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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Conundrum on January 19, 2011, at 10:25:30
Usually by now I would have noticed some positive benefit from the dose of prozac I am on, 5 mg every other day, but this time its not happening. Nor am I getting the usual side effects like diarrhea, headaches, and sexual dysfunction. Perhaps the trials of remeron, tianeptine, and adderall changed something in me and I need 5 mgs? I think I should know for sure by the end of the week if it is working. The last time I took it, it took 28 days to work and the side effects started a lot earlier.
I did take 5 mg everyday recently, but it just made me feel flat. I'm debating on whether or not to try 5 mg now that the effect of the drug seems to be weaker.
Also my pdoc wants me to go to the treatment resistant depression clinic at UPenn in Philadelphia. Perhaps they would have a better idea, cuz even if the prozac helps a little, I doubt I'll be able to increase it or that flat feeling may come back.
Posted by Phillipa on January 19, 2011, at 10:57:22
In reply to Prozac isn't kicking in..., posted by Conundrum on January 19, 2011, at 10:25:30
It sounds like you are seriously lucky to have a doc that is so concerned and also that there is a tx resistant facility. What would you like to do? Phillipa
Posted by SLS on January 19, 2011, at 11:38:19
In reply to Prozac isn't kicking in..., posted by Conundrum on January 19, 2011, at 10:25:30
Hi.
> Also my pdoc wants me to go to the treatment resistant depression clinic at UPenn in Philadelphia.
Can you describe more about their program? I'd be willing to make the trip.
Is Jay Amsterdam still around?
Anything you share would be greatly appreciated.
Thanks.
You might consider adding low dosages of lithium 300 - 600mg. For adding an "antipsychotic" with antidepressant properties, Abilify would be my first choice. Zyprexa might work, but the magnitude of weight-gain and risk of diabetes would not make it an ideal choice. Some people have luck with Geodon, but not as many. Geodon is truly the only second-generation antipsychotic (atypical) that is weight-neutral. Abilify isn't too bad as far as weight gain is concerned, but it can sneak up on you if you don't step on the scale every now and then.
Which other antidepressants have you tried? Did any of them tickle the brain?
Wellbutrin is known to be helpful when added to Zoloft. However, I have not heard that it is particularly potent in combination with Prozac.
A trial of lithium or Abilify can yield results in as little as one week. Therefore, if you don't see an improvement by 2 weeks of a therapeutic dosage, you can judge the drug to be ineffective.
Keep an eye on a new drug called lurasidone.
"Lurasidone (SM-13,496) is an atypical antipsychotic developed by Dainippon Sumitomo Pharma.[1] It was approved by the U.S. Food and Drug Administration (FDA) for treatment of schizophrenia on October 29, 2010, under the brand name Latuda[2] and is currently pending approval for the treatment of bipolar disorder in the United States." - Wikipedia
- Scott
Posted by Conundrum on January 19, 2011, at 12:34:01
In reply to Re: Prozac isn't kicking in... » Conundrum, posted by SLS on January 19, 2011, at 11:38:19
@phillipa
I'd like to go to this clinic and get another opinion about what is wrong, like to I really have BP disorder. A previous doc said I had an obsessive disorder because I research a lot. I'd also like to try nardil since my mom's mom responded well to it, and that is the lineage that carries the depression.
@Scott
I don't know a whole lot about the program, since I have not contacted them. They have TMS, vagus nerve stimulation, and they have done studies with deep brain stimulation. According to their website Jay Amsterdam is still there, he seems to be specialized with BP disorder. The doctor my pdoc recommended I see is O'Reardon, but I guess if they say I have BP disorder I'd be with Dr. Amsterdam.
I have tried abilify and didn't notice anything except a desire to get things done that lasted for 2 days when i went up to 2mg and 2.5 mg. 5mg actually made me feel worse, in an odd way I can't explain. Just made my head feel weird.
