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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 28 to 52 of 52. Go back in thread:
Posted by pretty_paints on August 23, 2005, at 13:42:45
In reply to Re: I'm thinking Prozac, posted by john berk on August 21, 2005, at 14:32:52
Hey Ed
I haven't read all of your replies, but I just wanted to say HI and what a good idea to take some time out of uni! I can almost feel relief for you! Any idea about how your exams are going/have gone?
Things here are ok, I'll prob post something a little later on. I'm stuck upstairs in my room as my mum and dad are being asked questions about how "the family deals with me being psychotic", la la la. Basically it's a course called Family Work For Psychosis. Hmm.
Anyway I am so glad for you taking time out.
Speak again soon.
Kate xxxxxxxx
Posted by ed_uk on August 23, 2005, at 15:53:37
In reply to Re: I'm thinking Prozac, posted by Declan on August 23, 2005, at 0:14:25
Hi Dec!
I feel calmer and suffer less intrusive/unwanted thoughts ie. OCD obsessions.
I don't tend to worry about the future on SSRIs, my immediate needs seem more important. I can sometimes act impusively, I don't consider the consequences on an SSRI. I don't think about morality very much on SSRIs - although I don't do anything really bad LOL.
It's difficult to cry on an SSRI. I can easily watch some disaster on the news without really feeling anything. During abrupt withdrawal of an SSRI, I can cry at the drop of a hat..... so to speak.
SSRIs make me feel satisfied sitting on the couch. It's difficult to get motivated to do anything. Lying in bed feels kind of serene.
SSRIs delay my orgasms substantially and lower my libido. They also increase sweating. Paroxetine made me drowsy. Fluoxetine and citalopram less so. I've never taken sertraline. Venlafaxine felt like an SSRI to me.
>Never taken any of them myself........
LOL, it's funny that you're taking Parnate when you've never tried an SSRI - that must be VERY rare!
Posted by ed_uk on August 23, 2005, at 15:54:06
In reply to Re: I'm thinking Prozac » ed_uk, posted by Empathy on August 23, 2005, at 9:41:54
I will do :-)
Ed x
Posted by ed_uk on August 23, 2005, at 15:56:16
In reply to Re: I'm thinking Prozac, posted by pretty_paints on August 23, 2005, at 13:42:45
Hi Katie!
My June exams went quite well :-) I was supposed to be taking my (missed) January exams this week but I'm delaying them till next year. I'm going back to uni in ~13 months. I'm working in (various) pharmacies at the moment.
Love Ed xoxoxo
Posted by john berk on August 23, 2005, at 18:30:45
In reply to How I feel on high-dose SSRIs » Declan, posted by ed_uk on August 23, 2005, at 15:53:37
Hi Ed.
i mentioned previously that i take 20 mgs. prozac for ocd, well, i went to a new pdoc yesterday, and it looks like i will be going to 40, he feels 20 is much too low for ocd.
when you were explaning the feeling on high dose prozac, it actually felt soothing, thinking about sitting serenely on the couch, anyone with ocd would know that is a trial with our obsessions!!i truly hate, [like i mentioned before] the apathy associated with higher doses, and the sexual side-effects, but this ocd is a unrelenting prescence, i guess i have to go along with the program for now. the new dr. was really nice, took time to explain his personal theory on ocd, so i hope the higher dose helps.
i wish you much luck if you decide to go to higher doses of "zac", and i'll keep you posted on my progress. i guess i'm "chairbound" soon, lol, but i would love to enjoy that serenity again of a cleared ocd mind!! take care....john
Posted by ed_uk on August 24, 2005, at 14:26:16
In reply to Re: How I feel on high-dose SSRIs » ed_uk, posted by john berk on August 23, 2005, at 18:30:45
Hi John! :-)
I was describing high dose Paxil/Celexa. I've never taken a high dose of Prozac. I'd like to try it :-)
I don't like the apathy either, I'm not too worried about the sexual side effects though......... OCD is much worse.
>i wish you much luck if you decide to go to higher doses of "zac", and i'll keep you posted on my progress.
Thank you, you are very kind :-) I hope Prozac 40mg works out really well for you. Keep us posted.
Kind regards
Ed
Posted by linkadge on August 24, 2005, at 16:56:27
In reply to Re: How I feel on high-dose SSRIs » john berk, posted by ed_uk on August 24, 2005, at 14:26:16
If you haven't taken zoloft, I would say that would be a very good idea.
I experienced severe apathy on celexa, and was able to turn a lot of that around on zoloft.
I think that apathy is the least likely on zoloft.
Linkadge
Posted by 4WD on August 24, 2005, at 20:46:50
In reply to Re: How I feel on high-dose SSRIs, posted by linkadge on August 24, 2005, at 16:56:27
> I think that apathy is the least likely on zoloft.
