![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by seekinginformation on November 1, 2014, at 18:40:21
Hello,
I want to get some help on issues I've been having the past couple of months. This post is a little long because I need to provide at least some back storyI took 5 MGs Prozac, 50 MGs Topamax, and .5 Mgs of Klonopin for years successfully for my OCD and GAD. It was like a miracle. However, I quit the Topamax about 2 years ago due to a kidney stone. Things got a little bumpy without my Topamax, so my doc added a low dose of Gabapentin, increased my prozac to 10 MGs, and added 1200 MGs of NAC over the course of a year.
That didnt seem to hold up as well, Topamax really calmed my OCD/intrusive thoughts, and "busy mind" down. Gabapentin and NAC certainly did not... Furthermore, the combo was increasing my appetite. Hence late last spring, we decided to change to a different SSRI (Lexapro).... I developed panic attacks within about 2 month, and held out until late August, when I asked to go back to Prozac. I had started seeing a new doc, who was fine with that. She also wanted me to try Topamax again as that had been so successful.
I cross tapered over the course of a month from 5 MGS Lexapro to 10 MGS Prozac. Then as I finished up that cross taper, we added in 30 MGS of Topamax sprinkles that I titrated up on. We then decided to try to go to 50MGS of Topamax (my previous dose) via titration, and within the week, all hell broke loose!I had such bad anxiety that i could not function. We backed down on the Topamax but the anxiety would not abate. Next, we increased the Prozac to 15 MGS. I also got off the NAC (1200 MGs) during that time because my new PDOC was not that familiar with it, and it really did not help that much. within 2 weeks I had developed Akathisia and tremors that were very noticable. I could not sit still and was twitching in my legs, trunk, arm, etc.... Hence we had to back off of that and go down to 10 MGS about 10 days ago. PDOC also allowed me to increase my Gabapentin from 200 MGs a day to 300 MGS a day total. All of these changes have left me reeling, and with very little improvement.
Long story short, I'm an anxious mess, and I am not sure what is causing it, or how to fix it. my brain feels like swiss cheese. I have anxiety, panic attacks, and my OCD has been awful. I feel so hyperaroused that I find it difficult to watch TV, read, or interact with other people. I've been taking Benedry, and that has helped.
My Pdoc did not want to make any major changes last visit because of all the other changes (as you can see there were ALOT) and she was really concerned about the Prozac EPS stuff. Hence getting the dose down was a top priority.
I take Klonopin .5 at night, and my pdoc has encouraged me to take it in the morning too, but I really dont want to go down the benzo path anymore than I already have, especially since I know that there are some very good meds out there.
I see her this week, and plan on seeing her every two to three weeks until I get stabilized, but I am not certain what is causing all of this anxiety!
Here are my meds.10 MGS Prozac daily
.5 MGS Klonopin at night
100 MGs Gabapentin 3 times daily (does this even do anything!?)
BenedrylI know that this is a long post, but I thought I would put my ordeal out there to see if anyone has any thoughts, or ideas as to how I can move forward and get some relief. The anxiety and OCD is so frustrating. I am trying my best on this.
Thanks for reading
Posted by Phillipa on November 1, 2014, at 22:21:59
In reply to Need thoughts as to where to go next- longer post, posted by seekinginformation on November 1, 2014, at 18:40:21
Have you ever thought about trying generic Luvox? Not the CR. That works well for OCD. Also the dose of klonopin is low in my opinion. I don't know of Topamax for anxiety and OCD. As OCD is a form of anxiety disorder? Phillipa
Posted by Christ_empowered on November 1, 2014, at 22:51:05
In reply to Need thoughts as to where to go next- longer post, posted by seekinginformation on November 1, 2014, at 18:40:21
I'd personally see about Luvox, like Phillipa suggested. I'd also see about either increasing the Klonopin or switching to another benzo, like xanax xr, ativan, or good ole valium.
Neurontin can help at that dose. I usually take 100mgs at a time when I need it, which isn't very often. But...I'm on other, stronger anti-convulsants, plus Abilify.
