![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 25 to 49 of 52. Go back in thread:
Posted by Cam W. on June 9, 2001, at 10:33:50
In reply to Re: Happen to be lurking around, Cam?, posted by gheld on June 9, 2001, at 9:39:26
Gordon - Yes, I have heard of several suicide deaths from from overdoses of benzodiazepines mixed with alcohol, resulting in respiratory depression. Also, more people have died from taking taking overdoses of benzodiazepines alone (granted, it is rare), while people who have taken massive overdoses of SSRIs alone have recovered without any problems. There have only been a few deaths reported in which someone has died from ingesting overdoses of SSRIs alone, but less than 10 worldwide (I believe).
As to considering the side effects profiles, the top ten side effects listed for any SSRI usually describe the start of side effets of these drugs, and disappear within 2 weeks in a vast majority of people.
The body has adjusted to a lack of serotonin by altering the mix of the other neurotransmitters. With an increase in serotonin, as a result of taking an SSRI, one must expect that the body would have to readjust the mix of other neurotransmitters, hence, the start up side effects.
If the depression/anxiety did not result in a decrease of serotonin and you add an SSRI, then, yeas, you are going to get side effects associated with excess serotonin. These side effects are similar to the start-up side effects and really, the only way to tell the difference is (sometimes) the intensity of the side effect and if the side effect does wane over 2 to 3 weeks.
Let's compare side effets profiles (in no particular order):
Rivotril™ (clonazepam - Klonopin™ -U.S.)
Most Common - CNS depression in approx, 50% of people, respiratory depression, aggressiveness, argumentative behavior, hyperactivity, agitation, depression, euphoria, irritability, forgetfulness, confusion, nystagmus, unsteady gait, slurred speech, dysarthria, vertigo, palpitations, gynecomastia, hallucinations, muscle weakness, low back pain, increased appetite, nocturia, hypersecretion in upper respiratory tract, urinary retention, enuresis....Prozac™ (fluoxetine)
Start-up side effects - headache, nervousness insomnia, anxiety, emotional lability, nausea, tremor, dizziness, diarrhea/constipation, myalgia, flu-like sympoms, anorexia.....Long-term side effects - decreased libido, anorgasmia, increased appetite, excessive sweating, fatigue, twitching, change in accomodation, acne, back pain, joint pain, dry skin, urinary tract infection, painful menstruation....
Choose your poison. (ref. Compendium of Pharmaceuticals and Specialties, 2000).
BTW - If your doc does not spend time with you, find one that does; one that you can trust and trusts you. My pdoc and I work closely together to monitor my progress. He is only a phone call away, day or night.
- Cam
Posted by Greg on June 9, 2001, at 10:38:49
In reply to Re: Xanax vs. Klonopin, posted by Elizabeth on June 8, 2001, at 15:47:38
Thanks everyone for the feedback on this. I knew I'd get a lot of varied responses and that really is what I'm looking for. I think I'll ask my psych to try me on the Klonopin, I can always go back to the Xanax if I need to. I have an extremely addictive personality and have some concerns about withdrawals effects I'll have coming off the Xanax. Hopefully this will be a better solution in the long run.
I really appreciate ya'll taking the time to respond to this.
Peace,
Greg
Posted by gilbert on June 9, 2001, at 14:35:10
In reply to Re: Happen to be lurking around, Cam? » gheld, posted by Cam W. on June 9, 2001, at 10:33:50
- Yes, I have heard of several suicide deaths from from overdoses of benzodiazepines mixed with alcohol, resulting in respiratory depression. Also, more people have died from taking taking overdoses of benzodiazepines alone (granted, it is rare), while people who have taken massive overdoses of SSRIs alone have recovered without any problems. There have only been a few deaths reported in which someone has died from ingesting overdoses of SSRIs alone, but less than 10 worldwide (I believe).
I can overdose on most of my blood pressure meds and certainly taking a bottle of beta blockers won't keep you breathing too long but no stigma with those. Also very very hard to predict how many suicides take place because of use of either of the above mentioned drugs. I think spontaneous suicidal ideation is a listed side effect on most ssris. Now a toxic dose of the drug did not kill them but what about the drugs effect on their decision to take their own life. This will not show up in a toxicology report but we all know the web is full of this data....some of which are not Christian Scientists sponsored web sites.....LOL
> As to considering the side effects profiles, the top ten side effects listed for any SSRI usually describe the start of side effets of these drugs, and disappear within 2 weeks in a vast majority of people.If that were true this board would be non existent. Look at these posts week after week month after month almost all are side effect related most of which are long time users of ssris
> The body has adjusted to a lack of serotonin by altering the mix of the other neurotransmitters. With an increase in serotonin, as a result of taking an SSRI, one must expect that the body would have to readjust the mix of other neurotransmitters, hence, the start up side effects.Are you sure this is what happens. The med research I have read isn't even really defining how other neurotransmitters are effected. They don't even know why wellbutrin works. If the predictable of brain chemistry were so certain we could just dose by body weight and everyone would have the same results. SSRI's have such an array of effects on people certainly the same cannot be said for other classes of drugs not to the same extent. Very unpredictable...physically and emotionally not to mention spirituallly.
