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Dr. Bob is Robert Hsiung, MD,
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Posted by rainbowlight on May 7, 2002, at 17:40:45
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
I also tolerate SSRI's poorly. After years of getting sick on different meds I found out I was a bad metabolizer. I have found that if I start out on a really low dose that I have fewer side effects. I also require a much smaller dose than your average person. Maybe you just need to try a smaller dose to begin with, might make it easier to tolerate.
Posted by katekite on May 7, 2002, at 20:26:18
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
If you haven't been on all of them in conjunction with wellbutrin, it could be worth a try, since wellbutrin may influence how you respond and even the initial side effects. Maybe just try the least bad one for a short time to see if you tolerate it better than before. -- kate
Posted by allisonm on May 7, 2002, at 23:35:45
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again » allisonm, posted by Leighwit on May 7, 2002, at 12:03:29
LW,
Thanks for writing. I couldn't tolerate Zoloft because it made my brain race, my heart and body race, and I had bad tremor. Effexor was similar but worse. Celexa gave me big tremor but turned off absolutely all energy so it was hurting my life because I could not do anything.
REmeron worked for awhile, but everything I have always taken has need augmentation. Added the WB and felt a lot better. Got off the Rem because over time the combo didn't seem to be doing the trick. WB has seemed to be the best drug I've been on. It just can't do the job by itself either. Weight gain on Remeron and lithium was really bad. Once I got off Rem and stayed on WB, I lost about 30 lbs.
You make good points on the Wellbutrin. I wish I had an answer.
I hope the Xanax helps.
Take care and thanks again for writing.
Allison
Posted by allisonm on May 7, 2002, at 23:45:13
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again » allisonm, posted by Phil on May 7, 2002, at 12:36:37
Hi Phil,
SE with Zolofft was racing mind and body, big tremor. Celexa was complete opposite. Felt I had the flu: NO energy and tremor on top.
Think I have had inorgasmia for years, although before it didn't matter. Now it does matter. Don't know what causes that. Not even so concerned about it as I am getting rid of these bad feelings.
Yeah, finals start Friday, and I'm too old to do mushrooms anymore. Just don't spring back like I used to . Oh, those days when we were indestructible. :-)
I'll ask him about alternatives. He's alreadyy kinda said I don't have to go in this direction... I'm even thinking about giving in to MAOIs and doing the 2-week washout and giving up the tofu and soy (I'm vegetarian, so it will be a loss).
I dunno. I am tired of being mentally ill. I am very afraid that my professors will find out -- especially my advisor. They say nothing will change in their opinions but it always does. You can see it in their eyes and the way they talk.
A>
Posted by allisonm on May 7, 2002, at 23:46:21
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again » allisonm, posted by sid on May 7, 2002, at 13:26:02
Posted by allisonm on May 7, 2002, at 23:48:10
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again, posted by rainbowlight on May 7, 2002, at 17:40:45
My pdoc did mention starting at a very small dose and working up. Maybe it will work as it does for you. I'll ask him about it again.
Thanks!
Posted by allisonm on May 7, 2002, at 23:52:01
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again, posted by katekite on May 7, 2002, at 20:26:18
Good point, also.
I did try Celexa with Wellbutrin, but not Zoloft with WB. I was hesitant at the thought of putting two activating ADs together, but maybe their interactions would be different together.
Thanks!
Posted by Janelle on May 8, 2002, at 2:16:27
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
Sorry to hear how you are suffering ... I can relate. Anxiety is a BIG problem for me.
From what I know (which admittedly isn't a whole heckuva lot!) it sounds like the combo you are on is pooping out but has been a good one in terms of BALANCE: Serzone, which is supposed to be a more sedating, calming AD could be offsetting the Wellbutrin, which is a more activating AD (it causes heart palpitations and agitation in a considerable segment of people).
Has your pdoc told you WHY/what his reason(s) are for wanting to wean you off the Serzone and try an SSRI again? If anything I would have thought he'd want to do the opposite - wean you off the activating AD (Wellbutrin) and maintain the Serzone. Hmm ...!
I can offer a theory (probably not a very good one, but I'll give it a whirl) as to why your pdoc would want to try SSRIs again after previous intolerable side effects and it is precisely what you happened to mention: YES, there is really a chance that an SSRI could help now! I think this is possible because your body chemistry has probably changed since the times you were on SSRI's and had the bad SE's, and perhaps what your body couldn't tolerate then it WILL be able to tolerate now.
Also, I have read and have a friend who has actually had it happen - a med that previously didn't help or had bad SE's did wind up helping and being tolerated on a later re-try.
Hope this helps. Good luck.
Posted by allisonm on May 8, 2002, at 10:55:42
In reply to Re: Bad SSRI side FX/trying again, my take: » allisonm, posted by Janelle on May 8, 2002, at 2:16:27
Hi Janelle,
Thanks for writing.
