All About Serotonin & Norepinephrine Reuptake Inhibitors SNRIs Psychiatrist Robert D McMullen, MD
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- Опубліковано 7 кві 2018
- All About Serotonin and norepinephrine reuptake inhibitors SNRIs with Psychiatrist Robert D McMullen, MD
Serotonin and norepinephrine reuptake inhibitors (SNRIs).Examples of SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
how do snri work | SNRI side effects | best snri for anxiety and depression
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You live once. Make it count. Take the meds if you need too. I did. And I’m very glad for it. The advantages of feeling and operating like a normal person outweigh the side effects by far.
when you have peace of mind you have everything when you don't you have nothing!
He is smart. This Dr knows what he's talking about. Thank you for your free advice and taking your time to do these videos. I've been on prestiq for a month and it causes me to get shakes and nervousness and energized. But it is almost a weird feeling 😕 I'm not sure it's for me but I'm not on the couch stewing in depression now. I'm up cleaning and it feels good to be able to get up and do things. I just don't know what to do about the nervousness and shakes I'm on 25 mgs now
Doctor Rob!!! Come back to UA-cams. Your videos are interesting and relaxing
What a good guy
The improvement in mood is within the same day, the first day.
Thanks doc
I’m 32. Depression and anxiety introduced itself at age 10. After high school I began SSRIs. Tried several over the years with zero effect positive or negative. Finally found Effexor at age 25 and it helped depression - didn’t remove it but helped a LOT. Didn’t help anxiety until about 1 yr mark. I stopped taking it cold turkey without any issue, and got pregnant. I began again after birth at 37.5 increasing to 150 as I was on prior. Have been on it the last 4 full years. Depression is still improved and anxiety is GONE. I had major anxiety disorder and panic disorder.
Issue is, I have ZERO sex drive (haven’t been intimate in 4 solid years) but that’s OK! The part I’m worried about is my anxiety is gone - which is good - right? But I’m not even worried about things I NEED to be worried about. I let it all go and don’t get bothered even when any normal person should be.
Additionally I was recently diagnosed with ADHD. Never assumed it could be an issue as I did very well in school and college (yet also missed 60% of classes each year!) somehow still never had below a 3.68 GPA.
I was ignorant to what ADHD really was. I possess almost all of the symptoms except hyperactivity.
I wish it had been found earlier, surely had I been medicated back then I would be in a far different place than now.
Either way I am happy about the diagnosis and stimulant meds. The increase in dopamine and such removes my depression (as long as I’m medicated)
I’m thinking about, once getting to my therapeutic dose of stim, weaning down on Effexor and seeing if this blunting leaves?
I've been on and off Lexapro for 15 years. I taking 5 mg of Lexapro for the past two years but I stopped taking it 2 weeks ago. It's definitely been an adjustment and my mood is up and down. But I have my energy and motivation back. While I was on the Lexapro I had no energy and no motivation and I just ate all day long and sat on my couch watching TV. I gained over 30 lb in those two years. But being off Lexapro for the past 2 weeks I have found energy to exercise everyday and I've already lost 8 lbs. I just hope that my mood stabilizes because I really really do not want to go back on Lexapro.
way better then ssri this med is good
How similar is Wellbutrin+Zoloft (welloft) compared to using an SNRI ?
pass me another magnet
Dr. Do weight and dosage have relation? I mean the less weught u are less dosage u need
Thanks for this . My psych Dr prescribed Effexor because of minor anxiety which is causing major insomnia. She wanted to put me on Lexapro but I thought Effexor would be better because I heard it worked better for women who are postmenopausal. I am afraid the norepinephrine is going to keep me more awake at night?
For effexor the ratio serotonine /noradrenaline reuptake is 30:1, so the noradrenaline part is very low compared on the serotonine part (otherwise I don't think they would have prescribed to you for anxiety) but I am just a patient and I have never tried that medication so talk with your doctor of course.
I just took Cymbalta for 2 days and I'm done with it. It's been horrible. I got absolutely NO sleep last night and the nausea was hell. Never again!
Issac Newton google Truehope
Gary Simone More bullshit where people are trying to sell you shit, and take your money. These vultures prey on the desperate, and hopeless. They are the dregs of society, and I wish them a painful, horrible death. Have a nice day :)
Hey there, I took Cymbalta and had a few side effects but after about a week they go away and the results were life changing for me with anxiety, and PTSD. Wish it would have worked better for you
Give it more time, took over a month before it started working for me. Been on 120mg for a few months now and its great.
