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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Alone on February 8, 2007, at 22:00:47
Just to let everyone know, I experienced chills and sweats when coming off Prozac, but if I increased my Neurontin, they went away. If I decreased Neurontin, the chills and sweats came back.
Posted by yxibow on February 9, 2007, at 3:37:32
In reply to Neurontin helpsChills + Sweats when coming off ADs, posted by Alone on February 8, 2007, at 22:00:47
> Just to let everyone know, I experienced chills and sweats when coming off Prozac, but if I increased my Neurontin, they went away. If I decreased Neurontin, the chills and sweats came back.
Interesting -- is this alone or in concerto with the Somatization?
I would believe that a GABA-nergic medication might help coming off an SSRI, such as one of the more.. mm... "unclean" agents like Prozac, which was the first SSRI (well actually the second, there was a disastrous one they pulled in the late 80s in Europe which had a distant relationship to OTC Clorpheniramine Maleate -- trivia, neither here nor there).
Of course the long half life of Prozac makes it a bit easer to come off it, since it isn't out of your body for 35 days -- one reason I wouldn't recommend it as a first line SSRI to someone because once you commit to a dose, its gonna be there for a month, whether you tolerate it or not. Not to say that Prozac responders shouldn't continue what works for them but I think that more recent medium half life agents are far better. Now Paxil is a hard one for some to come off because it has a far shorter half life and there can be interdosal withdrawal from eliminating it.-- tidings
Jay
Posted by SLS on February 9, 2007, at 5:32:40
In reply to Neurontin helpsChills + Sweats when coming off ADs, posted by Alone on February 8, 2007, at 22:00:47
> Just to let everyone know, I experienced chills and sweats when coming off Prozac, but if I increased my Neurontin, they went away. If I decreased Neurontin, the chills and sweats came back.
Thanks for posting this.
It has been a theory of mine that part of the SRI discontinuation syndrome involves kindling, and that anticonvulsants could be used to mitigate the withdrawal symptoms.
- Scott
Posted by Klavot on February 9, 2007, at 8:59:27
In reply to Re: Neurontin helpsChills + Sweats when coming off » Alone, posted by yxibow on February 9, 2007, at 3:37:32
Actually, I believe Luvox was around in Europe already in the mid eighties.
Klavot
> I would believe that a GABA-nergic medication might help coming off an SSRI, such as one of the more.. mm... "unclean" agents like Prozac, which was the first SSRI (well actually the second, there was a disastrous one they pulled in the late 80s in Europe which had a distant relationship to OTC Clorpheniramine Maleate -- trivia, neither here nor there).
Posted by Phillipa on February 9, 2007, at 10:14:07
In reply to Re: Neurontin helpsChills + Sweats when coming off » yxibow, posted by Klavot on February 9, 2007, at 8:59:27
Luvox was why is it no good? I'm on it? Love Phillipa
Posted by Klavot on February 9, 2007, at 12:19:24
In reply to Re: Neurontin helpsChills + Sweats when coming off » Klavot, posted by Phillipa on February 9, 2007, at 10:14:07
Luvox is fine, the drug that was pulled was something else, though I forget its name.
> Luvox was why is it no good? I'm on it? Love Phillipa
Posted by kaleidoscope on February 9, 2007, at 13:55:32
In reply to Re: Neurontin helpsChills + Sweats when coming off » Alone, posted by yxibow on February 9, 2007, at 3:37:32
Hi J
>"unclean" agents like Prozac
Why do you say that? Fluoxetine isn't a 'dirty drug'. It isn't such a 'selective' SSRI as some of the others (eg. citalopram) but all this means is that it is an extremely weak NE reuptake inhibitor. If this is what you mean by 'unclean', duloxetine (Cymbalta) is much less 'clean' than fluoxetine.
>I wouldn't recommend it as a first line SSRI to someone because once you commit to a dose, its gonna be there for a month, whether you tolerate it or not
Not really. As with all SSRIs, side effects appear rapidly. If someone has only been taking it for a few days, its active metabolite norfluoxetine (the one with a long half life) won't have built up in the body. Fluoxetine itself does not have such a long half life.
Personally, I think that (generic) floxetine is a suitable first-line SSRI for many patients suffering from depression. For elderly people, and for people on multiple medications, generic citalopram is a better first-line SSRI because of the reduced risk of drug interactions. IMO, Lexapro should never be a first-line SSRI because it is so overpriced - its alleged advantages over citalopram are somewhat dubious.