If you're wanting to try a supplement, maybe high doses of Inositol? You'll have to Google dosage for OCD, but it helps some people.
Its weird to me that you were on Topomax. That's beyond off label. Can you get a new pdoc?
Lyrica is sort of like super neurontin. Sufficiently high doses could replace both the klonopin and the neurontin. Its a barely controlled substance (schedule V), so there is a dependence issue sometimes. I think its 2x daily dosing.
Ummmm....for the AD start up and taper off Prozac, maybe a low dose AP? Some atypicals are generic now. Low dose risperidone, olanzapine (Zyprexa), maybe a low dose of loxapine or good ole thorazine, perphenazine, whatever...to ease the transition and maybe help you get some sleep, too. Actually, come to think of it, zyprexa is sold in combo capsules with prozac. Its for bipolar I depression and also treatment resistant depression, but....
...the zyprexa super charges the prozac and counteracts some side effects. There can be considerable weight gain, but that's not always the case. Just a thought...adding low dose olanzapine might counter some of the problems you're experiencing and get better control of your problems.
Good luck!
Posted by seekinginformation on November 2, 2014, at 1:24:51
In reply to Re: Need thoughts as to where to go next- longer post, posted by Christ_empowered on November 1, 2014, at 22:51:05
Thanks for the information. I am meeting with my doc later this week, and will discuss some options. The OCD and anxiety is frustrating, and I want to get it under control.
I personally wouldnt mind an AP, but the problem I have had with them is akathesia. I tried low dose seroquel years ago, and felt like I was going to blow right out of my skin. I couldn't increase my prozac either without severe issues, and I consider myself to be quite the trooper... I am usually willing to white knuckle the side effects, but those EPS issues floor me. The extreme weight gain also makes them concerning, particularly when there are good SSRIs out there.
I did do well on Zoloft years ago, and was able to ramp up the dose to 100 MGs. I also tried Luvox about 10 years ago. I remember alot of peaks and valleys, but it did help me.
As for my pdoc, she seems like a good doctor, and is compassionate. I think that she is concerned with all the changes made over the past couple of months, and wants to watch over things closely and see exactly what is happening with me before making any big changes.It's wierd, but the Topamax worked wonders... it calmed my mind so much. I miss it. I would be willing to revisit it, but I would drop the Neurontin first, I tried those two together and something did not work out. Another option I've considered asking about is to bump up the Neurontin... the dose is awfully low. Finally, I am going to start taking an AM dose of Klonopin that my doc wants me to take, it should help put out some of that anxiety fire.
I appreciate all the information! If you have any other ideas, please do share.
Thanks again!
> I'd personally see about Luvox, like Phillipa suggested. I'd also see about either increasing the Klonopin or switching to another benzo, like xanax xr, ativan, or good ole valium.
>
> Neurontin can help at that dose. I usually take 100mgs at a time when I need it, which isn't very often. But...I'm on other, stronger anti-convulsants, plus Abilify.
>
> If you're wanting to try a supplement, maybe high doses of Inositol? You'll have to Google dosage for OCD, but it helps some people.
>
> Its weird to me that you were on Topomax. That's beyond off label. Can you get a new pdoc?
>
> Lyrica is sort of like super neurontin. Sufficiently high doses could replace both the klonopin and the neurontin. Its a barely controlled substance (schedule V), so there is a dependence issue sometimes. I think its 2x daily dosing.
>
> Ummmm....for the AD start up and taper off Prozac, maybe a low dose AP? Some atypicals are generic now. Low dose risperidone, olanzapine (Zyprexa), maybe a low dose of loxapine or good ole thorazine, perphenazine, whatever...to ease the transition and maybe help you get some sleep, too. Actually, come to think of it, zyprexa is sold in combo capsules with prozac. Its for bipolar I depression and also treatment resistant depression, but....
>
> ...the zyprexa super charges the prozac and counteracts some side effects. There can be considerable weight gain, but that's not always the case. Just a thought...adding low dose olanzapine might counter some of the problems you're experiencing and get better control of your problems.
>
> Good luck!
