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Re: maybe switch to symbyax? » Christ_empowered

Posted by mtdewcmu on April 25, 2011, at 14:57:16

In reply to maybe switch to symbyax?, posted by Christ_empowered on April 25, 2011, at 14:18:08

Are you talking about going to Symbyax or going to Prozac + Zyprexa? I don't see a point in going to Symbyax until you know what combo works best, because all it does it limit your options.

Also, are you sure you need to change both your meds? Maybe you only need to change the Celexa or the Abilify. The thing I hate about Prozac is that it takes a whole month just to reach steady-state blood levels, and then if you stop taking it, it takes at least a week or two to exit your system. When I am suffering, I don't want to wait that long. The only two SSRIs I have been able to tolerate for an extended period have been Celexa and Paxil, and I only barely tolerated Paxil. So IME it doesn't pay to commit too much to a particular drug trial.

One of the few predictable features of the SSRIs seems to be the activating/sedating axis. Prozac and Zoloft are generally considered to be the more activating ones, so if you can tolerate Zoloft, that ought to be a decent proxy for whether or not you'll tolerate Prozac. In fact, Zoloft seems to be a better all-around drug than Prozac, so if you haven't tried Zoloft yet, I would definitely recommend trying that ahead of Prozac.

Hope something in here helps.

PS. One other thing: the cytochrome P450 interactions between psych meds are more often than not ignored by psychiatrists, but they can make a huge difference. Paxil is a super-potent inhibitor of CYP2D6, for instance, so adding or subtracting Paxil may affect your blood levels of your antipsychotic. Prozac is a weaker, but still significant, 2D6 inhibitor. Zoloft and Celexa don't mess with the P450 enzymes as much. Luvox is a potent inhibitor of several. I haven't done all the work of investigating the interactions you'll run into; that is for you to do. But I recommend keeping them in mind.


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