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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Peter on September 28, 2003, at 7:08:16
I know that there is a delayed therapeutic response to SSRI's, as it takes a few weeks for the serotonin reuptake inhibition to really begin working.
But what if you've been on one SSRI for 3-4 weeks and decide to switch to another SSRI?
Will there be another delayed period before the second one starts working, or will it sort of continue from where the first left off and thus begin working immediately?
Posted by Bill LL on September 29, 2003, at 11:20:25
In reply to switching between SSRIs, posted by Peter on September 28, 2003, at 7:08:16
I'm not totaly sure, but I think that the next one would kick in faster. I'm sort of surprised that you are switching after only 3 to 4 weeks. Oftentimes people give up on a drug instead of raising the dose. Usually raising the dose will make a big difference. Also, side effects tend to diminish over time.
> I know that there is a delayed therapeutic response to SSRI's, as it takes a few weeks for the serotonin reuptake inhibition to really begin working.
> But what if you've been on one SSRI for 3-4 weeks and decide to switch to another SSRI?
> Will there be another delayed period before the second one starts working, or will it sort of continue from where the first left off and thus begin working immediately?
Posted by Peter on September 29, 2003, at 12:57:58
In reply to Re: switching between SSRIs, posted by Bill LL on September 29, 2003, at 11:20:25
> I'm not totaly sure, but I think that the next one would kick in faster. I'm sort of surprised that you are switching after only 3 to 4 weeks. Oftentimes people give up on a drug instead of raising the dose. Usually raising the dose will make a big difference. Also, side effects tend to diminish over time.
> > I'm probably not switching; I just wanted to know more out of curiosity. I gotta say though, my mood really is not much improved. I have a feeling that the stimulant I'm taking (adderall) is rendering my mood more unstable and interfering with the effects of the lexapro I'm taking. So I am tapering the adderall and meanwhile I'm staying on the same dose of lex (10mg), and hopefully its AD and anti-anxiety effects will be more evident to me; so I'll probably give it another few weeks, and, if it has not improved after tapering the adderall, I'll discuss with my pdoc about changing the dose or changing ADs all together. Thanks for your response.
> Peter
>
Posted by Bill LL on September 29, 2003, at 14:24:13
In reply to Re: switching between SSRIs » Bill LL, posted by Peter on September 29, 2003, at 12:57:58
I have taken 20 mg of Lexapro for the past 12 months with excellent results. Good luck!
Posted by Jasmine Neroli on September 29, 2003, at 23:07:53
In reply to switching between SSRIs, posted by Peter on September 28, 2003, at 7:08:16
Hey Peter: Howz it going? Hope the Lexapro is beginning to help you now.
Just wanted to tell you a theory of mine re SSRI's. You may recall that I was on Celexa for 8 months, felt better, went off it. Bad mistake, after 2 weeks started to suffer greatly. Re-started again a month later.
Well, with the original Celexa treatment, my symptoms responded within 3 weeks. However, when I took it the second time, it was about 5-6weeks before I felt ANY improvement, and 8 weeks until I felt myself again! My theory is that, after an initial exposure to SSRI's, subsequent treatments take longer to work. I have no idea WHY (scientifically speaking) this might be the case. Just from personal experience and reading others' similar stories.
You might be experiencing this effect too.
The patience required by mental health sufferers is immense! Keep at it - there has to be a combo for you out there somewhere!
Jas
Posted by Peter on September 30, 2003, at 6:10:39
In reply to Re: switching between SSRIs, posted by Jasmine Neroli on September 29, 2003, at 23:07:53
> Hey Peter: Howz it going? Hope the Lexapro is beginning to help you now.
> Just wanted to tell you a theory of mine re SSRI's. You may recall that I was on Celexa for 8 months, felt better, went off it. Bad mistake, after 2 weeks started to suffer greatly. Re-started again a month later.
> Well, with the original Celexa treatment, my symptoms responded within 3 weeks. However, when I took it the second time, it was about 5-6weeks before I felt ANY improvement, and 8 weeks until I felt myself again! My theory is that, after an initial exposure to SSRI's, subsequent treatments take longer to work. I have no idea WHY (scientifically speaking) this might be the case. Just from personal experience and reading others' similar stories.
> You might be experiencing this effect too.
> The patience required by mental health sufferers is immense! Keep at it - there has to be a combo for you out there somewhere!