Posted by Christ_empowered on November 2, 2014, at 1:11:42
In reply to Re: Need thoughts as to where to go next- longer post » Christ_empowered, posted by seekinginformation on November 2, 2014, at 1:24:51
hey!
OK. Maybe a different, gentler anticonvulsant? I have an OCD acquaintance, he did OK on trileptal.
Posted by Lou Pilder on November 2, 2014, at 5:33:16
In reply to Need thoughts as to where to go next- longer post, posted by seekinginformation on November 1, 2014, at 18:40:21
> Hello,
> I want to get some help on issues I've been having the past couple of months. This post is a little long because I need to provide at least some back story
>
> I took 5 MGs Prozac, 50 MGs Topamax, and .5 Mgs of Klonopin for years successfully for my OCD and GAD. It was like a miracle. However, I quit the Topamax about 2 years ago due to a kidney stone. Things got a little bumpy without my Topamax, so my doc added a low dose of Gabapentin, increased my prozac to 10 MGs, and added 1200 MGs of NAC over the course of a year.
>
> That didnt seem to hold up as well, Topamax really calmed my OCD/intrusive thoughts, and "busy mind" down. Gabapentin and NAC certainly did not... Furthermore, the combo was increasing my appetite. Hence late last spring, we decided to change to a different SSRI (Lexapro).... I developed panic attacks within about 2 month, and held out until late August, when I asked to go back to Prozac. I had started seeing a new doc, who was fine with that. She also wanted me to try Topamax again as that had been so successful.
> I cross tapered over the course of a month from 5 MGS Lexapro to 10 MGS Prozac. Then as I finished up that cross taper, we added in 30 MGS of Topamax sprinkles that I titrated up on. We then decided to try to go to 50MGS of Topamax (my previous dose) via titration, and within the week, all hell broke loose!
>
> I had such bad anxiety that i could not function. We backed down on the Topamax but the anxiety would not abate. Next, we increased the Prozac to 15 MGS. I also got off the NAC (1200 MGs) during that time because my new PDOC was not that familiar with it, and it really did not help that much. within 2 weeks I had developed Akathisia and tremors that were very noticable. I could not sit still and was twitching in my legs, trunk, arm, etc.... Hence we had to back off of that and go down to 10 MGS about 10 days ago. PDOC also allowed me to increase my Gabapentin from 200 MGs a day to 300 MGS a day total. All of these changes have left me reeling, and with very little improvement.
>
> Long story short, I'm an anxious mess, and I am not sure what is causing it, or how to fix it. my brain feels like swiss cheese. I have anxiety, panic attacks, and my OCD has been awful. I feel so hyperaroused that I find it difficult to watch TV, read, or interact with other people. I've been taking Benedry, and that has helped.
>
> My Pdoc did not want to make any major changes last visit because of all the other changes (as you can see there were ALOT) and she was really concerned about the Prozac EPS stuff. Hence getting the dose down was a top priority.
>
> I take Klonopin .5 at night, and my pdoc has encouraged me to take it in the morning too, but I really dont want to go down the benzo path anymore than I already have, especially since I know that there are some very good meds out there.
>
> I see her this week, and plan on seeing her every two to three weeks until I get stabilized, but I am not certain what is causing all of this anxiety!
> Here are my meds.
>
> 10 MGS Prozac daily
> .5 MGS Klonopin at night
> 100 MGs Gabapentin 3 times daily (does this even do anything!?)
> Benedryl
>
> I know that this is a long post, but I thought I would put my ordeal out there to see if anyone has any thoughts, or ideas as to how I can move forward and get some relief. The anxiety and OCD is so frustrating. I am trying my best on this.
>
> Thanks for reading
>seeking...
You wrote,[...I want to get some help...I'm an anxious mess...brain feels like swiss cheese...I am not certain what is causing all of this...see if anyone has any thoughts...].
The state that you are in now could cause your death. Death by your own hand, or death from being mentally confused and impaired from the drugs that you are taking. In fact, the combination of the drugs could induce mental confusion exponentially so that you could go into a state of not knowing what to do and thinking what is OK for you to do could actually cause your death due to the impairment of your thinking caused by the combination of the drugs.