> If the depression/anxiety did not result in a decrease of serotonin and you add an SSRI, then, yeas, you are going to get side effects associated with excess serotonin. These side effects are similar to the start-up side effects and really, the only way to tell the difference is (sometimes) the intensity of the side effect and if the side effect does wane over 2 to 3 weeks.
Cam I really respect your intelligence and committement to this board but this whole lack of seratonin theory came to be the most popular theory once the ssris came into play. Look at the efficacy of lithium isn't it like thirty some percent for unipolar depression. All the other mood stabilzers and now all of a suddeen the anti pyschotics are back with a vengeance soon we will have a new thoery to supprot use of these meds it gets to be like squeezing the stepsisters foot into cinderellas slipper...if by chance the drug works then we come up with biochemical theories to explain why the slipper should fit... I really think we just don't know why some of this works. How does lithium effect seratonin. To belay every new physiological disorder with a mental twist to seratonin deficiency is getting old. OCD, Depression, Panic, Social anxiety, PMDD, Agressive Behaviour, Sexual Preditors, on and on. It seems to me the seratonin pharmacuetical companies have really done their jobs. That is not to say they have not helped millions I know they have.
> Let's compare side effets profiles (in no particular order):
>
> Rivotril™ (clonazepam - Klonopin™ -U.S.)
> Most Common - CNS depression in approx, 50% of people, respiratory depression, aggressiveness, argumentative behavior, hyperactivity, agitation, depression, euphoria, irritability, forgetfulness, confusion, nystagmus, unsteady gait, slurred speech, dysarthria, vertigo, palpitations, gynecomastia, hallucinations, muscle weakness, low back pain, increased appetite, nocturia, hypersecretion in upper respiratory tract, urinary retention, enuresis....
>
> Prozac™ (fluoxetine)
> Start-up side effects - headache, nervousness insomnia, anxiety, emotional lability, nausea, tremor, dizziness, diarrhea/constipation, myalgia, flu-like sympoms, anorexia.....
>
> Long-term side effects - decreased libido, anorgasmia, increased appetite, excessive sweating, fatigue, twitching, change in accomodation, acne, back pain, joint pain, dry skin, urinary tract infection, painful menstruation....
>
> Choose your poison. (ref. Compendium of Pharmaceuticals and Specialties, 2000).
Last but not least Cam we all know the side effect profiles you have just listed are not the real world just a sample of some people at some point in time with questions asked by the drug companies marketing people. Look at the change in ssri sexual dysfunction from what is listed. It is the way the questions are asked and by whom. Anyone who has tried differernt classes of drugs can tell you from personal experience the side effect lists are bogus. As for side effects dissapating over time there has been some very serious side effects associated with long term ssri use in "some" individuals. I don't want to scare people who are having success with them God Bless Them I would be willing to take the risk as well if they worked for me. They are not benign to overdose either. I know most people who overdose do so on a mix of narcotics and benzos or booze and benzos not just benzos. You can OD on booze and Luvox too if you try. The whole point is that once again it sounds like you justify ssri use based on brain chemistry and a chemical imbalance.... if it were that simple they would draw blood diagnose and dose us up. That benzo use is just a mask for symptomolgy. What about gaba shortage...Now I have also worked with addicts and alcohlics for a good 20 years and most people still kill themselves the good old fashioned way.....on booze. Slowly or quickly.Gil
Posted by Cam W. on June 9, 2001, at 15:12:59
In reply to Re: Response to Cam, posted by gilbert on June 9, 2001, at 14:35:10
> - Yes, I have heard of several suicide deaths from from overdoses of benzodiazepines mixed with alcohol, resulting in respiratory depression. Also, more people have died from taking taking overdoses of benzodiazepines alone (granted, it is rare), while people who have taken massive overdoses of SSRIs alone have recovered without any problems. There have only been a few deaths reported in which someone has died from ingesting overdoses of SSRIs alone, but less than 10 worldwide (I believe).
>
> I can overdose on most of my blood pressure meds and certainly taking a bottle of beta blockers won't keep you breathing too long but no stigma with those. Also very very hard to predict how many suicides take place because of use of either of the above mentioned drugs. I think spontaneous suicidal ideation is a listed side effect on most ssris. Now a toxic dose of the drug did not kill them but what about the drugs effect on their decision to take their own life. This will not show up in a toxicology report but we all know the web is full of this data....some of which are not Christian Scientists sponsored web sites.....LOL
>
• SSRIs do not induce a change in a person's thoughts toward suicide. I believe that the suicidal tendencies are in place before the person takes the SSRI. The drug alleviates some of the depressive symptoms, including increased energy, where the person is more able to act on their suicidal thoughts.
>
> > As to considering the side effects profiles, the top ten side effects listed for any SSRI usually describe the start of side effets of these drugs, and disappear within 2 weeks in a vast majority of people.
>
> If that were true this board would be non existent. Look at these posts week after week month after month almost all are side effect related most of which are long time users of ssris
>
• The people on this board are no where near the number of people who take SSRIs and we tend to hear much more from people who are having problems with the SSRIs. Besides, the long term side effects that we hear about on this board are pretty much the same handful, as with any effective antidepressant (sexual dysfunction, apathy, lack of energy, etc.).
