about 6 months ago my wife was put on a mixture of three drugs as follows : Faverin 100mg 1-0-1, Effexor XR 75mg 1-0-1 and Trazadone 50mg 0-0-1 due to a chemical imbalance resulting in clinical depression and suicidal tendencies. They seemed to be helping her although she also stopped alchohol consumption (which was a major problem). She has now been drinking again for the last few months and she has become a living nightmare for me and the children (abusive, had an affair, goes out all night, etc) - can anyone assist whether the three drugs mixed are having an adverse effect. I know the alchohol doesn't help at all but is this mix a time bomb.

[CamW]

Expatmark - I know that docs all have unique combinations of drugs in certain situations. I have never seen the combination of Faverin™ (fluvoxamine ; Luvox™-CDN) and Effexor XR™ (venlafaxine), especially when each are at relatively low dose.

Faverin may be blocking the production of some of certain liver enzymes (cytochrome P450 system; esp. 3A4 & 1A2) that are involved in the metabolism of the Effexor, as well as the Desyrel™ (trazodone). Whether the increases in plasma concentration of either, or both, drugs is of any clinical significance is debatable.

Now that she is drinking alcohol, she may be affecting her blood levels of her drugs in a couple of ways. The more wobbly pops (or other drink of choice) one has consumed, the more frequent become the trips to the WC. These meds, and especially the metabolites of these meds, are water soluble. This means that there is a risk of peeing off too much of the drug and not having enough drug left, to exert it's clinical effects.

People who tend to drink too much, or especially binge drink, tend to have decreased body water content (sort of a semi-dehydration state). The switches from hydrated to dehydrated and back may make her feel worse in the long run. One day the plasma concentration will be too low to work, then the next it is so high that it is causing side effects.

It sounds like your wife is still depressed. Is she, or both of you, attending any sort of therapy on dealing with the real core issues of why she became depressed in the first place. Once you figure out why one is depressed, then work can begin on resolving the depression as best as possible.

The anger may be coming from frustration, shame, guilt, &/or a thousand or so other negative thoughts and self-doubts. Lashing out could be a side effect of unstable medication blood concentrations. Anger is also a depressive symptom.

Or, your wife may be having a manic episode. Perhaps what was thought to be unipolar major depression, is actually the first break of bipolar disorder. The SSRI-like drugs that she is taking (all of them) may have caused something called "manic switch". This occurs when an SSRI causes the onset of a manic episode. Theories on how this happens abound, including one that states that the depression is preventing the manic side from emerging; once the depression "brake" is lifted, the mania manifests itself.

Your wife needs to get some help, before she injures herself or someone else.

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