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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Prefect on November 25, 2012, at 12:30:43
I've been experiencing my first anxiety (AG/PD) relapse after 7 years, since 3.5 months ago right after dropping from 50 mg/day Luvox to 37.5 mg/day.
I'm finding this relapse very stubborn. I dosed back up to 50 mg/day about 2.5 months ago, and have even gone up beyond my normal dose for a month (62.5 mg/day), and still haven't seen that much improvement. If dropping down caused a relapse, doesn't that logically mean my original dose (50 mg/day)was at theraputic levels and going back to it should make me feel like my old self within a month or so?
I'm not expecting miracles and am focussing most of my recovery effort on exposure (have not avoided going anywhere), but I'm actually getting some bouts of anxiety worse than the original condition, which shocks me because I thought this thing would be easy to tackle this time considering I'm experienced now.
What the heck is going on?!
Posted by Phillipa on November 25, 2012, at 14:44:28
In reply to Re-instated dosage not working?!, posted by Prefect on November 25, 2012, at 12:30:43
Same drug or med about same time period 50mg. First 25mg worked fine with 15mg of valium. Then a new pdoc decided to get a baseline on me to see if really needed ad ad. Didn't sleep for two weeks ended up in Er. Told to take the original luvox and had to go the 50mg. Still a low dose. But hesitate to up it more as afraid will even be harder to get off if the need arises. So before the 50mg was your dose and now it will maybe take l00mg. I once was on 250mg and felt great with ativan. Phillipa
Posted by jono_in_adelaide on November 26, 2012, at 0:21:22
In reply to Re: Re-instated dosage not working?! » Prefect, posted by Phillipa on November 25, 2012, at 14:44:28
It might have been coincidence that your condition worsened right at that time, maybe there was a change in your condition that will nececitate a higher dose, eg 100mg per day, or phehaps you need to add an anxiolytic (Buspar, Atarax, a benzodiazepine, mirtazapine)
Posted by SLS on November 26, 2012, at 17:29:07
In reply to Re-instated dosage not working?!, posted by Prefect on November 25, 2012, at 12:30:43
A phrase that is sometimes used is "antidepressant-induced antidepressant refractoriness".
This is quite common among the SSRIs. When you interrupt your taking of one of these drug during a period of successful treatment, it might allow the brain to finally "catch-up" with the influences of the drug on brain function. The brain becomes smarter than the drug once it has been exposed to it a first time such that a reinstitution of treatment yields diminishing returns. You might have to search for another drug or perhaps go to 200 mg/day on the Luvox.
- Scott
Posted by SLS on November 26, 2012, at 17:34:53
In reply to Re: Re-instated dosage not working?! » Prefect, posted by SLS on November 26, 2012, at 17:29:07
> A phrase that is sometimes used is "antidepressant-induced antidepressant refractoriness".
>
> This is quite common among the SSRIs. When you interrupt your taking of one of these drug during a period of successful treatment, it might allow the brain to finally "catch-up" with the influences of the drug on brain function. The brain becomes smarter than the drug once it has been exposed to it a first time such that a reinstitution of treatment yields diminishing returns. You might have to search for another drug or perhaps go to 200 mg/day on the Luvox.Actually, 300 mg/day is considered to be the maximum dose of Luvox.
Nardil represents a reasonable alternative.
- Scott
Posted by Phillipa on November 26, 2012, at 20:09:17
In reply to Re: Re-instated dosage not working?!, posted by SLS on November 26, 2012, at 17:34:53
At one time I took 250mg of luvox with ativan and felt great. What happened? Phillipa
Posted by Prefect on November 26, 2012, at 20:43:09
In reply to Re: Re-instated dosage not working?!, posted by SLS on November 26, 2012, at 17:34:53
Scott, I tried to look up this phenomenon you mentioned, and not a lot of luck with the terms you used. Is this the same ideas as the Oppositional Tolerance or "Tardive Disphoria" theory?
Posted by SLS on November 27, 2012, at 7:09:35
In reply to Re: Re-instated dosage not working?!, posted by Prefect on November 26, 2012, at 20:43:09
> Scott, I tried to look up this phenomenon you mentioned, and not a lot of luck with the terms you used.