One of the drugs, Prozac, is a fluorinated drug. Fluoride is a {neurotoxin} used in the commission of mass-murder and has been used in rodenticides. The benzodiazepine, Klonopin, can be addicting so if you try to stop taking it, further complications could result that could induce a mind-altered state to compel you to kill yourself and/or others. The movement disorders with the anxiety from these drugs could precipitate suicidal thinking and even to commit mass-murder.
I am prevent4ed from posting here educational material that IMHO could save your life, prevent a life-ruining condition or addiction due to prohibitions posted to me here by Mr. Hsiung. If you could have your provider of these drugs enter this forum, I could have dialog with her and possible bring out this educational material through our dialog here and show what these drugs are doing to you and how they could cause your death.
Lou
Posted by SLS on November 2, 2014, at 8:03:06
In reply to Need thoughts as to where to go next- longer post, posted by seekinginformation on November 1, 2014, at 18:40:21
How do you respond to fluvoxamine (Luvox)?
Fluvoxamine, along with its serotonergic properties, is a sigma-1 receptor agonist, which may act to mitigate the akathisia produced by neuroleptic antipsychotics. It will certainly be less apt to produce akathisia than other SSRIs. Sertraline (Zoloft) is probably the worst SSRI with respect to producing akathisia. This is not completely unexpectied, though. Sertraline is the SSRI that is most potent as a sigma-1 receptor antagonist.
How do you respond to clomipramine (Anafranil)?
- Scott
Posted by seekinginformation on November 2, 2014, at 10:18:42
In reply to Lou's warning-wunwheytik » seekinginformation, posted by Lou Pilder on November 2, 2014, at 5:33:16
Lou,
I do not agree with your perspective on psychiatric medications. In the future, I humbly request that you not respond to my posts out of respect for me and my triggers. Should you decide to respond, please know that I will not read them.Thank you
> > Hello,
> > I want to get some help on issues I've been having the past couple of months. This post is a little long because I need to provide at least some back story
> >
> > I took 5 MGs Prozac, 50 MGs Topamax, and .5 Mgs of Klonopin for years successfully for my OCD and GAD. It was like a miracle. However, I quit the Topamax about 2 years ago due to a kidney stone. Things got a little bumpy without my Topamax, so my doc added a low dose of Gabapentin, increased my prozac to 10 MGs, and added 1200 MGs of NAC over the course of a year.
> >
> > That didnt seem to hold up as well, Topamax really calmed my OCD/intrusive thoughts, and "busy mind" down. Gabapentin and NAC certainly did not... Furthermore, the combo was increasing my appetite. Hence late last spring, we decided to change to a different SSRI (Lexapro).... I developed panic attacks within about 2 month, and held out until late August, when I asked to go back to Prozac. I had started seeing a new doc, who was fine with that. She also wanted me to try Topamax again as that had been so successful.
> > I cross tapered over the course of a month from 5 MGS Lexapro to 10 MGS Prozac. Then as I finished up that cross taper, we added in 30 MGS of Topamax sprinkles that I titrated up on. We then decided to try to go to 50MGS of Topamax (my previous dose) via titration, and within the week, all hell broke loose!
> >
> > I had such bad anxiety that i could not function. We backed down on the Topamax but the anxiety would not abate. Next, we increased the Prozac to 15 MGS. I also got off the NAC (1200 MGs) during that time because my new PDOC was not that familiar with it, and it really did not help that much. within 2 weeks I had developed Akathisia and tremors that were very noticable. I could not sit still and was twitching in my legs, trunk, arm, etc.... Hence we had to back off of that and go down to 10 MGS about 10 days ago. PDOC also allowed me to increase my Gabapentin from 200 MGs a day to 300 MGS a day total. All of these changes have left me reeling, and with very little improvement.
> >
> > Long story short, I'm an anxious mess, and I am not sure what is causing it, or how to fix it. my brain feels like swiss cheese. I have anxiety, panic attacks, and my OCD has been awful. I feel so hyperaroused that I find it difficult to watch TV, read, or interact with other people. I've been taking Benedry, and that has helped.