>
>
> LinkadgeWhy is that, Linkadge? Zoloft is one of the few I've never given a real trial.
Marsha
Posted by john berk on August 24, 2005, at 21:21:41
In reply to Re: How I feel on high-dose SSRIs, posted by linkadge on August 24, 2005, at 16:56:27
HI,
IF THINGS DON'T WORK OUT ON PROZAC, ZOLOFT WOULD DEFINETLY BE MY NEXT CHOICE!
A FEW OF MY FRIENDS ARE QUITE HAPPY WITH ZOLOFT,
I'VE NEVER TRIED IT, I MAY BE MISTAKEN, BUT I THINK I READ IT HAS SOME SLIGHT DOPAMINERGIC ACTIVITY,
ALTHOUGH IT IS OF COURSE AN SSRI. MAYBE THAT IS WHERE THE DECREASED APATHY COMES IN. COOL SUGGESTION LINKADGE, THANKS...JOHN btw, sorry about the loud writing again, just realized my caps were on, lol! i've got to stop shouting over everyone..john
Posted by ed_uk on August 25, 2005, at 15:44:55
In reply to Re: How I feel on high-dose SSRIs, posted by linkadge on August 24, 2005, at 16:56:27
>If you haven't taken zoloft....
I haven't. I'd like to try it :-)
~ed
Posted by linkadge on August 25, 2005, at 17:08:29
In reply to Re: How I feel on high-dose SSRIs » linkadge, posted by ed_uk on August 25, 2005, at 15:44:55
It has a dopaminergic effect that you can definately feel.
When I took zoloft 50mg it was like 20mg celexa + 5-10mg ritalin extended release.
Zoloft is more frontal cortex friendly.
http://www.biopsychiatry.com/sertnor.htm
If I mixed zoloft with a mild dose of periactin (1mg 2x day) I would say that anhedonia was not a problem.Linkadge
Posted by 4WD on August 25, 2005, at 17:56:29
In reply to Re: How I feel on high-dose SSRIs, posted by linkadge on August 25, 2005, at 17:08:29
> It has a dopaminergic effect that you can definately feel.
>
> When I took zoloft 50mg it was like 20mg celexa + 5-10mg ritalin extended release.
>
> Zoloft is more frontal cortex friendly.
>
> http://www.biopsychiatry.com/sertnor.htm
>
>
> If I mixed zoloft with a mild dose of periactin (1mg 2x day) I would say that anhedonia was not a problem.
>
>
>
>
>
> Linkadge
>
Linkadge, Why don't you try this? Have you already?Marsha
>
>
Posted by fires on August 25, 2005, at 22:43:54
In reply to I'm thinking Prozac, posted by ed_uk on August 21, 2005, at 14:01:26
I didn't have the time to read all the posts in this thread, so maybe someone has already mentioned what Jay Goldstein, MD (retired) has written:
"IVIG is very effective in treatment refractory OCD which, perhaps, has an autoimmune basis."
Posted by ed_uk on August 26, 2005, at 13:50:50
In reply to Re: How I feel on high-dose SSRIs, posted by linkadge on August 25, 2005, at 17:08:29
Thank you Link,
For you, how does Prozac compare to Celexa? I can't say much about Prozac because I only took a low dose and it didn't do anything.
I'd like to try Zoloft. I'm not so sure about Lexapro but it (Cipralex) certainly comes in a pretty box LOL!
Kind regards
~Ed
Posted by linkadge on August 27, 2005, at 12:42:09
In reply to Re: How I feel on high-dose SSRIs » linkadge, posted by ed_uk on August 26, 2005, at 13:50:50
I know about pretty packaging. I liked the effexor umbrella, thats what sold me.
I definately found prozac more agitating than celexa. It may have had more antidepressant properties though. I slept less on it, and ate less.
I would say all around I liked celexa better, I felt more predictable on it. Prozac said a lot of things to me.
Linkadge
Posted by Dave001 on August 27, 2005, at 19:27:09
In reply to How I feel on high-dose SSRIs » Declan, posted by ed_uk on August 23, 2005, at 15:53:37
> I feel calmer and suffer less intrusive/unwanted thoughts ie. OCD
> obsessions.
>
> I don't tend to worry about the future on SSRIs, my immediate needs
> seem more important.[...]