I am reluctant to get off the Wellbutrin because I have had the best response with it. I think the pdoc thinks the same.
He did put me on the Serzone to help me sleep. I have insomnia. That's also why I was on the Remeron for so long. I am concerned that something like Zoloft will exacerbate the sleep problem. I cannot recall what Celexa did.
I just have a feeling that the WB and the Serzone aren't enough for the increased stress I have been under. Or maybe it is poop-out. I can never tell if poop-out is happening. Every circumstance has so many variables.
I see my pdoc Thursday and will ask the good questions you and others have posed. It's good to know that somebody has benefited by trying a drug a second time.
Thanks for your help!
Allison
Posted by kid47 on May 8, 2002, at 11:59:55
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
Hi Alli. Have you ever tried Trazodone. It is an older AD with some similarities to Serzone. I think Serzone is supposed to be a more refined version. Might be worth a look. With SSRI's start low & go slow. Maybe if you titrate up real slow you'll have better luck. Haven't talked to you in a while. Take care
kev
Posted by Janelle on May 8, 2002, at 19:51:14
In reply to Re: Bad SSRI side FX/trying again, my take: » Janelle, posted by allisonm on May 8, 2002, at 10:55:42
I have TERRIBLE insomnia, and have been tossing around the possiblity of going on one of the more sedating AD's, e.g. Remeron (but the weight gain scares me) or Serzone. So, I'm curious to know, has the Serzone taken care of your insomnia?
Thanks!
-Janelle
Posted by Janelle on May 8, 2002, at 19:56:33
In reply to Re: Bad SSRI side FX/trying again, my take: » Janelle, posted by allisonm on May 8, 2002, at 10:55:42
Do you find that Serzone gives you any kind of "hang-over" effect the next day after taking it the previous night? If so, how *bad* is it? And what dose of Serzone do you take?
Thanks!
Posted by allisonm on May 8, 2002, at 22:40:23
In reply to P.S. Oops forgot some stuff re Serzone: » allisonm, posted by Janelle on May 8, 2002, at 19:56:33
Janelle,
Remeron was tremendous when I started it. It put me right to sleep and I didn't wake up in the night. (I used to wake up every 2-3 hours and often could not go back to sleep. Got little sleep. Over time became exhausted.)
Weight gain was a problem and for that reason I would not go on Remeron again.
Serzone doesn't affect weight, and it puts me to sleep, albeit not as sound a sleep as the Remeron did. It works enough, though, so that I can sleep through the night. I find no hangover with Serzone. With Remeron, there always was a degree of fog depending on the dose. I had to have coffee in the morning to break it.
I take 150mg Serzone in the morning with 150mg Wellbutrin. Then 150mg Wellbutrin around 3 p.m., and then 150mg Serzone around 9 pm. One thing is that if I do take the Serzone later than 9 or 10, I find it harder to wake up and I am more apt to fall asleep after I shut off the alarm. Then invariably I am late to school or work, which I really hate because I tend to be a perfectionist. Taking it early enough works well. It is not so strong that it will make you sleepy and turn bleary and useless if you still are working on stuff (Remeron did do that; I couldn't really take it until just before I went to bed.)
Hope this helps.
Posted by Janelle on May 9, 2002, at 2:32:29
In reply to Serzone and insomnia » Janelle, posted by allisonm on May 8, 2002, at 22:40:23
Posted by allisonm on May 9, 2002, at 6:26:05
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again, posted by kid47 on May 8, 2002, at 11:59:55
Posted by katekite on May 9, 2002, at 10:21:20
In reply to Re: Bad SSRI side FX » katekite, posted by allisonm on May 7, 2002, at 23:52:01
I think its impossible to know what any drug will do, for sure, in combination with any other. We are all so completely different. But you would know pretty soon -- a week maybe, after you started if the side effects were going to be just as bad as before. So maybe worth a shot.
kate
Posted by allisonm on May 9, 2002, at 22:48:44
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
Now this is getting a little interesting. My pdoc first gave me the Remeron because I was depressed and had bad insomnia. A while later after I was off the Remeron and had tried a couple other things, he put me on the Serzone because of the insomnia thing.
So when I saw him today, I brought up the question re' switching Serzone and trying an SSRI again and what about this insomnia we've treating for 4 years, which has been a symptom of this insomnia. He didn't seem to think there was a problem not having an AD w/o having sleep aid as part of it. Said my sleep hygiene was not good and I should be working on that. Grr. We have gone around re' sleep hygiene and I know I need to practice better methods there, but even then I still seemed to have the insomnia. Don't know how eliminating Serzone for an SSRI is going to help the situation. Sorry, just venting a little.
