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Re: Has Anyone Taken Tramadol (Ultram) With An SSRI? » Brainbeard

Posted by SLS on July 25, 2009, at 6:16:54

In reply to Re: Has Anyone Taken Tramadol (Ultram) With An SSRI?, posted by Brainbeard on July 25, 2009, at 2:40:37

> > It is Stephen Stahl's contention that too low of a dosage of Geodon can be counterproductive and produce activation, agitation, anxiety, and dysphoria. He recommends 40mg as the average effective dose when treating depression. I couldn't find the article he wrote about this, though. A friend of mine dose better on 80mg than on 40mg in combination with Lexapro and Wellbutrin.
>
> I can't see why low dose Geodon would be counterproductive - though I might indeed be experiencing it for a fact. I'm on 25mg of Zoloft, 15mg of Buspar, 6mg of amitriptyline, 12.5mg of imipramine, and 5-20mg of Geodon. I haven't read anywhere what you say Stahl says. I've only read that he says a low dose might be too activating, not that it could cause dysphoria or anxiety.

I apologize for intruding on your thread, but I saw an opportunity to help.

Yes, my memory of Stahl's statements is flawed. I found the source I was thinking of. It wasn't anxiety and dysphoria that low-dosage (20mg) Geodon causes, but, rather, the activation and agitation. Still, it is something you may not want in a drug treatment. Perhaps this is only applicable to schizophrenia. If the low dosage is optimal for your condition, I guess that is all that matters. Perhaps this drug is useful for depression at the lower dosage if all you are looking for is 5-HTc blockade.

http://cme.medscape.com/viewarticle/484929

"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 â' 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."

- Stephen Stahl


Anyway, back to tramadol.


- Scott

 

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