Is this the same ideas as the Oppositional Tolerance or "Tardive Disphoria" theory?
Not tardive dysphoria so much. I am not familiar with the oppositional tolerance theory.
Why was Luvox chosen for you instead of other SSRI drugs?
- Scott
Posted by Prefect on November 27, 2012, at 20:03:14
In reply to Re: Re-instated dosage not working?! » Prefect, posted by SLS on November 27, 2012, at 7:09:35
Long storey short:
15 years ago - Suddenly (within a couple of weeks after contracting a mild brief case of hepatitis oversease) developed bizarre somatic symptoms (dizziness, memory problems, cognitive dysfunction extreme enough to make me homebound for about a year). Doctors suspected Chronic Fatigue Syndrome, put me on 25 mg Luvox to increase deep sleep. Luvox was chosen due to low side effect profile. I'm begining to suspect now those symptoms were likely severe anxiety symptoms and the diagnosis was likely incorrect.
7 years ago - Developed agoraphobia out of nowhere. I decided to raise my dose (no doctor involvement) to 50 mg and made myself tough it out and get outside again after 3 months of being a frightened hermit who didn't know what to make of this. Pretty much recovered after a year or so, pretty sucessfully. Travelled abroad, etc.
3.5 months ago - Began wondering if the subtheraputic dose of Luvox I've been on had anything to do with my amazing recovery lasting 7 years, rather than my own aggressive exposure regiment, so took 6 months to dose down to 37.5 mg and boom! Here I am.
2.5 months ago - Back to 50 mg, got worse.
1 month ago - Dosed up to 62.5 mg, still getting worse in certain aspects.
The odd thing is I'm getting better at going to places now, but lately have developed free floating anxiety during times when I'm not supposed to get anxious. I'm talking about palpitations that go on for 5-6 hours in settings that shouldn't make me anxious, without anything particular going on in my head. That's not like me. I only get anxious in places outside my routine, I never get bouts of random anxiety in response to no stimulus what so ever. This is very peculiar to me and I have no idea what to make of it.
Footnote: Anxiety runs in my family. When I tell my storey I realize I'm not one of those people who dabbles in depression or anxiety once in their life. I'm the real deal...
Posted by SLS on November 28, 2012, at 6:25:32
In reply to Re: Re-instated dosage not working?!, posted by Prefect on November 27, 2012, at 20:03:14
Have you ever tried imipramine or any other tricyclic?
What about Nardil?
Effexor?
Those are the antidepressants that I would think to try.
Nardil + Klonopin?
Seroquel?
There are quite a few other things that come to mind. I am sure others will offer suggestions. Nardil or imipramine have been well studied in the treatment of GAD with agoraphobia.
- Scott
Posted by ChicagoKat on November 28, 2012, at 13:35:13
In reply to Re-instated dosage not working?!, posted by Prefect on November 25, 2012, at 12:30:43
Sadly, any drug that once worked for you can poop out on you. The SSRIs are usually the first to go it seems. I do think you need to try a different class of drugs.
Scott had some great solutions. I especially like the idea of Nardil b/c it helps anxiety a LOT and is very good with depression too. I honestly think it is one of the very best antidepressants out there, even though I have experienced the dreaded 'poop out' with it, but then I have been on pretty much every drug there is and over decades all of them except stims have given out on me.
Anyways, with your situation, I like Nardil, but it might be too early to give that a try. It's great, but it's a pain in the *ss too, what with washouts and lots of drug and food interactions.
Have you ever tried Remeron? It's *great* for anxiety, and for depression too. I miss it. But it joined the ranks of all my pooped out soldiers.
Good luck to you whatever you decide.
Kat
Posted by Laney on December 3, 2012, at 12:07:46
In reply to Re: Re-instated dosage not working?!, posted by Prefect on November 26, 2012, at 20:43:09
Just wanted to say here's a link for tardive dysphoria theory.
Laney
Posted by Phillipa on December 3, 2012, at 20:51:18
In reply to Re: Re-instated dosage not working?!, posted by Laney on December 3, 2012, at 12:07:46
I so agree as I curse the day I ever let a pdoc prescribe an ad for me when I had panic disorder. I did not need it. Phillipa
This is the end of the thread.
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