>
> > The body has adjusted to a lack of serotonin by altering the mix of the other neurotransmitters. With an increase in serotonin, as a result of taking an SSRI, one must expect that the body would have to readjust the mix of other neurotransmitters, hence, the start up side effects.
>
> Are you sure this is what happens. The med research I have read isn't even really defining how other neurotransmitters are effected. They don't even know why wellbutrin works. If the predictable of brain chemistry were so certain we could just dose by body weight and everyone would have the same results. SSRI's have such an array of effects on people certainly the same cannot be said for other classes of drugs not to the same extent. Very unpredictable...physically and emotionally not to mention spirituallly.
>
• I am absolutely positive that the concentration of other neurotransmitters change when you change one of them. This has been shown time and again in many of the geek journals (eg check out some of the journal articles under the neurotransmitter section of http://www.neuroscion.com ). I do not believe that this change in neurotransmitter &/or concentration of specific receptors results in alleviation of depressive symptoms and a reconnection of the HPA axis, but is one part of a more wholesale changes that results from this initial increase in a specific neurotransmitter. I think that there is something going on inside the cells with second messengers relaying different information to produce variations in what mRNA is produced and thus what signals, (in the form of proteins, enzymes) that cell sends out. This could have something to do with the altering of the sensitivity of ACTH receptors in the adrenal gland; perhaps changes in concentration and sensitivity of glucocorticoid receptors; &/or changes in adrenal gland corticosteroid output. Also, hypothalamic changes in the output of CRH or pituitary output of ACTH could mediate the renormalization of the HPA axis, thus alleviating depressive symptoms. There is no need to stop here, though. Other endocrine systems are probably involved. It would be silly to think that altering on neurotransmitter would effect all of the changes that occur when one goes from a depressive state to a euthymic state. The body does not work in such a reductionist way. Play with one part of the system and you are playing with all of them.
>
> > If the depression/anxiety did not result in a decrease of serotonin and you add an SSRI, then, yeas, you are going to get side effects associated with excess serotonin. These side effects are similar to the start-up side effects and really, the only way to tell the difference is (sometimes) the intensity of the side effect and if the side effect does wane over 2 to 3 weeks.
>
> Cam I really respect your intelligence and committement to this board but this whole lack of seratonin theory came to be the most popular theory once the ssris came into play. Look at the efficacy of lithium isn't it like thirty some percent for unipolar depression. All the other mood stabilzers and now all of a suddeen the anti pyschotics are back with a vengeance soon we will have a new thoery to supprot use of these meds it gets to be like squeezing the stepsisters foot into cinderellas slipper...if by chance the drug works then we come up with biochemical theories to explain why the slipper should fit... I really think we just don't know why some of this works. How does lithium effect seratonin. To belay every new physiological disorder with a mental twist to seratonin deficiency is getting old. OCD, Depression, Panic, Social anxiety, PMDD, Agressive Behaviour, Sexual Preditors, on and on. It seems to me the seratonin pharmacuetical companies have really done their jobs. That is not to say they have not helped millions I know they have.
>
• Yes, lithium does cause changes in in neurotransmitter signalling. Lithium interferes with the phosphoinositol pathway, which changes intracellular calcium ion levels (at the nerve cell wall and from the endoplasmic reticulum), thus changing the responsivity of the cell membrane to electrical signals. Basically, lithium calms the cell from firing sporatically and evens out the flow of electricity down an axon.
>
> > Let's compare side effets profiles (in no particular order):
> >
> > Rivotril™ (clonazepam - Klonopin™ -U.S.)
> > Most Common - CNS depression in approx, 50% of people, respiratory depression, aggressiveness, argumentative behavior, hyperactivity, agitation, depression, euphoria, irritability, forgetfulness, confusion, nystagmus, unsteady gait, slurred speech, dysarthria, vertigo, palpitations, gynecomastia, hallucinations, muscle weakness, low back pain, increased appetite, nocturia, hypersecretion in upper respiratory tract, urinary retention, enuresis....
> >
> > Prozac™ (fluoxetine)
> > Start-up side effects - headache, nervousness insomnia, anxiety, emotional lability, nausea, tremor, dizziness, diarrhea/constipation, myalgia, flu-like sympoms, anorexia.....
> >
> > Long-term side effects - decreased libido, anorgasmia, increased appetite, excessive sweating, fatigue, twitching, change in accomodation, acne, back pain, joint pain, dry skin, urinary tract infection, painful menstruation....
> >
> > Choose your poison. (ref. Compendium of Pharmaceuticals and Specialties, 2000).