> Jas
>>Hey Jasmine!
How are you? Haven't seen you posting in a while. How's the klonopin treating you? Did you try provigil? How's work at the school?
Thanks for your info about it taking longer for subsequent SSRI treatment to kick in. That's definitely been the case with lex for me. But what I don't understand is that I've been on all the other SSRI's multiple times, and I never ran across the issue of their not kicking in for over 4 weeks. Within the past year alone, I took zoloft for months followed by prozac for months, and the prozac didn't have a more-than-usual lag time to start working. And usually the combination of adderall + an SSRI proved to work pretty well with me - the SSRI 'smoothed over' any mood choppiness created by the adderall, while the adderall lowered such SSRI SE's as apathy, lethargy, and heightened impulsiveness due to dopamine down-regulation. But this time, with the lex +adderall, everything is so wierd; the synergy between the 2 seems to be working to my detriment, not my benefit. Each adderall dose gives me a slight lift in mood, sociability, focus, energy, but is much more short-lived than when I took adderall alone or with other SSRI's; within 1-2 hours after each dose, I become EXTREMELY socially-withdrawn, avoidant, and depressed. There are also bizarre physical symptoms involved that seem to stem from this adderall/lexapro synergy: for instance, I get FREEZING cold regardless of the weather, like the cold is inside my bones. I could wear 3-4 layers of clothes and still feel frigid. This effect tends to increase throughout the day, maybe an attestment to the phenomenon being brought on by the synergy of the lex+adderall, since I take adderall thru the day (3 doses) and I suppose it thus builds up in my system, and I get colder and colder. At night, however, when most of the immediate adderall effects have worn off, I get a wind of energy and restlesness, sometimes to the point of it being uncomfortable. So in a way it seems like the adderall, during the day, is curbing my impulses TOO much, and maybe 'covering up' the possible energizing, mood-improving effects of the lex. Maybe it's because of the adderall that it seems like the lex ain't doin' crap. So, I've been tapering the adderall by 5mg every 4th day, and I'll see how that affects me. What I don't understand is that I have symptoms that I can't attribute to the adderall; for instance, I have a heck of a hard time waking up in the morning and usually feel hungover and sick BEFORE I take any meds (including adderall). So maybe that's proof of the lex not really working, because, in the past, one of the first therapeutic effects of SSRI's for me is that they improved my wake/sleep architecture and helped me wake up earlier and with more energy and better mood. Not so with the lex; and this fact is independent from the adderall, since this occurs before I begin taking my daily adderall. Also, in terms of the klonopin: remember my pdoc had me go up to 3.75mg when he was on vacation in August? Welll, since then, I've gradually gone down to 3.5, 3.25, 3, and the last taper was to 2.5mg (pdoc told me to do it, as the daytime klonopin could also be interfering with energizing effects of the adderall). So now I take 2.5mg total klonopin (only .5mg during the day divided into 2 doses). But I wonder if the klonopin tapering could be contributing to my feeling lousy, although none of the symptoms really involve any rebound anxiety, and my pdoc said that I won't have any withdrawal from the klonopin decreases. Another thinng that might be making it hard to gage whether the lex is working at all (this is day 25) is that I've been so used to my patterns of isolation that I haven't ventured out to any social thing or played any gigs in months; it's been really hard to get out of my isolation rut, especially because of the mood lability and bizarre physical symptoms I've been experiencing, and I thus haven't been in a context from which I could gage whether my social anxiety/anticipatory anxiety has improved at all. It's a real catch-22. Sorry, I'm blabbering away again. Thanks again for your post, it's good to see you here again! Keep in touch!
Peter
Posted by Jasmine Neroli on October 2, 2003, at 0:04:19
In reply to Re: switching between SSRIs » Jasmine Neroli, posted by Peter on September 30, 2003, at 6:10:39
Hi Peter:
Well, I'm "up and down" as they say. I was diagnosed by a psychiatrist with GAD (surprise, surprise!!!.....my GP insisted I had depression with anxiety). The psych wanted me to try BuSpar and taper off Klonopin, using Klon. only "as needed". Well a month later I'm having anxieties again more and more frequently and see no effect from the dose of Buspar I'm on. I try not to take Klonopin (per Doc's orders) but have to quite often to function at school ( which is going quite well, thanks)..have been busy and found it exhausting! I go back to doc's next week to revisit the meds issues.
