Psycho-Babble Medication Thread 4832

Shown: posts 1 to 5 of 5. This is the beginning of the thread.

 

Micro-doses?

Posted by Steve on April 13, 1999, at 21:29:14

Does anyone know anything about microdoses helping
when normal ones don't. I have baffled many doctors with
my fatigue in response to 20 mgs paxil or .25 mg xanax,
akathisia from 20 mg Prozac, dystonic reactions in response
to 1 mg haldol and 5 mg zyprexa, which were given in response
to a manic episode precipitated by 20 mg paxil. Not to mention
that 2.5 mgs of DHEA made me extremely restless for days.

Does anyone know of any success treating cases like this with
miniscule doses?

 

Re: Micro-doses?

Posted by Victoria on April 14, 1999, at 12:39:03

In reply to Micro-doses?, posted by Steve on April 13, 1999, at 21:29:14

I am very sensitive to medications and prone to getting side-effects. I have been taking low doses of various meds. Am getting a reasonable AD response to 50 mg of trazadone, and just started augmenting that with 25 mg. serzone. My doc says combining small doses of different drugs may be the solution to getting a good response without side effects.


> Does anyone know anything about microdoses helping
> when normal ones don't. I have baffled many doctors with
> my fatigue in response to 20 mgs paxil or .25 mg xanax,
> akathisia from 20 mg Prozac, dystonic reactions in response
> to 1 mg haldol and 5 mg zyprexa, which were given in response
> to a manic episode precipitated by 20 mg paxil. Not to mention
> that 2.5 mgs of DHEA made me extremely restless for days.
>
> Does anyone know of any success treating cases like this with
> miniscule doses?

 

Re: Micro-doses?

Posted by JD on April 14, 1999, at 12:58:17

In reply to Micro-doses?, posted by Steve on April 13, 1999, at 21:29:14

Steve,

Doctors really should start being more aware of this (and stop chalking it up to placebo-loving and/or hysterical patients!) Beyond my personal experience of exactly the same kinds of things you mention, there exist some reliable medical reports of people who can only tolerate, say, much less than 1mg of Prozac, but who go on to have quite good results. (I actually used an eye-dropper for the liquid stuff for a while, personally.) Especially for patients with a history of panic attacks, I know of some doctors who INSIST on beginning with 25% of a"normal" SSRI dose and only adjusting it on an as-needed basis. Interestingly, I also had just the kind of micro-dose response to DHEA you mentioned... unsympathetic doctors can think such reactions are nuts but they're can be very frustrating and are usually very much for real.

To make a long story short, a good doctor should absolutely consider smaller dosages across the board in your case. Your previous manic reaction to a standard Paxil dose is a potential area of concern in any further use of SSRIs (there's lots more out there!), but the main issue may be that ALL of your dosages for these meds have been too high from the get-go. If you don't have such a doctor already, you might invest your time in finding one who knows pharmacotherapy well enough to do more than prescribe the standard dosages listed in the Physicians Desk Reference. (No offense to psychiatrists, but it's surprising how many of them are out there who prescribe meds on a less than fully-informed and fully patient-oriented basis!)

Chin up and good luck! - JD


> Does anyone know anything about microdoses helping
> when normal ones don't. I have baffled many doctors with
> my fatigue in response to 20 mgs paxil or .25 mg xanax,
> akathisia from 20 mg Prozac, dystonic reactions in response
> to 1 mg haldol and 5 mg zyprexa, which were given in response
> to a manic episode precipitated by 20 mg paxil. Not to mention
> that 2.5 mgs of DHEA made me extremely restless for days.
>
> Does anyone know of any success treating cases like this with
> miniscule doses?

 

Re: Micro-doses?

Posted by Toby on April 14, 1999, at 13:05:18

In reply to Micro-doses?, posted by Steve on April 13, 1999, at 21:29:14

Mini-doses are indeed effective for some people. Getting the lowest dose-form of an antidepressant and then halving or quartering it and then slowly building up to whatever is effective before the side effects take over. Once you start increasing the dose, when side effects begin, hold the dose there for at least a week or however long it takes for the side effect to diminish, then continue to increase it until the depression responds. Another alternative is to use mini-doses of two or more (hopefully only two) antidepressants (usually of different classes). I have recently heard tell that using Effexor and Remeron together negates all the side effects of both. Of course, could you possibly have two more expensive medications? No. However, if very small doses are used, the expense may be lessened. Also, don't forget the importance of what time of day you take a medication. Switching from morning to night or vice versa sometimes relieves lethargy/restlessness.

 

Re: Micro-doses?

Posted by MA on April 18, 1999, at 19:22:08

In reply to Re: Micro-doses?, posted by MA on April 18, 1999, at 19:14:57

I now know that I usually have the best response at a much lower dosage than most people. I have had so many really bad side effects to several meds, in particular, Zoloft, where I was increased to 450 mg, which I now know is outrageous.

I have taken Prozac from 10-20 mg, Paxil 10 mg, and Wellbutin 100-200mg. In the past before I was an "expert" on AD's I would increase my meds just like the doctor ordered. Now I take half of what is prescribed and only increase it if there is no improvement after a week or two. If I have any bad side effects, I cut back the dose to where the side effects.
dissapear.

It has been the only way I can tolerate the meds. Small doses and very slow increases are the way!

> > Mini-doses are indeed effective for some people. Getting the lowest dose-form of an antidepressant and then halving or quartering it and then slowly building up to whatever is effective before the side effects take over. Once you start increasing the dose, when side effects begin, hold the dose there for at least a week or however long it takes for the side effect to diminish, then continue to increase it until the depression responds. Another alternative is to use mini-doses of two or more (hopefully only two) antidepressants (usually of different classes). I have recently heard tell that using Effexor and Remeron together negates all the side effects of both. Of course, could you possibly have two more expensive medications? No. However, if very small doses are used, the expense may be lessened. Also, don't forget the importance of what time of day you take a medication. Switching from morning to night or vice versa sometimes relieves lethargy/restlessness.


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.