Its been a while since I posted here and I see from the dates of the last post that things look pretty quiet. I hope Venla is still about.
I have been having some issues (lets say). I think it was October/November 07 I started taking venlafaxine. I went up to 300mgs in about a month. To be honest I felt a bit better for a while and then it tailed off. Since then as I have not been seeing the benefits of the drug I decided to try to lower the dosage. I came down to 225 over about 2 weeks in June and had about a month of getting used to it. My mood was pretty up and down to be honest. At the end of August I tried to get down to 150. I am currently on 187.5mgs. I do this by taking 225 one day and 150 the next. It is this reduction that is causing the issues. I have been very anxious and depressed again. The problem I have is that I cant distinguish the side effects of the drug from the symptoms of anxiety. As I am not on a constant daily dosage I am wondering if this could be causing the problem as I know only too well how sensitive brains seem to be to this drug. So I was wondering if that has been an issue for other people.
Unfortunately my GP has been altogether useless. I have been back to see him something like a dozen times since last december and get fobbed off with the old 'its just a bit of anxiety, ride it out' . Today I asked if I could go on a waiting list to see a psychologist and he actually told me it would be pointless as it wouldnt help. He also changed my prescription today to Cymbalta, telling me it wasnt addictive and had no side effects. I looked it up on the internet and my understanding is it is even more problematic than Venlafaxine to come off. So Im pretty much up against it with him, although I will now be looking for a more sympathetic doctor. I will probably go back and see my psychiatrist although the issue with him is he is very happy to prescribe pills and then forget about you.
My other question is related to SNRI drugs as opposed to SSRI. I had success with Paroxetine for 10 years before it became less effective. I came off the drug a couple of times and it wasnt exactly a piece of cake but it was manageable. My understanding of SNRI drugs is fairly narrow and I only know about Venlafaxine and what I have read about Cymbalta however they both seem to have similar side effects and very similar withdrawal issues. Is this common of all SNRI drugs? If this is the case I think I might be asking to go back to Paroxetine and see if not being on that for 3 years has made it effective for me to take again.
What are your thoughts? And how are you doing these days?
Ive not been on here for a few months but I found this site so useful. I hope everyone comes back again. It was so reassuring to have someone here answering your questions and being able to talk to people in the same situation. I hope everyone is doing well whatever your up to.
>>>150. I am currently on 187.5mgs. I do this by taking 225 one day and 150 the next.
Ideally you're not supposed to go up and down like this, esp. since venlafaxine has a pretty short half life. Why don't you get a script for 150 + 37.5? I, for instance, am currently on 75 + 37.5. Or, you could manually split the capsules yourself to approximate the 187. I know Venla would kill me for suggesting this, but I'm thinking at this high a dosage, the body probably can't tell the difference between 187 and 177 mg. :) Having said that, my "feeling" is that your anxiety problem is not due to this inconsistencies. After all, you mention venlafaxine is has been giving you irregular benefits even when you stayed put on a daily dosage.
>>>distinguish the side effects of the drug from the symptoms of anxiety.
Tell me about it..
>>>Cymbalta, telling me it wasnt addictive and had no side effects. I looked it up on the internet and my understanding is it is
Brian is our resident expert of Cymbalta, but seems to me Cymbalta shouldn't be more "benign" than FXR. In fact FXR isn't really addictive anyway, so not sure if your doc knows what he's talking about.
>>>might be asking to go back to Paroxetine and see if not being on that for 3 years has made it effective for me to take again.
Venla would know more about Paroxetine. Now, if your issues are mostly related to anxiety, venlafaxine might work for you on 75mg. As you probably know it deals with serotonin regulation at that dosage pretty well, and if you go up to 150 and above you're dealing with NE and DO. Could it be that your NE is more than normal at this dosage?
Perhaps more importantly though is to ask yourself what kind of anxiety you have. For instance, 2 yrs into my venlafaxine treatment I kind of realized I have ADD and started taking Adderall. And that had a surprising effect on stabilizing my agitated mind. (Currently I'm on 112.5 of FXR + 20 mg of Adderall.)
Also, what about exercise -- does that help? I think the first thing to figure out (if possible) is whether your anxiety is due to screwed up neurotransmitter action, or something more physiological (hormones, etc.) or something psychological that's part of your life (neighbor playing the drums all night, etc. :)
Well I have long standing Anxiety and Depression issues. Both fuel each other basically. The situation has been made all the more worse over the last few years and especially the last 12 months by several people close to me going through very long illnesses and deaths and I have had a ringside seat for.