> >
> > My Pdoc did not want to make any major changes last visit because of all the other changes (as you can see there were ALOT) and she was really concerned about the Prozac EPS stuff. Hence getting the dose down was a top priority.
> >
> > I take Klonopin .5 at night, and my pdoc has encouraged me to take it in the morning too, but I really dont want to go down the benzo path anymore than I already have, especially since I know that there are some very good meds out there.
> >
> > I see her this week, and plan on seeing her every two to three weeks until I get stabilized, but I am not certain what is causing all of this anxiety!
> > Here are my meds.
> >
> > 10 MGS Prozac daily
> > .5 MGS Klonopin at night
> > 100 MGs Gabapentin 3 times daily (does this even do anything!?)
> > Benedryl
> >
> > I know that this is a long post, but I thought I would put my ordeal out there to see if anyone has any thoughts, or ideas as to how I can move forward and get some relief. The anxiety and OCD is so frustrating. I am trying my best on this.
> >
> > Thanks for reading
> >
>
> seeking...
> You wrote,[...I want to get some help...I'm an anxious mess...brain feels like swiss cheese...I am not certain what is causing all of this...see if anyone has any thoughts...].
> The state that you are in now could cause your death. Death by your own hand, or death from being mentally confused and impaired from the drugs that you are taking. In fact, the combination of the drugs could induce mental confusion exponentially so that you could go into a state of not knowing what to do and thinking what is OK for you to do could actually cause your death due to the impairment of your thinking caused by the combination of the drugs.
> One of the drugs, Prozac, is a fluorinated drug. Fluoride is a {neurotoxin} used in the commission of mass-murder and has been used in rodenticides. The benzodiazepine, Klonopin, can be addicting so if you try to stop taking it, further complications could result that could induce a mind-altered state to compel you to kill yourself and/or others. The movement disorders with the anxiety from these drugs could precipitate suicidal thinking and even to commit mass-murder.
> I am prevent4ed from posting here educational material that IMHO could save your life, prevent a life-ruining condition or addiction due to prohibitions posted to me here by Mr. Hsiung. If you could have your provider of these drugs enter this forum, I could have dialog with her and possible bring out this educational material through our dialog here and show what these drugs are doing to you and how they could cause your death.
> Lou
Posted by seekinginformation on November 2, 2014, at 10:21:13
In reply to Re: Need thoughts as to where to go next- longer post, posted by Christ_empowered on November 2, 2014, at 1:11:42
Hey there, thanks so much. I actually took Trileptal about 10 years ago. It was helpful for the "busy mind" but I kept on having bouts of vertigo with it. I suppose if I figured out how to mitigate that, I could perhaps give it another whirl.
Thanks again!> hey!
>
>
> OK. Maybe a different, gentler anticonvulsant? I have an OCD acquaintance, he did OK on trileptal.
>
>
Posted by seekinginformation on November 2, 2014, at 10:26:56
In reply to Re: Need thoughts as to where to go next- longer post » seekinginformation, posted by SLS on November 2, 2014, at 8:03:06
Hi Scott,
Luvox was interesting for me. If I recall, think that it helped me with some of my anxiety issues. The most prominent issues I noticed with the Luvox were sexual dysfunction (fine with me if I can get some relief from the OCD/GAD) and it seemed somewhat "peak and valleyish". I would do okay for a week, and then slip into anxiety issues. But at the end of the day, I am betting that it would provide far more relief than what i have been able to squeeze out of the prozac these days. The big issue is trying to convince my PDOC to make a change.> How do you respond to fluvoxamine (Luvox)?
>
> Fluvoxamine, along with its serotonergic properties, is a sigma-1 receptor agonist, which may act to mitigate the akathisia produced by neuroleptic antipsychotics. It will certainly be less apt to produce akathisia than other SSRIs. Sertraline (Zoloft) is probably the worst SSRI with respect to producing akathisia. This is not completely unexpectied, though. Sertraline is the SSRI that is most potent as a sigma-1 receptor antagonist.
