Effexor: The Great Earthly Antidepressant Hope?
August 25, 2007, 11:52 AM
DISCLAIMER: The views and opinions in the article, although backed up with sources and others' research, were written by a pre-med student. Always consult your doctor before taking any sort of medication. The SAS Magazine, SAS website, or SpeakEasy cannot be held liable if anyone decides to actually take this advice and for some reason, does not find positive results.
Sure, I’ve slandered her in the past, but I didn’t actually mean to hurt venlaxafine’s feelings, so hopefully she can forgive me. By the way, psychotropic medications are all female, if you didn’t know. All but Zyprexa, who is a fat nasty man with horrible temper tantrums and unkempt chest hair. Chew it up. Enjoy it. Ok, let’s take a look at SSRIs versus Effexor in antidepressant efficacy. You may or may not have heard about Effexor withdrawal, along with the brain shivers that could make you want to punch a baby. But does horrible withdrawal mean a horrible medication? Effexor says, “No. Eat me”. Don’t listen to her, though. Listen to the wonderful scientists over at PubMed. In a recent study, it had been brought to light that “remission rates were significantly higher with venlaxafine than with an SSRI”. But why, you ask; why are you giving this notoriously hellish medication such good ratings? Allow me to explain. Let’s take an SSRI, Celexa. All of the clinical effect from Celexa is coming from one single receptor. That lucky receptor is serotonin. However, it may as well be called "unlucky" for the patient because by around 20mg, he or she has gotten as much serotonin effect as they’ll ever receive from their darling Celexa. 40mg? Pointless. 60mg? Stand up, do a little dance, fire your psychiatrist, and tell him you just “schooled” him as you prance out of the door. He'll be confused and repulsed at the disgusting site he just witnessed, but maybe, just maybe, he'll take a look at some notes from past courses, and then, while chuckling to himself, exclaim, "Ah! It all makes sense! I'm a genius. Where's my secretary? Nancy! Get in here! I just found out that Celexa doesn't really do that much above 20mg. I'm an awesome human being. Publish it and hire my half-hourly rates by 400%. ". Ok, let’s look at Effexor, which is a serotonin/norepinephrine reuptake inhibitor. You don’t get both serotonin (S) and norepinephrine (N) at all doses. S is maxed out by 75mg, and N really starts to kick in at about 150mg. Taking 300mg of Effexor is the same S as 75mg, but the N is more. So, would you expect 75mg Effexor to be more efficacious than 40mg Celexa? No, because they are both doing the same thing: blocking about 80% of serotonin transporters. However, this efficaciousness changes after 150mg Effexor, because you have both S and N. At a higher dose (above 75mg), Effexor acts as a double-medication. A 2 for 1 deal. Effexor says, “Eat me until 150, baby”. In no way am I saying that Effexor is better than an SSRI, because what may work for one may fail for another. However, at less than 150mg, it would be impossible for it to be BETTER than an SSRI, because they’re both doing the same exact thing. If it is going to be better, it would be better after 150mg, and only because that second system is kicking in. So, think of it this way, how one responds to 75mg is not at all indicative of how one would respond to 150mg, because at different doses, they act as completely different meds. Sources:PubMed article
PDF of Celexa package instert (important to look at clinical efficacy trials)
Most of the numbers come from a psychiatry manual and from the Thomson-Gale Databases.