The anxiety I am suffering at the moment is definitely of the General Anxiety Disorder. I think basically my mind held itself together whilst it had to and then 2 weeks after the last death had enough and rebelled. The issue at the moment for me is I cant break out of the constant circle of anxious and depressive thought.
I am seeing my psych this week, for the first time in 6 months and I am going to ask him to review my meds. I will also ask him about any tests that can look in to hormones or miss firing neurotransmitters as nothing has ever been investigated in the 20 years I have had these issues.
I have taken note about what you said about see sawing doses. I am investing in some micro scales at the moment so shall be making my own pills very shortly.
Thank you as always for your advice and I will post what the doc says after I see him on Tuesday.
It's hard to say whether your anxiety symptoms are related to the decrease in Effexor or whether the anxiety is a result of its pooping out on you since different people experience different things on these medications. It could also be a combination of both of those things. If Effexor worked for you for a while, then Cymbalta may not be a bad choice for you. It would also stop the problem of the Effexor withdrawal as long as you decreased the Effexor slowly. You could add in the Cymbalta as you're decreasing the Effexor to speed things along or you could take the Cymbalta immediately after stopping the Effexor. You're likely to have less problems with withdrawal if you add in the Cymbalta as you're decreasing the Effexor.
Neither Effexor nor Cymbalta are considered addictive though they both can have withdrawal effects. You may consider this to be just a matter of semantics though as addictive medications are considered those that cause the person taking them to constantly increase dosage to get the same effect. In terms of Effexor and Cymbalta, a dependence is created but not an addiction. I've heard and read the opposite of what you've read which is that Cymbalta's withdrawal is not as bad as Effexor's. With both medications, there are ways to mitigate the withdrawal however.
It may be worth trying the Paxil again if you had a good response to it earlier. That would also prevent the worst of the Effexor withdrawal. These days the SNRIs (Effexor, Cymbalta) are more popular to prescribe than the SSRIs such as Paxil so it may be more difficult to get your doctor to go along with that choice.
In terms of your Effexor withdrawal, I agree with ven that it's best not to seesaw the dosages like that. As you go back up in dosage on the alternate days, it just resets your level to the higher dosage. Glad you're getting the scale. Also, once your medication gets control of the anxiety symptoms, then the anxiety itself and the worried thoughts should decrease as well. It's helpful to break that cycle of the thoughts causing more anxiety which cause more of those thoughts.
I'm sorry to hear that your doctor is not a lot of help. I can't believe that the comment about the psychologist not helping. A good psychologist can be extremely helpful - especially when one is dealing with the kind of issues you've had to contend with recently. In addition to talk therapy for your grief, I wanted to recommend that you ask your doctor about Cognitive Behavioral Therapy but it looks like he might not be a good person to ask about this. It can be very effective for controlling thoughts (although if there is an obsessive compulsive component to your thoughts then it may not be the right kind of approach for you). Are you in a position to change your doctor?
Great idea to have your hormone levels etc. checked. People who are under a lot of stress often have cortisol levels that are too high, which contribute to the over-response of the nervous system. If this is the case, then there are things that they can do to bring down your cortisol levels.
Good luck with your appointment on Tuesday and please keep us posted!
Well I saw the pysch on Tuesday and I broached everything that has been on my mind. I basically told him I have been put off SNRIs due to some adverse reactions I have experienced and also a lot of what i have read. Bsically he agreed that i should go back to trying the paxil. Which to be honest is supposed to be one of the worst to come off. However having done it before I know what Im dealing with. I am to reduce from my current dosage of Venlafaxine 187.50 over about a month whilst going up on the paroxetine up to about 40 mgs which is more than i ever took before. So we will see what happens. I am hoping that the withdrawal symptoms will be managed by the increase in the other drug.
What I was disappointed about was that he wouldnt send me for blood tests. My gut instinct is that i do have high cortisol levels. The first whiff of adrnaline and my body over reacts. Tonight I carried some boxes out in to the car, not exactly strenuous but enough to release a little adrenaline. Before I knew what was going on my head was dizzy and the familiar wooziness of anxiety was there. A complete over reaction to a normal everyday action. I will have to look and see if there are any over the counter/natural suppliments that might help me get my cortisol levels back in order again as I dont think my doctor is going to help. The issue in the UK is that our national health system is really stretched and doctors wont send you for tests unless you are at deaths door. My GP back in Australia would have had no issues with getting my hormone levels looked at.