Posted by Janelle on May 10, 2002, at 2:57:54
In reply to Insomnia..., posted by allisonm on May 9, 2002, at 22:48:44
Interesting discussion you had with your pdoc regarding insomnia ... what did he/you mean by "sleep hygiene"? I am guessing it refers to sleep habits, perhaps including going to sleep what might be considered *too late*?
IMHO there's only so much one can do or try to do with their sleep habits and patterns and if insomnia persists, it would seem to be a biochemical type problem (beyond the scope of behavioral techniques) and necessitate medical assistance!
The only thing I can come up with for how eliminating Serzone for an SSRI is going to help your sleep (or lack thereof!) situation is that some of the SSRI's *supposedly* help with insomnia.
Now here's an interesting contrast: Both I and a friend of my sister's are on EffexorXR for AD; she said that ever since she got on it she sleeps like a baby, whereas me, I have extreme difficulty falling asleep/major insomnia. Same med, two very different scenarios! Argh ... it's so frustrating!
Posted by beardedlady on May 10, 2002, at 10:54:31
In reply to Re: Insomnia... I understand your frustration! » allisonm, posted by Janelle on May 10, 2002, at 2:57:54
Janelle:
Do you have a pdoc? It's hard to believe you have insomnia but don't know about sleep hygiene. It's the very first thing most docs (and articles and news stories) try to fix before putting you on meds. It's about going to bed and waking up at the same time, following a routine, using the bed for sleeping and sex only (not t.v. watching or eating), doing something relaxing--not stimulating--before bed, etc.
Sometimes changing sleep hygiene does, indeed, work, especially if you're a person who sits in front of the computer all night, instead of winding down with a warm bath, then getting into bed to close your eyes and completely relax. Insomnia is a common problem, and it's not always one that needs meds thrown at it. In my case, however, I already had good sleep hygiene and probably got insomnia due to hormonal problems and grief. When the insomnia is a side effect of other meds, there's really nothing you can do about it without a new or additional medicine.
beardy : )>
Posted by beardedlady on May 10, 2002, at 10:56:16
In reply to Insomnia..., posted by allisonm on May 9, 2002, at 22:48:44
I'm on 250 of Serzone (more than 300 doesn't work for sleep as well) AT NIGHT, and I take an occasional Sonata for help when I need it. Ask your pdoc?
beardy : )>
Posted by allisonm on May 10, 2002, at 20:23:04
In reply to Re: Insomnia... » allisonm, posted by beardedlady on May 10, 2002, at 10:56:16
Thanks, beardy,
I might be wrong, but I have the impression that he thinks I can deal with the insomnia by myself now with better "sleep hygiene."
According to a little handy-dandy chart I've been given, that would mean:
1. Arise at the same time daily
2. Limit daily in-bed time to the usual amount present before the sleep disturbance.
3. Discontinue CNS-acting drugs, (caffeine, nicotine, alcohol, stimulants).
4. Avoid daytime naps (except when sleep chart shows they induce better night sleep).
5. Establish physical fitnes by means of a graded program of vigorous exercise early in the day.
6. Avoid evening stimulation; substitute radio or relaxed reading for television.
7. Try very hot, 20-minute, body temperature-raising bath soaks near bedtime.
8. Eat at regular times daily; avoid large meals near bedtime.
9. Practice evening relaxation routines, such as progressive muscle relaxion or meditation.
10. Maintain comfortable sleeping conditions.Makes sense, I guess, in a perfect world.
I know, I'm whining...
Posted by beardedlady on May 11, 2002, at 5:04:25
In reply to Re: Insomnia... » beardedlady, posted by allisonm on May 10, 2002, at 20:23:04
The sleep hygiene thing is good. I'll tell you my experiences with each:
> 1. Arise at the same time daily
You're supposed to go to bed the same time each night, too. I do that, but I also feel that if I'm sleeping, I'll be damned if an alarm clock is going to wake me!
> 2. Limit daily in-bed time to the usual amount present before the sleep disturbance.
Yes. But many docs advise you to get out of bed and do something boring if you can't sleep. I just lie in bed and rest. Eventually (it takes between 30 minutes and two hours) I fall back to sleep, and I will sleep for another two or three hours. So I just try to hold as still as possible (or allow myself about twenty minutes to rock or wiggle or get comfortable). At least it's resting, and most of the time, it's not so stressful because I know I'll eventually fall asleep (though sometimes my confidence is bad).
> 3. Discontinue CNS-acting drugs, (caffeine, nicotine, alcohol, stimulants).
Yes, but caffeine's usually okay before noon. I like my beer, though, and I try to drink it around 6 p.m., but I do wake up at 2:00. Still, I do that anyway, so I allow the beer!
> 4. Avoid daytime naps (except when sleep chart shows they induce better night sleep).
Because my problem is anxiety, being able to nap restores my confidence in my own ability to sleep. I have taken three-hour afternoon naps before (even after a good seven hours of sleep) and have managed to sleep fine that night. But everybody--and every body--is different.
