[lenjan]

Just curious if anyone is taking a dose of anything that is over and above the recommended maximum. My in-house pdoc put me on 450 mg Effexor XR -- I've been at 375 (the max, as far as I knew) for years.

I called my regular pdoc and he said two things: 1, that he regularly goes over the max recommended on several drugs, just not Effexor, and 2, that I should trust my in-house guy because he sees the hardcore cases in the hospital and knows better what works. (Good to know I'm considered "hard-core" ....)

It's not that I don't trust either of them, I'm just a little worried and a lot curious. Anybody know anything about this?

Candy

[Larry_Hoover]

Truly, there's nothing inherently dangerous in what's being suggested. Some people metabolize drugs very differently than do others. The limiting factor is not dose, explicitly, it's adverse effects. I'm sure you'll be appropriately monitored for adverse effects, so if you feel OK (side-effects are tolerable), then it is okay.

Lar

[lenjan]

Thanks, Larry, as always. It's only been a few days, but I haven't noticed any side effects at all.

Candy

[Butterfly_Faerie]

Some people do need to go over the dose if they need it.
People do that for Zoloft etc.

I don't know much about Effexor though as I just started it.

I think though that you will be fine, your Pdoc likely know's what he/she is doing, and wants you higher to perhaps stabilize you, if that's what is going on.

It's likely not permanent. If it is a concern bring it up to your Pdoc and maybe then you'll feel a bit better.

Sorry I couldn't be of more help.

[dasiy6]

I have taken 600 mg. of effexor xr for the past year. I have been on the drug for 5 years now and realize I have probably hit the top. I tend to develope a tolerence for meds over time so i usually top out and have to move on to a new med....i hate that

[CamW]

Candy - As Larry said, there is no problem to take higher doses of Effexor XR (venlafaxine) if there are no side effects issues. I'd just like to add a little information on this particular medication.

Effexor differs from other commonly used antidepressants that collectively go by the Name SSRIs (selective serotonin reuptake inhibitors). Examples of SSRIs are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram), and Luvox (fluvoxamine). SSRIs act by blocking the reuptake of the neurotransmitter serotonin between certain specific nerve cells in the brain that are involved in emotion. Serotonin has been shown to be deficient in many people who exhibit depressive &/or anxiety states. There are several other neurotransmitters that interact closely with serotonin and are linked to emotion; specifically norepinephrine (aka noradrenaline) and dopamine. All the neurotransmitters are functionally linked to one another, so that any change in concentration of one has an impact on the functioning of all the others.

At lower doses (< 150mg / day) Effexor act exactly like the SSRIs, but as the dose increases above 150mg / day the concentration of norepinephrine is increased, increasing the activity of nerve cells that use norepinephrine to carry an electrial signal from one nerve cell to another. As you increase the dose of Effexor above 300mg / day there is a significant increase in the concentration of dopamine, by blocking it's reuptake into the nerve cells that use it as a signaling agent increasing their activity (in much the same way as the increase in actvity of serotonin and norepinephrine).

After a certain dosage the activity of SSRIs "plateau"; that is, the reuptake mechanism becomes fully saturated and increasing the dose does not increase the amount of serotonin available, thus an increase in dose no longer results in an increase in antidepressant/antianxiety activity. Effexor activity, on the other hand, does not plateau, because as serotonin activity peaks, significant norepinephrine activity, and subsequently as norepinephrine activity peaks, dopamine neurotransmission increases. Since dopamine and norepinephrine are functionally linked to serotonin, in many cases (but not all) the increase in the neurotransmission of norepinephrine and dopamine result in greater antidepressant/antianxiety activity.

Thus, by increasing your Effexor dose your doctor is quite likely increasing the overall neuronal signaling in your brain, hopefully with the desired results.

BTW, I have seen doses of Effexor XR of 600mg / day used in a couple of cases treatment-resistant depression. I myself was taking 450mg / day for about six months (along with 300mg of Wellbutrin SR - bupropion) when my depression was at it's worst. It worked for me.

I hope that this is of some help - Cam

[lenjan]

Wow, thank you, Cam! Very useful stuff to know.

Candy

[bethesdabob]

Be careful with that high dose of Effexor, let me tell you my story.

My wife Barbara died 12/16/03, the Maryland State Medical Examiner ruled that she died from the results of a seizure disorder.

Barbara was an epileptic and bipolar, in the course of our twenty year marriage I witnessed her have many seizures, in the months before she died she told me that she felt like she had several seizures in her sleep.

Barbara's psychiatrist treated both her epilepsy and her bipolar, it is my belief that the meds that she was given for her acute depression might have lowered her seizure threshold and precipitated her fatal seizure.

Barbara had been taking Effexor XR and Remeron for two years, three months before her death she got pretty depressed and some of her meds were increased, her psychiatrist raised her Effexor XR from 450 mgs to 600 mgs, and her remeron from 45 mgs to 90 mgs at night.

In addition to the Effexor and the Remeron her psychiatrist also had my wife taking a cocktail that consisted of 20 mgs of adderal twice a day, 3 mgs. of risperdal, 900 mgs. of trileptal, 6 mgs. of clonazepam and 10 mgs of ambien at night.

My wife developed several side effects, instead of looking at her medicines and adjusting them she was provided with other medicines.

She got pretty severe headaches and was given two nasal sprays, imitrex nasal spray, and Stadol to use as needed , she developed high blood pressure and was given 32 mgs. of atacand, she was often complaining of vomiting and nausea - for that she was prescribed 30 mgs of prevacid.

It has been suggested to me that my wife was taking way too many medicines and that this polypharmacy mix might have created the conditions that led to her fatal seizure. Given her medications and their dosing I was advised by a physician relative to have a malpractice attorney review her medical records and her care. The records were received over nine months ago and are still under review.

Am still waiting for some sort of an answer, though my bride died over a year ago there is no feeling of closure, I never thought my wife's seizures would kill her, always figured that her shrink knew what she was doing too.