Crazy Meds US

Effexor's Pros: There are two last resorts among the modern meds to cure the deepest, blackest depression when your doctor is just switching you from one horsie to another on the med-go-round: Effexor XR (venlafaxine hydrochloride) and Remeron (mirtazapine). Either in combination with an antipsychotic would really get you out of that hole of despair, but first you should throw away every mirror and scale in your house and buy expandable clothing. But for deep, despairing clinical depression that needs to respond to the standard tweaking of the three most popular neurotransmitters, Effexor XR (venlafaxine hydrochloride) often pulls people out of the abyss.

Effexor's Cons: For many people Effexor XR has the absolute worst discontinuation syndrome of an antidepressant. Effexor (venlafaxine hydrochloride) is a medication people utterly loathe to have taken. It is not uncommon for someone to fire doctors during or immediately after they quit taking Effexor XR(venlafaxine hydrochloride).

Effexor's Typical Side Effects: The usual for SSRIs and NRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido and a host of other sexual dysfunctions. Most everything but the weight gain and sexual dysfunctions usually goes away within a couple of weeks. Although some women will notice that the sexual side effects will diminish above 200-225mg a day when the norepinephrine kicks in. Maybe.

Effexor's Not So Common Side Effects: Increased or lowered blood pressure, sweating, farting, anorexia, twitching, shock-like sensations.  Also alcohol intolerance and/or alcohol abuse. So Effexor XR (venlafaxine hydrochloride) is going to be just the thing to talk about at AA meetings. I used to have these last two listed as rare side effects, but I've received way too many e-mails and have read far too many similar reports on various other sites after putting up this page about both of them. As is often the case here, the anecdotal evidence will often trump what is in the US PI Sheet. Best guess to date as to why both of these side effects can happen - Paul of Leeds (in the U.K.) posits that Effexor's broad spectrum use of liver enzymes probably interferes with alcohol clearance and tolerance, thus leading to the type of alcoholism that affects people without the proper enzymes to effectively metabolize alcohol. Between that and the way Effexor XR works your liver, you're probably better off giving up booze entirely if you're taking this med.
These may or may not happen to you don't, so don't be surprised one way or the other. Although I make no promises about the alcohol abuse

Effexor's Freaky Rare Side Effects: Someone's reflexes increased and someone else's breasts got bigger, proving that there is no pleasing some people. Someone else's hair changed color and, really, no Revlon was involved. But the most disturbing freaky rare side effect with Effexor XR (venlafaxine hydrochloride) is what Wyeth disingenuously calls "withdrawal syndrome," that once you acclimate to Effexor (venlafaxine hydrochloride) you are basically hooked for life. If not on Effexor XR then at least on some SSRI to take the worst of the edge off. The discontinuation syndrome never goes away if you try to stop. For someone with unipolar depression that's a pain in the ass, but something you might be able to work around barring any really adverse side effects, but for someone who is bipolar you can be royally screwed because Effexor XR (venlafaxine hydrochloride) can really aggravate mania and especially rapid cycling.
You aren't going to get these. I promise..

Interesting Stuff Your Doctor Probably Won't Tell You: Few, if any doctors, will discuss the possibility that Effexor XR (venlafaxine hydrochloride) could become a permanent part of your life, whether you like the results of Effexor XR (venlafaxine hydrochloride) or not. Granted that is a very rare adverse effect, but it does happen. It's hard enough to get them to discuss SSRI discontinuation syndrome., let alone get them to admit that Effexor's symptoms are the absolute worst and the longest lasting of all serotonergic drugs. The discontinuation from Paxil (paroxetine) is bad enough, it's much, much worse with Effexor (venlafaxine hydrochloride).
And the way Effexor XR (venlafaxine hydrochloride) works on neurotransmitters is very complicated. Your doctor may or may not explain this to you. Here's how it works: First it starts to work on your serotonin. Then somewhere around 200 mg a day it starts to work on norepinephrine. Then around 300 mg a day it starts to work on your dopamine. Mileage will vary for each individual, and there's no guarantee on getting all that much dopamine action.

Effexor's Dosage and How to Take Effexor: Effexor (venlafaxine hydrochloride) comes in immediate and extended release flavors, although hardly anyone takes the immediate release form anymore. Just be sure to check your prescription for that XR to make sure you are getting the extended release form. For the XR flavor, you start at 37.5 to 75mg a day, taken with food, at either breakfast or dinner, depending on if you're apt to get wired or tired. Once you get the wired/tired issue straightened out, you take the med all at once at the same time every day. If you start at 37.5mg you can move up to 75mg after a week. As with any antidepressant, it takes a month to feel any positive effect, so give it a month. Seriously, don't move up above 75mg a day for at least a month. You'll know if it's going to do anything then. If you feel nothing, give up and take a much easier discontinuation. After that you can move up in 37.5-75 mg increments, allowing at least a week between each increase until you reach the maximum of 375mg a day for the most severely depressed of patients. The older immediate release version is pretty much the same, except that the dose is divided into two or three doses a day.

