Posted by SLS on August 7, 2008, at 2:03:32
In reply to Re: What is the best SSRI in our opnion? » SLS, posted by Bob on August 6, 2008, at 20:44:14
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> > It is tempting to try to figure out what these drugs will do in advance of taking them using laboratory observations of their in vitro properties. It would be a shame if you were to skip over a drug that would work based upon a theory. With Geodon, it is important to START at 40mg. Anything less will produce anxiety and agitation. The effective dosage range of Geodon for depression (and negative symproms) is 40-80mg. For psychosis, the dosage is more like 120mg.
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> > Good luck with whatever path you choose.
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> > - Scott
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> It seems almost counterintuitive that an activating med like Geodon would be activating at lower doses than higher. I asked my pdoc about the rumors surrouding Abilify and this phenomen and he claimed there wasn't a lot of evidence supporting it.
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> What scares me about jumping to a higher dose of something like Geodon or Abilify is how would one ever taper off of the med if it went awry down the line. I'm exquisitely sensitive to Abilify and if I just started taking a high dose and 3 months down the line had to taper off, I think it it would be mighty, mighty scary.
Stevan Stahl:"Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
- Scott
poster:SLS
thread:844562
URL: http://www.dr-bob.org/babble/20080805/msgs/844745.html