Lost. Maximum dosage Effexor for severe MDD?

I have to type slowly. At some time Wednesday afternoon I crossed the line and have to be cautious to make certain that my lucid side stays in control.

I can't trust my memory so I don't know when I started making this deal with myself but it had to be within the past six weeks. Four weeks. The 225mg daily dosage of Effexor wasn't working as well as when I first started it. I started having the nothing to eat days, only get up for the bathroom days, dark days of pain and sorrow and suffering and grief. Maybe one okay day out of seven. My caregiver put jars of applesauce in my bedroom so that I could eat. I don't need to go into everything. Some of you know. But I made a deal with myself. Instead of panicking, instead of checking myself into the psych ward, I would just wait until I could get a 75mg increase in the Effexor to 300mg. That would clear me up. That was the bargain I made. Bear the unbearable in the full knowledge of salvation shortly.

My auditory hallucinations have been terrifying for the past week. They woke me up at two this morning. I have them through the day. Coming from behind all four walls, three completely different radio stations and, from my neighbors bedroom, various chants. That's what I hear now. It's been three mornings now that I've been awoken by the monotonous cadence of my city and state chanted, by a man with a country twang this morning, and then joined by a lower voiced monotonous repetitive drone of the days of the week. I told my doctor that the original female voice sounds like the new wave avant garde experimental artist Laurie Anderson. He didn't know who she was.

I told my doctor what was going on as far as my depression and he made an appointment two weeks ago for me with their psychopharmacologist right after I saw him Wednesday morning. I told him that I would like to try a 75mg increase in Effexor as it has been the only antidepressant, other than Nardil, that I have responded to in almost thirty years of taking antidepressant medications. I also told him about the increasingly disturbing hallucinations so that it would be charted for Amanda, the psychopharmacologist.

I rolled into her office and she got my chart and looked over it. The first words that she spoke – "Well, I can't increase the Effexor because you're on the maximum dose..." and I didn't hear much else that she said except that she was calling in a script for an antipsychotic to my pharmacy. I know that I called the van service to pick me up and that I called my neighbor and asked her to go to the pharmacy later in the afternoon. I remember waiting for the van and thinking of reading of people, many people, who were not institutionalized and who were on daily doses of 375mg+ of Effexor. But I recalled reading – and could only conclude that I had crossed the line when bargaining with myself – that 225mg was the maximum dosage.

I started losing it coming home. Like now my brain hurt. I lost at least four hours. A little more. I had to be in bed but I don't think I slept. I think that it just took that long for me to crack. My neighbor came to the door with the pills. I thought that I should go ahead and take one but the instructions said to take half a pill at bedtime. They're call quetiapine. 100mg tablets.

I wanted to either call my doctor or go to the hospital. Instead I looked up the dosage for Effexor. In one way, Amanda had been right. 225mg was the maximum daily dose of Effexor for MODERATE MDD. My diagnosis is for SEVERE MDD. Somehow I had screwed up. In something that I had said or written or in body language or tone of voice I must not have communicated what I was feeling. The blame, for making a bargain with myself and for the sudden (unexpected and not told to me) re-diagnosis was mine. It must have been something that I exhibited in his office or written.

I wrote a letter to my doctor. Very short, for me. 1 1/2 pages. It took me over four hours to write. I faxed it. I was insane when I wrote it. I haven't read it again and I don't recall much about it. I told him of the bargain that I had made, how I had flipped, how the antipsychotic tablets were coated and had no score line and how I had crushed two of them trying to cut them, how I felt responsible for my own demise and I asked him not to contact me.

He didn't try to contact me.

I fell asleep at about five yesterday morning and woke up two hours later. Most of the day I felt as I do now. So very close to shutting off hoping that, like Wednesday, the insanity will let time pass again. The pain will be here either way. All I have to do is stop being careful and cautious. It has taken me three hours to write to this point. I still have hypergraphia. Parts of my journal are a mess.

Oh. Those antipsychotic pills. My good and kind neighbor, Melba, checks on me daily. When she called yesterday I asked if she had a pill cutter. She brought me one. She sat with me as I destroyed another two tablets. I let her try and she destroyed another. I have to call my doctor's office today and, I suppose, try to speak to Amanda. See what she suggests because I am becoming desperate for the antipsychotic pills. I am so afraid to call. I'm afraid that my doctor shared my fax with her and that she must think that I'm a junkie. Making deals with myself for a pill. She probably won't believe that those five pills were crushed but rather that I took them all at the same time.

I need to ask my question:

Is there anyone out there who has been prescribed a daily dosage of 300mg or more for severe MDD to take outside of an institution?

I hope that I can get some quick responses. While ECT is, again, on the table and my cardiologist (if certain conditions are met) will approve it, my heart is in terrible shape. Thirty-two different types of heart disease. I would rather try the drug in a higher dosage.

My caregiver will be here today. I have to smile for her.

Thanks to anyone,

My usual dose of effexor xr was 300mg. I don't know what the usual dose is for regular effexor. It might be different. You sound more in need of an antipsychotic at this point though. Is the quetiapine you were given the SR version (sustained release) because generally seroquel (brand name) is easy to cut in half? You do need to call the doctor to find out about how to cut them in half if they are SR seroquel. Your pharmacist might be able to help also.

My caregiver called and her car won't start. She won't be back until Monday.

I called my pharmacy. He said that these tablets weren't meant to be halved. He suggested that I call my doctor and have some 50mg tablets of the antipsychotic ordered. But I wouldn't be able to get them until Monday.