Days to Reach a Steady State: Three days.

When you're fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you'll have fewer valleys after this point. In theory anyway.

How Long Effexor Takes to Work: Up to one month.

Effexor's Half-Life & Average Time to Clear Out of Your System: Effexor (venlafaxine hydrochloride) does the double metabolism trick, so its half-lives are 3-7 hours and 9-13 hours. That means the combined half-life is anywhere from 12-20 hours, so it takes anywhere from two to five days to clear out of your system. This is a huge part of why Effexor's discontinuation syndrome is so harsh. No popular SSRI does the double metabolism, and the half-lives of each metabolism is so bloody short. So while you clean out of one metabolite, you still have another one in your system. Your body is completely confused! Wyeth states in the pharmacokinetics section that there's only one active metabolite worth mentioning. Who the hell knows about other metabolites and what part they play in Effexor's discontinuation syndrome, or how long you should take in stepping down your dosage!

How to Stop Taking Effexor: Unless you need to discontinue Effexor XR at a more rapid rate, your doctor should be recommending that you reduce your dosage by 37.5mg a day every week if you need to stop taking it, if not more slowly than that. For more information, please see the page on how to safely stop taking these crazy meds. You shouldn't be doing it any faster than that unless it's an emergency. Yes, that means if you've maxed out at 375mg a day it'll take 10 weeks to get off of Effexor (venlafaxine hydrochloride). Believe me, it's better that way. You can try it faster and hope it works out. The odds are with you, but it's hardly a sure thing. Once you get down to that last 37.5mg a day you have several options:
If the discontinuation symptoms you're experiencing are mild, if you're experiencing any at all, then you may as well stop taking it. You're in the plurality of people who have taken either version of Effexor who could stop taking Effexor (venlafaxine) without too much of a hassle.
If the brain zaps or shivers and other discontinuation symptoms are still bad you can try taking one 37.5mg capsule every other day, or getting a prescription for generic venlafaxine in the immediate-release form and working your way down. As immediate-release venlafaxine comes in a variety of dosages you have all sorts of ways you and your doctor can work out a discontinuation schedule from there.
If you still can't stop taking it at a low dosage, you and your doctor may want to try Prozac (fluoxetine) prescription or samples. Generic fluoxetine will even do. 10mg a day is all you should need. Even with the proper discontinuation stopping the last 37.5mg can be hellish. Taking two weeks worth of Prozac (fluoxetine) will make the discontinuation a lot easier. So when you're off of Effexor and you cannot function, get on the Prozac for a week or two, then stop taking the Prozac. By that time you should find you'll have either no discontinuation syndrome, or it won't be nearly as bad.
If worse comes to worst, there's always the liquid Prozac. Then you can work your way down from the equivalent of 10mg, or higher if 10mg was too low, to ever-so-slowly try to wean yourself off of the serotonergic part of Effexor that had its claws in you.

If you've worked your way up to a particular dosage, it's usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

Comments: This is a multiple reuptake inhibitor, acting sort of as both an SSRIand NRI, so be sure to read up on all three classes of meds, as those pages will cover a lot of stuff common to all meds similar to Effexor (venlafaxine hydrochloride).

Everybody hates their meds because of the costs and the side effects, but people just loathe Effexor (venlafaxine hydrochloride) because the discontinuation can be so harsh; it's the med everyone wishes they never took. Yes, people will change doctors because some doctor had the nerve to punish them with Effexor (venlafaxine hydrochloride). Yet for many people it is a godsend, because the combination of serotonin, norepinephrine and dopamine reuptake is literally just what the doctor ordered for the darkest of depressions. Of course Effexor (venlafaxine hydrochloride) has to be complicated about it, it can't just work on everything all at once from the beginning. Oh, no. First it starts to work on your serotonin. Then somewhere around 200 mg a day it starts to work on norepinephrine. Then around 300 mg a day it starts to work on your dopamine. Mileage will vary for each individual, and there's no guarantee on getting all that much dopamine action. Of course as you up your dosage to get to the next neurotransmitter, you keep pushing the previous neurotransmitter, whether you need more action on them or not. And that's what leads to problems, and why people have to stop taking Effexor (venlafaxine hydrochloride). So they stop taking it from a higher dosage, and they stop taking it quickly, and they learn about things like brain shivers.

For people in the bipolar spectrum Effexor (venlafaxine hydrochloride) should really be the last of the modern antidepressants that is tried. I feel that the risk/reward benefit runs too high on the risk side of things. More than most SSRIs Effexor (venlafaxine hydrochloride) is likely to trigger not just mania, but rapid cycling. Combine that with the very rare, but still real chance that you could be stuck taking Effexor (venlafaxine hydrochloride) for the rest of your life, even if it doesn't work. That complicates things greatly in Bipolarland.