Out of curiosity, would you say that your obsessive thoughts are
composed of a lot of "intrusive imagery"?I wonder how often symptoms that are attributed to the obsessional
component of OCD are really neurobiologically similar to those which are
seen in its classical form. It's an important question, because there
seems to be a dogma that SSRIs and antidopaminergic agents are
necessarily beneficial, when that may be true for only a subset of
patients. Perhaps the opposite approach would work better for others.The animal models used to study OCD are inadequate. I don't think
there's any good evidence that the stereotypical behaviors seen in
animals have much if anything to do with obsessive thinking. There's a
paucity of data to suggest that a visual component (i.e., thoughts with
imagery) may be a distinguishing feature of OCD, thus making it seem
somewhat similar to schizophrenia. Without any such distinction,
excessive worriers (e.g., GAD) could be lumped into that category as well.It'd be interesting to see more neuroimaging studies to see whether
obsessional thinking has anything in common with "true" OCD. So-called
ADD/ADHD is often contrasted with OCD, yet the frequent overlap in
diagnoses make me wonder how many people are being treated with drugs
that may have an almost OPPOSITE action from what might help them best.
SSRIs are given for just about everything, so it doesn't necessarily
mean much when successful treatment of a given symptom complex is
ascribed to them. When amphetamine first became popular, it was also
"successfully" used to treat every imaginable condition.The problem with all of these so-called disorders is that they're just
symptom complexes that are probably heterogeneous in origin, and thus
using up the limited space remaining for new acronymical designations.
Posted by zeugma on August 28, 2005, at 5:33:23
In reply to Re: How I feel on high-dose SSRIs, posted by Dave001 on August 27, 2005, at 19:27:09
hi, I suffer from depersonalization, usually conceptualized as an OCD-spectrum disorder, but which has nothing penenomenologically in common with OCD. This study shows that fluoxetine is ineffective for this disorder: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15231553&query_hl=4
The medications that I have found useful for this condition are stimulants, particularly Ritalin. I feel more like I'm 'in my body' on this medication. As a matter of fact I am going to ask my pdoc if I can try a very low amount of Focalin to treat this condition.
Benzodiazepines have a reputation for being helpful for dissociation disorders, and certainly feeling stressed to the point of panic attacks encourages depersonalization. But it's more a matter of a 'loose' connection that I have to my body, and believe the sense of embodiment is dopaminergic in nature.
There is some evidence, too, that disorders traditionally conceptualized as OCD-like, such as skin picking and trillichtromania, are more closely related to dopaminergic dysregulation, which is intuitively sensible, since these are disorders of embodiment.
-z
Posted by ed_uk on August 28, 2005, at 7:55:01
In reply to Re: How I feel on high-dose SSRIs, posted by Dave001 on August 27, 2005, at 19:27:09
Hi Dave,
>Out of curiosity, would you say that your obsessive thoughts are
composed of a lot of "intrusive imagery"?No, mainly somatic obsessions. I sometimes have compulsions, sometimes not.
>I wonder how often symptoms that are attributed to the obsessional
component of OCD are really neurobiologically similar to those which are
seen in its classical form. It's an important question, because there
seems to be a dogma that SSRIs and antidopaminergic agents are
necessarily beneficial, when that may be true for only a subset of
patients. Perhaps the opposite approach would work better for others.For me, SSRIs are useful but antipsychotics are not. Typical APs aggravate my anxiety and induce akathisia.
>The problem with all of these so-called disorders is that they're just
symptom complexes that are probably heterogeneous in origin, and thus
using up the limited space remaining for new acronymical designations.Well said..... I've often said the same ;-)
>So-called ADD/ADHD is often contrasted with OCD, yet the frequent overlap in
diagnoses make me wonder how many people are being treated with drugs
that may have an almost OPPOSITE action from what might help them best.I do have some ADD symptoms. I'd like to try a stimulant + an SSRI.
Kind regards
~ed
Posted by Smith562 on August 28, 2005, at 19:13:00
In reply to Re: How I feel on high-dose SSRIs » ed_uk, posted by john berk on August 23, 2005, at 18:30:45
On 200 of Zoloft alone and 100 of zoloft with 450 of lithium to boost serontonin I felt extremely apathetic. Even more difficult to get out of bed and impossible to go out an see my friends and family .... Smith
Posted by ed_uk on August 29, 2005, at 3:20:36
In reply to Re: How I feel on high-dose SSRIs, posted by Smith562 on August 28, 2005, at 19:13:00
Hi Smith,
>apathetic
In your experience, how does Zoloft compare with other SSRIs?
~Ed
Posted by temoigneur on August 30, 2005, at 20:19:17
In reply to Re: How I feel on high-dose SSRIs ?Smith562, posted by ed_uk on August 29, 2005, at 3:20:36
> Hi Smith,
>
> >apathetic
>
> In your experience, how does Zoloft compare with other SSRIs?
>
> ~EdHI Ed, my chemistry is wacked, but for me, I did beautifully on 80 mg prozac, for four months, then the horrible anxiety came flooding back over the course of a couple weeks.