>
> Last but not least Cam we all know the side effect profiles you have just listed are not the real world just a sample of some people at some point in time with questions asked by the drug companies marketing people. Look at the change in ssri sexual dysfunction from what is listed. It is the way the questions are asked and by whom. Anyone who has tried differernt classes of drugs can tell you from personal experience the side effect lists are bogus. As for side effects dissapating over time there has been some very serious side effects associated with long term ssri use in "some" individuals. I don't want to scare people who are having success with them God Bless Them I would be willing to take the risk as well if they worked for me. They are not benign to overdose either. I know most people who overdose do so on a mix of narcotics and benzos or booze and benzos not just benzos. You can OD on booze and Luvox too if you try. The whole point is that once again it sounds like you justify ssri use based on brain chemistry and a chemical imbalance.... if it were that simple they would draw blood diagnose and dose us up. That benzo use is just a mask for symptomolgy. What about gaba shortage...Now I have also worked with addicts and alcohlics for a good 20 years and most people still kill themselves the good old fashioned way.....on booze. Slowly or quickly.
>
• Agree with everything that you are saying, but depression is a set of disorders which have a common manifestation, the depressive symptoms. Some people react to medications and their depression becomes worse. Obviously the breakdown of the HPA axis is at a different point than in someone for who that medication works. Depending upon the reaction, this should be a clinical marker to help the doc to decide on which drug to use next. This type of clinical deciding is still in its infancy, but is being used more and more by astute psychopharmacologists.
Posted by gilbert on June 9, 2001, at 16:29:49
In reply to Re: Response to Cam » gilbert, posted by Cam W. on June 9, 2001, at 15:12:59
Cam,
I agree with much of your data however to say that you beleive that suicidal ideation is present prior to the use of an ssri and that the ssri is simply the catalyst is just "your belief". I know the cases have all been lost against Lilly but I don't think all of them were without merit. The first time I took prozac I had very vivid violent dreams, I also had very atypical outbursts of anger, and found myself involved in aggressive fantasies like thinking about fighting etc. These did subside and then prozac almost had a calming effect on me but for that initial period I was definitely not myself. I think the case could be made that someone on klonopin could have a depressive response and if the depression remained untreated and they committed suicide would it have occurred without the klonopin? I think to let the ssris off the hook for personality changes sufficient to cause violent behavior toward oneself or others is negligent. To say well that was a preexisting condition prior to meds or that person was wired to do this anyways is still conjecture. You yourself mentioned to me that a patient came in with mood swings and erratic behavior on an ace inhibitor of all things. You said once the drug was stopped all symptoms of bipolar disappeared. Now the drug must have been the culprit. Where in any medical journals or studies have ace inhibitors been shown to produce mania or bipolar tendnencies. But I do believe your story... we are all differnt and all react to meds differntly. You are giving the ssris a pass that you wouldn't give to a blood pressure med. I think the facts are clear in that ssris do effect and have an effect on all neurotransmitters. It is the preciseness and predictability of that effect that is in question. After all we are playing with one's brain chemsitry here....there should be effects on behavior and tendencies.
Lithium is a differnt way to achieve the same goal. Lithium may effect calcium channels and help neurotransmitters to operate more efficiently but lithium does not operate the same way an ssri does. So once again the whole seratonin shortage theories are simply that theories. They are looking at the egg and saying wow this came from the chicken. I think that the progress that has been made has been wonderfull and don't get me wrong I do believe that ssris are a very beautifull thing for some. However they are not manna from God or drugs from heaven and I think all too often you are willing to give them a pass especially versus benzos. I am not one of those who beleives the whole FDA is on the grassy knoll with Eli Lilley. I do believe however unfortunate that in a small few....let me repeat, a small few people the drugs have caused fatal side effects and personality changes that were not pre-existing or the behavior would have peeked it's ugly little head out at some prior time. IF you read some stories from the survivor groups there was dramtic changes in personality after adding the ssri to the mix. To be able to unequivically say well that person was suicidal prior to the med is as unprovable as it is to prove the med caused the suicide. The families who have been effected by one of these tragedies would disagree as well. There are more suicides caused by alcohol than any other drug. From my own experience with being an aloholic I was not suicidal prior to drinking but once alcohol was induced in chronic doses for long periods of time I was very suicidal. My only pre-existing condition may have been alcoholism......suicide was not.Thanks for the back and forth,
Gil
Posted by Elizabeth on June 9, 2001, at 22:30:09
In reply to Re: Elizabeth what works for you, posted by gilbert on June 8, 2001, at 23:57:14
> Are you saying that if staying on ssri's long enough the side effects become less.
Yes, usually. You start at a minimal dose and don't raise it until you feel comfortable on the little dose. This takes forever, of course. The sexual dysfunction, unfortunately, isn't something that goes away.
This doesn't apply to everyone. The side effects you mention sound pretty typical for the drugs that caused them, except for the sex problem on Serzone and Remeron. Stimulants are supposed to be good for anorgasmia, BTW. Buspar might be too. People who have experience can give better advise than I could.
Middle age is hard for men...you start losing your sex drive (desire and functioning) and at the same time your partner starts becoming more interested.
-elizabeth
Posted by Elizabeth on June 9, 2001, at 22:31:28
In reply to Your medicines » gilbert, posted by SalArmy4me on June 9, 2001, at 2:00:41
> I was thinking of desipramine or an MAOI/RIMA for you. MAOI's are some of the most effective and potent antidepressants still on the market.
