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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by bearfan on July 4, 2009, at 4:37:16
Hi 28 year old male here.
I've been on 20mg Prozac for several years (6-7) and while it has helped with many symptoms, I haven't really made any more progress on it and it really put a damper on my libido and often times felt a tad bit jittery on it (often buspar or a benzo needed to be added to it). My main dx is depression, anxiety and a bit of OCD/ADD. I have trouble tolerating most antidepressants. I've tried Wellbutrin (made me worse), and the other two well known SSRIs (Zoloft, Luvox and Paxil) and preferred prozac over them.
As for SNRIs, I've tried Cymbalta for about 6-8 months. At first it was working well and I was able to handle both full time work and grad school without to much difficulty. To me, it was like a stronger Prozac, it was better for Generalized anxiety, concentration, but eventually I started gaining weight, had terrible bloating/digestive problems with it, pretty bad fatigue (needed to goto bad pretty soon after work or low dose provigil) and sexual dysfunction. Taking the full 60mg made me a bit jumpy (not being able to stand still after awhile). After awhile it didn't even work all that great on depression anymore either.
Lexapro 10mg: 6 Month trial, first started working well, calmed general anxiety down pretty well, good sleep, sexual dysfunction not as bad as some others, although motivation and concentration were worse and often times my thinking felt slower and a bit dopey-harder to follow social conversations. Was not quite as outgoing or social as other antidepressants. Coordination for sports was better than other medications. Did not have the same sense of confidence; gained a few pounds after on it for awhile.
Celexa: Tried 10-20mg for a few days and slept quite a bit; discontinued (maybe a longer trial later?)
Pristiq: Tried about 3 weeks, had a few really good days, but the stuff was just making me overly anxious (Norephrine effect?) and very fatigued the longer I was on it.
Effexor: 75mg and 112.75, more calming than Pristiq, did not give a full 8 week trial by itself (felt if I was on a drug sometimes), but noticed cardiac/blood pressure effects and still had some sexual dysfunction including ED, low libido (worth trying again-side effects go away)?
Emsam: Tried it a few days and it just felt different than other medications and I didn't like that patch thing (kept wanting to take it off before bedtime)
Stablon: 12.5 3x a day for 2 weeks, helped somewhat although the triple dosing was inconvenient (different moods if missed dose) and antidepressant affect maybe not as strong as a traditional SSRI. Sexual Dysfunction was less though
I don't really know what to do anymore, I'd really like to have a libido again (no sexual dysfunction) while not being able to gain weight either; yet still being able to keep depression/anxiety and OCD in check
The frustrating part is that I'd like to have confidence/outgoing social feeling again and have a fulfilling life.
My doctors don't really know anything more than me and wanted some help from the board. I'm not sure whether a different drug, higher dose, longer trial or an augment of an existing one (ie Provigil, Dexedrine) I've tried would make any more senseThanks!
Posted by SLS on July 4, 2009, at 5:24:45
In reply to Best Alternative after Prozac Poopout?, posted by bearfan on July 4, 2009, at 4:37:16
Maybe Parnate? It is a far different drug than anything you have been on thus far. I would be more tentative in recommending Nardil first because of the weight-gain and anorgsmia it can produce.
I am currently adding a small amount of lithium to my other medication. It can sometimes throw the switch to make ADs work better when used at low dosages (300-600mg). If it is going to work, you will know in two weeks or less. Many people begin responding to it within days. You can try adding lithium with Prozac first before moving on to other antidepressants. Have you gone as high as 60mg with Prozac?
- Scott
Posted by SLS on July 4, 2009, at 5:43:19
In reply to Re: Best Alternative after Prozac Poopout? » bearfan, posted by SLS on July 4, 2009, at 5:24:45
> Maybe Parnate? It is a far different drug than anything you have been on thus far. I would be more tentative in recommending Nardil first because of the weight-gain and anorgsmia it can produce.
>
> I am currently adding a small amount of lithium to my other medication. It can sometimes throw the switch to make ADs work better when used at low dosages (300-600mg). If it is going to work, you will know in two weeks or less. Many people begin responding to it within days. You can try adding lithium with Prozac first before moving on to other antidepressants. Have you gone as high as 60mg with Prozac?Now that I am thinking about it, you can add a tricyclic (TCA) to the Prozac and bring back the lithium afterwards. I personally favor the secondary amines, desipramine and nortriptyline because their side effects are about the mildest in this class of drug. The tertiary amines like imipramine and amitriptyline have stronger anticholinergic side-effects by comparison (dry mouth, blurred vision, constipation, etc.)
Ideally, you would want to explore some of these things first before switching to Parnate. Once you are taking Parnate, you can't mix it with any serotonin reuptake inhibitors (SRI), and your doctor might be afraid to combine Parnate with other drugs that are known to be relatively safe. I have taken Parnate along with desipramine and amphetamine at the same time.
- Scott
Posted by bearfan on July 4, 2009, at 13:55:50
In reply to Re: Best Alternative after Prozac Poopout?, posted by SLS on July 4, 2009, at 5:43:19
Did not want to go the MAOI route due to the life threatening drug interactions and dietary restrictions. Apparently they have similar side effects as well.
Posted by manic666 on July 4, 2009, at 14:22:44
In reply to Best Alternative after Prozac Poopout?, posted by bearfan on July 4, 2009, at 4:37:16
you just want a life like the rest of us ,if your mentaly ill your never going to be like normal every day people, you make the best of it, now prozac that worked good for me to , make,s you fat so do most ?you say you prefered it over other simular meds like luvox an zoloft , in what way do you mean.i take setraline its not the greatest but i have a life,im sorry but you wont get 100% better with anything,an you have tried most ,if like you say prozac was good try another in its class an give it a real go ,i got no releaf from sertraline for months but its helping now ,not great as i said , but it keeps the deppression monster at bay
Posted by chumbawumba on July 4, 2009, at 14:23:53
In reply to Best Alternative after Prozac Poopout?, posted by bearfan on July 4, 2009, at 4:37:16
If you search psychobabble tips you'll find anectodatal evidence for naltrexone augmentation to remedy prozac poop out. If you try it post about it, because I'm curious and thinking of trying it myself.
