I have been taking a high dose of Avanza SolTab ( well, quite amazingly, Avanza in higher dose, taken in the form of "readily-absorpable" form ), the second dose taken in that same day, does not cause further sedation, instead, I find it quite useful to alleviate pain, tension headache, fatigue, it also promotes an amazing general well-being to me.

Most patients, as my Psychiatrist explained to me, were given a small-dose of 15mg, and he noted the small dose is sedating as it acts on the H-1 ( Histamine-1, responsible for allergic reaction, the same action that other anti-histamines do, like Diphenhydramine, Doxylamine succinate, Chlorpheniramine Maleate, found in Benadryl, unisom and other cold and flu tablets), but a higher dose beyond 90mg-120mg given in hospitalised in-patients, in the "readily absorpable" SolTab form, Avanza binds to the opioid receptors too, that is the "mu" receptor which is responsible for the "reinforcement-effect"/ good feeling we get from opiates like Morphine, Codeine etc., and also it binds to the "kappa-3" receptor which is responsible to help with the withdrawal symptom from the use of opiates.

So, even in the literature it is written that the highest reccomended dose is 60mg/day, the study with the hospitalised in-patients are as high as 120mg, as Avanza has a wide margin of safety.

When the Psychiatrist upped my dose to 45mg thrice/day in the SolTab form, I notice the big difference in the effect to when I only took it in a small dose. I find that I could cut down on the use of opioid painkillers, and still get the feeling of well being. ( I was having a chronic tension headache, anxiety, fatigue etc). The first dose i take makes me a bit sleepy, but the second and third dose does not further increase the level of sleepiness, instead, it gives me a kind of feeling good, less tension, no anxiety, no depression. I guess because it binds to the opioid receptor "mu", and I have no trouble /withdrawal symptom upon reducing my opioid painkiller as Avanza binds to the "kappa-3" opioid receptor, responsible to reduce the withdrawal symptom from any opiates.

Well, to me Avanza in a higher dose and readily absorpable form ( 90mg or more of the SolTab) benefits me so much, compared to other antidepressants I have tried before.
Tricyclics are useful for chronic pain, but there is no evidence that they bind to opioid receptors.
So far, in the research I read, only Mirtazapine and Venlafaxine ( Effexor) that bind to opioid receptors.
But again, everyone is different, and react differently to different antidepressants. To me, Venlafaxine caused too much side effects, especially with sexual dysfunction, sleeping problems, paraesthesia ( pins and needles feeling), sweating.

Mirtazapine has no affinities for any of the opoid receptors.... what are you sources?

This post has been edited by min0taur: Jul 12 2009, 01:01 AM