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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by ben on May 24, 2001, at 12:45:44
Which ssri has the lowest incidence of nausea ?
I tried celexa 100 mg/day without any problems, but now on 50 mg Zoloft (4 weeks) I have an awful nausea coming and going (esp. at morning). And I feel agitated and anxious. Could Paxil be a try worth ?Thanks
ben
Posted by sl on May 24, 2001, at 12:57:23
In reply to SSRI and nausea please help !, posted by ben on May 24, 2001, at 12:45:44
I have no idea.
But you can try nibbling on candied-ginger until you get an answer, it's a well-known natural nausea remedy.sl
> Which ssri has the lowest incidence of nausea ?
Posted by ben on May 24, 2001, at 14:10:31
In reply to SSRI and nausea please help !, posted by ben on May 24, 2001, at 12:45:44
Does Paxil cause fewer nausea than Zoloft ?
Posted by Astrologer30 on May 24, 2001, at 19:06:55
In reply to Re: Paxil better than Zoloft ?, posted by ben on May 24, 2001, at 14:10:31
> Does Paxil cause fewer nausea than Zoloft ?
Of course everyone is personal in there chemistry and so on, but when I was on Paxil, it was a big mistake for me, I was extremly nauseous and just gross all over for quite a while, it didn't help and I was offered Zoloft, but my mum had taken an allergic reaction to it, so I opted not to take it and to try and help myself as naturally as I could.
Now this may sound silly, but, in regards to the nausea, you can look up nausea help in regards to morning sickness (pregnancy) or chemotherapy related, etc, to find suggestions to help to curb and/or stop nausea all together.
One thing that had/has helped me alot is crackers and tea, or sucking on mints.
And lastly, there is always research on your own, buy looking up the pharmacetical effects and percentages etc. of each drug, including others. As I said in a previous message about Effexor xr, I had little to no nausea when I started it at a high level, so, it is all individual, and it is a matter of finding out what is best for you, and you'll find it!, even if your a little queasy for a day or two, or three, in the long run if the medication works, than that is all that matters.
Posted by Cam W. on May 24, 2001, at 21:51:46
In reply to Re: Paxil better than Zoloft ?, posted by ben on May 24, 2001, at 14:10:31
Ben - In general, Paxil™ (paroxetine) causes less nausea than Zoloft™ (sertraline), but remember, everyone has different chemical make-ups. Nausea is usually a self-limiting start-up side effect with SSRIs and lasts only 2 to 3 weeks after starting the antidepressants. The SSRIs stimulate serotonin-3 (5-HT3) receptors in the gut causing the nausea. This usually stops once the 5-HT3 receptors desensitize.
Also, Zoloft should be taken with food to help avoid first-pass effect through the liver. Food in the stomach increases hepatic (liver) blood circulation and more Zoloft gets through the liver unmetabolized. This allows more Zoloft to get into the brain. Food also lessens some of the nausea caused by Zoloft.
Now, I can't say that you won't get nausea with Paxil, especially at the start of therapy. Approximately the same number of people (approx. 25%) have nausea as a start-up side effect of both Zoloft and Paxil, where about 20% of people who start Celexa get nauseous. Over the long-term, Paxil does seem to cause less nausea, though.
Ya pays your money and takes your chances - Cam
Posted by ben on May 26, 2001, at 11:52:55
In reply to Re: Paxil better than Zoloft ? » ben, posted by Cam W. on May 24, 2001, at 21:51:46
> Ben - In general, Paxil™ (paroxetine) causes less nausea than Zoloft™ (sertraline), but remember, everyone has different chemical make-ups. Nausea is usually a self-limiting start-up side effect with SSRIs and lasts only 2 to 3 weeks after starting the antidepressants. The SSRIs stimulate serotonin-3 (5-HT3) receptors in the gut causing the nausea. This usually stops once the 5-HT3 receptors desensitize.
>
> Also, Zoloft should be taken with food to help avoid first-pass effect through the liver. Food in the stomach increases hepatic (liver) blood circulation and more Zoloft gets through the liver unmetabolized. This allows more Zoloft to get into the brain. Food also lessens some of the nausea caused by Zoloft.
>
> Now, I can't say that you won't get nausea with Paxil, especially at the start of therapy. Approximately the same number of people (approx. 25%) have nausea as a start-up side effect of both Zoloft and Paxil, where about 20% of people who start Celexa get nauseous. Over the long-term, Paxil does seem to cause less nausea, though.
>
> Ya pays your money and takes your chances - CamThis is my 5. week on Zoloft but I still feel nauseous (coming and going esp. by awakening in the morning). Will I get used to this drug !? Ginger doesnt help and domperidone or metoclopramide either. A gastrointestinal examination was okay. I didnt have this probs with Celexa or Efexor (other probs of course). Thanks
Posted by Cam W. on May 26, 2001, at 12:16:55
In reply to Re: Paxil better than Zoloft ? Cam, posted by ben on May 26, 2001, at 11:52:55
Ben - It is really hard to say if you will get use to the Zoloft. After 5 weeks, if there has been no diminishing of the nausea, I'd say probably not. If the nausea has lessened some from the start of therapy, then perhaps it may still lessen.
It may be prudent to give the drug another couple weeks, anyway. It would be a shame to throw away an effective drug, as there are too few out there. This is especially true of when you've found an SSRI that doesn't affect Willy.
I know that you have tried a number of remedies for nausea and they are seemingly ineffective. I'll give you one more to try. Keep a bag of peppermints beside you bed and see if succking one or two upon waking helps. If the candy doesn't help, at least you will have sweeter smelling breath than your significant other.