You should take it during the day.
I wish I could see you as a patient.
I have a question. If Effexor, beginning at 150 mg begins to effect norepinephrine, and norepinephrine is stimulating - fight/flight - Then how is it effective in reducing anxiety? I’m interested in this seeming paradox. Currently I am going up to 75 mg of venlafaxine. I’m concerned about potentially going to 150. My depression is very controlled, but severe anxiety is my primary and current symptom. Perhaps I might even need more than 75. But at 150 mg and above, will it create more anxiety instead of less, or will it actually decrease anxiety? Basically, what is the mechanism that allows norepinephrine in this case to help anxiety rather than increase anxiety/fightflight?
Hello mate! I’ve just started on venlafaxine 10 days ago and have also just gone up to 75 mg but am really struggling with it atm,I started taking it to help with my depression and anxiety particularly the constant feeling of overwhelm but feel even worse than before I first started atm,spoke to my doc yesterday and she has said to give it time and that she will review me in 4 weeks but really am struggling with it,how are you finding the medication yourself mate?
@@jasoncartmell7400 So I’m finally up to 75 mg and it’s working well for me. The reason I asked the question is because I’m concerned whether or not 150 would be stimulating or not. No one seems to have a good answer. But it 75 I’m OK. But I also have 1 mg of clonazepam at night along with 50 mg of trazodone at night. It may not be the right medication for you. It does take some experimentation unfortunately. What are the symptoms you’re having that are bothering you right now? For me, depression is pretty under control, it was severe anxiety that I needed to deal with. And for me, right now, the combination I have right now is working. The only disappointing thing is some sexual side effects. And that kind of sucks.
@@jasonsignor7237 You just need to try,some people cant handle 37.5mg of Effexor and some people can handle 300mg whit no side effects.
@jasonsignor perhaps in the .” Re uptake “
@@jasoncartmell7400 I just got notified that someone commented on this post and I thought I would reply again. I’ve been at 150 mg for a while now. I just went through Covid, now dealing with post Covid symptoms. It’s been awful. I’m taking a variety of supplements to deal with it. However, one of the things that has happened is, I seem to have increased heart rate. And that was actually going on prior. But when I look back at my medical records a year ago, my blood pressure and heart rate were lower. Granted, even though I have gone from 234 pounds to Now 160, through, working out and eating right, I actually slacked off for the past six months and haven’t been to the gym. Because of being busy. Not a good excuse. So I don’t know if that has had an impact on my heart rate and BP. It certainly could. But I’m also wondering if the 150 mg is maybe causing this and Covid made it worse or accommodation of all three. Considering talking with my psychiatrist and going back to a lower dose, or maybe a different medication. I don’t know. Currently recovering from post-covid symptoms though. So no changes at the moment. Did bloodwork today and going to be interested in what that looks like. So just thought I would comment again here because I got a notice that someone added to the thread. The perfect time too because I was just thinking about this in the past couple of days.
Wait let me pause wait wait let me pause again wait wait
Funny
Can you combine Pristiq with Wellbutrin for sexual type symptoms from the Pristiq?
Hello Doctor. I am currently taking 30mg Mirtazapine but still have anxiety issues. Depression seems just ok. Is 30mg Mirtazapine usually effective for anxiety or should dose be increased to 45mg with doctors guidance? Been taking Mirtazapine for 6 months.
Thank you for your informative videos.
Would like to meet this doctor for my daughters anxiety problems
She was on Effexor. Her 6th antidepressant for anxiety caused by PMDD and a traumatic event.
She got akethesia from a bump in Effexor dose.
She’s been off it for 4 months now. We had to slow down the taper. Because the brains apps were too painful for her and she seem to be vibrating from the inside out. I would touch her skin and it felt like a motor was running.
takes clonazepam For panic attacks now and her anxiety but only once in a while. Just because it doesn’t seem to reduce the attacks by that much. Xanax seem to be the best for her but no doctor will prescribe it. We had a genetic assay done End it turns out that SSRI s and SSNIs she has a gene that makes these not work.
We are at a loss. She is only 14 and will graduate at 16 the rate she is going.
Very intelligent.
We will not hospitalize her as they will only drug her up against out wishes.
Plus her greatest fear is missing school. Very dedicated.
She is well. Holds down a summer job and is sleeping again.
But she needs treatment to reduce the anxiety and to stop the attacks when they do happen.
Do not no where to turn.
papasofalbany@nycap.rr.com
Sorry brain zapping.
Like I
Said we had genetic testing done. For medications.