With regards to therapy, I have taken matters in to my own hands. I have found an extremely good councillor. She isnt a psychologist but she is undoubtedly the best person I have had to date in 15 years. I also saw an extremely expensive CBT specialist last year. She cost about $400 US a session and basically read through a chapter of a text book with me each week. I could plainly see the benefits of CBT but at the time I found it didnt work wonders for me. Basically I would work my way through each thought process and analyse it and try to come up with a balanced and more reasoned thought just to find that actually I wasnt far off the mark in the first place, I was just dealing with some very heavy and nasty stuff at the time. I do intend to go back to it at some point though and follow it up as it has definite benefits. I consciously used the techniques this week whilst i was having some problems and it did seem to help.
Anyway that is where I am up to this week.
I will keep you posted as I go along and let you know how the drug change over goes.
It sounds like you're glad to be going back on the Paxil. As you know, it does have a good track record against anxiety. Hopefully it will work for you again this time.
Really a shame that you can't get your cortisol tested. I've heard similar stories from other folks in the UK. The health care system there is not what it used to be unfortunately. Plenty of problems with ours in the U.S. as well. There are places you can send away for your own kits but it will cost you and I don't know if it's legal there (as it is in most states in the U.S.). Phosphatidylserine is a supplement that's supposed to be good at lowering cortisol levels. Whey protein powder can also reduce it. Actually there are a lot of things that can help with this problem.
One thing to watch out for here is that the symptoms of over-reacting to stressors can be a sign of LOW cortisol as well. I don't know if you know anything about adrenal fatigue. If not, it might be helpful to read up on it. To try to simplify this, when you are under too much stress, your body can end up over-producing cortisol. If this state of affairs goes on for too long however, it can burn out your adrenal glands and they start under-producing cortisol. There are some simple procedures you can do at home that can indicate whether you may have this problem. Also, some of the symptoms of adrenal fatigue are intolerance to cold, difficulty in waking up in the morning (you may not feel fully awake until much later in the day), crushing fatigue within an hour or two of exercise, feeling overwhelmed and unable to cope, increase in allergies etc. If you think this may apply to you, then definitely don't start on cortisol lowering supplements. Also, if you think that this describes you, there are things you can do to raise your cortisol levels. That's what I'm dealing with right now.
That's great news about your councilor as it can be so hard to find a good one. Looks like you're way ahead of me on the CBT and you know when it's helpful to you and when it's not. I know that there are some people who have been helped tremendously with anxiety by utilizing this. I have found it helpful for me in choosing how to react to things and making decisions but not for the anxiety itself.
Good luck with all of your efforts! I'm looking forward to hearing about how you're progressing.
To update you. I have been aware of Adrenal Fatigue for about 6 months or so and I have strongly suspected that this might be an issue with me. Getting a GP over here to actually believe it is actually a real condition is another issue completely. The list of symptoms for the condition reads like I personally wrote it myself and as it came off the back of what I had just been through does more than ring a small bell with me. I went to my GP yesterday to get my prescription for paxil. Not only did he make me feel like I was wasting his time seeing him when I could have just picked up the prescription at the reception he also flatly refused to think about the possibility of adrenal fatigue as he had not heard of it before. This is just another in a long line of let downs by him to be fair but when youve had a doctor for 20 years its hard to let go and move on.
On to the next part of my interesting 24 hours.
I took my first dosage of paxil 10mgs with 150mgs of FXR at about 4pm yesterday. By about 9pm I had a bit of the light headedness. I dismissed this out of hand as I have had it so often in the last year that I have put it down to a side effect of venlafaxine. By the time I got in to bed last night I was fairly down as well. I tossed and turned all night and didnt manage to get any sleep. I had a couple of brief and frightening nightmares which is very unlike me. I cancelled what I was doing today (tutoring IT) on the grounds that if I had had no sleep it would make my day so much harder as I teach one lady for 8 hours each Saturday and without a clear head, nice as she is, I would probably attempt at some point to give her a laptop enema when she asks me for the 50th time where the shift key is or the like :). I was still feeling the dizzy feeling this morning but figured I would feel better after some sleep. I have basically spent the day in bed and have possibly had an hour or twos sleep punctuated by horrific nightmares. My head is on a different planet at the moment it is just swimming. I am getting the odd brain zap thrown in for good measure as well and I also have an upset stomach as well as a lot of general anxiety. I dont know how long this is going to last but next friday I am supposed to drop to 75mgs of EXR and go up to 20 mgs of Paxil. Naturally if I get this reaction from dropping 37.5 mgs after a day, next weeked is going to be interesting to say the least. My plan for changing the meds is as below.
