Dr. Subhan Ullah
Psychiatry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am on Effexor XR 150 mg daily morning (for chronic anxiety and GAD), and Crestor 10 mg daily (for controlling the lipid profile), and recently the doctor has added Cozaar 50 mg daily (because of high blood pressure). I used mostly all types of SSRIs, but I found Efexor is the best for anxiety and has the least side effects. I am doing well on Effexor 150 mg to control the whole case of anxiety and do not think about changing, stopping, or even decreasing the dose. I have continued symptoms since I started Effexor 8 months ago which includes erectile dysfunctions, slight libido, anorgasmia, and a little semen when ejaculation. Also, I have abnormal sleeping during the night with waking up many times during the night or insomnia. Actually, I do not know of all the above symptoms from Effexor or Crestor. I tried Buspar 10 mg thrice daily, but it did not help much regarding those symptoms of sexual side effects, so I stopped it. Remeron has been excluded completely because of the very high weight gain ratio.
The options available to me here and still not used are Trazodone XL 150 mg daily before bedtime. What do you think about this option? Can it help with those symptoms? Is this medication safe overall? Or is it related to cardio disorders and problems with the valve over time? The other option is Cabergoline 0.5 mg twice weekly, Is this safe medication for the heart? And overall, on the body? Can I use it for the long term? About starting 50 mg Cozaar, can this medication encounter Effexor-induced high blood pressure? In your opinion, which one is better regarding erection, weight gain, and blood pressure control, Cozaar 50 mg or Micardis 40 mg? Because I saw that my blood pressure at night did not drop enough.
Thank you.
Hi,
Welcome to icliniq.com.
I read your case, and I found you are concerned about your treatment regimen and comorbid conditions. I found still you are taking Effexor 150 for GAD, and you continue to feel anxiety symptoms as well as sexual dysfunction and sleep disturbance. In my opinion, after reading your case, you may choose to change your regimen. You should take, tablet Wellbutrin XL 150 mg once daily. It has a side effect profile less severe than Effexor 150. If I consider your side effects like sexual dysfunction and sleep disturbance, I prefer Well Butrinb XL 150mg over Effexor. It does decrease your weight, which is an advantage. It is activating drug. But it can increase blood pressure like Effexor, but the risk is somehow less than Venlafaxine. You can add Xanax 0.25mg. One tablet at an hour of sleep, for improvement and anxiety attacks. For Trazodone, I prefer it only for mild to moderate anxiety and insomnia. Still, in your case, where anxiety symptoms are persistent, you should take Trazodone as an add-on to some other antidepressants. My regimen of Wellbutrin and Xanax holds good promise for you. You must keep taking blood pressure-lowering drugs as well as cholesterol-lowering drugs as per need and prescribed by a physician. My regimen will also help you manage weight and blood pressure if properly taken as my advice. Besides lifestyle management with meditation and daily walking, counseling can provide relief.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
I tried Wellbutrin before as well, and it did not work. I want to keep Effexor because it is wonderful for me, but I want an add-on medication. So what are your suggestions?
Thank you.
Hi,
Welcome back to icliniq.com.
I think we need to get an appointment and discuss things in detail about various options and combinations. It is sometimes necessary to discuss the full profile of drugs before opting for them.
Thank you.
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