Yeah, I was thinking of Parnate because it has an amphetamine-like action that may cancel out some of the sexual side effects of Nardil and Marplan.
-elizabeth
Posted by Elizabeth on June 9, 2001, at 22:36:47
In reply to Re: Happen to be lurking around, Cam? » gheld, posted by Cam W. on June 9, 2001, at 10:33:50
> Gordon - Yes, I have heard of several suicide deaths from from overdoses of benzodiazepines mixed with alcohol, resulting in respiratory depression.
When I was in the hospital recently (comatose), the initial dx was benzo overdose (wrong, BTW). I was breathing irregularly and had lung damage and low pulse oxidation.
> Also, more people have died from taking taking overdoses of benzodiazepines alone (granted, it is rare), while people who have taken massive overdoses of SSRIs alone have recovered without any problems.
True, but it's still a very small risk with either one. Mixing alcohol is the big problem with benzos in depressed patients, which is why I think that Klonopin and the low-potency benzos should be avoided.
> As to considering the side effects profiles, the top ten side effects listed for any SSRI usually describe the start of side effets of these drugs, and disappear within 2 weeks in a vast majority of people.
Not the sexual dysfunction and apathy. Those are long-term side effects. Benzos are really better tolerated in anxiety patients without depression and probably are useful (with an AD) in patients with both.
-elizabeth
Posted by Elizabeth on June 9, 2001, at 22:39:08
In reply to Re: Xanax vs. Klonopin - Thanks all, posted by Greg on June 9, 2001, at 10:38:49
> I have an extremely addictive personality and have some concerns about withdrawals effects I'll have coming off the Xanax.
Unless you mean cravings, withdrawal symptoms aren't exclusive to addictive personalities. Xanax is hard to get off of, but if you need it long term and are concerned about depression from Klonopin or other benzos, it's worth it.
-elizabeth
Posted by gilbert on June 10, 2001, at 1:27:52
In reply to Re: what works for you » gilbert, posted by Elizabeth on June 9, 2001, at 22:30:09
Elizabeth,
I tried all of the slow titration measures and still had other side effects stick around besides sexual ones. I had raise in blood pressure from both effexor and celexa. I had heart rythym disturbances from tricyclics. I had vivd dreams and anger outbursts on prozac. I was too dizzy to drive on both buspar and trazadone. There is the inherent risks of cholesterol problems with remeron. My decsions were based on more side effects than libido although as a guy that's the one that smacks your ego the hardest.
I have a pretty great wife who is very understanding and up to this point in our life our sex life has only been interupted by ssri use. She has been exceptional through it all. We have an active normal intimate relationship and are both on the same wavelength there although I am sure as I head into my mid forties I will slow down and she may speed up, we have not gotten to that role reversal as of yet......I know it will come.
The funny thing really isn't the sex it just seems so odd to me I really have tried most antidepressants except for maoi's and I have never felt good on them. I never really felt like me. I have had some pretty distubing side effects and stuck it out through long slow dosing periods only to be dissapointed time after time. There should be more caution exercised on this board....it feels and sounds as if everyone is so sure side effects will dissappear or lessen my experience has been the opposite. I have put myself through a fair amount of self med induced self torture in hopes that the side effects would wear off. I think the broad brushes being used to paint people into an ssri colored corner can be misleading and dangerous at times.
If I match side effect for side effect the safest drugs I have used have been the benzos. They have given me the most bang for the buck. I become more functional without having to give up something. This may be greedy on my part but of all places you would think the stigma of benzo use would be tolerated most here. The people who would understand most would be fellow sufferrers who would applaud each others progress. Many decisions about what drugs to try are made based on what people read here. I know I tried many drugs because of reading posts here. I just wish I had trusted how I felt more than some of the contributors to the board...I could of saved myself some pain. It is one thing to be optimistic about what to expect it is completely another to be misleading. I don't mean people are misleading in a bad way......just by accident...by thinking they know. I think this is a wonderfull service and there are great people here and I will certainly continue to read the posts. But my guinea pig days are over.
Thanks,
Gil
Posted by gheld on June 10, 2001, at 9:24:21
In reply to Re: Happen to be lurking around, Cam? » gheld, posted by Cam W. on June 9, 2001, at 10:33:50
> Gordon - Yes, I have heard of several suicide deaths from from overdoses of benzodiazepines mixed with alcohol, resulting in respiratory depression. Also, more people have died from taking taking overdoses of benzodiazepines alone (granted, it is rare), while people who have taken massive overdoses of SSRIs alone have recovered without any problems. There have only been a few deaths reported in which someone has died from ingesting overdoses of SSRIs alone, but less than 10 worldwide (I believe).
Cam: Is that as even comparison in that you mention death with benzo's AND alcohol and are comparing to SSRI's with no mention of alcohol. How about deaths from benzo OD'ing alone or SSRI's and alcohol. Enough alcohol alone can cause death.
>
>
> Let's compare side effets profiles (in no particular order):
>
> Rivotril™ (clonazepam - Klonopin™ -U.S.)