After about 10 days, remeron increased my interest and desire, but pooped out, after only a couple of days. Pristiq increased what I call "color" almost immediately. It also increased sexual sensitivity. It made me look at things and trigger memories and emotions, I liked it, but it stopped working after a couple weeks. Lamictal only helped a tiny bit with interest and motivation when I got to 400mg for a couple of days as well, but nothing at 450mg.
Low dose prozac had worked in the past for at least a week, so I figured it was a better shot. I need something that doesn't just poop out and hits all the symptoms I'm experiencing.
I had tried wellbutrin but could not tolerate the tinnitus. When not depressed, I'm a musician, and I can't lose my hearing. Also took lexapro, but not for very long because it was my return to SSRIs and I was nervous about the spaciness it caused and thought it could hurt my brain. Probably only took it for 3-4 weeks. No benefit in that short amount of time.
I'd be willing to give another SSRI a true shot, or maybe cymbalta.
Adderall and ritalin have not helped with my core symptoms, but sometimes when I just get normal sad type of feelings, ritalin gets rid of those, but it doesn't help cognition or anhedonia.
I'm wondering if a remeron + SNRI combo could help, or find the effective dose of prozac and add a TCA to it. Or maybe a somewhat serotonergic TCA like nortriptyline would be enough. No TCA though if they think I'm BP.
Posted by Conundrum on January 19, 2011, at 13:03:07
In reply to Re: Prozac isn't kicking in... » Conundrum, posted by SLS on January 19, 2011, at 11:38:19
prozac + low dose zyprexa sounds like an effective combo, but probably a fast track to diabetes. Think an MAOI would be safer to try first before going down that route.
Posted by morgan miller on January 19, 2011, at 22:23:57
In reply to Re: Prozac isn't kicking in... » Conundrum, posted by SLS on January 19, 2011, at 11:38:19
I'm guessing you've already done a fair trial of the other popular SSRIs.
Is Prozac the only medication you're on right now? Sorry if I missed this.
Posted by morgan miller on January 19, 2011, at 23:19:54
In reply to Re: Prozac isn't kicking in..., posted by Conundrum on January 19, 2011, at 12:34:01
How long were you on Pristiq?
Are you sure that it pooped out for good?
How long did you continue to take it after it stopped being effective?
Did you or your doctor consider that raising the dose would have helped? Maybe you tried this.
I do think giving an SSRI like Zoloft or Lexapro a fair trial, long enough to find your sweet spot dose if there is one, is a good idea, especially if you had not done this in the past.
The low dose SSRI plus Nortriptyline sounds like a good idea too.
Hope you figure something out this year. I know this rollercoaster ride of trials can be hell.
Morgan
Posted by SLS on January 20, 2011, at 3:08:56
In reply to Re: Prozac isn't kicking in..., posted by morgan miller on January 19, 2011, at 23:19:54
> Hope you figure something out this year. I know this rollercoaster ride of trials can be hell.
Yeah. You look forward to a new treatment and swear to give it a fair chance to work, only to want to abort the trial after only a few days. Sometimes it's side effects. Sometimes the drug just doesn't work fast enough. Sometimes you just don't feel like yourself. I felt weird for a few weeks when I tried Parnate + desipramine for the first time. I didn't feel right and there were side effects that were difficult to tolerate. I hung in there for three weeks. Then it started working. Then the side effects disappeared. Then I felt like myself. Then I discovered a new world. That was 24 years ago.
- Scott
Posted by SLS on January 20, 2011, at 3:10:48
In reply to Re: Prozac isn't kicking in... » SLS, posted by Conundrum on January 19, 2011, at 13:03:07
> prozac + low dose zyprexa sounds like an effective combo, but probably a fast track to diabetes. Think an MAOI would be safer to try first before going down that route.
I would.
Is there any family history of mental illness, particularly bipolar disorder?
- Scott
Posted by Conundrum on January 20, 2011, at 5:54:18
In reply to Re: Prozac isn't kicking in..., posted by morgan miller on January 19, 2011, at 23:19:54
> How long were you on Pristiq?
>
> Are you sure that it pooped out for good?
>
> How long did you continue to take it after it stopped being effective?