>
> How do you respond to clomipramine (Anafranil)?
>
>
> - Scott
Posted by seekinginformation on November 2, 2014, at 10:32:26
In reply to Re: Need thoughts as to where to go next- longer post » seekinginformation, posted by SLS on November 2, 2014, at 8:03:06
Hi Scott,
One other thing I forgot to mention... the Clomipramine. My Mom has OCD, as does my twin brother. They both took it at one point.My mom seemed to be able to handle it, but the side effects eventually drove her off of it and back to an SSRI. She gained weight and was generally "a zombie" for lack of a better word, even at a lower dose. She really checked out on life while she was on it.
My twin tried it, and it caused intense anxiety and racing heart to the point that he was told to stop taking it.
Mental illness runs in my immediate family and extended family, particularly OCD and GAD.
> How do you respond to fluvoxamine (Luvox)?
>
> Fluvoxamine, along with its serotonergic properties, is a sigma-1 receptor agonist, which may act to mitigate the akathisia produced by neuroleptic antipsychotics. It will certainly be less apt to produce akathisia than other SSRIs. Sertraline (Zoloft) is probably the worst SSRI with respect to producing akathisia. This is not completely unexpectied, though. Sertraline is the SSRI that is most potent as a sigma-1 receptor antagonist.
>
> How do you respond to clomipramine (Anafranil)?
>
>
> - Scott
Posted by burial on November 2, 2014, at 14:45:41
In reply to Re: Need thoughts as to where to go next- longer post » SLS, posted by seekinginformation on November 2, 2014, at 10:32:26
from what i've gathered so much, paroxetine is the most helpful in treating OCD and especially anxiety among the SSRIS.
Posted by SLS on November 2, 2014, at 14:57:07
In reply to Re: Need thoughts as to where to go next- longer post, posted by burial on November 2, 2014, at 14:45:41
> from what i've gathered so much, paroxetine is the most helpful in treating OCD and especially anxiety among the SSRIS.
Interesting about the OCD. I agree with you about paroxetine and anxiety disorders.
Thanks for the information.
- Scott
Posted by Phillipa on November 2, 2014, at 17:00:28
In reply to Re: Need thoughts as to where to go next- longer post » seekinginformation, posted by Phillipa on November 1, 2014, at 22:21:59
I forgot that the only benzo that is approved to use with luvox is ativan also. But I take both valium & xanax with it. Night time only. Phillipa
Posted by seekinginformation on November 2, 2014, at 22:33:09
In reply to Re: Need thoughts as to where to go next- longer post, posted by Phillipa on November 2, 2014, at 17:00:28
Thanks for that information Phillipa. From what I've read, Luvox has a lot of drug/drug interactions, most of the benzos being among them. From what I understand, it can increase the potency of the benzo (I could be wrong with this). I think that it really depends... I've seen people with the klonopin/luvox combo and I didnt see them mention it. Its definitely something I would ask the doc about if she is willing to switch me to it. I suppose I could cross taper to ativan too if needed.
> I forgot that the only benzo that is approved to use with luvox is ativan also. But I take both valium & xanax with it. Night time only. Phillipa
Posted by Phillipa on November 3, 2014, at 19:59:41
In reply to Re: Need thoughts as to where to go next- longer post, posted by seekinginformation on November 2, 2014, at 22:33:09
I did take ativan the first session I took luvox when got to 250mg. But needed like 4-5mg a day. I had another pdoc say that taking the luvox meant I didn't have to raise does of xanax or valium. Coffee is supposed to be the worse at makes it higher caffeine. I don't drink coffee though. Phillipa
Posted by phidippus on November 4, 2014, at 19:45:58
In reply to Need thoughts as to where to go next- longer post, posted by seekinginformation on November 1, 2014, at 18:40:21
> I took 5 MGs Prozac, 50 MGs Topamax, and .5 Mgs of Klonopin for years successfully for my OCD and GAD.
You do know it takes very high doses of SSRI to treat OCD? A therapeutic dose for OCD of Prozac is 60 mg.
>It was like a miracle.