Posted by Laurie Beth on August 30, 2005, at 20:33:03
In reply to Re: How I feel on high-dose SSRIs » Smith562, posted by ed_uk on August 29, 2005, at 3:20:36
I am experiencing post-partum apathy and anhedonia that I hope (based on a prior experience while on 300 mg for several years a few years ago) is caused largely by being on high dose of Zoloft. Over the past two months, I have been slowly tapering off the Zoloft - was at 50 mg a month ago, now at 12 mg, will be off completely within a week. As I've decreased, I think I've been experiencing much less sleepiness and maybe 25% less apathy and anhedonia (varies from day to day in no pattern that I can discern), but I'm crossing my fingers that eventually I will feel much better.
If the Zoloft is actually causing these problems, how long might I expect to keep seeing improvement after going off completely? I did see at least one case report in which the woman's apathy resolved completely 1 month after going off the SSRI. I know that the Zoloft should be out of my brain within 16 days after stopping (according to pdoc), but I imagine that other cascasing effects (dopamine increase?) might take much longer.
Any experiences? Or even speculation?
I may regret saying this later, but it seems now that anxiety, irritability, whatever, would be better than this.
Thanks.
Posted by Dave001 on September 1, 2005, at 1:31:10
In reply to Re: How I feel on high-dose SSRIs » Dave001, posted by zeugma on August 28, 2005, at 5:33:23
> There is some evidence, too, that disorders traditionally
> conceptualized as OCD-like, such as skin picking and
> trillichtromania,But isn't there a difference between e.g., someone who has a conscious
obsession with depilating his/her body, and someone who has a proclivity
for nervous habits such as biting his/her nails?> are more closely related to dopaminergic dysregulation, which is
> intuitively sensible, since these are disorders of embodiment.Perhaps, but is it a matter of too much or too little dopamine, or both?
And couldn't dopamine be only a marker or consequence of some other
process? Or maybe downstream processes modulate behavior. It seems
plausible that increasing or decreasing dopamine concentrations is
regional and/or receptor specific, and that one might want to manipulate
concentrations differently, even oppositely, depending on the brain
region and receptors. I gave up trying to speculate from biochemistry a
long time ago. The more that I learn, the more I appreciate how VERY
little is known about human biology, especially the brain.> -z
Posted by Dave001 on September 1, 2005, at 2:16:47
In reply to Re: How I feel on high-dose SSRIs » Dave001, posted by ed_uk on August 28, 2005, at 7:55:01
>> The problem with all of these so-called disorders is that they're
>> just symptom complexes that are probably heterogeneous in origin,
>> and thus using up the limited space remaining for new acronymical
>> designations.
>
> Well said..... I've often said the same ;-)
>I knew that I wasn't the only one annoyed by the medicalization of every
imaginable behavior. It's only going to get worse, I fear, so prepare
for it. Look at what came up in my results from a search related to a
subject in a different thread:An exceptionally convoluted snippet of psychobabble (not to be confused
with this board) follows:"Psychogenic excoriation is not yet recognised in the DSM. We propose
preliminary operational criteria for its diagnosis that take into
account the heterogeneity of behaviour associated with psychogenic
excoriation and allow for subtyping along a compulsivity-impulsivity
spectrum. Psychiatric comorbidity in patients with psychogenic
excoriation, particularly mood and anxiety disorders, is common.
Patients with psychogenic excoriation frequently have comorbid disorders
in the compulsivity-impulsivity spectrum, including obsessive-compulsive
disorder, body dysmorphic disorder, substance use disorders, eating
disorders, trichotillomania, kleptomania, compulsive buying,
obsessive-compulsive personality disorder, and borderline personality
disorder."Blah! The only commonality among the disorders above is that nothing is
known about their etiologies. A new DSM category needs to be invented to
include persons with nothing better to do than invent superfluous
medical wastebasket diagnoses. Government funding of such studies is
warranted to ensure maximal waste of taxpayer's money. Of course.
Posted by zeugma on September 1, 2005, at 6:38:13
In reply to Re: How I feel on high-dose SSRIs, posted by Dave001 on September 1, 2005, at 1:31:10
I gave up trying to speculate from biochemistry a
long time ago. The more that I learn, the more I appreciate how VERY
little is known about human biology, especially the brain.>>I agree. I was simply repeating the researcher's speculation that dopaminergic rather than serotonergetic dysregulation might be at the core of such disorders that are provably nonresponsive to fluoxetine. Pharmacological dissection is a very weak tool for getting insight into the mechanism of CNS disorders. But it is nonethelesss used by researchers, which shows there's so little to go on otherwise.
-z
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