Posted by Fuscia on July 5, 2002, at 16:24:24
In reply to Fuscia, please respond, posted by hildi on July 5, 2002, at 12:27:28
> Hi fuscia. this is sort of a add-on to the other post I wrote you . . .
> I am thinking of going back on prozac. Your posts, and some others, have confirmed the idea I already had that I might have been taking too much of the med, and thats why it pooped out, that also could be why I started to get undesirable effects after taking it for while.
> My question to you is: in your opinion, should I take it daily for only a little while to let it 'build up' a bit before going to bi-weekly (I'm thinking of trying 10mg, not 20) dosing? Or, should I just start off taking prozac a couple of times a week? What worked for you?
> Did you reduce to your bi-weekly dosing, or did you always do it that way?
> I'm interested to hear how you approached this.
> Thanks much, HildiHi Hildi,
Prozac, name brand, by Eli Lilly, but actually it is made by Dista labs.
I'm one to experiment, and, to listen to my body. I tend to be sensitive to drugs. I was taking 20mg of Celexa prior to starting Prozac. I went cold turkey off of Celexa and by day 7 I was going through a topsy turvy emotional roller coaster ride. I didn't have to do this, but could have directly switched to Prozac. Anyway, I started taking Prozac capsule 20mg daily for one month. I began feeling it's positive effects immediately. I then started taking it every other day since I was doing well. I order my main purchase of prescription medicines from a Canadian pharamcy - much less expensive than our local pharmacist. So, I would have to wait about 2 - 4 weeks for my refill to arrive in the post. In the meantime, I went ahead and got a month's refill of generic fluoxetine made by Geneva Labs. 20mg tablets. I took these every other day for one month, but for me it didn't seem to work as well as the Prozac name brand. I became depressed quite often. So, after about 2 1/2 months of beginning date of starting on Prozac, I started back on Prozac name brand and within two weeks I started taking it on Mondays and Thursdays, and so far this has been very good. I have been taking this dosing schedule for about 1 month now. Celexa didn't cause anorgasmia, but once on Prozac, the anorgasmia came back (as it did when I took low dose of Zoloft). That was one main reason for twice weekly dosing, to reduce this effect of not being able to have an orgasm. I think it frustrates my husband more than me. Anyway, I chose that scheduling so as to have a 3 day drug-free holiday over the weekend. Since Prozac has such a long half-life in the body, it really doesn't reduce too many of any side effects, so I am still working on the anorgasmia part. My doc was fine with this dosing schedule when I mentioned it to him over a month ago. In the future, I plan to switch to 10mg of Prozac and try it twice weekly, and then once a week to see how it goes. My doc wants me to start taking BuSpar (buspirone) 10mg twice a day to see if this will counteract any anorgasmia side effects, and possibly get a better response from me and my problems with depression, anxiety, impulsiveness, and anger outbursts. BuSpar works differently in that it "stimulates serotonin receptors on postsynaptic receptors" (Feeling Good, by David Burns, M.D.). I did have one anger outburst recently and it quite shocked me for I haven't lost my temper in quite a long time. I'm also trying to eat healthier (avoiding too much caffeine, which I've lowered drastically, and eating less snack foods and eating more quality protein, besides taking a vitamin/mineral complex, besides vitamin B -complex, Nutritional yeast, Green Magma green food drink (for enzymes), and I occasionally take Dong Quai, Black Cohosh, Red Clover, and Sarsasparilla for hot flashes - it works great for this, as well as menstrual cramps for which I used to take Ibuprofin. I'm also using progesterone cream, FemGest brand. I use it for two weeks every month prior to start of my period. I've been using this for about 3 months. It also works great for hot flashes. I began experiencing these prior to SSRI meds. I am 39 yrs old.
It's interesting to note that if you follow a supplementation program for longer than a year, that one should change brands periodically so that one does not develop an intolerance or build up a resistance to one or more ingredients in one supplement. Why not for antidepressants and antianxiety medicines?
My doctor thinks I have either borderline personality disorder, which is difficult to treat, or bi-polar disorder.
Here is some intersting reading that may better answer your questions: The best to you, Fuscia
Feeling Good, by Dr. David D. Burns, M.D.
"Doses of SSRI's. The doses of the five SSRI's are listed on page 520. Unlike the other antidepressants, which are often prescribed in doses that are too low, the SSRI's are often prescribed in doses that are unnecessarily high. Because they have so few side effects, doctors feel comfortable prescribing high doses and may prescribe more than is really needed. For example, although 20mg to 80mg per day was the dose range initially recommended for Prozac, a single dose of 10mg per day will be sufficient for many patients. Once they are feeling better, many patients need only 5mg per day, or even less. These smaller doses are much less expensive and will produce fewer side effects.
