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1. The antidepressants people love to hate.
The data are contradictory regarding how effective SNRIs are compared with SSRIs. When it comes to treating neuropathic pain SNRIs generally work a lot better, especially the ones that have more of an effect on norepinephrine. Savella has a practically equal effect on serotonin and norepinephrine1, while Effexor is essentially an SSRI until you’re taking 187.5–225 mg a day, give or take 37.5 mg. Depression and anxiety are something else. On one hand SSRIs are easier to deal with, on the other SNRIs are far less likely to poop out (tachyphylaxis).
- Cymbalta (duloxetine HCl)
- Effexor (venlafaxine HCl)
- Pristiq (desvenlafaxine succinate)
- Savella (milnacipran HCl)
2. Dosage Equivalents
As with SSRI equivalents there are numerous factors that keep this from being straight forward, including what you are taking the drug for. My main problem is not being able to find any two studies with NET (norepinephrine transport/reuptake) numbers that aren’t all over the map and make sense when compared with a TCA or NSRI. So the best I can determine so far is:
75 mg Effexor = 50mg Pristiq = 20mg of Cymbalta
Essentially the minimum available dosages of Pristiq and Cymbalta are worth the minimum therapeutic dosage of Effexor. The 1.5:1 ratio of Effexor to Pristiq doesn’t hold up for very long.
1 Little wonder Forest went for the fibromyalgia approval instead of banging their heads against the wall for an increasingly difficult to get depression approval. Plus: there's more money in pain than in the overly-saturated depression market. And they know doctors will write off-label prescriptions for it in any case.
Page created by: Jerod Poore. Date created: 26 November 2010 Last edited by:
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