Posted by bleauberry on July 4, 2009, at 19:20:43
In reply to Best Alternative after Prozac Poopout?, posted by bearfan on July 4, 2009, at 4:37:16
Two things I am familiar with on this particular topic...
1. Add nortriptyline, starting with a half capsule (5mg) for a week or two, and then increase in 5mg steps slowly until you find a place you like.
2. Add Provigil and/or Zyprexa. A little experimentation here to see if one or the other or both together is better.
Back to nortriptyline. There are several generic versions. It is important to try at least 3 of them one at a time for a week or so. They are different enough. One may work nice, one may not work at all, one may just cause anxiety, one may feel bad. My doctor does this sequential trial of nortriptyline generics with his patients all the time. They all find one they like. It is a good companion for prozac. As are zyprexa and/or provigil.
Posted by bearfan on July 4, 2009, at 19:45:22
In reply to Re: Best Alternative after Prozac Poopout?, posted by bleauberry on July 4, 2009, at 19:20:43
Although does it make sense to augment the Prozac or switch to another SSRI/anti-depressant altogether? Most likely the Sexual Dysfunction side effects will remain
Posted by manic666 on July 5, 2009, at 3:18:13
In reply to Re: Best Alternative after Prozac Poopout?, posted by bearfan on July 4, 2009, at 19:45:22
to true, the sex side does suffer , its not the actual doing the deed as wanting to,plus if you put on weight ,it kinda makes you feel unsexy,the sertraline is not as bad as prozac an im on a much higher dose i only took 20mg prozac ,when it was poopin i added more, but but my body had said no to 20mg 40mg total rejection,the meds that dont slow the sex life usually make weight a biger problem, so really lifes a bitch.the erection is there its the will to use it, good luck my friend
Posted by bearfan on July 5, 2009, at 3:28:05
In reply to Re: Best Alternative after Prozac Poopout?, posted by manic666 on July 5, 2009, at 3:18:13
Yes especially with Prozac, really makes you lack sexual appetite (especially when first started)
Posted by Phillipa on July 5, 2009, at 11:10:32
In reply to Re: Best Alternative after Prozac Poopout?, posted by bearfan on July 5, 2009, at 3:28:05
Well definitely guys on this thread but doesn't feeling good overweight the sexual side effects? I'd just like to feel relatively well. Phillipa
Posted by manic666 on July 5, 2009, at 11:17:41
In reply to Re: Best Alternative after Prozac Poopout? » bearfan, posted by Phillipa on July 5, 2009, at 11:10:32
phillipa dont forget we have wifes .its not there fault we lack thee urge,course we love to feel well, but we also like a good shag???
Posted by bearfan on July 5, 2009, at 15:55:57
In reply to Re: Best Alternative after Prozac Poopout?, posted by manic666 on July 5, 2009, at 11:17:41
> phillipa dont forget we have wifes .its not there fault we lack thee urge,course we love to feel well, but we also like a good shag???
I concur, sexual dysfunction and weight gain are quite a tradeoff for mitigation of depression symptoms.
Posted by ColoradoSnowflake on July 5, 2009, at 17:44:30
In reply to Re: Best Alternative after Prozac Poopout?, posted by bearfan on July 5, 2009, at 15:55:57
Bearfan,
How about Wellbutrin? I took 450mg/day of it for several years. I only got about 65-70% depression relief, but it had absolutely NO sexual side effects. In fact, for me, Wellbutrin had no side effects at all, even on such a high dose!
I'm on Parnate now. I think it's working better. The diet part was scary at first, but I think its overblown and not bad at all and actually, very easy now that I'm getting used to it.....and best of all, there are NO sexual side effects!
Good luck!
Gayle
Posted by bearfan on July 5, 2009, at 23:39:53
In reply to Re: Best Alternative after Prozac Poopout? » bearfan, posted by ColoradoSnowflake on July 5, 2009, at 17:44:30
> Bearfan,
> How about Wellbutrin?Unfortunately, Wellbutrin is a no-no for me. I was absolute misery trying trying to tolerate it just for a few days. Also, even though the risk of seizures is low for this medication; I always felt like I was about to maybe have one (for instance flashes of lights and sounds sounds really bothered me).
It's so frustrating that there isn't more medication on the market that don't have the weight gain and sexual problems out there.
Posted by NewQuestions on July 7, 2009, at 16:46:30
In reply to Re: Best Alternative after Prozac Poopout?, posted by bearfan on July 5, 2009, at 23:39:53
I was on SSRIs for a while and then reached poop-out. I then cycled through other antidepressants looking for relief, all with devastating side effects. I realized my body had adapted and that no medications would work anymore, and in fact, could damage me more. I am now med free. In retrospect, I wish I had not cycled through the drugs and gone off of them at the beggining of poop out, because I am now experiencing neurological problems which are a result of the long term use of them. Go to paxilprogress.org and you will see others in a similar situation. You may want to try non-med alternatives or you risk further damage.
Posted by zzzz7 on July 9, 2009, at 2:27:50
In reply to Best Alternative after Prozac Poopout?, posted by bearfan on July 4, 2009, at 4:37:16
You might try combining two of the drugs that worked for you (e.g. two SSRIs). That can help. Also, an SSRI plus small dose of TCA can help, too. Also ProVigil + SSRI can help with poop out.
Though all may cause weight gain.
This is the end of the thread.
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