[Bird Feeder]

I take 600 mg of Effexor xr,
450 Wellbutrin
100 seroquel
15 abilify
1 mg klonopin
3 mg lunesta.

Is there any room to go up?? I am desperate take ECT every 2 weeks and still feel suicidal. Ugh!!!!

I hate to be a bother to my podcasts he is a nice guy

[childofchaos831]

When I was on effexor xr, my pdoc had me on 225mg and it was my understanding that was the max dose for it. You really should ask your pdoc instead of on here. We aren't doctors, and can't give medical advice. That is your pdoc's job. That dose sounds really high for effexor to me.

[Guiness187055]

I know abilify helps to boost anti depressants.

Those are REALLY high doses of both effexor and wellbutrin. That would concern me.

[Bird Feeder]

I have been on both the Effexor and Wellbutrin doasages for about 15 yrs. I am glad the abilify looks like it has some movement, I think I'll ask my pdoc about that.

The Effexor and Wellbutrin have worked well in the past now I feel like I'm just in a holding pattern.

Thank you.

[still_crazy]

hi. i don't think you can increase the wellbutrin or the effexor. you're maxed out already. abilify could conceivably go up to 30, but w/ antidepressants on board, you might be maxed out there, too (antidepressants tend to increase tranquilizer/antipsychotic blood levels).

what are your remaining symptoms? now and then, stimulants are used with antidepressants, especially in "treatment-resistant" and/or severe depression. amphetamines, ritalin, focalin, now and then provigil or nuvigil. those come with risks (dependence, addiction, agitation, mania, psychosis), but do help some people. with your cocktail, a stimulant might trigger serotonin syndrome.

remeron is added to effexor sometimes. the combination is called "california rocket fuel," and there's a little bit of data on it. the problem there is you're already maxed out on effexor and wellbutrin, plus you're taking 2 "atypical" tranquilizers. remeron tends to be sedating, especially at the lower doses people usually start on, so that might not be a good idea with the seroquel on board.

have you ever tried a mood stabilizer? if you're doing ect treatments, probably not the best idea, but...some anti-epileptic drugs can reduce the frequency and severity of dips into depression. lamictal is one increasingly popular option. lithium is still used, especially at lower doses.

klonopin can sometimes cause depression, or make ongoing depression worse. kinda lame. any benzodiazepine -can- do that, but its apparently worse w/ klonopin. xanax, on the other hand, is used now and then to treat depression and/or to boost other treatments for depression. i think there's a once daily, all day xanax out now.

hope this helps. keep in mind; im -not- any sort of expert or anything, just sharing random info i've picked up here and there.

have you run a drug-drug interactions checker on your combination? might be worthwhile.

[Bird Feeder]

Originally Posted by still_crazy

hi. i don't think you can increase the wellbutrin or the effexor. you're maxed out already. abilify could conceivably go up to 30, but w/ antidepressants on board, you might be maxed out there, too (antidepressants tend to increase tranquilizer/antipsychotic blood levels).

what are your remaining symptoms? now and then, stimulants are used with antidepressants, especially in "treatment-resistant" and/or severe depression. amphetamines, ritalin, focalin, now and then provigil or nuvigil. those come with risks (dependence, addiction, agitation, mania, psychosis), but do help some people. with your cocktail, a stimulant might trigger serotonin syndrome.

remeron is added to effexor sometimes. the combination is called "california rocket fuel," and there's a little bit of data on it. the problem there is you're already maxed out on effexor and wellbutrin, plus you're taking 2 "atypical" tranquilizers. remeron tends to be sedating, especially at the lower doses people usually start on, so that might not be a good idea with the seroquel on board.

have you ever tried a mood stabilizer? if you're doing ect treatments, probably not the best idea, but...some anti-epileptic drugs can reduce the frequency and severity of dips into depression. lamictal is one increasingly popular option. lithium is still used, especially at lower doses.

klonopin can sometimes cause depression, or make ongoing depression worse. kinda lame. any benzodiazepine -can- do that, but its apparently worse w/ klonopin. xanax, on the other hand, is used now and then to treat depression and/or to boost other treatments for depression. i think there's a once daily, all day xanax out now.

hope this helps. keep in mind; im -not- any sort of expert or anything, just sharing random info i've picked up here and there.

have you run a drug-drug interactions checker on your combination? might be worthwhile.

Thank you so much. I really don't want anything sedating. The seroquel, klonopin and lunesta help with sleep but leave me a little dragging in the morning. I would love a stimulant but it has never been offered as a additional med. I don't know why. I just feel like nothing is working anymore for me and the suicidal thoughts are just getting overwhelming again. Ugh. Well thank you again. I will run a drug to drug interaction on my meds

[still_crazy]

hi. sorry about your situation. suicidal thoughts can be the absolute worst. with that much effexor, you should have plenty of serotonin reuptake inhibitor action going on, which can help with ruminations, ocd-type stuff, anxiety, etc.

do you need the seroquel to sleep? personally, i try to take 1 tranquilizer. i take 20mgs/abilify daily, and its good for me. when i get really agitated, i'll (rarely...) take a low dose of risperdal, at night. not ideal, but it "gets the job done," and I don't do it very often.

i don't know your insurance situation, but maybe another shrink? have you tried talking treatments, non-drug stuff? i take a lot of supplements. its called Orthomolecular. the idea from the old school Orthomolecular doctors was that one would take psych drugs (in my case, a tranquilizer) while also taking the massive doses of vitamins. over time, the dose of the psych drug(s) could be reduced or tapered, and one would stay on the vitamins.

sorry this is happening to you. in addition to stimulants, other drugs are used "off label" for mood disorders, including mirapex (a neurology drug), opioids, ketamine. there's a new round of research into hallucinogens for various psychiatric indications, and they're apparently showing good results in -some- cases.

i hope you and your doctor can find a solution.

450mg Wellbutrin is a high dosage -- it's maxed. In fact my pdoc just today upped my wellbutrin to 450mg as well. So I can attest to that being the at least consensus of "the limit". Internet says 450 or 400 depending on formulation.

Good luck with your medicine maintenance!