You got lucky.
> That didnt seem to hold up as well, Topamax really calmed my OCD/intrusive thoughts, and "busy mind" down. Gabapentin and NAC certainly did not...
Topamax helps with your anxiety because it antagonizes glutamate. Gabapentin should be doing the same thing if its at the right dose-about 2400 mg a day.
NAC never worked for me.
>I cross tapered over the course of a month from 5 MGS Lexapro to 10 MGS Prozac. Then as I finished up that cross taper, we added in 30 MGS of Topamax sprinkles that I titrated up on. We then decided to try to go to 50MGS of Topamax (my previous dose) via titration, and within the week, all hell broke loose!
OCD and GAD have a way of 'blooming' during certain times. I believe you were doing fine and came under some extra stress and your symptioms worsened. I don't think the med changes had anything to do with the worsening of your symptoms. What sort of stressors were you having at this time?
Also, your low doses of medication did nothing to help quell your 'bloom'. Had you been on 60 mg of Prozac, I think you would have been fine.
>Next, we increased the Prozac to 15 MGS.
Wow. You needed 45 mg more.
>we had to back off of that and go down to 10 MGS about 10 days ago.
This is not helping you. I would add propanolol 80 mg and increase your prozac to 30 mg.
>All of these changes have left me reeling, and with very little improvement.
Because you do not have ENOUGH medication in your body. I am not speaking from experience alone. Many years of studies and research indicate that OCD is treated best with higher doses than given for depression. Luvox 300 mg, Lexapro 30 mg, Zoloft 200 mg, Prozac 60 mg, Paxil 40 mg.
When augmenting an antidepressant with an anti-glutametergic agent such as Tompomax or Gabapentin, doses should be adjusted until maximum effectiveness is achieved. 300 mg of Gabapentin is a small dose to be taking for your level of anxiety. Try to get that dose into the 1000s
> Long story short, I'm an anxious mess, and I am not sure what is causing it, or how to fix it. my brain feels like swiss cheese.
Raise your dose of Prozac to 60 and Gabapentin to 1200. Add an atypical antipsychotic, like Geodon or Abilify-not too much though. Too much atypical antipsychotic can backfire and make OCD worse.
>I've been taking Benedry, and that has helped.
Benedryl has been shown to be useful in the treatment of OCD.
>she was really concerned about the Prozac EPS stuff. Hence getting the dose down was a top priority.
Wrong priorities. You can get the EPS under control with cogentin, propanalol or artane. Pindolol wwould help to and it has been shown effective in the treatment of OCD. OR switch to another antidepressant-might I recommend Clomipramine or Luvox, both which have been shown morer effective in treating OCD than Prozac.
> I am not certain what is causing all of this anxiety!No real reason. Don't waste your time reasoning out the anxiety. Welcome the OCD thoughts and don't fight them.
> .5 MGS Klonopin at night
Don't take too much of this as it can worsen OCD-it blocks serotonin receptors and your brain is fairly starved for serotonin. OCD=low serotonin, high dopamine, excess glutamate.
> I know that this is a long post, but I thought I would put my ordeal out there to see if anyone has any thoughts, or ideas as to how I can move forward and get some relief.
I've been doing the OCD, panic, anxiety thing for 16 years now. I've taken every pill under the sun and I know what works and what doesn't work.
Please let me know how you are doing.
Eric
ps. you should read this: http://www.aafp.org/afp/2008/0701/p131.html
Posted by kirkglen on November 14, 2014, at 12:05:52
In reply to Re: Need thoughts as to where to go next- longer post » seekinginformation, posted by phidippus on November 4, 2014, at 19:45:58
Eric
I know many people push SSRI's for anxiety. For some it may be a blessing.
I suffer panic attacks and sheer anxiety along with severe depression. I tried the SSRI's and SNRI's and they both cause severe anxiety/panic attacks with me.
The only drug I've found that kills anxiety,panic, and depression is Nardil. I'm sure for OCD it would be helpful.
If you go this route insist on the Gavis brand. 90 mg for @ 7-8 wks. then 60 mg.
Good luck!
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