>
> Did you or your doctor consider that raising the dose would have helped? Maybe you tried this.
>
> I do think giving an SSRI like Zoloft or Lexapro a fair trial, long enough to find your sweet spot dose if there is one, is a good idea, especially if you had not done this in the past.
>
> The low dose SSRI plus Nortriptyline sounds like a good idea too.
>
> Hope you figure something out this year. I know this rollercoaster ride of trials can be hell.
>
> MorganHi,
Looking back at it, I can say I didn't really give Lexapro or any SSRI a fair trial. I chalk most of my cognitive problems to taking an SSRI as a teen. The first drug I went back on after not taking any pharmaceuticals for 7 years was lexapro. I was hardly even taking ibuprophen or aspirin prior to that. I took 5 mgs for a couple weeks then 10 for maybe a week or two and felt spacey and stopped it. Perhaps I should have stayed on it longer.
With pristiq I was on 50 mgs for about two weeks when I noticed it not working as well, so my doc increased to 100 mgs which immediately felt worse and I stayed on that for 2 weeks then back to 50 for about a week, since it started to seem like it was doing something again, but then I stopped. I can't say what it was doing was even worth it, it was so fleeting, its just i would look at something and it would trigger a memory or feeling, it was like being in black and white with ocassional bursts of color. I know its hard to explain to someone who is used to rating things on a scale of calm to nervous, or sad to happy, stable to manic, but for me that drug was on the grey to color scale. I'm more convinced I gave that drug a fair trial than I had with SSRIs.
Lexapro was the only other drug SSRI I tried other than prozac. Perhaps zoloft would be worth a shot especially since the higher doses of prozac that i tried caused flatness, although maybe that would have gone away with time. Lexapro caused spaciness but not flatness. Pristiq felt more balanced to me.
Posted by Conundrum on January 20, 2011, at 5:59:28
In reply to Re: Prozac isn't kicking in... » Conundrum, posted by SLS on January 20, 2011, at 3:10:48
> > prozac + low dose zyprexa sounds like an effective combo, but probably a fast track to diabetes. Think an MAOI would be safer to try first before going down that route.
>
> I would.
>
> Is there any family history of mental illness, particularly bipolar disorder?
>
>
> - Scott
You would do what? add zyprexa or prefer an MAOI?There is a family history of mental illness, no bipolar disorder. Atypical depression and anxiety though.
Posted by SLS on January 20, 2011, at 6:12:32
In reply to Re: Prozac isn't kicking in... » SLS, posted by Conundrum on January 20, 2011, at 5:59:28
> > > prozac + low dose zyprexa sounds like an effective combo, but probably a fast track to diabetes. Think an MAOI would be safer to try first before going down that route.
> >
> > I would.
> >
> > Is there any family history of mental illness, particularly bipolar disorder?
> >
> >
> > - Scott
> You would do what? add zyprexa or prefer an MAOI?
>
> There is a family history of mental illness, no bipolar disorder. Atypical depression and anxiety though.
>I would try an MAOI first before venturing down the antipsychotic road. Of course, you might need one as an augmenter anyway. I should check out lurasidone to see what properties it has.
Feeling spacy is one of those side effects that can disappear within 4 weeks.
- Scott
Posted by SLS on January 20, 2011, at 6:15:00
In reply to Re: Prozac isn't kicking in... » Conundrum, posted by SLS on January 20, 2011, at 6:12:32
> I would try an MAOI first before venturing down the antipsychotic road. Of course, you might need one as an augmenter anyway. I should check out lurasidone to see what properties it has.
http://jpet.aspetjournals.org/content/early/2010/04/19/jpet.110.167346
Interesting drug. I will probably give it a try if my doctor still wants to proceed with giving it a trial.
- Scott
Posted by morgan miller on January 20, 2011, at 21:37:02
In reply to Re: Prozac isn't kicking in... » morgan miller, posted by Conundrum on January 20, 2011, at 5:54:18
>I chalk most of my cognitive problems to taking an SSRI as a teen.
