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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by terrysb on June 12, 2009, at 13:58:15
My doctor recommended that I try Luvox for depression. I generally have a low tolerance for SSRIs. I lasted 5 days on Prozac and 3 days on Lexapro. Imipramine was working for me for 2 years.
I just started Luvox yesterday at an extremely low dose (12.5mg). To my surprise it didn't keep me up all night like the other SSRIs and aside from being slightly tired in the morning I didn't notice any other side effects.
Has anybody taken Luvox for depression and what is your experience with it?
Posted by Phillipa on June 12, 2009, at 18:18:52
In reply to Luvox for Depression, posted by terrysb on June 12, 2009, at 13:58:15
Still take have for years. It's the most sedating of the SSRI's. 50mg used to be the starting dose and then up the next day to 100mg. I did take with benzos and still do. Phillipa ps prozac made me anxious when I wasn't before taking it and I wasn't depressed so lasted three days and flushed it away too stimulating for me.
Posted by terrysb on June 12, 2009, at 19:25:55
In reply to Re: Luvox for Depression » terrysb, posted by Phillipa on June 12, 2009, at 18:18:52
Thanks. Prozac did exactly the same to me. Given my past history of getting on any drug I'm going to take it slow with Luvox and just climb my way up to a dose that works. I also take Klonopin at night.
Posted by Phillipa on June 12, 2009, at 20:01:27
In reply to Re: Luvox for Depression, posted by terrysb on June 12, 2009, at 19:25:55
Really same with prozac? Then I'm not the only one. Do you get tired a lot? Love Phillipa
Posted by terrysb on June 12, 2009, at 21:11:22
In reply to Re: Luvox for Depression » terrysb, posted by Phillipa on June 12, 2009, at 20:01:27
Prozac and Lexapro were way too activating for me. However, I'm not tired a lot normally. Terry
Posted by Phillipa on June 12, 2009, at 21:15:19
In reply to Re: Luvox for Depression » Phillipa, posted by terrysb on June 12, 2009, at 21:11:22
I think benzos have turned on me and now make me tired or I'm tired of this kind of living with fears and a new TV show Obsessed. About OCD kind of scarey to have to work out 50 times a week. Love Phillipa
Posted by terrysb on June 12, 2009, at 22:34:21
In reply to Re: Luvox for Depression » terrysb, posted by Phillipa on June 12, 2009, at 21:15:19
I take mine mainly to help with sleep. No OCD. I was under control for the longest time on imipramine but it gave out and I discovered it was raising my blood pressure. Now its starting all over again - into new territory - with luvox.
Posted by Brainbeard on June 16, 2009, at 8:43:37
In reply to Luvox for Depression, posted by terrysb on June 12, 2009, at 13:58:15
I have been on Luvox for about half a year, which admittedly is not very long but long enough to get an idea of how it works. Earlier in life I have been on Paxil for a couple of years.
I also build the dosage up very slowly, going up in 12.5mg increments and usually waiting for at least several days before increasing the dosage. The initial physical side-effects were very bearable (mild nausea in the mornings before getting up, mild stomach upset), but the initial mental side-effects were a challenge: overall increased anxiety and sudden anxiety peaks.When I arrived at 125mg though, a definite antidepressant effect kicked in. The hightened anxiety disappeared, but Luvox never helped much with my OCD. I experimented with higher dosages. I found 150mg to be my most convenient dose. I even tried 300mg for a few days, but that disturbed my bowels too much. On any dose, Luvox caused significant flatulence with me - this is a well known Luvox side-effect (they might have called it 'Farthox' for that matter).
I also experimented with adding a small dose of clomipramine. Luvox inhibits clomipramine's metabolism, so this is a potentially dangerous combination. But I only took 10mg of clomipramine and had my blood levels monitored. Although its blood level was pretty low, the clomipramine made a huge difference since it countered the apathy caused by Luvox somewhat and also helped with anxiety.
That was my main problem with Luvox: it made me feel well but apathetic and unmotivated.
