mg and above). However, any adjustments should always be discussed with a psychiatrist, as they can monitor for side effects.
Switching to a Different Antidepressant: Sometimes, switching to a different medication can make a big difference, particularly if you've been on Effexor for many years. Some alternatives might include:
Duloxetine (Cymbalta): Another SNRI that can be effective for both depression and anxiety.
SSRIs like Escitalopram (Lexapro) or Sertraline (Zoloft): Though similar in some ways, these medications may work differently and provide relief.
Tricyclic Antidepressants (TCAs) or MAOIs: Older classes of antidepressants, like Amitriptyline or Phenelzine, can be effective in treatment-resistant cases, but they have more side effects and require careful monitoring.
2. Combination Therapy (Augmentation)
Adding an Atypical Antipsychotic: Medications like Aripiprazole (Abilify), Quetiapine (Seroquel), or Brexpiprazole (Rexulti) are often added to antidepressants to enhance their effectiveness, especially for severe depression with anxiety.
Mood Stabilizers: For some, mood stabilizers like Lamotrigine (Lamictal) can help with mood stabilization, particularly if there's any bipolar component to the depression.
Bupropion (Wellbutrin): This can be added to Effexor for a stimulating effect that may help with energy levels and focus, without increasing anxiety.
3. Newer and Alternative Treatments
Ketamine/Esketamine: Spravato (nasal esketamine) and ketamine infusions have shown promise for treatment-resistant depression. These treatments work quickly and are often used alongside a traditional antidepressant.
Transcranial Magnetic Stimulation (TMS): A non-invasive treatment that stimulates brain areas associated with mood. TMS has been helpful for some people who don’t respond to medication alone.
Electroconvulsive Therapy (ECT): For severe, treatment-resistant depression, ECT remains a highly effective option, particularly if symptoms are disabling.
4. Psychotherapy and Lifestyle Modifications
Psychotherapy: A combination of medication and therapy, like Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT), can significantly enhance treatment for depression and anxiety.
Lifestyle Changes: Activities like regular exercise, maintaining a routine, proper sleep, and mindfulness practices can improve symptoms, especially alongside medication.
It can be helpful to have a thorough discussion with your psychiatrist about these options to decide which adjustments may best suit your specific situation. The right combination often requires some trial and error but can lead to meaningful improvements in mood, energy, and anxiety levels.
WildcatVet
27 March 2024
You might also ask your doctor about increasing your dosage of the Effexor.
Nopain50
27 March 2024
I take Wellbutrin SR 100 and it’s the only thing that has motivated me.
WildcatVet
18 Sep 2023
You should always consider talk therapy. CBT (Cognitive behavioral Therapy) which is very beneficial to most people alone, in many cases, but often used with medication too.
Talk to your doctor about Auvelity which is a combination of bupropion and dextromethorphan, or adding an anti-psychotic like Abilify, Rexulti, Latuda, or Seroquel.
If you’re not on a mood stabilizer like lithium or lamotrigine get on one. If you doctor won’t consider prescribing any of these then find a new doctor, preferably a psychiatrist.
There are a world of options out there so get with a doctor ASAP. You really don’t need to suffer!
birdmom9726
18 Sep 2023
I have been treated for major depression since Elavil came out - that's a LONG time! I have tried pretty much every depression med there is, and around this time last year was on a cocktail of 5 meds and was STILL depressed - I had been good for about 10 years, but finally I guess the drug or drugs just didn't work as well for me. Due to my past history, my NP was stumped as to what to do for me. I wanted to try ketamine, but of course it's difficult and expensive to find someone who will do that for you. Finally she said she had heard of a new drug called Auvelity, and gave me a month's worth of samples. From the very first day, I was a bit less anxious and depressed - that has never happened to me before. And I am off all of my other psych meds except three, and am taking very low doses of those.
I have been on it for about six months, and the only problem is, this stuff is $1000 a month and I have no idea how long my $10 manufacturer's coupon is going to last. Plus it makes me sleepy if I don't take it at the right time, but we're working on that and trying different dosing times. Otherwise, it's a great medication and has been very helpful for me. I just wish it weren't so expensive, because that's just one more thing to worry about.
pixie12
5 Aug 2022
I've been treated for severe atypical MD, anxiety, ADHD, chronic insomnia for over 20 years as well. Currently I am on a "cocktail" of meds. I'm taking Effexor XR caps, it was titrated from 75mg/day to 225mg/day. Psych doc told me Effexor XR can be titrated to 375mg/day for severe depression if need be.
Inactive
11 March 2022
Hello PNHHM2,
I too have been down that road, where at one time, I was afraid of leaving the house. It took time but eventually I learned to control both my panic and anxiety attacks. With the assistance of my inner self, I walked down memory lane when I was happy and lived a carefree life. With that positive energy, I learned to tackle my fear, depression and panic/anxiety attacks. Now when I take my prescribed medication, I am a lot stronger mentally.
I guess what I am trying to say is that anti-depressant medication(s) can only do so much, we can be the master of are fate.