> Most Common - CNS depression in approx, 50% of people, respiratory depression, aggressiveness, argumentative behavior, hyperactivity, agitation, depression, euphoria, irritability, forgetfulness, confusion, nystagmus, unsteady gait, slurred speech, dysarthria, vertigo, palpitations, gynecomastia, hallucinations, muscle weakness, low back pain, increased appetite, nocturia, hypersecretion in upper respiratory tract, urinary retention, enuresis....
>
> Prozac™ (fluoxetine)
> Start-up side effects - headache, nervousness insomnia, anxiety, emotional lability, nausea, tremor, dizziness, diarrhea/constipation, myalgia, flu-like sympoms, anorexia.....
>
> Long-term side effects - decreased libido, anorgasmia,Go no farther. I doubt anyone who is sexually active would take the Prozac, (read SSRI), side effects when compared to those above. I rest my case.
> BTW - If your doc does not spend time with you, find one that does; one that you can trust and trusts you. My pdoc and I work closely together to monitor my progress. He is only a phone call away, day or night.Mine, too. He is actually one of the few psychiatrists left who does his own therapy.
Again I'm referring only to those with anxiety, not anxiety connected with depression. I agree that benzo's are a risk factor for depressives. I suspect most people who are clinically depressed don't have much sex life anyway so that side effect of the SSRI's isn't going to hurt much initially. The issue is; will the sex life return once the depression is cured and the SSRI's stopped?
Gordon
Posted by Snowie on June 10, 2001, at 9:40:11
In reply to Re: thanks elizabeth, posted by gilbert on June 10, 2001, at 1:27:52
Gil,
I understand where you and others are coming from. In my search for the perfect med or combo in order to have a functional life in spite of panic and/or anxiety, I've tried several benzos, every SSRI except for Paxil, as well as Serzone, Neurontin, and a few others that I've probably forgotten. I was with my first pdoc for over 5 years and occasionally I'd want to try something new that I'd heard someone was having great success with. My pdoc finally told me to take a hike. He felt that I should stick with what works and forget what other people are taking. Maybe he had a point, but he was also unprofessional, so I'm better off without him.
I now augment Xanax with low doses of Neurontin, which allows me to keep my Xanax intake fairly low and works better for me than Xanax alone. Neurontin alone was making me feel as if I was in a brain fog, but if I take .5 mg. of Xanax first and later follow that with 300 mg. of Neurontin twice a day, I don't get the brain fog effect. For some reason Neurontin seems to extend the life of Xanax in my body.
I think everyone has to be attuned to their own bodies. I'm not afraid to try something new or give a med I've tried before another chance as long as well-known side effects don't include weight gain or loss of libido. If it doesn't work, I'm not afraid to say so. After all, it's my body and I'm the one experiencing the side effects, not my pdoc or anyone else.
Snowie
> Elizabeth,
>
> I tried all of the slow titration measures and still had other side effects stick around besides sexual ones. I had raise in blood pressure from both effexor and celexa. I had heart rythym disturbances from tricyclics. I had vivd dreams and anger outbursts on prozac. I was too dizzy to drive on both buspar and trazadone. There is the inherent risks of cholesterol problems with remeron. My decsions were based on more side effects than libido although as a guy that's the one that smacks your ego the hardest.
>
> I have a pretty great wife who is very understanding and up to this point in our life our sex life has only been interupted by ssri use. She has been exceptional through it all. We have an active normal intimate relationship and are both on the same wavelength there although I am sure as I head into my mid forties I will slow down and she may speed up, we have not gotten to that role reversal as of yet......I know it will come.
>
> The funny thing really isn't the sex it just seems so odd to me I really have tried most antidepressants except for maoi's and I have never felt good on them. I never really felt like me. I have had some pretty distubing side effects and stuck it out through long slow dosing periods only to be dissapointed time after time. There should be more caution exercised on this board....it feels and sounds as if everyone is so sure side effects will dissappear or lessen my experience has been the opposite. I have put myself through a fair amount of self med induced self torture in hopes that the side effects would wear off. I think the broad brushes being used to paint people into an ssri colored corner can be misleading and dangerous at times.
>
> If I match side effect for side effect the safest drugs I have used have been the benzos. They have given me the most bang for the buck. I become more functional without having to give up something. This may be greedy on my part but of all places you would think the stigma of benzo use would be tolerated most here. The people who would understand most would be fellow sufferrers who would applaud each others progress. Many decisions about what drugs to try are made based on what people read here. I know I tried many drugs because of reading posts here. I just wish I had trusted how I felt more than some of the contributors to the board...I could of saved myself some pain. It is one thing to be optimistic about what to expect it is completely another to be misleading. I don't mean people are misleading in a bad way......just by accident...by thinking they know. I think this is a wonderfull service and there are great people here and I will certainly continue to read the posts. But my guinea pig days are over.
>
> Thanks,
>
> Gil
Posted by Elizabeth on June 10, 2001, at 9:55:38
In reply to Re: thanks elizabeth, posted by gilbert on June 10, 2001, at 1:27:52
> I tried all of the slow titration measures and still had other side effects stick around besides sexual ones.