Try everything else first, and if you just react badly to SSRIs, forget about Effexor (venlafaxine hydrochloride) entirely.

As for unipolar depression, if you're in the blackest pit of despair and your doctor recommends Effexor (venlafaxine hydrochloride), go for it. What? You don't think I care about you people? I do. For people with unipolar depression a lifelong addiction to Effexor (again, this is a very rare side effect) is just a pain in the ass. Of course Effexor (venlafaxine hydrochloride) works with popular liver enzymes, so there would be dosage adjustments required for some meds, and you'd have extra side effects for having to take 37.5-75mg of Effexor every day, but it wouldn't be making you manic or triggering rapid cycling. As long as the reason why you had to stop taking Effexor (venlafaxine hydrochloride) wasn't too bad, and that reason isn't too harsh at the low dosage, the exceedingly small risk of permanent Effexor (venlafaxine hydrochloride) maintenance is well worth running when weighed against the benefits you'd potentially receive with Effexor (venlafaxine hydrochloride).

Effexor (venlafaxine hydrochloride) is also approved for GAD. Yet it frequently makes the anxiety that is part of bipolar much worse. I can't honestly give a good risk/reward analysis for Effexor (venlafaxine hydrochloride) and anxiety. Given the experiences I've read of everyone who has taken it for bipolar and depression, I'm surprised it was even approved for anxiety.

Why in God's name do people call this medication?

It is stated in the above review that nobody takes Effexor's predecessor Venlafaxine anymore. This is a gross misrepresentation of facts, a few years ago a number of papers appeared in major public psychiatric journals describing the adverse effects of Venlafaxine. In layman's terms: It is psychiatric poison, recognized as such, and subsequently was reduced to junk-status by professionals. Effexor XR is just a rebranding for financial purposes of the same poison by Wyeth since no-one touches Venlafaxine anymore.


Smokescreen: Flash in HTML5 & JavaScript

The ad network company RevShock created Smokescreen, an open source product that converts Flash to HTML5 & Javascript. While mainly designed for ads, not fully conformant, and lacking in performance for the higher-end flash applications, it solves a lot of problems.

I doubt they'll ever reach full conformance, but it is interesting, and I guess Flash will -for banner ads and other simple applications- just be a great front-end to it.


Who Needs More Than 640kB?

I am thinking about bit representations in my compiler, and I wonder about the x86-64 bit model. Most modern desktops have about 4-16GB memory, I think. A byte is 8 bits, therefore encoding one out of 28 values. A kilobyte is 10241 = 210 bytes, a megabyte is 10242 = 220 bytes, a gigabyte is 10243 = 230 bytes. At least according to binary number interpretation, your local vendor may disagree.

Now, in a 32 bit address space, you can index 232 bytes, or 22 x 230, is 4GB of data. Thing is, for desktop models, we are somewhat at the end of what we need for memory. The 64 bit encoding generates pretty fat binaries, and I am really clueless where all the memory goes. At the other end, the computer word to address space ratio is ridiculous at the moment. Why do we address individual bytes on a 64 bit address space machine? It is just as ridiculous as being able to address individual bits on a 64kB machine.

In my opinion, they shouldn't have doubled the address space, but they should have quadrupled the word size first.

On a 32 bit machine with 32 bit words, you can have 16GB of byte data which is just enough for current standards. My best guess is they didn't want to because the C language, in which most operating systems are written, just assumes characters are 8 bits wide, and because high-end systems will want more addressable space. But still, 32 bit words are a good choice, and in the Internet era it makes sense to standardize on 32 bit wide characters and just bit pack older data.

Then again, who cares about 2 bits when you got 64 of em?


Silent Killers

From Slashdot.

As someone with bipolar disorder all I can say to you is "fuck you".

Diagnosis and treatment has allowed me to become a fully-functioning member of society rather than a burden on society and everyone around me. Absent medication and psychotherapy, I'm at the mercy of horrible mood swings and psychosis. My parents listened to a quack of a child psychologist who felt that diagnosing and "labelling" a 10-year old was more damaging than any disorder that might be present. The result of that was a slow decline into madness, and as an adult, I was too sick to seek treatment on my own, and not sick enough for involuntary commitment. I was finally diagnosed at 41 years old as a result of some circumstances that I don't care to share with someone like you. Do you have any idea what it's like to lose half your life to untreated mental illness?

Treatment probably saved my life - and there is no treatment without diagnosis and as you put it, "labelling". The suicide rates for persons with bipolar disorder are truly staggering - and those who don't take their own lives frequently have abbreviated lives due to irrational choices made as a result of the disorder.

"Trying harder" hardly factors into it when you're at the mercy of a very real and debilitating disorder.

Try a little empathy, fuckwit.

It's back, again...