K
Posted by yxibow on February 9, 2007, at 18:46:40
In reply to Re: Neurontin helpsChills + Sweats when coming off » yxibow, posted by kaleidoscope on February 9, 2007, at 13:55:32
> Hi J
>
> >"unclean" agents like Prozac
>
> Why do you say that? Fluoxetine isn't a 'dirty drug'. It isn't such a 'selective' SSRI as some of the others (eg. citalopram) but all this means is that it is an extremely weak NE reuptake inhibitor. If this is what you mean by 'unclean', duloxetine (Cymbalta) is much less 'clean' than fluoxetine.Cymbalta has something like a 6:1 ratio (varying by patient) of 5HT to NE. But it still has a NE kick to it.
Yes, I mean it is not as selective as Amitriptyline is not as selective either.
> >I wouldn't recommend it as a first line SSRI to someone because once you commit to a dose, its gonna be there for a month, whether you tolerate it or not
>
> Not really. As with all SSRIs, side effects appear rapidly. If someone has only been taking it for a few days, its active metabolite norfluoxetine (the one with a long half life) won't have built up in the body. Fluoxetine itself does not have such a long half life.Rapidly for some, but I'm talking about ramping up dose to a therapeutic level. And if you're at that therapeutic level and you're still having problems, it will take a month to go away. So that's why I wouldn't recommend it.
> Personally, I think that (generic) floxetine is a suitable first-line SSRI for many patients suffering from depression. For elderly people, and for people on multiple medications, generic citalopram is a better first-line SSRI because of the reduced risk of drug interactions. IMO, Lexapro should never be a first-line SSRI because it is so overpriced - its alleged advantages over citalopram are somewhat dubious.
I was going to suggest citalopram in general or Luvox. Yes, Lexapro is another one of those metabolite patented agents, some people do benefit from fewer side effects but I would agree that in general the cases where that are true are lower than the profits. Same with desvenlafaxine.
Posted by yxibow on February 9, 2007, at 18:52:26
In reply to Re: Neurontin helpsChills + Sweats when coming off » Klavot, posted by Phillipa on February 9, 2007, at 10:14:07
> Luvox was why is it no good? I'm on it? Love Phillipa
No, it wasn't Luvox -- Luvox was just made generic because it wasn't a selling point and they didn't apply for an ANDA for whatever reason so it fell off patent. There's nothing wrong with Luvox, fluvoxamine is quite a potent agent for OCD.
I was referring to Zimelidine which was made in the early 80s in Sweden and had disastrous consequences with all sorts of rare disorders. It is correct that Luvox followed afterwards in EMEA-land and wasn't marketed in the US until after Prozac, which was the second successful (technically, for our European friends) SSRI, and was also derived from an antihistamine, Benadryl.
Posted by kaleidoscope on February 10, 2007, at 14:42:16
In reply to Re: Neurontin helpsChills + Sweats when coming off » kaleidoscope, posted by yxibow on February 9, 2007, at 18:46:40
Hi
>I mean it is not as selective as amitriptyline is not as selective either
You can't really compare fluoxetine with amitriptyline. Amitriptyline hits a whole range of receptors eg. it's a potent anticholinergic agent, antihistamine, alpha-1 antagonist, 5-HT2 antagonist etc. Fluoxetine is completely different, having no affinity for most of these recepors.
>Luvox
As SSRIs go, Luvox is probably the least 'clean'. It increases melatonin levels during the daytime and disrupts the sleep-wake cycle.
K
Posted by yxibow on February 10, 2007, at 16:00:44
In reply to Re: Neurontin helpsChills + Sweats when coming off » yxibow, posted by kaleidoscope on February 10, 2007, at 14:42:16
> Hi
>
> >I mean it is not as selective as amitriptyline is not as selective either
>
> You can't really compare fluoxetine with amitriptyline. Amitriptyline hits a whole range of receptors eg. it's a potent anticholinergic agent, antihistamine, alpha-1 antagonist, 5-HT2 antagonist etc. Fluoxetine is completely different, having no affinity for most of these recepors.
That wasn't my point so much as that Prozac hits a wide range of 5HT receptors in the same way that Amitriptyline hits a wide range of receptors period. It wasn't phrased right.> >Luvox
>
> As SSRIs go, Luvox is probably the least 'clean'. It increases melatonin levels during the daytime and disrupts the sleep-wake cycle.Hmm... I didn't feel any worse insomnia on 400-450mg of Luvox than I already do. But I suppose that's possible.