Good Luck
Rose of Life
Angalia
26 Jan 2022
First I just wanna say hi my name is angalia pronounced same as Angela. I have been diagnosed with severe depression, stress disorder which cause seizures when I get really nervous or stressed. I also have bipolar disorder stage 2, and alot of other things that come with it. I was a guinea pig for 16 years pretty much, trying to find a medicine that would help, I've been prescribed everything from a to z... and still hasn't helped. I went to a neurologist to get scans of my brain bc of the seizures I was having, he told me it was brought on by stress. He then told me he could prescribed me seizure meds but they really wouldn't help with the type I had. I asked him if there was anything at all and, if seizure meds won't help then what else is there. At that time I was having 5 to 6 seizures a day.
He said he could let me try Neurontin bc at the time they were testing the medicine to see what else it may help. After that he said he would write me Neurontin/gabapentin to see if it would help. I went straight to the pharmacy and got it, took it right away... about 20 mi utes had passed and right then I started feeling better, not only did it stop my seizures but it helped with the stress, depression, anxiety, and other things I was feeling. Years I had searched for help, and never found anything to help me until I got prescribed the Neurontin. My family and friends seen a big change In me. My parents cried while telling me about it, and said they finally got their daughter back. And I haven't had any problems since with any of my issues. I was relieved knowing I finally could be normal again... and be the mother that my kids deserve. Over the years I lost a lot of friends and just wasn't me. I lost my husband due to mental health problems and everything else. I wish I could've got the help I needed before , then I would still have my husband. But as far as the medicine you described I've been on all of them and then some. They made me wanna sleep, and never wanted to socialize , and I was just unfriendly and while experiencing the highs and lows of bp disorder... on top of being suicidal and seizures I was a mess and that's while I was medicated with lithium and effector, I've tried them all. Nothing helped me until I was prescribed Neurontin/gabapentin. It saved my life. I'm not saying run to the doctor and get them ,but maybe you can speak to your doctor and maybe mention that you heard others say it helped them. I promise you that it helped me so much, I've got a good job now and friends, and I can go out to public places without getting anxiety and seizures. I'm myself again. Goodluck with everything I hope you get the help you deserve.
Seayakermi284
31 Aug 2020
I have been suffering from depression all my life and antidepressants either gave me horrible side effects or didn't work. I was put on tramadol for pain and for some reason it really helped with my depression. I'm not promoting taking a pain pill, but for some reason it helped.
lauramorrick
30 June 2020
I have all of the above as well, more PTSD more than depression but basically depression caused by th PTSD; severe anxiety & panic attacks that will make me run out of groceries, public places & take up to an hr to stop the shaking, crying & try to figure out where I was/what happened, etc while sitting in my car bc I can’t drive! I take Effexor also but with Lamictal (a mood stabilizer) & a Klonopin every 12 hrs (beats the Xanax I was in prior that only lasted 3-4 hrs)!
Hope that helps, Laura
Rathmullan
30 June 2020
Hello:
Sorry to hear of your resurgent symptoms.
If you feel that Effexor XR has worked for you in the past it may be best to try increasing the dosage to 225 mg per day. Speak with you Doctor about this. However, if you have some doubt as to whether the Effexor has been effective it may be best to "bite the bullet" and try a new medication. Because of the anxiety you may wish to avoid one that has an SNRI component like Effexor has. Titrate down your Effexor by 37.5 mg each week for 4 weeks (including one week of no medication) before titrating up on the new anti-depressant. I'm thinking Viibryd or Trintellix could be could options for you. But obviously speak to your Doctor about all of this. Give both of these medications a fair shot to work when you are at 20 mg and 10 mg dosage levels respectively before titrating up in dosage. A fair trial means a full month.
If those lower dosage levels work for you it will save you a lot of grief when you eventually decide to get off of them.
Take care for now and all the best.
MarieannH
30 June 2020
Get your doctor to increase the dosage. It’s safe as my friend is on 375 mg daily
Inactive
13 April 2019
I find Pristiq very helpful, but so far I'm on a low dose of that plus effector. We have tried multiple times to go higher on Pristiq n quit the Effexor but became very irritable n depressed... also take lamictal with this. Anyone else out there who takes both effexor and Pristiq together?
Rubo123
13 April 2019
I´ve had depression with panic disorder and OCD. Firstly I was given an SSRI (fluvoxamine). It was ok for panic attacks and OCD. In a month I was panic free and in half a year OCD free. However, I used to be very tired and had low energy. From this point a low dosage of Mirtazapine was added. It sas better than the SSRI alone, but something was off yet and my weight increased. Then I stopped Mirtazapine and was added bupropion to the SSRI. I had a lot of energy and felt out of depression in about 3 days. The downside is that my anxiety upped a little bit, but I got used to it and felt better if I didn´t take it twice a week (I skipped some doses). Whatever, my point is that don´t give up, talk to your psychiatrist, sometimes you need to combine 2 different antidepressants working on different neurotransmitters. And there are a lot of options and new drugs. It is worth trying. I hope you´ll be fine.
ktm55648
1 Oct 2018
I deal with Generalized Anxiety Disorder and OCD (lucky me, right?
Related topics
effexor, effexor xr, depression, anxiety, panic disorder, generalized anxiety disorder, medication
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