She needs something to help
Stabilize her mood. The high anxiety that she is always showing. Starting to develop malifacisms to cope with and reduce her anxiety by trying to control other aspects of her life.
This girl has remarkable academic abilities and we fear she will never realize her med school or even college dreams due to this.
Anxiety is not under control. Cannot find doctor willing to treat.
We did find one or so we thought but the doctor only wanted to put her latuda and Latuda and same all while she was still suffering movement problems left over from Effexor akethesia.
It was a horrible time for our family to watch it with you this. She no longer feels the effects of these medications because she isn’t on them. They were basically just pure evil in her system. She always had the worst side effects. And they didn’t work on her anyway. She was dismissed from one practice after we complained about the movement side effects from the Effexor bump up in dose. Neurologist said it was akethesia. But, this doctor did not believe it and put her through a grueling to our intake evaluation where she put her own sons suicide, yes a doctor that was trying to treat my daughter or son had committed suicide and she was trying to put all of her fears onto my daughter. She scared the heck out of her. Talking things or talking to her about things like schizophrenia and suicide. When we complained about the side effects we were then it dropped from the practice.
Because they said she was unstable and could not be treated. They said we needed to take her to the ER to make sure she was stable which we did. And she was stable. She was simply having a panic attack and going through Effexor side effects. No danger to herself.
This woman just about destroyed my daughters life. And then the new doctor we thought we found told my daughter that she looked depressed. This was during the four months grueling withdraw from Effexor. Sure, my daughter looked exhausted during this time. Because she wasn’t sleeping due to the constant vibrations under her skin and the brain zapping. So she diagnosed her with depression. My daughter is not depressed. She is a fearful child. She is afraid of everything.
Suzanne Papa google Truehope. And if a need any help let me know
Suzanne Papa these meds kill and destroy the brains receptors, the neurotransmitters and synapse process. It disrupts blood flow to the brain, and causes aneurism and stroke. It destroys endocrinological functioning of the thyroid, testosterone and hormones. It destroys everything natural the brain and body have. Do not go to these doctors for they will just prescribe more meds and call her mentally ill and leave it at that as they are fearful of lawsuits and too ignorant to be educated on the true damages these drugs cause.
Do u think desvenlafaxine will help with SAD and GAD
Do these SNRI’s affect dopamine also
What would you say is a good approach for someone who wants to get off of Effexxor with the least amount of withdrawal symptoms
Following. Im in the same boat. Thinking about prozac bridge but not sure
open the capsule and take two balls out every two days!! You should have no withdrawls!!!!
Slow paper
Do SNRIS work on social anxiety?
I took wellbutrin xl 150 mg...i only took it for a week and I will never take it again. I know it doesn't start working until around 2-4 even to 6 weeks but I couldn't go on taking it because of the side effects were so bad. I couldn't stand myself, I was hateful, moody, I would snap at the very Ora's kettle things, I wanted to crawl out of my skin and on top of it I was so nauseous and sick to my stomach. I just want something that helps with my anxiety and depression and lack of energy.
What is your disorder??
try amitriptyline(elavil)
Me too, wellbutrin was real bad for me. Effexor (venlafaxine is what I use now, with no side effects for me at least.
Hi Dr, I am on 70mg Venaflaxine and 30mg Mitazapine. I have only just started on this formula. Do you think it is a good treatment?
antidepressants drugs can take fish oil while taking
The placebo group is brought on and payed for by the companies making the drugs and placebo groups where they wee out positive placebo patents. Increasing a ratio of placebo vs non is irrational. Saying that 100/200 people gagues the gap. It's a finding, not a sure stage. Cellular makeup differs.
venlafaxene made me more depressed than ever
Andrew James same
Same for me
Me too, and so tired.
My psychiatrist was so rude in today. I am in a breakdown and he answering phones and not focusing at all i am telling him i can't anymore my head doesn't want to stoppppppp so fast i can't sleep i can't do anything. I want to die. And he was so rudeeeeeeeeeeeeeeèeeeee !!!!!!! Why only private ones treat better because it's a lot of money. That hurts.
I see you like to use lithium.
Do a course on presentation technique and picture composition. It's hard to take your message seriously.
WOW! Real nice guy aren't ya??
Why remron don’t mention Spence it doesn’t have sexual side effect what’s diffrent show does at John’s works
Which antidepressant do not cause sexual dysfunction
javid bhatt I was prescribed Wellbutrin because of its lack of sexual dysfunction seen in clients. Might want to look into it.
