Posted by ed_uk2010 on December 4, 2013, at 8:59:11
In reply to Re: Safest tricyclics?, posted by Lamdage22 on December 4, 2013, at 3:37:28
> Thanks, i will keep that in mind.
>
> Its good to know that other SSRIs are still an option.
>Zoloft, Celexa and Lexapro have the fewest drug interactions amongst the SSRIs, which is useful if you're on multiple meds. Given your previous reaction to Zoloft, a low starting dose of any SSRI would be essential eg. Lexapro 5mg in the morning, or Celexa 10mg in the morning. You could even take less for the first few days if you prefer, just to make sure you're OK with it, and then increase up to a more normal dose over a period of a few weeks. No more than 40mg of Celexa or 20mg of Lexapro should be taken per day. Some people do take higher doses off-label, but it's not safe when you're on other drugs which may prolong the QT interval.
After an initial low starting dose, 'standard' therapeutic doses are 20mg Celexa or 10mg Lexapro, but individual adjustment may be needed. To be honest, it might be best not to exceed these doses while taking Seroquel, unless it's unavoidable. I do not think it would be a good idea to take either Celexa or Lexapro while still on two antipsychotics, since the effect on the QT interval may be additive. Once you've tapered off Zyprexa you have more options. It is possible (thought not entirely clear) than Lexapro may be slightly more effective than Celexa. It is unfortunately a lot more expensive, and not everyone prefers it. Overall, they are very similar meds.
Zoloft has no effect on the QT interval, but it sounds like you tolerated it badly so I guess it's a no-go.
Prozac and Paxil have very little, if any, cardiac effects, but they do have a lot of drug interactions which can make med combinations awkward. I do not believe that either of these drugs interact greatly with Seroquel, however. On the other hand, they do tend to cause slightly more side effects than Celexa or Lexapro.
Have you considered mirtazapine (Remeron)? It may be a useful AD. It does not appear to prolong the QT interval and it may improve depression and insomnia when coming off Zyprexa. You could consider starting Remeron after (very slowly) reducing your dose of Zyprexa.
Any idea what your doc thinks about all this? Stopping Zyprexa is a major event because there is a risk of relapse and withdrawal anxiety/insomnia.
poster:ed_uk2010
thread:1054839
URL: http://www.dr-bob.org/babble/20131115/msgs/1055417.html