When I quit the drug I did have some withdrawal effects, mostly depression, but it was nothing compared to the Paxil withdrawal which was terrible.One thing. DON'T MIX THIS DRUG WITH COFFEE OR OTHER CAFFEINE-CONTAINING BEVERAGES! Luvox inhibits caffeine metabolization so bad that the caffeine of just one cup of coffee will stay in your blood all day. Believe me, it doesn't feel nice. And you could get caffeine intoxication.
By the way, what dose of imipramine were you on? Imipramine it said to have a curvilinear dose-response curve in some aspects, one of which is blood pressure: on higher doses, it's more likely to LOWER your blood pressure, causing orthostatic hypotension (getting dizzy when standing up to quick). Couldn't a higher dose of imipramine have worked for you? Or were you already on a high dose?
I think imipramine is a lot less apathizing than Luvox.Still, Luvox is not a bad drug. It's just that it's still an SSRI, and the SSRIs have their wellknown drawbacks, especially in the long term (loss of libido, weight gain, emotional flatness, apathy, possibly 'poop-out', and a withdrawal syndrome for desert).
Posted by terrysb on June 16, 2009, at 23:21:31
In reply to Re: Luvox for Depression, posted by Brainbeard on June 16, 2009, at 8:43:37
I am following the same course - building up slowly. I started at 12.5mg for the first 3 days. Now, I am at 18.75 and plan to increase to 25mg after two more days.
At first, it made me noticeably sleepy in the morning but that is now subsiding. I did notice the flatulence for the first two days but that has now disappeared. The nausea is very mild and tends to fade quickly.
I've had a couple of anxiety peaks. Usually, they lasted for an hour or two. One was bad enough that I took some Klonopin and that settled it down.
I have had no caffeine since I started on Luvox as I already knew about the effect - even at very low dosages of the drug.
I was on 50mg/d of imipramine and it was effective at this dose. However, instead of hypotension I was hypertensive. After reducing salt intake and taking diuretics without effect we decided that imipramine was a factor. Sure enough my BP dropped to normal soon after I weaned off.
SSRIs are a dilemma for sure. Its a trade off between feeling depressed or putting up with the baggage.
Posted by Brainbeard on June 17, 2009, at 3:11:26
In reply to Re: Luvox for Depression » Brainbeard, posted by terrysb on June 16, 2009, at 23:21:31
> I was on 50mg/d of imipramine and it was effective at this dose. However, instead of hypotension I was hypertensive. After reducing salt intake and taking diuretics without effect we decided that imipramine was a factor. Sure enough my BP dropped to normal soon after I weaned off.Again, 50mg is the kind of dose that leads to hypertension, while higher doses (say, 150mg) actually lead to hypotension. So I still think that raising the dose might have eliminated your problem! But you're on the Luvox track already, so maybe this information comes just a little too late. The good thing about Luvox compared to imipramine is, I would say, that it doesn't mess with your heart (or your BP...) and doesn't give you dry mouth.
Posted by Brainbeard on June 17, 2009, at 3:12:16
In reply to Re: Luvox for Depression, posted by Brainbeard on June 17, 2009, at 3:11:26
Or constipation.
Posted by Brainbeard on June 17, 2009, at 3:12:55
In reply to Re: Luvox for Depression, posted by Brainbeard on June 17, 2009, at 3:12:16
Quite the contrary.
Posted by terrysb on June 17, 2009, at 14:58:32
In reply to Re: Luvox for Depression, posted by Brainbeard on June 17, 2009, at 3:11:26
>
> Again, 50mg is the kind of dose that leads to hypertension, while higher doses (say, 150mg) actually lead to hypotension. So I still think that raising the dose might have eliminated your problem!At the peak I was on 100mg of Imipramine but the side effects were greatly increased and I didn't stay there long. Right now, I'm at day 6 of Luvox and am noticing the increased anxiety. That's manageable so far, but the really radical peaks in anxiety that last maybe 30-60 mins are a bit scary.
