An end of an era

[desiderata]

Effexor has helped me for over 10 years and it's time to say goodbye. For those who do not take psychotropic medications should note that it is very hard sometimes to find what works for the individual and for how long. I have noticed the decline of the effects of this medication and the rise of the symptoms of my illness for about a year. The hard part was that Effexor has been a good fit for me the majority of the years and I was afraid to and unable to see where I would be without it. But like all things change is inevitable. My body (mind) has adapted so well over time to the effects of this drug and rewired itself to it's original state to where this drug has "pooped out" on me. Like alcohol or nicotine we build up tolerances even for things that have helped us. I just wish I would have been more adamant with my doctor (I don't fault him in any way) and not waited as long for my life has been taking a downward spiral for a while now. Therapy has helped quite a bit and I believe most of us need the one-two punch of meds and therapy to conquer what ails us in our minds. So, I start today with Cymbalta. It may not be the answer but at least I'm trying.

 

[Retired]

If I understand correctly you were prescribed Effexor (venlafaxine) for ten years, but suddenly developed tolerance, ie symptoms were no longer being controlled, so your doctor switched you to Cymbalta (duloxetine).

Was there ever a consideration to increase the dose of Effexor or were you at the maximum dose?

Cymbalta is also an SNRI Serotonin and Norepinephrine Re-uptake Inhibitor that has gained worldwide popularity and has been very effective in treating not only depression and anxiety, but has received approval for other indications as well, including fibromyalgia and other specific forms of pain relief.

Be sure your doctor and pharmacist are fully aware of all medications and over the counter preparations you use, including stomach preparations and cough and cold remedies because Cymbalta has drug / drug interaction potential different from Effexor which has virtually no potential for drug / drug interaction.

This is in no way a criticism or indictment of Cymbalta, or a reflection of its potential for effectiveness in relieving your symptoms, just a statement of fact about the pharmacokinetics of the compound duloxetine, which is different from venlafaxine in the way it is metabolized.

Ask your pharmacist to run an interaction check on all your current medications, and whenever you need to use an over the counter remedy, check with the pharmacist for interaction potential before buying it. Your pharmacist can usually offer you a substitute OTC product that is compatible with your new medication.

Do keep us posted on your progress.

 

[desiderata]

Thanks, for the input Steve. The tolerance hasn't been sudden, it's been a very gradual shift for some time now (1-2 years.) So slow it's been hard to be aware of the subtle changes I've made. Over the course of my treatment I have switched meds and just not felt that I had gotten the positive results I've gotten from Effexor. I am aware of the side-effects of Cymbalta just as I've been aware of those associated with Effexor. I am also aware of OTC medications and SRI's and to be careful of any combination of the two. My primary and psychiatric doctors have a current list of my meds. For every action there is a reaction. The trick is to balance as well as can be balanced.

 

[David Baxter PhD]

What you describe, Desiderata, is a well known phenomenon with SSRIs and SNRIs, although why it occursd is not well understood and it doesn't happen for everyone. The strategy you and your doctor are pursuing is generally successful, although it may take one or two tries to find the best replacement.

 

[desiderata]

It's strange what works and who it works for. I read that there is a blood pressure medication engineered in the 50's that helps people with PTSD and the frequent nightmares they have. They still dream but don't have as many of the bad ones. I guess that's why pharmaceutical companies are in the numbers of trillion of dollars.

 

[Retired]

a blood pressure medication engineered in the 50's that helps people with PTSD and the frequent nightmares......I guess that's why pharmaceutical companies are in the numbers of trillion of dollars.

It's the front line physicians and researchers who make these discoveries of medications that sometime have unexpected benefits, or mechanisms of action that were not observed in the initial development. Sometimes it's due to new technology by which testing and evaluations can be made in subsequent years, or because discoveries are made serendipitously.

However if a medication first developed in the fifties is used for whatever purpose today, it's unlikely that medication is making any money for the manufacturer. Chances are the original manufacturer has scrubbed it from their manufacturing and it's being made by a generic manufacturer. It gets no promotion and it's off label use is made known through journal articles and word of mouth by physicians at medical conferences.

 

[desiderata]

Well it will get a lot of word of mouth; it's a feature article in TIME magazine.

 

[Retired]

feature article in TIME magazine

What's the medication? Would you point me to the article if it's on the Time online version?

 

[desiderata]

It's in the July 9th edition. The medication is called prazosin and it was developed in the 1960s. The title is "Nightmare Scenario."

 

[Retired]

The Time Magazine article is located HERE, but the article is only available Time subscribers.

I am not one, so unfortunately cannot access it.