None
Trintellix (vortioxetine), Wellbutrin (buproprion), lithium, dopamine agonists, lamotrigine, depakote, and many more. They are all rather atypical in nature. The mainstream ssris and snris are more or less guaranteed to cause sexual side effects.
This guy is wrong in a lot of ways. Very old fashion. Effexor is saving my life right now. I was on Prozac for years and ended up hospitalized. I started taking it less than a week ago and felt it almost immediately. Maybe I’m an anomaly? 🤷🏻♀️ stats aren’t always up to par
Hey Erica I’m so glad to see your comment, I’m having severe anxiety and cannot sleep at all. I’m thinking about starting effexor. But I only have 150mg capsules do you think that will work?
It starts at 37.5
Erika Lee i am starting it now for panic attacks and anxiety it getting. Really bad did h have any bad side effects
Anyone who mentions "a low dose of lithium" is definitely on the old-fashioned side.
Effexor was a nightmare for me. So I tried cymbalta. It was even worse. I felt like a zombie. I was only on it for 4 days because it made me tired and things that should have made me cry or really happy did nothing. Also dizziness, nauseous, really cloudy.
I’ve only been on Pristiq for a few days but I do feel a little different honestly. Not as anxious. I am a bit nauseous and have no appetite but I am sure it will go away. I am on Wellbutrin right now. I can’t get off of it because the withdrawal is so bad.
Uhhhhhhh
Put a bit of effort into presentation. You sound bored, and then the coughing and inability to think of words. It feels disrespectful.
Maybe it’s just his personality not everyone can be a superstar in front of the camera
duloxetine and cymbalta are the same drug. 🙄
Serotonin is not an amino acid, it’s an amine which is not the same thing. l-tryptophan which is a necessary precursor of serotonin production is an aa. Much of your spiel is regurgitating marketing literature from relevant pharmaceutical companies. Dude...I mean, you had like one job, which was to do a bit of background research on thechemicals you prescribe which potentially induce chronic harms up to &including death and you were too intellectually lazy even for that. Eye opening.
Ella Lees Yeah, lets confuse the fuck out of everyone. He’s not making a video for a grad school chemistry class
Never seen or heard of anyone dying from SNRIs. As far as background research goes - it would be difficult to find training more rigorous than 4 years of med school and and additional 4 years of psych residency.
@Brazoncius Roxfort Wowsers that was kinda impressive. Are you a Psych?
Brazoncius Roxfort 👏🏻👏🏻👏🏻🙏🏻
Cannabis works way, way better than all these pills, and has none of these nasty side effects, and for most people has a much, much more tolerable withdrawal syndrome when you want to stop. The worst side effect is memory disruption, which can be offset with more organizational effort. TMS is worth a try, if you can get insurance to pay, but it didn't work for me at all. Neither did any of these pills (and I've been on about 10 different medications, including most mentioned in the video)
@A Smith You're right. Different things work for different people. I didn't say it's a cure-all. It only lasts for a day or two and you develop tolerance like with anything. In fact it does a really poor job. It doesn't cure my depression at all. It just helps a lot more than the pills (for me)
Cannabis doesn’t work for everyone. For me venlafaxine works much better
@@channalmath8628 only benzodiazepine (for anxiety) develop tolerance. antidepressant not. they are time long effective.
@@amedeocristiano4181 A quick google will show you that "tolerance" is experienced by a significant percentage of those who use antidepressants (I guess about 50%) but it's true that for some people, antidepressants work for a long time, while almost everyone on benzos will develop tolerance fairly quickly.
@@channalmath8628 I have taken zoloft for 7 years, the effect it's always the same.
Maybe they confuse tolerance with no resolution of the problem despite that medication. a quick google will show you how you don't have to believe of everything that a quick google is saying to you.
This video doesnt fill me with confidence...
Someone's been in the sample closet.
Guy has no clue what he's talking about when it comes to withdrawals.
PLEASE HELP! I have been tapering off desvenlafaxine (Prestiq generic). I was taking 50mg and went to 25mg. Since these are hard tablets that are extended-release, they are not supposed to be cut. So, I instead extended the time interval to 36 hrs, then 48 hours. BUT the problem is the intended effects of the med has NEVER lasted until the next dose - even when I took them every 24 hours! I would begin feeling the discontinuation/withdrawal symptoms after about 12-15 hours between doses meant to last 24 hours.