Posted by Brainbeard on June 18, 2009, at 3:29:14
In reply to Re: Luvox for Depression, posted by terrysb on June 17, 2009, at 14:58:32
> At the peak I was on 100mg of Imipramine but
> the side effects were greatly increased and I
> didn't stay there long.Ah, the side-effects... That's right, they can be intolerable.
> Right now, I'm at day 6 of Luvox and am >noticing the increased anxiety. That's >manageable so far, but the really radical peaks >in anxiety that last maybe 30-60 mins are a bit >scary.
I know, I found it pretty hard to ride it out. But you KNOW that's best. Right now, you just can't trust your warning bells. But when they're ringing for sixty minutes it can be hard to believe it's really a false alarm.
Benzo's can help. The longer-acting Klonopin has shown to be of great help with the initial side-effects of Prozac. Klonopin (clonazepam) is metabolized by CYP3A4, which is only weakly inhibited by fluvoxamine, so there isn't any significant drug-interaction.
Good luck in riding it out. Just keep in mind that it's the price you pay for the lessening of fear after these anxiety circuits in your brain have been desensitized.
Posted by terrysb on June 18, 2009, at 15:35:28
In reply to Re: Luvox for Depression, posted by Brainbeard on June 18, 2009, at 3:29:14
> Good luck in riding it out. Just keep in mind that it's the price you pay for the lessening of fear after these anxiety circuits in your brain have been desensitized.I'm on day 7 which is a new record for me for trying to start an SSRI. I had a bit of trouble getting to sleep last night but managed with some additional Klonopin and Ambien. Actually, today, my mood is more uplifted than it has been since coming off the Imipramine. I'm only up to 18.75mg of Luvox for the past 4 days. I plan to increase to 25mg tonight. Maybe for me a much lower dose will be possible to get an AD effect.
Posted by Phillipa on June 18, 2009, at 20:25:26
In reply to Re: Luvox for Depression » Brainbeard, posted by terrysb on June 18, 2009, at 15:35:28
Seriously good luck have been on it for many years. Phillipa
Posted by Brainbeard on June 19, 2009, at 4:10:18
In reply to Re: Luvox for Depression » Brainbeard, posted by terrysb on June 18, 2009, at 15:35:28
I'm all for lower dosages and believe that the conventional strategy of upping the dose when a med fails can be a shabby one. On the other hand, there has been an evidence-based minimum effective dose established for fluvoxamine (Luvox), which is 50mg a day. The average therapeutical dose is 125-150mg.
Nevertheless, therapeutic effects might be gained by lower doses. Apart from being a serotonin reuptake inhibitor, fluvoxamine is also a relatively strong sigma-1 receptor agonist, which is thought to account for its capability to lift depression and/or anxiety in the beginning of treatment when the therapeutic benefits of serotonin reuptake inhibition still have to come off the ground.
Still, because of the ban on caffeine, I would personally like to have, if not maximum, than at the very least significant therapeutic benefit from this drug. Giving up on coffee was a huge sacrifice for me!
Posted by terrysb on June 19, 2009, at 15:09:20
In reply to Re: Luvox for Depression, posted by Brainbeard on June 19, 2009, at 4:10:18
At the rate I am increasing dosage it could still be a week or more before I am at 50mg. I increased last night to 25mg. The only noticeable difference was a slight elevation in anxiety level mid-day today. I'm assuming that until I stabilize at a particular dose that this is to be expected.
Posted by Brainbeard on June 20, 2009, at 9:06:25
In reply to Re: Luvox for Depression, posted by terrysb on June 19, 2009, at 15:09:20
> (.....) elevation in anxiety level (.....) I'm assuming that until I stabilize at a particular dose that this is to be expected.
Not really. Once the serotonergic circuits involved have been desensitized, anxiety won't flare up when upping the dose. This is both my theory and my experience. After the therapeutic effect kicked in for me at 125mg, I could go up to 200mg without experiencing any related anxiety.
It just takes a couple of weeks, and I suspect that dose doesn't matter that much. Though you would probably have more initial anxiety if you'd start out on a higher dose. And the initial anxiety MIGHT last longer if you titrate up slowly.
