Ask Three Docs . . . Get Four Opinions . . .

I have been on medications for almost 11 years. I have been through so many. and At the present time I am on Effexor xr 150mg, Prozac 40 mg as the Dr. was trying to wean me from 225 of the effexor xr and add the prozac. 1 mg of xanax 4 x’s a day, seroquel 150 mg at night. So this was my new medication line up after switching psych drs. after 10 years. need a new beginning. not feeling good.
So this is what she added in. I am a homembody and fear the everyday so it was hard to get to some appts. what she was aware of in the beginning and after i missed 3 appt.s she called to tell me her office is to busy to help me even though she knew my issue.
So off to a new Dr. yesterday—he hates all my medicine and can’t believe what they have me on. So he wants me to start taking effexor xr 150 every other day, prozac every other day for about 4 days then just come off. xanax to kolonopin-take one xanax and next dose kolonopin for a few days then just kolonopin. He wants seroquel xr one night and then trazadone the next night at 75mg or up to 150mg and then let go of the seroquel xr. I am scared to death with all these medicine changes. Can I have some input here. I am already fearing life and now I fear the medicine. Thank you.

This hasn’t been easy for you, has it?  I think the root of the problem is not WHICH medicine you take, but WHICH doctor you see.  I don’t get from any of your comments the sense that you feel good about anyone that you have seen lately.  I don’t hear that they are inspiring confidence.  Above all, your doc should inspire confidence.  After all, this doc is going to be messing with your brain chemistry . . . better feel ok about them as a person and as a doctor!!!  You have been to three doctors lately and have gotten three different opinions . . . I’m not surprised.  The good news is that there is no such thing as a “good” medicine or a “bad” medicine.  Switching medicines can make a big difference, even when there is no good reason for it.  One medicine that inhibits serotonin re-uptake is as good as another . . . why would switching work?  No good reason . . . but it does.

It sounds like you have been through the mill with the medicine and, now, with doctors.  I can give you some quick thoughts about the meds you are on and the process of transition.  Effexor is not my favorite medicine . . . but it is a good medicine.  I have many people who have had great success with it and swear by it.  Side-effect wise, it is generally well tolerated.  The biggest problem with it is the high rate of discontinuation syndrome felt by patients who try to go off it.  This uncomfortable mix of physical symptoms is sometimes felt by Effexor-takers when they miss a single dose by as little as a few hours.  Going off it by taking that high a dose every other day and then stopping is likely to make you feel quite uncomfortable.  Interesting, the ‘antidote’ to Effexor related discontinuation syndrome is . . . Prozac!!!  I would not take you off both meds quite this fast, however, because of how long you have been on the medicine.  If someone has been on antidepressants for years, I will opt for a very slow taper down on the medicine.  Sometimes, this taper will take months.  Unless there is an specific reason to move more quickly, I have found it to be less uncomfortable for the patient, and less likely to be associated with a return of underlying psychiatric issues. So, assuming that you wanted to get off the Effexor, I might make a quick switch over to Prozac, and then make a multi-month taper of the Prozac.

Regarding you benzos, I am certainly more of a fan of Klonopin than I am of Xanax.  In making the switch, I typically keep the Xanax dose close to the original dose and add the Klonopin in.  The patient can then skip doses of the Xanax as they are able.  Most find that they don’t feel the “need” to take the Xanax almost as soon as the Klonopin is started.  The trick is to not get sucked into the feeling that you “need” them both.  The point of the Klonopin is to eliminate the need for the Xanax whenever possible.  Sometimes, both are needed and are beneficial.

Now, the Seroquel/trazedone . . . it really depends what the Seroquel was for.  If it was for mood stabilization or to enhance the benefit from the antidepressant, switching over to the trazedone might not do as well for you.  If it is strictly for sleep, then switching over to the trazedone might be good.  Trazedone tends to cause less daytime sedation than the seroquel.  If it turns out the Seroquel WAS helpful for your mood, you might not do as well without it.

I am not hearing anything particularly scary with the changes that have been outlined by your new psychiatrist.  My biggest concern would be the number of changes going on.  Whenever possible, I try to keep the number of changes down to a minimum.  One or two at most, avoiding three or more changes unless there is a very specific reason to do so.  If all these changes are made quickly, it will be impossible to know what caused what if you start to do poorly.  Perhaps a conversation with your new doc about slowing down that pace of the changes is in order.

2 comments to Ask Three Docs . . . Get Four Opinions . . .

  • T

    Thank you so much for your response. I am thrilled that you answered and you really listened to me. No I am not really trusting in any of these drs. It has been tough. My First Dr. I was with for 10 years and he just switched switched switched..Never ever talked about what was wrong. just medicine. Finally decided to switch because my life -i want it back. So I started with a reputable center and she was very new to Psychiatry and even looked like me..
    So she listened but no feedback. Then I had to miss like 3 appts due to my fear of sometimes leaving home and she called me (even though she knew this may happen from the beginning) and told me she just got too busy and just would not be able to accomodate me after she made the change to all my meds. ugh. even sent me a letter terminating me as her patient. really wanted to report her.
    So now onto a new caring dr. who has been practicing for years. He is now willing to take the process slow after getting to know me. He wanted it quickly.
    So at this point now -I withdrew from the 40 mg of Prozac I guess a little over a week now. I also switched my Xanax to Colonopin. Today is my first full day without xanax. I tapered as slow as I could.
    Now I tried to taper the 150 mg of Effexor xr just 37.5 mg less and it was an automatic headache. I went right back to my regular dose because I have a 5 year old son to take care of. And then now he would like me to switch from the Seroquel xr to regular seroquel and drop by 50 mg while adding half trazadone. I only used the seroquel xr for sleep. I appreciate any feedback. I feel so confused and sick for only being in my 30s. I actually feel better going ont he kolonopin and taking away the prozac.
    Thank you.

  • doctordan

    T–The easiest way to get off the Effexor (if you are having a discontinuation problem) is to . . . ahem . . . go on Prozac first . . . and then go off the Effexor. It would likely have been easier to get off the Effexor first and do the prozac later (zero chance of discontinuation with prozac). It does sound like you got someone who will work with you. Good luck!!

    DH MD