Well, it doesn't work for everybody; the initial jitteriness was what I was thinking of in particular, with a starting dose of at most half of the lowest strength tablet (Zoloft and Luvox are my favourites for pill splitting). I totally agree that benzos are easier to tolerate than *any* of the antidepressants.
> I had raise in blood pressure from both effexor and celexa.
That's unusual from Celexa. How does your BP run normally?
> I had heart rythym disturbances from tricyclics.
That's one of the serious risks from these drugs. Do you remember what type of arrhythmia you had?
> I had vivd dreams and anger outbursts on prozac.
The anger is surprising. Vivid dreaming is common on SSRIs and Effexor.
> I was too dizzy to drive on both buspar and trazadone.
Again, not unheard of. This is the kind of thing that I would expect to go away after a few days, though. You would start out taking the med only at bedtime, when you don't need to be alert or operate machinery.
> There is the inherent risks of cholesterol problems with remeron.
I'm getting the impression that cardiovascular disease is a serious concern for you. True?
> My decsions were based on more side effects than libido although as a guy that's the one that smacks your ego the hardest.
That's hard to deal with for people of any gender. It's good to hear that your wife is dealing with it so well.
> The funny thing really isn't the sex it just seems so odd to me I really have tried most antidepressants except for maoi's and I have never felt good on them.
I think that's a strong indicator for MAOIs, myself. You know that the side effects aren't *guaranteed* to happen to everyone who takes them. Parnate is probably the one that I would suggest you try, based on its typical side effect profile (less likely to cause weight gain, sexual problems, etc. than Nardil or Marplan). The main advantage of Nardil is that it's a terrific anxiolytic and is less likely to cause overactivation than is Parnate.
> There should be more caution exercised on this board....it feels and sounds as if everyone is so sure side effects will dissappear or lessen my experience has been the opposite.
Most side effects do *usually* disappear with time. But that doesn't mean always, nor does it invalidate your experience.
> I become more functional without having to give up something. This may be greedy on my part but of all places you would think the stigma of benzo use would be tolerated most here.
I don't think it's greedy. I think it's completely reasonable. The reason we take meds is to be functional, no?
> Many decisions about what drugs to try are made based on what people read here. I know I tried many drugs because of reading posts here. I just wish I had trusted how I felt more than some of the contributors to the board...I could of saved myself some pain.
There's no way you (or they) could have known that your reactions to the meds would be different from typical reactions. It does seem that some people are sensitive to side effects in general, but otherwise there's no way to predict who will have problems with what.
-elizabeth
Posted by Elizabeth on June 10, 2001, at 10:00:19
In reply to Re: Happen to be lurking around, Cam?, posted by gheld on June 10, 2001, at 9:24:21
> Go no farther. I doubt anyone who is sexually active would take the Prozac, (read SSRI), side effects when compared to those above. I rest my case.
Believe it or not, I took Prozac for somewhere between two and three years and never experienced that side effect. Must be one in a million, huh? < g >
> Again I'm referring only to those with anxiety, not anxiety connected with depression. I agree that benzo's are a risk factor for depressives.
I agree, with the exception of alprazolam. I would like to see adinazolam (a benzo with proven antidepressant activity) approved in the US, but the patent on it has expired so it's not likely.
-elizabeth
Posted by Lorraine on June 10, 2001, at 11:09:28
In reply to Re: thanks elizabeth » gilbert, posted by Snowie on June 10, 2001, at 9:40:11
> > I have a pretty great wife who is very understanding and up to this point in our life our sex life has only been interupted by ssri use. She has been exceptional through it all. We have an active normal intimate relationship and are both on the same wavelength there although I am sure as I head into my mid forties I will slow down and she may speed up, we have not gotten to that role reversal as of yet......I know it will come.
Maybe it's just the crowd I hang with, but I haven't seen women in their mid-forties becoming more randy. Even when I am off meds, that's not the case for me (course I'm depressed....still) Nor have I seen it with other women I know. My personal view is that Masters and Johnson were wrong about this.
> > it feels and sounds as if everyone is so sure side effects will dissappear or lessen my experience has been the opposite.My experience is they don't go away either.
> >
> > If I match side effect for side effect the safest drugs I have used have been the benzos. They have given me the most bang for the buckI'm glad you are writing this. I suspect they should be on my "to try" list, but I'm leary of them. Funny though, I'm on amphetamines now. I'm also leary of MAOs, though again I suspect part of this is ignorant fear.
> > I don't mean people are misleading in a bad way......just by accident...by thinking they know.
Isn't that the way of life? A persons position depends on where they sit?
> >But my guinea pig days are over.
I hope that means you have found something that works well for you:-)
Lorraine
Posted by gilbert on June 10, 2001, at 11:46:32
In reply to Re: Gill, posted by Lorraine on June 10, 2001, at 11:09:28
Elizabeth,
I am sensitive to cardiac concerns a part of my anxiety triggers but I am also aware when it is drug induced. My panics were the result of being overly afarid of death lost my brother when he was one from heart defects. I was 4 at the time. Doesn't take a rocket scientist to figure out my presdiposition. That being said I did have a calming effect from prozac after the intitial rage period so that really ins't the big issue. With prozac the longer I was on it the less a.m. erections I had the less functional I could become....so it got to be like putting a wet noodle through a spaghetti strainer. OOPPPs!