Venlafaxine / Paroxetine 187.50mgs 0mgs 150mgs 5-7 days 10mgs 75mgs 5-7 days 20mgs 37.5mgs 5-7 days 30mgs -------- 40mgs
I have my doubts at the moment as to whether or not this might be achievable on that time scale. Id love to hear from anyone who has had experience change to another antidepressant from FXR.
Venla, if you are interested I can give you the details of the CBT workbook I used. I bought it on amazon on the advice of a psychologist. It is intended that you go through this on a weekly basis with a trained CBT therapist however my personal experience was that the therapist was a huge waste of cash and that the book was very useful on its own.
Anyway that is where I am up to today. I am looking forward to tomorrow with....................anticipation is the wrong word, fear is probably a better one. I will keep you informed.
There is nothing worse that that. I do it with hotmail all the time. You write an epic and then accidentally hit the back button or something. You would think with all the technology in these browsers these days that they would be caching what you write as you write it just in case you hit the wrong button.
Update on today is that my last dosage of effexor and paxil leveled me right off and and dealt with all the withdrawal within about 3 hours of taking the dose. It is still frightening that i had such a reaction in the first 24 hours after reducing the dose by only 37.5mgs from such a high dosage. I guess next friday will be interesting when i cut the effexor dose in half.
I am going to get some 5-HTP tomorrow and take 50mgs a day whilst I am changing the meds over. I think I might up the paxil to 20 mgs 2 days before I drop the effexor this coming friday, basically to make sure i have a nice cushion of seratonin to fall back on. What do you think?
Have been a bit anxious today. Unfortunately I am surrounded by stress at the moment which due to the meds and my prolonged exposure, I tend to overeact to. I have felt like this for so long that I dont know if its the reduction in the FXR or just the way I am at the moment. I have pretty much been avoiding everything for the past 4 months or so and have spent most of it in bed avoiding everything. That alone drives me mad but it does keep me calm. Its just that when I do go out I tend to notice how different I feel so much more and that causes a lot of anxiety in me. Me and my brother are having to clear all my dads stuff out of his house this week to get it ready for rent. We have been unable to sell anything and havnt even been able to give much away. It is truly heartbreaking to have to destroy and throw away so many nice things and furniture that we both grew up with. Its quite soul destroying. I suppose that alone would be enough to cause anxiety and depression. I find it so frustrating to not know what is causing my feelings though. Its been 6 months since he passed away and I have been so self absorbed with my own feelings of anxiety and depression and anger that I havnt really had time to grieve to be honest.
Phew!!! I seemed to go off on one a bit there.
Anyway I will keep with the 150mgs FXR and the 10mgs Paxil tomorrow and see what happens. I am actually going out tomorrow to do a bit of tutoring for a friends parents. I am really apprehensive about it to be honest but I am also very muich aware of the dangers of putting off going out and letting my anxiety control me too much. We will see how it goes and if I run from the house screaming like an idiot without warning :) .
I was reading through a lot of the discussions on this site earlier and I followed the thread in 'Withdrawal' Brian and Venla were having. Im interested in what you were saying about 'non-flush niacin'. I still need to go and buy some 5 HTP from a health food shop and I am assuming that they will sell the the niacin there. What do you think? I dont really want to find myself overloading my system with too many different things at once.
Well if you get the chance tell me what you think.
Sorry for not getting back to you sooner. I have a cold so I'm not at my best but I did want to say a few things about your posts. I was really surprised that you had such a strong reaction to cutting back the Effexor by only 37.5 mg. It's possible that the Paxil itself was giving you that feeling - or was at least partially responsible for making you feel that way. You're probably remembering how you felt on Paxil in the past but you haven't been on it in a while and your body has to adjust to it again. In addition, SSRIs can create more anxiety when first started especially when you're already anxious and stressed out. One way to test this of course would be to take an increase of Paxil without decreasing the Effexor. I'm glad that the last time you took both the Effexor and Paxil, you felt ok. If, at any point, during the cutting back on Effexor, you feel too ill, then just slow it down again (assuming you have enough medication to do that).
