I was taking

Effexor XR 300 mg - mornings
Paxil 5mg - mornings
Ritalin (to wake me up from the effects of the Paxil) - mornings
Risperdal 0.5 mg - bedtime

to treat chronic depression (4 years and counting) where the most annoying symptom is constant fatigue/low energy (can do something for max. 2 hrs before I crash), insomnia, and unreliable short term memory.

I wasn't happy with the addition of Paxil (for anxiety) then Ritalin because Paxil made me really drowsy. So, I was referred to a psychopharmacologist (psychiatrist who specializes in medication - usually does research into drug combinations) who asked me questions and listened - Yes ladies and gentlemen, there really are those rare species of doctors who listen - before he made some conclusions.

1) based on my chaotic childhood (5 year old adoptee, emotional fireworks at home) and loss of memory (anything before the age of 5), he diagnosed me as having chronic Post traumatic stress disorder (cPTSD) due to life turbulence before the age of 12. Not curable but treatable.

This was a specific diagnosis instead of the "you have chronic clinical depression". I'd spent quite a bit of time trying to figure out why I succumbed to stress while my friends in similar situations managed to keep on going.

2) The paxil was causing chemical toxicity in my body! Paxil, according to Dr. Bakish, interacts with almost every kind of depression and anxiety medication. In my case, it was preventing my body from excreting Effexor XR and the Risperdal.

3) Symptoms of insomnia and fatigue partially caused by my medication regimen. (Partly caused by my cPTSD which was a result of the neuron wiring in my brain before the age of 12). Knew what 2 medications he would recommend to deal with my original psychological issues and resolve the sleep insomnia and muscle twitching. Even told me that there was a new medication coming down the pipeline that was looking promising for cPTSD.

So, imagine my surprise when my psychiatrist modified (dropped 2, added one) my meds instead of my starting on meds that were supposed to specifically address my issues.

New regimen:
Effexor XR 300 mg - mornings
Desyrel (trazodone) 50mg to 100 mg - bedtime
Risperdal 0.5 mg - bedtime

I've been on the meds for a week. Hasn't really helped my sleep - some nights I sleep really well, other nights I wake up early again and don't even feel rested. Worst part is I have a really strange taste in my mouth and feel "chemically" if that makes sense to anyone.

I'm going to get a copy of Dr. Bakish's recommendations - have to for my own peace of mind. It's really sad when you can't trust your doctor and feel like you have to check up on them.

In the meantime, I am wondering if anybody has experience with this combo. It's so hard to find information on drug interactions and contra-indications, and even harder when it involves more than 2 drugs.

I was on Effexor RX 175mg X4 (2 morrning, 1 afternoon,1 night) and Trazodone 50mg-100mg at bedtime.

I have sever depression, its genetic, I used to self harm and I have periods of insomnia, usually i can sleep well with no aids for 2 months, then cant sleep or stay asleep for 5-7months, and thats when i use the Trazodone. It works for me most of the time. When i was first prescribed it my doctor told me it was made to be an anti-deprssion medication, but it wasnt that good of one, but it made people sleepy. If i dont have a full nights rest on Trazodone it feels like Chemicalls moving in my body (i had never thought to use that word to describe the feeling. I get really warm in my arms and legs, and i can almost feel my blood moving).

The effexor didnt really make me "happy" or change made the depression go away. It made me feel just "blah" constantly which i didnt like because i couldnt feel any emotions. So i stopped taking it, now that i have found away to control the urges to self harm by drawing. Sometimes i cry for no reason now and can get really depressed, but i can also feel happy now.

I see you live in Canada too, theres this Program that some Pharmacies are preforming. If you are on more than three different medications you can go in and make an appointment and a Pharmasist will talk to you about the drug interactions and such. I think i saw the poster in Zehers. So you could check there.

Erin, thank you. It's good to know that I'm not alone.

I know about the talk to the pharmacist option. Actually, most pharmacists were willing to talk to customers even before OHIP decided to pay for one visit. I used to work in a pharmacy and knew several pharmacists from different stores.

Problem is, even the pharmacists don't have information on how three or more drugs interact cause the drug studies usually only look at how one drug interacts with another.

Thanks again.