RE your experiences on the Lex..I'm convinced that Lexapro and Celexa are the longest to take effect of all the SSRI's (especially for previous users). You have toughed it through some awful side effects, by the sound of it. The freezing cold thing is strange! Saw your post re the hives too. I've seen that reaction posted before( not here though)...exactly the same...hives on hands, that eventually may turn to blisters, according to some. I remember someone having to stop Lexapro because they didn't respond to anti-histamines. I think for others, it's a transient thing though. Hope it is for you.
Regards,
Jas
Posted by EscherDementian on October 2, 2003, at 17:14:48
In reply to switching between SSRIs, posted by Peter on September 28, 2003, at 7:08:16
A curiosity:
If (Do?) different SSRIs selectively inhibit seratonin reuptake differently from each other, what would be the effect of alternating between two (say Zoloft and Lexapro) every other day?
Would they work synergistically? Or parallel? Or conflict?
Would there be an added benefit?Escher
Posted by Ame Sans Vie on October 3, 2003, at 9:58:14
In reply to Alternating Daily between SSRIs, posted by EscherDementian on October 2, 2003, at 17:14:48
Hmmm... that's a really good question. Hope someone here has an answer.
Posted by EscherDementian on October 3, 2003, at 13:19:51
In reply to Re: Alternating Daily between SSRIs » EscherDementian, posted by Ame Sans Vie on October 3, 2003, at 9:58:14
> Hmmm... that's a really good question. Hope someone here has an answer.
>>A curiosity:
>>If (Do?) different SSRIs selectively inhibit seratonin reuptake differently from each other, what would be the effect of alternating between two (say Zoloft and Lexapro) every other day?
>>Would they work synergistically? Or parallel? Or conflict?
>>Would there be an added benefit?
>>
>>Escher
Posted by Ame Sans Vie on October 3, 2003, at 19:23:39
In reply to Ask Larry Hoover, or-?, posted by EscherDementian on October 3, 2003, at 13:19:51
That's a technique I think I may actually experiment with... I could go off the Ultram and use the Duragesic as my depression/OCD med, and then see whether alternating daily between two SSRIs boosts the effects any. It'd definitely be Lexapro and Prozac that I'd try since they have (for me) the least side effects.
Posted by EscherDementian on October 4, 2003, at 8:54:31
In reply to Alternating Daily between SSRIs, posted by EscherDementian on October 2, 2003, at 17:14:48
Let me know what you observe~ i'm interested.
Yesterday and today i took Lexapro 20mg instead of the Zoloft 100mg. Not intentional experimenting per se: my pdoc is out of town for 2 weeks, and we both forgot to get a perscription in for Zoloft. Still have Lexapro from previous. i could call the office or get a message through for what i need, but it seemed like a good opportunity to explore & compare.
Here's what i've noticed so far-
First day (switched): didn't notice any difference at all (which surprises me; usually i can feel a molecule difference from 1000 paces, lost in a fog, buried under 1000000 tons of bs, and one hand tied behind my back). Very late, later that night, a slight frequency change in my ear screeeeing.
Second day: Houston, this is Mission Control. Who turned the gravity up a notch? And co-pilot Adderall here is acting very spacy... Audio's receiving alien frequency transmissions in unrelentingly continuous volume... And i feel like i'm navigating dark matter, where i was sure i left those stars...
Perhaps tomorrow i'll go get that Zoloft.
I really don't like Lexapro's screeeeing inside my space helmet ;)
i'll post serious(useful) discoveries or interesting phoenomena if anything occurs...Escher
Blasting off on another fun-filled adventure in The Final Frontier
Posted by Larry Hoover on October 4, 2003, at 10:19:11
In reply to Ask Larry Hoover, or-?, posted by EscherDementian on October 3, 2003, at 13:19:51
> > Hmmm... that's a really good question. Hope someone here has an answer.
>
> >>A curiosity:
> >>If (Do?) different SSRIs selectively inhibit seratonin reuptake differently from each other, what would be the effect of alternating between two (say Zoloft and Lexapro) every other day?
> >>Would they work synergistically? Or parallel? Or conflict?
> >>Would there be an added benefit?
> >>
> >>EscherI'll give you my opinion....because of the relatively long half-life of SSRIs, I don't think it would much matter that you alternate days. It would be the same as taking both at the same time, with all the attendant risk of additive effects like serotonin syndrome. Of course, total dose would be an issue.