> 5. Establish physical fitnes by means of a graded program of vigorous exercise early in the day.
Oh, yes. That first-thing-in-the-morning run is the best.
> 6. Avoid evening stimulation; substitute radio or relaxed reading for television.
Read. It works. When I read, I'm able to take my mind of sleep pressures. I have read about four books this month, just in the half-hour before bed.
> 7. Try very hot, 20-minute, body temperature-raising bath soaks near bedtime.
Every night. Can't live without 'em. Sometimes I fall asleep in the tub. Try Burt's Bees something or another eucalyptus tub soak, if you can stand the smell. Otherwise, Epsom Salts are a great muscle relaxant.
> 8. Eat at regular times daily; avoid large meals near bedtime.
Absolutely.
> 9. Practice evening relaxation routines, such as progressive muscle relaxion or meditation.
This only makes me worse. I expect too much.
> 10. Maintain comfortable sleeping conditions.
Of course. I poke my husband and whisper, "Roll over!" all night long, and then I go into the guest room when the noise is too much. If you sleep with someone else, get those pink foam earplugs (Ekert (sp?) online). They really work.
> Makes sense, I guess, in a perfect world.Yes. In a perfect world. Make these improvements a little at a time, but I would start with regulating bed time, reading, and baths. (I read in the tub, so sometimes I'm too tired to stay awake to read in bed!)
Take your Serzone at night, too. That makes a big difference.
>
> I know, I'm whining...Whine away. Only those with insomnia can understand how horrible it is. It ruined my life for a very long time. Now I have learned that it's okay to be on meds, and it's okay to have this problem, and that there are some worse things out there, so I consider myself blessed. Of course, I am in a much better mood when I sleep.
I had a colonoscopy yesterday, so I came home and fell asleep at about 7:00 p.m. and slept until 4:00 a.m. It took me awhile (until 5) to say that I'd had enough sleep and get up. But I have had enough. And if I need it, I'll take a nap today. And if I need it, I'll take a sleeping pill tonight.
When I sleep, life feels good. I get it however I can, without guilt anymore!
I wish you great luck and good sleep.
beardy : )>
Posted by dove on May 13, 2002, at 15:52:19
In reply to Re: Insomnia... » allisonm, posted by beardedlady on May 11, 2002, at 5:04:25
Prozac was/is definitely different from the other SSRIs (although, I believe that each have their own little personalities), and caused quite a bit of anxiety for me at first. It also gave me even more problems with insomnia (which are no longer a problem due to med management).
I countered the sleep problems with Serzone and Amitriptyline, 300MGS of Serzone throughout the day and 100MGS with 150MGS of Amitriptyline at bedtime. It worked very well indeed. I no longer need to take 150MGS of Amitriptyline at bedtime, I can even lower it to 50MGS with positive sleep results.
When I first ramped up on Prozac I went bananas, and finally dropped it altogether. Almost a year later, back on Prozac, double the original dosage and doing much better and *not* going bananas. I also went the Wellbutrin route, in combo with SSRI's and Amitriptyline, and Adderall, and just never had a good result with it. Serzone seems to activate my other meds in positive ways, which is why I don't want to get rid of it from my current med cocktail.
I would also add that I'm taking Adderall in addition to Prozac, so I do have some nervous system activation going on; and since I suffer from Panic Disorder and GAD, I also take klonopin, which helps subdue all that activation.
Many people I know find that Paxil is a good sleep enhancer, and just as many have said the same for Zoloft. I've not heard the same said of Celexa, Effexor, or Prozac. Serzone supposedly repairs faulty sleep structure (whether due to drug or other induced sleep problems) according to my p-docs.
And Reading is my absolute favourite addition to my "sleep hygiene" practices, just make sure you're not reading something so good that you can't put it down :o)
dove
Posted by allisonm on May 14, 2002, at 19:09:37
In reply to Re: Insomnia..., posted by dove on May 13, 2002, at 15:52:19
Dove,
Thanks for your information. Do you have any idea why the Prozac worked the second time with out the "bananas" feeling?
Thanks.
Allison
Posted by dove on May 15, 2002, at 16:08:14
In reply to Re: Insomnia... » dove, posted by allisonm on May 14, 2002, at 19:09:37
>
> Thanks for your information. Do you have any idea why the Prozac worked the second time with out the "bananas" feeling?
>
> Thanks.
>
> AllisonI have absolutely no *real* theory as to this bizarre fact. I know that I was taking Wellbutrin at the time, so that's one possibility. It was during the November-January season--which is a terrible time of the year for me anyway. And possibly, I didn't go "bananas" this time around due to the other mood-stabilizing meds already in place. But, that's all just random thoughts :o)
dove
This is the end of the thread.
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