>
> K
Posted by Phillipa on February 10, 2007, at 20:34:39
In reply to Re: Neurontin helpsChills + Sweats when coming off » yxibow, posted by kaleidoscope on February 10, 2007, at 14:42:16
So luvox keeps me awake? I thought it was best sedating SSRI? Love Phillipa
Posted by yxibow on February 10, 2007, at 21:45:50
In reply to Re: Neurontin helpsChills + Sweats when coming off » kaleidoscope, posted by Phillipa on February 10, 2007, at 20:34:39
> So luvox keeps me awake? I thought it was best sedating SSRI? Love Phillipa
It is the most sedating SSRI, or you could argue Paxil is too. It is least likely to cause the anxiety that less targeted and more activating agents such as Prozac do.
He was referring to more esoteric properties of sleep-disruption by some serotonergic agents.
Posted by Phillipa on February 10, 2007, at 22:16:38
In reply to Re: Neurontin helpsChills + Sweats when coming off » Phillipa, posted by yxibow on February 10, 2007, at 21:45:50
Thanks Jay I don't understand all the technical stuff. So at night it's okay? Won't disrupt sleep? Would it calm me down if half in the am instead of a benzo? Love Jan
Posted by Alone on February 10, 2007, at 22:33:49
In reply to Re: Neurontin helpsChills + Sweats when coming off » Phillipa, posted by yxibow on February 9, 2007, at 18:52:26
> No, it wasn't Luvox -- Luvox was just made generic because it wasn't a selling point and they didn't apply for an ANDA for whatever reason so it fell off patent. There's nothing wrong with Luvox, fluvoxamine is quite a potent agent for OCD.
>
>
Luvox was made by a Canadian company. One of the Columbine shooters was on Luvox and the Canadian company never recovered from the bad press so they stopped making Luvox, but you can still buy it in the US as a generic.Just thought you might find it of interest.
Posted by Alone on February 10, 2007, at 22:36:40
In reply to Re: Neurontin helpsChills + Sweats when coming off » Phillipa, posted by yxibow on February 10, 2007, at 21:45:50
> It is the most sedating SSRI, or you could argue Paxil is too.
I can personally attest to this. When they tried Paxil on me alls I did was sleep all day and all night for a week until they took me off it. I only got up to pee!
Posted by Phillipa on February 10, 2007, at 22:58:28
In reply to Re: Neurontin helpsChills + Sweats when coming off » yxibow, posted by Alone on February 10, 2007, at 22:33:49
But very expensive the luvox. Love Phillipa
Posted by yxibow on February 11, 2007, at 3:12:51
In reply to Re: Neurontin helpsChills + Sweats when coming off » Alone, posted by Phillipa on February 10, 2007, at 22:58:28
> But very expensive the luvox. Love Phillipa
Luvox should be generic, it is no longer marketed by the manufacturer in the US. I took it and it switched to generic, it shouldn't cost very much today compared to the remaining patented SSRIs
Yes, there were various trivia about teenagers on a number of SSRIs but the outcome of any tragic events would not really matter which SSRI frankly or whether they were on them or not -- the signs of serious mental illness was not watched for by their respective guardians and breakthrough symptoms could have occurred with or without medication.
Posted by Phillipa on February 11, 2007, at 17:33:25
In reply to Re: Neurontin helpsChills + Sweats when coming off » Phillipa, posted by yxibow on February 11, 2007, at 3:12:51
It is generic still costs me $l79 a month as I only have medicaire. Love Phillipa
Posted by yxibow on February 12, 2007, at 0:31:21
In reply to Re: Neurontin helpsChills + Sweats when coming off » yxibow, posted by Phillipa on February 11, 2007, at 17:33:25
> It is generic still costs me $l79 a month as I only have medicaire. Love Phillipa
Did you get any of these bumbled up medicaire prescription part D drug plans ?
I'm not a member of Costco, but I believe for 5% more if you're not you can order it from them. A 30 day supply of 100s generic from Barr is around $20. You would just have your doctor fax a prescription in to Costco.com I believe. Poke around their website.
You can do the same at Walgreens.com but their quote as you have noted is significantly higher.
I hope that helps
-- Jay
Posted by Phillipa on February 12, 2007, at 18:24:47
In reply to Re: Neurontin helpsChills + Sweats when coming off » Phillipa, posted by yxibow on February 12, 2007, at 0:31:21
Thanks Jay Greg just added wellcare signiture this should help. At least I hope it will. Love Phillipa
This is the end of the thread.
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