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Fluoxetine (Prozac) vs Fluvoxamine (Luvox)

Posted by tensor on May 17, 2020, at 6:29:47


I suffer from MDD, anxiety/panic disorder and social phobia. My depression got so bad a few years ago that I was no longer able to work even part time, I still do not work and I receive disability pension.
Currently on following meds:
Escitalopram 20mg (anxiety)
Mirtazapine 7.5mg (for sexual dysfunction)
Lamictal 75mg (depression)
Nortriptyline 25 mg (depression)
Clonazepam 2mg (social phobia)
Melatonin 3mg (sleep)
Oxazepam 30mg prn (sleep/anxiety)

I use low doses for depression because higher doses only yield stronger side effects, I never remit from depression anymore and the best I can get and what I aim for is that I'm in a good mood and that I can enjoy my hobbies a few hours a few times a week.
The problem right now is increasing anxiety, for several years escitalopram kept my anxiety manageable, but last year I noticed I kept getting more anxiety attacks and I often feel a knot in my stomach. Now I can't sleep at other places than at home, this limits my life in a way that is not acceptable, I do wildlife photography and sometimes you want to go to places that are too far away that sleeping at home is not feasible.
I get panicky when too far away from home and my anxiety level makes it impossible to enjoy whatever activity I intended to do.

My pdoc is not comfortable raising the dosage of escitalopram above 20mg. So my idea is to switch to another SSRI, 50mg of sertraline was once great against my depression but stopped working and higher doses gave me akathisia while remaining ineffective for my depression. I didn't like paroxetine for reasons I can't remember, it was so long ago.
Fluoxetine was the first antidepressant I ever tried, while not effective for my depression, I remember it had a good effect on my anxiety, pretty bad sexual side effects but I don't worry too much about that now. Back then I ended up with a combo of fluoxetine + mirtazapine, the latter was like a miracle drug for my depression.
So fluoxetine seems like a good candidate, but since I last took it, it has been twenty years and maybe 35 different medications, hard to say if I would respond similarly today.
Never tried fluvoxamine, looks interesting but a lot of interactions. I think I would have to drop nortriptyline due to interactions which is okay, it's more of a "legacy" medication at this point. I think the rest of my medications would be okay.

So what do you think, what are your experiences with these two medications for anxiety disorders? Any other ideas welcome, of course.





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