At what dose does Effexor hit norepinephrine?

Hi everybody,

It seems to me that many here have had success when one or a combo of medications are effecting BOTH serotonin and norephemine. And Kelley really helped me understand a little about this. So I went online to read more about both of these and the medications that affect both parts of the brain (very fascinating stuff). But I could not find specific information about what doses of Effexor hit norephemine and what amount of dosage affects serotonin? I actually found conflicting information about both. One source says that Effexor hits serotonin at a low dose and norephemine at a high dose. One pharmacist says that Effexor hits norephemine at a low dose and serotonin at a high dose :roll:

So I thought I’d consult with all you experts out there!!! My dr just increased my Effexor to 112.5mg and I’m hoping that will improve my symptoms. I’m currently at 75mg and doing much better, probably about 70-75%. But my driving is still on the scary side (better but not great). I’m wondering if norephemine or serotonin will help with the driving. Anyone have any thoughts on that.

Ok, will if anyone has any insight on this, that would be fabulous. Thank you Kelley(rockysmom) for your help on this too. You have made me more educated on this and now I can ask my dr about it when I see him in June. I’m hoping the increase will kill the rest of this crap.

MP

The Merck Manual for Health Care Professionals says:
“Venlafaxine functions like an SSRI in low doses (75 mg/day), a dual mechanism agent in moderate doses (150-225 mg/day) and affects serotonin, norepinephrine, and dopamine in high doses (375 mg/day).”

Even at 150 mg (where it begins to affect serotonin), consider this: Effexor has a SE:NE (serotonin:norepinephrine) reuptake-inhibition ratio of 30:1 – or, said simply, it’s 30 times more potent on serotonin than on norepinephrine.

By comparison, Cymbalta (for example) has about a 10:1 ratio.

The question about driving is hard to answer. Tim Hain finds Effexor highly effective for visual-sensitivity problems, though he rarely goes beyond 75 mg/day, so whether the dose increase will help more is uncertain.

When my doc added in Effexor (NOT generic) he said we would cap at 75mg for the reason that was stated in last post. Ask your doc about adding in Nortriptalyne or Verapamil to the mix and to keep your Effexor dose at 75. I have been on 3 daily preventatives for about 5 years and function at about 95%! Some of us do better with more than one daily preventative :mrgreen:

Pam

Thanks you guys for the info. I’m still a wee bit confused. It seems to me that if it’s affecting both serotonin and norephemine, then that would be a GOOD thing for MAV! I’m still an amateur at the drug thing, and trying to learn more. I have a great MAV doctor in Dr. Fife but I love getting info from all of you since you are the ones actually trialling these drugs.

I am very interested in Nort, but my dr wants me to give the increase in Effexor 4-6 weeks than I will entertain the idea of Nort! I’m a little scared of it since its a Tricyclic AD. My first drug was a Tricyclic AD (imipramine) and I felt worse on it. I wonder if Nort would have the same effect.

Pam, thanks for sending me your response. I could not handle verapamil. It made me more dizzy and I had very severe and painful constipation. I would be willing to give it another try in the future if things don’t get better but I’d like to see if I can find something more effective.

Thanks so much. :smiley:

mavprincess,
Most docs would agree that if you can get control with just one medicine, all the better. What George wrote earlier had a bit of a conflict to it…it says effexor works like an ssri at low dose (meaning it only hits serotonin) and becomes a dual agent at higher doses (like 150 or more) and eventually hits all sero, NE and Dopamine at the highest doses…So anyone who says Effexor hits noriephinerine at the low dose is mistaken. (Not you George)…
Cymbalta is a more balanced SNRI, which means it hits sero and NE in a more balanced way…I have read 10:1, but my docs say it’s more half and half. I truly don’t think there’s a way to measure exactly. Cymbalta, according to my research, is usually better tolerated in the sexual side effects department.
IF it were me, I would go up on my effexor. There are concerns about coming off of it, but none of these meds are easy to get off…if we ever have that option.
Good luck to you!
Kelley

Thanks so much Kelley~

That makes so much sense. You have a great way of explaining this stuff and I appreciate you always taking the time to further explain. You are such an asset to this forum. :smiley:

I am now on 112.5 of Effexor and the first few days have made me worse. Prior to that, I was already getting a return of my symptoms so I’m a bit discouraged now as I was feeling so great and even went back to work which could’ve triggered all of this. I am wondering if the Effexor stopped working. Just praying that this new dose will return me to feeling better. I know I have probably asked this of you before but I just don’t remember. What meds are you on?

Thanks.

Mary

Mavprincess,

Don’t have any insights on what proportions of seratonin and norepinephrine are effected via various dosages of effexor; Kelley and others on this board have a more informed opinion than I. I did want to tell you that I’m probably one of the few patients Dr. Hain prescribed 150 mg. of effexor. Like you driving was a big issue for me. 75 mg. helped but I still had some bad days. The 150 mg. dosage took a while to kick in but I’ve been at 90 - 95% for well over a year. Unless you start to feel much worse on your new dosage I’d suggest trying to give it a trial of at least 60 days. The sexual side effects for me have been a little weird, but so far manageable. Good luck to you.