I have screwed myself up so badly. Please, answer if you're able.

Call your doctor. She may just tell you to go ahead and take the full dosage (don't do that until you ask though). It will make you sleepy, but otherwise probably won't be a problem. They just like to titrate up preferably. Even 100mg is a fairly small dose. Make that phone call to get clarification about how to proceed.

Hi cider. Your post is completely lucid, so no worries there.

Wow, that sounds so frustrating about the quietapine (Seroquel) pills. Can you or your neighbor call your pharmacy to tell them about the problem with cutting them in half? Pharmacies usually will do that for you if you ask. They do it all the time and are pretty skilled at it. If they do cut some pills in half, you might ask them to only do two week's worth.

I have seen posts by more than one person on Psych Central who was taking as much as 600 mg Effexor. I remember because it surprised me - I didn't know that much was ever prescribed.

Regarding your auditory hallucinations - I'm asking this because I once had my psych meds interact with a narcotic pain medication and cause auditory hallucinations - do you think there's any other medication that you're taking that could be interacting with your psych meds and causing the auditory hallucinations?

In any case, I'm glad that you told your doctor about them, because they become exhausting the longer they go on.

Suggestion: Ask your doctors to write down everything he/she recommends. It is very difficult to remember things when you're very depressed.

Hugs.

Thank you so very much.

I just talked to my pharmacist and these tablets, by Lupin, not SR, are not meant to be halved. I wrote a note below – pharmacist said to call doc for 50mg, but I can't get until Monday.

Yes, the psychosis is as bad as it's ever been but the depression is nearing that point. I need both but, you're right, at this very moment I need the Seroquel. I really wanted to talk to my cardiologist before I took it because I have so many cardio problems, including the exact type of arrhythmia that is listed under the "Do Not Take If:" list.

I don't know that I trust the psychopharmacologist now.

Thank you so very much.

Cider, does the pill bottle say Seroquel XR (quetiapine fumarate XR) or just quetiapine and no mention of Seroquel?

(I'm questioning your pharmacist here.)

In any case, if you can't get some answers or different pills today, I would just take a whole tablet. 50 mg is a starting dose. It helps the drug not to be such a shock to your system.

Of course it's always best to get your doctor's approval before taking a dose other than exactly what's prescribed, but I would choose to violate that rule before I'd spend a weekend with no meds and the company of the auditory hallucinations.

Yes, I saw one 600mg post yesterday. And I didn't know if my memories of seeing similar doses were correct or delusional.

I'm drowning. I need some relief.

I cannot tell you how very much I appreciate your reply, help and support.

I was hospitalized for quite a while and had severe hallucinations and depression. ECT stabilized me. I'm making a call right now.

I just tried and was able to find posts discussing higher doses of Effexor by typing "600 mg Effexor", "450 mg Effexor" etc. in the search box. I had to put it in quotation marks to find the posts.

Just FYI.

My pdoc did not like to prescribe higher than 300mg except in the most severe cases, and then only for a short period of time.

Thank you, jo. If my doctor read my fax (and there is always the possibility that it's behind the fax machine) Amanda, the psychopharmacologist, made no mention of either my frustration at being on, what is for me I think, too low a dosage nor the mention that I made of having problems splitting the Seroquel.

I don't believe that he has read the letter. I don't know if that's good or bad. My next appointment with him is on the 23rd of this month and I have to know what my diagnoses really are and use your search method to take a dozen or so messages with me to prove that I am not unhinged when I put forward, again, the message that there are a number of people that more than a 225mg daily dosage.

So, yes, Amanda called me back and I explained the psychotic episodes but said nothing about my depression. She told me to go ahead and take a 100mg tablet but warned that I was certain to sleep. That was just under 7 hours ago. I haven't slept yet and while my auditory hallucinations aren't gone, they aren't as severe.

I didn't call my cardiologist and I think that I should have. I've been having severe angina since noon. I've taken four sublingual nitro tabs but the chest pains return. I still feel as if my brain has been cloven, right hemisphere from left, both frontal lobes cloven from the larger hemispheres, etc.

I know that I have taken antipsychotic meds before, but I was hospitalized and I don't recall how they 'made' me feel nor do I know what I'm 'supposed' to feel. Less crazy? Rid of hallucinations? 'Happy?' Less depressed? I don't know. I feel tired but I think that's caused by a lack of sleep for 3 days.

Yes, I am still angry and bitter at myself. I am sick at myself. I have vomited twice.

But to those who replied, and so quickly, any words of gratitude would seem too small, unable to adequately express the depth of my feelings. Because I did feel something other than pain at one time. I have purchased and not yet read a number of books on depression. Most, if not all, dealing with severe MDD. I've not quite finished Andrew Solomon's "The Noonday Devil," which everyone who has suffered from severe depression should read (just not WHILE you're depressed).

Thank you, again – I 'm off to post a new question (or search for answers to old questions) to see what others may have to say about how Seroquel 'feels' or 'felt' to them.

Thank you all so much.

My pdoc did prescribe higher than 300, but said it was very hard to get insurance to allow it. He had to petition it for me every month. Finally my insurance co. gave up and gave me a 10 year approval. Since that was 12 years ago, they cut me off 2 years ago, so I've had to switch to Pristiq + abilify.

Hang in there. Hope you get relief soon and the voices go quiet.

I've been on 375 mg of Effexor for at least 10 years with no problems, but I've never had hallucinations. I also take Seroquel - 300 mg, with no problems.

Good luck getting it sorted.

splitimage

I'm on 300 and my Pdoc said that was the top for me.