I do think that these medications may be more likely to cause more severe reactions both short term and long term when administered while the brain is still developing. The same goes for recreational drugs.
>I can't say what it was doing was even worth it, it was so fleeting, its just i would look at something and it would trigger a memory or feeling, it was like being in black and white with ocassional bursts of color. I know its hard to explain to someone who is used to rating things on a scale of calm to nervous, or sad to happy, stable to manic, but for me that drug was on the grey to color scale.
I think I understand.
>Perhaps zoloft would be worth a shot especially since the higher doses of prozac that i tried caused flatness, although maybe that would have gone away with time.
I do not think Zoloft would be nearly as likely to cause the flatness that Prozac caused. Prozac causes flatness in me whereas Zoloft mostly does not. I cried very easily and felt empathy on Zoloft though. I admit there were occasional moments of flatness though. All of these drugs sort of flatten emotions on some level, that's why they are effective.
If you do find that you have success with something like Zoloft, I would seriously consider just staying on it for good. I wouldn't have said that a few years ago, but now I realize it just is not worth risking ending up in the gutter again.
Posted by Conundrum on January 20, 2011, at 22:13:00
In reply to Re: Prozac isn't kicking in..., posted by morgan miller on January 20, 2011, at 21:37:02
> I do not think Zoloft would be nearly as likely to cause the flatness that Prozac caused. Prozac causes flatness in me whereas Zoloft mostly does not. I cried very easily and felt empathy on Zoloft though. I admit there were occasional moments of flatness though. All of these drugs sort of flatten emotions on some level, that's why they are effective.
My problem is flatness. I'm trying to cure anhedonia, not sadness or despair. When I feel suicidal I don't feel despair so much as a pointlessness to go on because nothing brings me deep joy anymore. I need a cure for that. Stimulants and opioids haven't helped. I also need something entactogenic. I know longer get good feelings cuddling or being intimate with another person. Perhaps there is a need for balance. Perhaps I need an increase in serotonin with an increase in other neurotranmitters. Pristiq increased sexual sensitivity and sorta started to help with feelings so maybe norepinephrine is needed. Nardil would add dopamine, even better. I would think taking nardil would cover all my bases, and like I said, I had a family member who responded to it after having no response to doxepin, lithium, and haldol.
Posted by Conundrum on January 20, 2011, at 22:14:36
In reply to Re: Prozac isn't kicking in..., posted by SLS on January 20, 2011, at 6:15:00
I like that it does not seem to have afinity for the 5 HT2C or histamine receptors, if that would work for you. It shouldn't cause much weight gain.
How do you know of Dr. Amsterdam, have you spoken with him before?
> > I would try an MAOI first before venturing down the antipsychotic road. Of course, you might need one as an augmenter anyway. I should check out lurasidone to see what properties it has.
>
>
> http://jpet.aspetjournals.org/content/early/2010/04/19/jpet.110.167346
>
>
> Interesting drug. I will probably give it a try if my doctor still wants to proceed with giving it a trial.
>
>
> - Scott
Posted by SLS on January 20, 2011, at 23:52:48
In reply to Re: Prozac isn't kicking in... » SLS, posted by Conundrum on January 20, 2011, at 22:14:36
> How do you know of Dr. Amsterdam, have you spoken with him before?
I've had my nose in the medical literature since 1983. Certain names show up repeatedly. I called U of Penn in the mid 1990s. By that time, Dr. Amsterdam was no longer taking on individual patients. I was given the name of a doctor in Cherry Hill instead. I never followed up. It seemed like too long a trip to get there. Besides, I felt like I was spreading myself too thin by seeing many different doctors, being prescribed many different drugs, and being suggested to try many different alternative treatments. There was no sense of solid ground beneath my feet with being asked to consider so many different treatments.
- Scott
Posted by bearfan on January 25, 2011, at 16:35:38
In reply to Prozac isn't kicking in..., posted by Conundrum on January 19, 2011, at 10:25:30
5mg is basically nothing and probably even less if its generic.