I would advise against adding 5-HTP to the mix. You do not want to be taking too much serotonin. If you've read my other posts on this, you know that a very serious problem called serotonin syndrome is possible. This can be fatal so it's not something you want to risk. Also, the effect is cumulative so if you feel fine after taking this mix for a night or two, it doesn't mean that it's a safe dosage combination.
Both non-flush niacin and niacinamide can be calming. (Don't use regular niacin though.) They can be found at the health food store. It's readily available in the U.S. but I think Brian had a hard time finding it in the UK. It can be ordered over the Internet too but I'm sure you want to get it sooner than that. Just don't take more than 500 mg. of niacinamide at a time and only take that 3-4 times a day. I can only take about 175 mg. at a time though others can handle more. For me, any more than the 175 mg. will make me too groggy to function so go slowly and see what you can handle. Another good reason not to take the full 500 mg. is because the calming effect of niacinamide is created (at least in part) by an antihistaminic action and Paxil has some antihistaminic effect as well. You don't want to overdo that effect either.
You might also want to consider supplementing with magnesium as that can be quite calming for some people. It can help with depression as well if you're at all deficient. I've known of a couple of people for whom it has made a huge difference. Just try to get a form other than magnesium oxide. That's the cheapest form and so it's the most prevalent but it isn't easily absorbed or utilized by the body.
I'm so sorry to hear about your father. I helped my mother clear out her house and sell it about a year ago so that she could move into an independent living facility. That was the house I grew up in so it was a sad time. I'm sure it's a much more painful process having lost your father. You said that you haven't grieved yet but I wonder how much of your depression is the grieving turned inward if you know what I mean.
Keep us posted on your progress. My fingers are crossed that the rest of your withdrawal and switch over to Paxil are smooth and uneventful.
Venla
P.S. Yahoo mail now has an autosave function that saves your message quite frequently so you don't lose it all if something goes wrong. I think gmail has that as well so you might want to check them out.
I am actually thinking that I might have forgotten to take my venlafaxine that first day I took the paroxetine. It is possible but I am 99% sure I did take it. I am very good with remembering to take pills. I suppose I wont know for sure till I make the next reduction on friday. Just tried to get some non flush niacin and some magnesium from Holland and Barrett (a very overpriced health food shop in the UK). The poorly trained chimp behind the counter didnt have a clue and all he could do was grunt. I found the normal niacin and magnesium oxide but that was all so aborted mission till tomorrow.
Well this weekends reduction went a lot more smoothly than last weekends. Apart from a bit of dizziness and some stomach upset that was all I had really. So I am not complaining. It could be down to me now having some paxil in my system to help things. I just hope that the paxil can help bring be a bit more back to normal as things havnt been too good the last year.
Fingers crossed. I will keep you informed how the rest of the changeover goes.
Dont know why my last post didnt work. I am due to be off the effexor completly in about 10 days. Hopefully it will go OK. Im thinking if I am going to be having a problem though that it is going to be coming when I go from 75 to 37.5 and from 37.5 to 0. We will see and I will keep you posted.
I am still very anxious and depressed although I have noticed that since I cut to 150 and below a lot of the symptoms like the dizziness and the fuzzy head have gone so I am putting that down to side effects of venlafaxine. I think it must be metabolised very fast and if i am getting near my dosage time I start getting those strange feelings. Now I am on a lower dosage they seem to have disipated. Hopefully it continues.
Yeah, unfortunately reducing from the lower dosages seems to be more difficult. I don't remember having any problem going from 75 to 37.5. I might have done it in two stages though. But the only problem I had was once I got under 37.5 mg. However, I wasn't taking any other serotonergic medication to compensate for the loss of it from the Effexor. Once I started feeling sick, I quickly got something else and I was fine so you might not have any problems at all.
Interesting about how you would get the dizzyness before it was time to take your next dosage. I would get that feeling if I went about 4 hours over the time I was due to take it. It's not a lot of fun. On the bright side, you can never completely forget to take it. The sick feeling is a constant reminder.
Well this week has been interesting. I have slept a lot this week infact I have barely gotten out of bed. This is pretty much a common thing for me with my depression and anxiety. Whether or not it is down to my reducing the dosage from 75 to 37.5 or not, I couldnt say. I am now on 30mgs of paxil which is a sizable dose so I would imagine that it isnt down to the effexor reduction. Tonight I felt quite strange, like edgy and nervy like i had this excess energy inside but at the same time I could hardly keep my eyes open. I seem to remember feeling like that when I was first going up on the effexor. I went up very fast from nothing to 300 in about 2 or 3 weeks and I had to slow it down for a week or so at that point. Perhaps it is the same thing again.