The way I have dealt with those symptoms fairly successfully in between doses is to take some specific amino acids ( 5-HTP, Tyrosine a/or D-Phenylalanine). You have to KNOW what you are doing if you take these, be observant and in touch with your body, because if you take too much you can experience Serotonin Syndrome…
I have also found that using a little dab of OTC 1% hydrocortisone cream on my wrist, arm…relieves cold sweats, shakiness, and dizziness (adrenal related) symptoms!
But now here I am, I want to reduce my dose to continue my taper BUT there is nothing lower than 25mg (😡criminal!).
I have tried crushing, weighing and dividing the 25 mg into smaller doses and using delayed release empty gel caps (Amazon) but I just don’t completely trust this method.
The outside coating of the tablet is only meant to get the medication past your stomach before dissolving and into your intestines before med begins releasing. The core ingredients (fillers,binders) added to the active (desvenlafaxine) are inside the tablet. One of those is hypromellose which is the element that makes it extended release. It swells up and holds onto the active med so it dissolves more slowly.
I am interested in possibly using venlafaxine (to take over for the desvenlafaxine) to continue tapering down and off with gradually smaller dosages… but they are not made in equal strengths to desvenlafaxine.
NOTE: I do not intend to take another SNRI/SSRI …But ONLY trying to figure out what to do next: 🤷🏻♀️
✔️venlafaxine immediate release and cut them up (25 mg into quarters)
✔️venlafaxine extended release in smaller doses
✔️use Prozac because of its very long half life.
✔️bail on the desvenlafaxine altogether at this point and increase the Amino Acid supplements.
Lastly, PLEASE don’t suggest I “should” be able to “just quit” with no issues at this dose…I wouldn’t be going to all this trouble if I could do that! I’m very sensitive to medications and am so mad that I ever took this SNRI in the first place.
Thank you in advance for any guidance! 🙏🏻🙏🏻🙏🏻
Kill 2 birds with a stone and go directly to an MAO inhibitor. Not only did Parnate improve my depression and concentration but my bad habits went away. I wake up and actually smile for a change. =)
@WizardKing
True which is why I take it. Nothing else worked.
@WizardKing
Sure. You shoukd also take M&Ms daily that should help.
@WizardKing
Lol. Incorrect? It was soley opinion based. There are lots of misconceptions about MAOIs. They aren't bad or dangerous drugs.
@WizardKing
Mao inhibitors often save lots of time compared to SSRI's that usually result in multiple trial and error of different medications. This is actually based on statistical facts. Side effects will vary greatly.
@WizardKing
Now you are just full of baloney. We're done.
Mirtazapine is best for major extreme depression
whats the regularl name for mirtazaphine!
Mary Frederick mirtazapine sent me crazy I was ready to kill myself on that drug
Plus I blew up like a balloon in it
@@healthyone100 remeron
@@thameekstaninjahman8337 mirtazapine make eat like dinausor causes weight gain
When I was on mirtazapine I became incredibly depressed and was constantly tired. I wouldn’t wish that medication on anyone. I’ve been on 75mg of venlafaxine for three days now and I already feel ten times better than I did on mirtazapine.
The person is ‘a little bi-polar’ okay that’s too much for me I’m out. Do you know anything about the brain, or the repertoire of compensatory mechanisms available to mitigate against a neurotoxic stimulus? The degree of response primarily reflects the dose, previous brain injury in response to neurotoxic harms which may induce long lasting neurological changes making the brain more susceptible to subsequent response, variation in metabolism etc. not because they are a little bipolar. Do you have any evidence to suggest this is the case, if so perhaps you could provide a reference? You know ‘sciencing’. Utterly moronic.
Can you please tell me if any person is taking desvenlafaxine 50 every morning what could be the side effects..
And that person is getting much hunger and gaining weight.
Hi,
I’ve seen a study with results suggesting Venlafaxine (the metabolite of which is desvenlafaxine) typically increases insulin sensitivity resulting in decreased blood sugar levels however increases serum triglycerides with a trend towards weight gain which is apparently paradoxically greater at lower doses, perhaps due to its appetite suppressant or bsl lowering effects at higher doses. I actually started rapidly gaining weight on discontinuation. Please discuss with a dr if you are considering altering the dose or discontinuing it, a slow taper eg 5-10%reductions and maintains for a month or two/until withdrawal symptoms cease is recommended although this doesn’t guarantee avoidance of discontinuation syndrome.see dr Ashton’s method on benzodiazepine withdrawal.
@@michmonty95 thank you
It's all poison
Deadly poison
@@clausmehl8731 gave me a brain injury almost died fuck pharma ! Can't even sue