Posted by Conundrum on January 26, 2011, at 13:40:42
In reply to Re: Prozac isn't kicking in..., posted by bearfan on January 25, 2011, at 16:35:38
> 5mg is basically nothing and probably even less if its generic.
5mg every other day, effectively 2.5 per day, had been somewhat effective for me last year on two occassions. The first time I increased to 5 mg every day and then I started to feel flat. Now taking 5 mg every other day feels very weak. I'm not getting any sexual dysfunction or headaches, which where there when it was kind of working before. I really need it or some other drug to work, so I don't drop out of my classes and then lose my internship. Need something to help my PFC functioning which seems really bad and stimulants don't help. So i'm thinking take 5 mg every day now that I seem to have a tolerance to the drug, or order nortriptyline and take it with nortriptyline, or take nortriptyline alone, or wait to see a new dr., or go to the UPenn clinic and shell out $1000 dollars. PFC functioning(ordering, evaluating, etc) would be helpful in figuring out this dilemma. I just avoid making a firm decision and flounder.
Posted by Phillipa on January 26, 2011, at 20:13:39
In reply to Re: Prozac isn't kicking in... » bearfan, posted by Conundrum on January 26, 2011, at 13:40:42
$1000.00 to a University Clinic isn't that really steep? Phillipa
Posted by Jeroen on February 1, 2011, at 9:49:40
In reply to Re: Prozac isn't kicking in..., posted by bearfan on January 25, 2011, at 16:35:38
i took 20 mg, 5 mg wont do a thing i think
i must admit it helped somewhat, but it didnt make me feel better
if i knew that those meds can induce psychosis or make you handicapped i would never take this
psychiatric doctors are liars
Posted by Conundrum on February 1, 2011, at 16:57:24
In reply to Re: Prozac isn't kicking in..., posted by Jeroen on February 1, 2011, at 9:49:40
> i took 20 mg, 5 mg wont do a thing i think
>
> i must admit it helped somewhat, but it didnt make me feel better
>
> if i knew that those meds can induce psychosis or make you handicapped i would never take this
>
> psychiatric doctors are liars
I took 20 as a teenage but I dont' think I could tolerate it now. I took 5mg every other day last year and started noticing an increase in motivation and interest after 28 days. Last year I also experienced headaches, sexual dysfunction, and diarrhea. Since then I have taken Remeron, Adderall, and Tianeptine. Now 5 mg every other day feels like nothing except I get minor headaches. I increased it to 5mg every single day and the headaches have gone away, not gotten worse. Also since that last increase I noticed I don't get these thoughts like I want to die as much. However anhedonia is still present.I'm gonna be seeing a new Pdoc this Friday. I really don't know if I should do anything at all at this point. Maybe give it more time on its own? But I already made the appointment and I am a bit skeptical it will be enough for my anhedonia on its own.
How did you end up disabled from taking prozac. For me, the problems started after stopping the drug. It was at that point the bizarre thoughts occurred and the atrocious memory loss and impairment in concentration began. Now that I am on it, I am feeling a bit more level headed. Maybe its because I'm gonna be seeing a new doc and my first assignment is done for my class, that I am feeling a bit calmer, but I think it could be there really is something to this serotonergic theory of depression.
Posted by Conundrum on February 1, 2011, at 17:01:50
In reply to Re: Prozac isn't kicking in..., posted by Conundrum on February 1, 2011, at 16:57:24
While not addressing anhedonia, it might be helping with my thoughts that I'm at my wits end and the end of my rope. I still face the same challenges with motivation and my class. Basically my job/internship depends on me doing well in my classes, which depends on my motivation. Last week I was feeling my world was gonna fall apart but now I'm feeling more calm inspite of the fact that there is no increase in motivation. However I can look at my work and not get overwhelmed by the whole thing. So maybe this is the calming effect of serotonin. However last night I got a big weird surge of nervous energy and couldn't sleep. Last year prozac made me tired. Perhaps taking remeron has made me more sensitive to activating meds.
This is the end of the thread.
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