I don't think you'd get the benefits of one plus the benefits of the other. I think you'd get the adverse effects of one plus the adverse effects of the other. But that's just my opinion.
Lar
Posted by stjames on October 4, 2003, at 11:24:42
In reply to Re: Ask Larry Hoover, or-? » EscherDementian, posted by Larry Hoover on October 4, 2003, at 10:19:11
It would be the same as taking both at the same time, with all the attendant risk of additive effects like serotonin syndrome. Of course, total dose would be an issue.
Given that SSRI's tend to potentiate each other the risk of exponential increase in levels is very real.
As Lar says, this would lead to more side effects and maybe SS.
Posted by EscherDementian on October 9, 2003, at 1:19:23
In reply to Re: Alternating Daily between SSRIs, posted by EscherDementian on October 4, 2003, at 8:54:31
After a week on Lexapro i am returning to Zoloft tomorrow or next day.
Did reduce the Lexapro to 1/2 dose after the second day's not-so-pleasant differences (Adderall spaciness and 'stuck in a cul-de-sac thinking', physical heaviness, emotional darkness).
Not much more different about following days except the Lex + Adderall SEs returned (ear ringing, itchiness that when scratched produces hive-like bumps)...basically reaffirmed my reason for switching from Lexapro in the first place (Doh!).
All in all, didn't achieve anything that i would by any means call added benefit, Ame Sans Vie, although the second night's mild hallucinogenic patterns in my carpet and wall were mildly amusing...
My PhDoc told me that 'seratonin syndrome' is actually rather uncommon. He asked me how long ago i'd run out of the Zoloft, and about flu-like symptoms, temperature and heart palps, but not about the things i thought described 'seratonin syndrome' effects. Perhaps i got that wrong, will have to scout the definition again. Quick and easy definition, anyone? I did MILDLY experience what i assumed was seratonin dump visuals similar to mdma or lsd, but no "feel good" effects. But i'm no doc.Anyway, glad to have my pdoc and zoloft back in my life. Not much else i can offer about this alternating thing. Thanx for the answers, LarryH & SusanStJ~ :) Anything i might need to know before picking up my Zoloft and resuming at 100mgs? My pdoc didn't mention anything, but i didn't ask. We discussed my heavy darkness in that $pendy 45min session. ;)
Escher Dementian
-Reloaded
Posted by Ame Sans Vie on October 9, 2003, at 22:14:59
In reply to Re: Alternating between SSRIs, posted by EscherDementian on October 9, 2003, at 1:19:23
> All in all, didn't achieve anything that i would by any means call added benefit, Ame Sans Vie, although the second night's mild hallucinogenic patterns in my carpet and wall were mildly amusing...
Just found it somewhat odd that you mentioned these hallucinogenic effects... although I realize the causes were (probably... maybe?) entirely unrelated, I found myself witnessing some "mildly amusing" little visual anomalies myself last night. :-)
I assume this has something to due with the fentanyl I just started since I notice some pretty heavy visual alterations every two or three days when I apply a new patch, and these last about an hour or two. The "hallucinations" are always very erratic and rather annoying on the fentanyl though, while last night they were quite smooth and more "tryptamine-feeling"... more of a psilocybin/LSD-25 à la mode kinda thing, lol. Nothing like Nexus, 2C-T-7, DOM... as someone once so delicately put it, the experience wasn't nearly so much the complete "mind f*ck" that the latter tend to be, lol.
As an aside, from what I understand serotonin syndrome actually is fairly uncommon -- though I've known personally more than one or two pdocs to use the term to describe SSRI-withdrawal. Well holy $h*† on a stick, last time I checked serotonin syndrome was potentially life-threatening..... what's with the cavalier attitude, doc??? lol Seems like each time I come to PB, I'm reminded of another little humorous anecdote or tidbit I'd otherwise forgotten that really makes me think about psychiatry a little more... like, as much as I enjoy making the effort to learn as much about all these treatment possibilities that's possible to the layman, each time I come here and read some of these posts, I can't help but do a double-take and remind myself that I'm ultimately putting my BRAIN in some stranger's hands, lol. I dunno. Sorry for rambling -- I'm still feeling loopy from the Duragesic... not to mention seeing everything on a continually changing slope along the horizon... think I'm gonna be seasick. :-p
This is the end of the thread.
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