Tomorrow I am due to come off the effexor completely and increase the paxil to 40mgs and maintain till i see the psych at the end of November. I have to say I am a bit pessimistic as to whether the paxil will work for me again. After all I changed from it 3 years ago as it didnt seem to be doing much for me back then, although I was only on 20mgs at the time.
Once again I will keep you informed as to my progress.
I have just been scanning the forum for a post about dopamine. I cant seem to find it but I will ask what is on my mind and hope that whoever mentioned it doesnt mind typing it out again.
I am aware of how both seratonin and nor-ephenephrine work with regards to depression and anxiety but how does dopamine work? Is it worth me looking in to seeing how I can boost my dopamine levels? Can it be done safely with over the counter meds or is this a doctor thing? Might it mess with my current meds?
Just a though and on that note and at 5am I shall try to get some sleep before I am forced to shout obscenities at the birds should the dare to sing when the sun comes up in a couple of hours.
It's so hard to know whether your symptoms are from Effexor withdrawal or from increasing the Paxil or both. You'll have to experiment to figure out what is causing what. If you start feeling too unwell, then definitely slow it down. No need to rush this. The last part is the toughest part, as you know. Also, your depression could be from the lack of antidepressants. Although, you're building up on the Paxil, you probably haven't been on it long enough to get the antidepressant effect from it. That's usually 4-6 weeks at a substantial dosage and it's no different just because you're dropping down on the Effexor at the same time.
Hope you got some sleep before you felt the need to yell at those poor birds. :) I didn't get much sleep last night either. There was a huge fire close to where I live and I was worried about it traveling down to my apartment complex. Hopefully I'll sleep a long time tonight. To that end, I'm going to get off of the computer now. I'll answer your second question tomorrow.
I'm not sure how to answer your question as I'm not sure which dopamine post you were referring to in your message. I'm going to take a guess that the post was about the relationship between dopamine and serotonin as I know I've mentioned that a few times before.
One of the major problems with the SSRI medications is that they eventually tend to reduce dopamine. Think of it as a see-saw with serotonin on one side and dopamine on the other. Eventually the continuous serotonin enhancement has a diminishing effect on dopamine. Once dopamine is diminished, you take away a lot of the joy from living. Dopamine (along with norepinephrine) is also involved with motivation so one might have less drive as well. The SSRI would still be lifting mood so the person isn't totally depressed but they're drive deficient and they don't derive much pleasure from their activities. You might have heard the term "SSRI apathy". That's what the term refers to. One theory is that this is what really happens when an antidepressant "poops out". This can pertain to SNRIs like Effexor or Cymbalta as well because even though they have some noradrenergic activity, they are still predominantly serotonergic.
In order to get a complete response from a serotonergic antidepressant (particularly when you've been on it for a while), you often need to augment with other medication(s). There are several different types of augmentation strategies but one of the main ones is to add in noradrenergic/dopaminergic medications. I mention both of these neurotransmitters because they often work together. I don't remember the exact sequence but they even change into each other in our systems. If you had an incomplete response to the Paxil and were to add on a strictly dopaminergic medication, you would probably experience more joy and music would sound amazing to you. However, most of the pure dopaminergic medications (anti-Parkinson's meds) tend to give that reaction for a little while and then peter out. They also tend to produce a lot of day time sleepiness. So obviously, the situation is more complex than just adding in a dopamine agonist or a dopamine reuptake inhibitor. People I've seen on other boards have had success augmenting SSRIs or SNRIs with both norepinephrine and dopamine. Wellbutrin (bupropion) and stimulants enhance both of these neurotransmitters and are commonly used for augmentation.
There are other types of strategies for enhancing the antidepressant effect of SSRIs but I won't go into that here as that would make this a very long post. I did want to mention, however, that there are other chemicals and neurotransmitters that may be involved with depression for different individuals. Consequently, the situation could be more complicated than just enhancing the three neurotransmitters we've been talking about here. In fact, there are currently antidepressants in the testing stages that have little or nothing to do with any of the neurotransmitters we've been discussing.
Anyway, I hope that I've answered your question. I also hope that you're surviving the last stage of the transition to Paxil.