Posted by terrysb on June 20, 2009, at 16:18:51
In reply to Re: Luvox for Depression, posted by Brainbeard on June 20, 2009, at 9:06:25
> It just takes a couple of weeks, and I suspect that dose doesn't matter that much. Though you would probably have more initial anxiety if you'd start out on a higher dose. And the initial anxiety MIGHT last longer if you titrate up slowly.
>
>I am getting closer to the 2 week mark. For the past couple of days the anxiety has been very low level and doesn't kick in until mid afternoon with no real peaks. Would you recommend titrating up more quickly so that I can get to the therapeutic level?
Posted by Brainbeard on June 21, 2009, at 5:21:57
In reply to Re: Luvox for Depression » Brainbeard, posted by terrysb on June 20, 2009, at 16:18:51
> Would you recommend titrating up more quickly so that I can get to the therapeutic level?
That was the route I tried to follow when I started sertraline (aka Zoloft) a couple of weeks ago. My idea was that titrating up slowly would only stretch out the start-up anxiety. I did have a pretty hard time though with the anxiety it gave me in the first two weeks. And after that I impulsively and prematurely quit, just when the drug was beginning to have some therapeutic effects. I still think of going back.
So, I don't know: going up a bit faster might give you some harder to digest anxiety, but on the other hand you might already have reached the spot where anxiety starts subsiding. I have my doubts about the latter possibility though, since 25mg is a very low dose.
If I were you, I would just take my chances and jump up to 50mg and stay there for at least a week. See what it does for you. If it's not enough, I would go to 100. If that turns out to be too rough, an intermediate 75. Or perhaps 75 would be your tailor-fit therapeutic dose.
About the dosing: for some reason, Luvox is advised to be given in separate doses on higher dosages. I've experimented with both once (evening) and twice a day (morning and evening) dosing. For me, a single evening dose turned out to work best. The morning dose would make me too sedated. 'Maileage may vary', if you allow me to throw in the cliché most worn out on medication forums.
Good luck and let us know what happens (if you like).
Posted by terrysb on June 21, 2009, at 21:06:40
In reply to Re: Luvox for Depression, posted by Brainbeard on June 21, 2009, at 5:21:57
> So, I don't know: going up a bit faster might give you some harder to digest anxiety, but on the other hand you might already have reached the spot where anxiety starts subsiding. I have my doubts about the latter possibility though, since 25mg is a very low dose.>
> Good luck and let us know what happens (if you like).Since I have been at 25mg the past few days I will move up to 37.5mg tonight and get to 50mg by mid week. So far the start-up anxiety has been present but relatively mild. It tends to elevate mid afternoon.
I want to get past this stage sooner rather than later. I'll keep posting progress. I know that I'm experiencing the normal ramp up onto an SSRI. I think staying at 50mg for a longer period is a good idea.
Posted by Phillipa on June 21, 2009, at 21:54:39
In reply to Re: Luvox for Depression, posted by terrysb on June 21, 2009, at 21:06:40
Are you taking it once or twice a day? As it has a short half life. Maybe divide dose morning and night or if not at night morning and late afternoon. Phillipa
Posted by terrysb on June 21, 2009, at 23:23:18
In reply to Re: Luvox for Depression » terrysb, posted by Phillipa on June 21, 2009, at 21:54:39
I'm taking one dose at night. I'll see how the next day or so goes. It does seem that the anxiety comes at about the half-life point of around 15-17 hours. So maybe splitting the dose makes sense here.
Posted by terrysb on June 22, 2009, at 17:57:10
In reply to Re: Luvox for Depression, posted by Brainbeard on June 21, 2009, at 5:21:57
I increased the dosage last night to 37.5mg. I don't know if this is a result of the increased dosage or just an isolated event but I woke up after about 4 hours and wasn't able to get back to sleep. However, today there has been no real increase in anxiety or peak in the afternoon. I'm debating whether to stay at 37.5 or give 25 a little bit longer before I push up the dosage.
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