These low doses are effective because Prozac stays in the body for a much longer period of time than most other drugs--as long as several weeks. When you take Prozac, your blood level continues to increase each day because the Prozac leaves your body so slowly. After a while your blood level becomes quite high. This is why you may need only a tiny dose if you have been taking Prozac for several weeks or more.
To understand this better, lets go back to the bathtub analogy I introduced in Chapter 19 to explain drug interactions. Let's imagine that the Prozac you are taking is like the water going into the bathrub, but the hole in the bottom of the tub is tiny. Over time, the water level increases, because more water goes into the tub than goes out. The water level can be compared to the level of the Prozac in your blood. After four to five weeks, the water level finally gets up to the correct theappeutic range. Now you can turn the faucet down quite a bit so that the level in the tub does not continue to increase and overflow. This would be analogous to reducing the dose of Prozac after you have been on it for several weeks. Paradoxically, you are not tkaing much smaller doses than when you first started taking Prozac, but your blood level is far higher.
Techincally, we say that "steady state" has been reached. Steady state means that the blood level remains more or less constant, because the amount you take each day is similar to the amount that your body eliminates each day. The other four SSRI's do not have this property, because they leave the body much faster than Prozac. You generally cannot reduce the doses after several weeks.
The effectiveness of very low doses of Prozac is now well known among the psychiatric profession, but I first learned this from my patients soon after Prozac was released onto the market. Many patients reported that after they had been on Prozac for a month or two, they seemed to need only tiny doses, often as little as one tenth of a tablet per day, and sometimes even less. At first I thought these patients had overly lively imaginations, but soon many patients were reporting the same thing. I advised them to take one Prozac tablet, grind it up, and dissolve it in water or apple juice to store in the refrigerator. Then they adjusted their dose of Prozac by drinking a certain amount of the fluid each day. So, for example, if you have dissolved one 20 mg pill in some apple juice and you drink one tenth of the juice each day, this would correspond to a dose of 2 mg per day. But if you try this, make sure you label the juice clearly so that no one drinks your Prozac for breakfast! Also, make sure you talk it over with your doctor and that she or he approves of what you are doing.
It is also important for you to know that after you stop taking Prozac, it will stay in your body for a long time because it leaves your body so slowly. This would be like a bathtub that takes an extraordinarily long time to empty out after you pull the plug because the drain is clogged up. After you are no longer taking the Prozac, significant levels will remain in your blood for as many as five weeks or more before the drug is entirely cleared out of your system. Many medications can be dangerous to mix with Prozac. You must not take these specific medications until you have been off the Prozac entirely for at least five weeks. For example, tranylcypromine (Parnate) is an antidepressant knowns as an MAO inhibitor. This as well as other MAO inhibitors can cause dangerous and potentially fatal reactions if mixed with Prozac. After you stop taking Prozac, a delay of at least five to eight weeks will be necessary before you can safely start taking tranycpromine (Lisa's note: does any doctor prescribe MAO inhibitor antidepressants these days?).
The other SSRI's, such as citalopram (Celexa), fluvoxamine (Luvox), sertraline (Zoloft), and paroxetine (Paxil), leave the body more rapidly than Prozac but they are still metabolised rather slowly. For example, if you stop taking one of these drugs, it will take your body approximately one day to get rid of one half of the amount in your body. It will take approximately four to seven days for most or all of the drug to leave your body. This is much faster than Prozac. Therefore, these other SSRI drugs do not build up to such high levels in your blood after you have been taking them for more than a few weeks. Because they go in and out of your blood more rapidly, they are usually taken once a day, some taken several times per day, whereas Prozac can be taken once a day, twice a week, or even once a week, or very small doses once daily. Once again, consult your doctor concerning Prozac dosing.
Age can also influence your dose requirements if you are taking an SSRI. For examply, levels of citalopram (Celexa), fluoxetine (Prozac), and paroxetine (Paxil) are approximately twice as high in older individuals. If you are taking one of these drugs and you are over 65, you will need a lower dose. Blood levels of sertraline (Zoloft) are also higher in older individuals, although the differences are not as pronounced. In contrast, fluvoxamine (Luvox) blood levels do not seem to be affected by age. (Lisa's note: Does any doctor prescribe Luvox?-it seems like the most untried SSRI. I guess it is because one must take several doses a day due to its very short half-life).
Sometimes gender can play a role as well. For example, the blood levels of fluoxetine (Prozac) are 40 percent to 50 percent lower in males than in females. Similarly, young men develop blood levels of sertraline (Zoloft) that are 30 to 40 percent lower, on the average, than young women. Men may need relatively higher doses of these drugs, whereas woman may need relatively lower doses."
poster:Fuscia
thread:111095
URL: http://www.dr-bob.org/babble/20020628/msgs/111498.html