Sorry that I cannot be of more help than this. - Cam
Posted by ben on May 26, 2001, at 12:34:39
In reply to Re: Paxil better than Zoloft ? Cam » ben, posted by Cam W. on May 26, 2001, at 12:16:55
> Ben - It is really hard to say if you will get use to the Zoloft. After 5 weeks, if there has been no diminishing of the nausea, I'd say probably not. If the nausea has lessened some from the start of therapy, then perhaps it may still lessen.
>
> It may be prudent to give the drug another couple weeks, anyway. It would be a shame to throw away an effective drug, as there are too few out there. This is especially true of when you've found an SSRI that doesn't affect Willy.
>
> I know that you have tried a number of remedies for nausea and they are seemingly ineffective. I'll give you one more to try. Keep a bag of peppermints beside you bed and see if succking one or two upon waking helps. If the candy doesn't help, at least you will have sweeter smelling breath than your significant other.
>
> Sorry that I cannot be of more help than this. - CamCam, I mconsider to switch Paxil when this nausea doesnt stop. Paxil could be better for me becaus it is less activating than zoloft (I have feelings of agitation and anxiety on zoloft too) but my willy probably wouldnt like that paroxetine at all !? Or I will give the Edronax a second chance (had urinary retention on 4 mg after two weeks and couldnt have an erection...perhaps this could lessen within time ?)
ben
Posted by Cam W. on May 26, 2001, at 13:01:03
In reply to Re: Cam, posted by ben on May 26, 2001, at 12:34:39
Ben - Paxil™ (paroxetine) is a bugger (no pun) for sexual disfunction (unless you have a hair-trigger). Also, be aware of the delayed weight gain that is very common with Paxil. Four or five months after starting the drug you realize that none of your clothes fit. I recommend that everyone who start Paxil get some kind of dietary counseling (ie. keep a food diary to make sure that your eating habits don't change and keep a decent exercise program).
As for the Edronex™ (reboxetine), it is not my favorite drug. We had a clinical trial or two with it at our University hospital and, after some seemingly initial success, many of the people who tried it relapsed. I believe that, if ever released in the U.S. and Canada, may find a niche market for those who cannot tolerate or don't respond to SSRIs. The side effects that you had do sound like start-up side effects. Another trial may be in order, but like I said, only a select few respond and maintain response on Edronex.
I am not totally convinced that taking away either norepinephrine- or serotonin-reuptake blocking activity from an antidepressant works as well as an antidepressant that has both activities. It seems that TCAs which affect both of these mechanisms work better than either SSRIs or NRIs. Perhaps blocking both leads to a third action in the brain; one we haven't figured out, yet.
I'm sorry, I can't remember whether you tried Wellbutrin SR™ (bupropion), yet. It would seem a logical choice. You could also add it to Celexa™ (citalopram) to try to reverse the sexual stuff. Ask your doc about this.
- Cam
Posted by ben on May 26, 2001, at 15:07:54
In reply to Re: Cam » ben, posted by Cam W. on May 26, 2001, at 13:01:03
> Ben - Paxil™ (paroxetine) is a bugger (no pun) for sexual disfunction (unless you have a hair-trigger). Also, be aware of the delayed weight gain that is very common with Paxil. Four or five months after starting the drug you realize that none of your clothes fit. I recommend that everyone who start Paxil get some kind of dietary counseling (ie. keep a food diary to make sure that your eating habits don't change and keep a decent exercise program).
>
> As for the Edronex™ (reboxetine), it is not my favorite drug. We had a clinical trial or two with it at our University hospital and, after some seemingly initial success, many of the people who tried it relapsed. I believe that, if ever released in the U.S. and Canada, may find a niche market for those who cannot tolerate or don't respond to SSRIs. The side effects that you had do sound like start-up side effects. Another trial may be in order, but like I said, only a select few respond and maintain response on Edronex.
>
> I am not totally convinced that taking away either norepinephrine- or serotonin-reuptake blocking activity from an antidepressant works as well as an antidepressant that has both activities. It seems that TCAs which affect both of these mechanisms work better than either SSRIs or NRIs. Perhaps blocking both leads to a third action in the brain; one we haven't figured out, yet.
>
> I'm sorry, I can't remember whether you tried Wellbutrin SR™ (bupropion), yet. It would seem a logical choice. You could also add it to Celexa™ (citalopram) to try to reverse the sexual stuff. Ask your doc about this.
>
> - Cam
Thanks CamBut I think Edronax could be a good ad on if someone doesnt get full relief with an ssri alone. I didnt have side effects like dizziness, anxiety, nausea... which are mostly common with ssri`s (not only in the initial period of 3 weeks). Celexa was good for me because I adjusted very quickly to each dose increase (side effects and probably the effect too) but I didnt give me a full remission after one year (dose up to 100 mg). And it made me tired (took it at 8 pm)......was always yawning.
My doc doesnt want to put me back on Celexa cause of the reasons I described above. He hasnt good experiences with Floxyfral (fluvoxamine) so he suggested Paxil if the Zoloft fails of any reasons. I would try the Paxil but I have fear of the sexual side effects; thats not funny. Prozac takes very long to act ... Another opinion of my doc was to try the MAO inhibitor Aurorix (moclobemide). I read about this drug and there are some points I hesitate to start a trial:
-short half life: intake of 3-4 daily
-effectiveness: very different reports and studys
-side-effects: restlessness, insomnia,anxietyInterestingly it could be combined with a NRI like Edronax (read it in the web) for some reason (counteracts the cheese like-effect ?).
Pearsonaly I think moclobemide could be combined with small (recommended starting dose) amounts of ssris when its done very carefully (slowly). There are a few reports of successfull combination these two drug classes.
ben
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