Ed

Hi Ed,
Haven’t seen you in a while…glad you are doing well! For the record, 75mg of effexor is the usual starting dose for many people…150 is still considered a reasonable amount as some people need to go up to 375!! I used to be super afraid of these meds, but after a while, it’s just what you have to do to get your life back. None of us know what tomorrow holds, so lets make today the best we can…
Kelley

Kelley,

You expressed a wonderful sentiment. I finally realized that having to take effexor didn’t make me a weak person. It’s just something that allows me to live my life. I should be and am thankful. Good luck to all.

Ed

Hi Ed,

You have no idea how much better I felt when I read your reply. I seriously thought I was the only MAV person who needed to take more than 75mg and good to hear that Dr Hain sometimes goes over that. The first 5 days I felt like I was getting worse but that is starting to die down. I know I need to give it more time.

Did Hain start you out at 75mg? How did you feel at that amount? The reason why I ask is because I was feeling so good for several weeks at that dose, but than all of a sudden, I started to feel worse again. I didn’t and still don’t understand how that happened? So my dr just increased it to 112.5 and I felt really bad, but starting to feel just slightly better now. Did you feel bad at first when you upped it? How long did it take? Are you taking any other meds?

Your story inspires me to stay on it and stick with it.

Thank you. Thank you!

Mavprincess,

Dr. Hain started me out at 37 mg. and I then moved up to 75 mg. I recall it was at least 2 months before each step up in dosage and it took quite a while to feel better after each. I also take 120 mg. of verapamil. I’m glad my post gave you some encouragement. Hang in there, I hope effexor ends up being your answer to feeling better. But if not, don’t get discouraged. There are alot of other med options and its all trial and error.

Ed

Hey all,

I have been on 12.5 Effexor for about 8 days. I have been taking at night but I am getting some inconsistent insomnia. I am going to try switching to mornings next weekend and then increase to 25 if I feel okay. I did just stop taking my klonopin .5 at night so that may have something to do with the insomnia. I was just afraid to stay on the klonopin any longer (been about 3-4 months) because I have read that it makes it more difficult for your brain to normally adjust to this condition. How many of you are taking the Effexor at night?

I would not suggest taking it at night. I made that mistake the first night and literally slept maybe 2 hours. I take it in the morning right after my breakfast. I take 112.5 of it and I take the generic.

Do you take Effexor or the generic? Are you feeling any better? I certainly hope so.

Mary

Thanks for your post Mary! I have both the generic and the Effexor XR. I am on day 11 of the generic at 12.5 at night. I just took an additional dose of 12.5 this morning and did okay today. My doc prescribed .5 of Xanax to help me sleep because the Effexor was definitely keeping me up at night. It did help me sleep last night but I felt a little foggier than normal today. I am planning on transitioning to 25 mg of generic effexor on saturday and stay on that until the following weekend and then try the Effexor XR 37.5(this is generic also) in the morning. Is it even possible to get the “brand name” anymore?

New, first post.

Years ago I sat done with a Dr. and he pulled out this book. In bold print, simple charts, the book showed a list of medicine and the reactions to neurotransmitters immipramine: norepinephrine+++++ serotonin ++ Prozac: norepinephrine++ serotonin+++++
That is why he said my brain responded more to the tricyclics than the SSRI because I did feel much better on immipramine when I took Prozac it was like sugar pill.

Now I am on Elavil 150 at bedtime. My current pain management (Also pshyciatry and int. med.)
said that works better for pain. But I am going to ask him to try tofranil since I always felt better I think. You are right, I want to try for the medication that hits the most norepinephrine. Meds concentrating on serotonine did nothing. Have you used tryciclic (sp) the old antidepresants? I My appetite can back (I am too skinny) , slept better.
They do make your mouth dry. I did not care I felt better.
brian

— Begin quote from "BHKTOPS"

New, first post.

Years ago I sat done with a Dr. and he pulled out this book. In bold print, simple charts, the book showed a list of medicine and the reactions to neurotransmitters immipramine: norepinephrine+++++ serotonin ++ Prozac: norepinephrine++ serotonin+++++
That is why he said my brain responded more to the tricyclics than the SSRI because I did feel much better on immipramine when I took Prozac it was like sugar pill.

Now I am on Elavil 150 at bedtime. My current pain management (Also pshyciatry and int. med.)
said that works better for pain. But I am going to ask him to try tofranil since I always felt better I think. You are right, I want to try for the medication that hits the most norepinephrine. Meds concentrating on serotonine did nothing. Have you used tryciclic (sp) the old antidepresants? I My appetite can back (I am too skinny) , slept better.
They do make your mouth dry. I did not care I felt better.
brian

— End quote

Well interesting you say that because I didn’t feel a lot better until I hit Effexor at 150 mg. that’s where I am at now and am soo much better. The first drug I tried was a Tricyclic ad and it was imipramine (Tofranil). I didn’t give it enough time because some of the side effects were not fun. But I also didn’t know what I know now about meds and should’ve given it a bit more time. What drug are you on? I believe that the Effexor at 150 is working so well for me is because it’s hitting norepinephrine. Do you know if it’s hitting norepinephrine at this dose. I never really followed up on that?

Can I ask whether you guys would recommend as being more effective,…nortriptyline or effexor? I have an dilemma in that I am a high dose of zoloft and after a quick try of nort(a couple of weeks in which nort was pushed up too high too quickly and the zoloft pushed down too quickly) I was taken off the nort…Recently put on topamax, did not last long. My thought is to make a long term plan of switching to effexor from the zoloft or trying the nort again…but without the risk of the serontonin syndrome? Any advice would be great! Thanks