Th remeron chloesterol connection is from my internest.....I looked it up I think it was around 15% had increased lipids and other had elevated triglycerides. I run 25 miles per week I have good cholesterol around 158 total......I eat like a hermit......It has taken me 3 years of very disciplined effort to establish that kind of health profile. I don't want to risk it for the sake of a med that when I did try it made me so tired it was like I took 3 xanax. I figure it feels like xanax so I will take the xanax without the risk. Plus mom was on rmeron for about 8 months her trigylcerides went through the ceiling her weight jumped 35 pounds and her cholseterol went up about 20 points so I figure I have gentics working against me with that one. The cardiac symptoms i got from the other meds was mostly tachycardia in the middle of a dead sleep...it would wake me. I would take a xanax and boom back to normal. I have had all the cardiac work ups so I know it was med induced. it is the only time it happens. I figure now I got to take the xanax to reduce other med side effect...I might as well just take the xanax. It is sooooo frustrating I know I would do well on a ssri mentally......especially prozac but I am not willing at 42 and in shape to give up sex.
I tried some of the sexual anecdotes lited here while on prozac and did not get good results. I mean without getting to deatiled the whole sex thing on a ssri is either you feel very randy and can't climax or you can climax but your head is not in the game you might as well be playing checkers. I kind of like my sex where it has both ....you know how it used to be prior to meds.P >S > you mentioned male mid life sexual decline....If off anti depressants I would describe my sex drive as above average not to stroke my ego but just because I take pretty good care of myself and just don't feel a decline in that area.....yet.
I keep talking about xanax like it is some wonder drug....it has it's faults too.....just seems they are less than other. I ac get a little depressed if I have to dose change up or down. It has a way of letting you know it's time for a pill.
Thanks for all of your insights I really enjoy your perspectives.
Gil
Posted by Elizabeth on June 10, 2001, at 20:32:17
In reply to To Elizabeth side effect concerns, posted by gilbert on June 10, 2001, at 11:46:32
> I am sensitive to cardiac concerns a part of my anxiety triggers but I am also aware when it is drug induced. My panics were the result of being overly afarid of death lost my brother when he was one from heart defects.
That's not altogether surprising. A lot of people who have panic attacks fear that they're having a heart attack or something.
> The cardiac symptoms i got from the other meds was mostly tachycardia in the middle of a dead sleep...it would wake me. I would take a xanax and boom back to normal.
That sounds like a nocturnal panic attack. Sinus tachycardia (a common side effect of ADs) isn't a serious arrhythmia, although it is unpleasant.
> I keep talking about xanax like it is some wonder drug....it has it's faults too.....just seems they are less than other.
I agree.
-elizabeth
Posted by Dr. Bob on June 10, 2001, at 23:59:46
In reply to Re: thanks elizabeth » gilbert, posted by Snowie on June 10, 2001, at 9:40:11
> I understand where you and others are coming from...
Hey, long time no see, welcome back! :-)
Bob
Posted by grapebubblegum on June 11, 2001, at 8:17:17
In reply to Re: wb » Snowie, posted by Dr. Bob on June 10, 2001, at 23:59:46
Wow, what an information and insight-packed thread.
It will take A LOT to ever get me on SSRI's again. My fiance flew down here for the weekend, and Gil, it does not matter that we are different genders.. I'm betting you can guess what I'm trying to say here. Your "might as well be playing checkers" analogy was so true. In the recent past while on Zoloft and then Paxil, I was just sadly doing the checkers routine by myself and doing the "it's ok, sweetie, it just isn't gonna happen" routine with my fiance, but now that I'm off Paxil for good, I'll spare all of you the salacious details but let's just say my sexual responsiveness is back to being way through the roof, which is the way it should be, goshdarnit, for anyone who chooses to be sexually active. (I can safely say the fiance, being a caring man, is happy to see me out of just-playing-checkers mode and delighted to see me umm... enjoying his company -to put it mildly - in that specific way again.)
As for the stereotype about men declining and women ascending some mythical sexual peak in their forties... Don't worry about that, Gil; I happen to think it's a load. IMHO people are sexually responsive from puberty through whatever age ill health makes them less able than they were. Who wants to take meds that will make you basically sexually crippled?
If it sounds like I am down on SSRIs, I admit that I am. I'm sorry to anyone who finds them helpful. They helped me at times... I guess my stance now is that I would consider them to be a good choice for relatively short-term treatment (as someone mentioned, they can be a lifesaver for someone so depressed they wouldn't have much of a sex life anyway) but I just can't praise them as the long-term panacea that they are being touted as. Just my opinion based on my experience, though.
Posted by Elizabeth on June 12, 2001, at 2:43:38
In reply to My twin Gilbert and all of you fine posters, posted by grapebubblegum on June 11, 2001, at 8:17:17
> As for the stereotype about men declining and women ascending some mythical sexual peak in their forties... Don't worry about that, Gil; I happen to think it's a load.
At the very least, the years seem to be wrong. My experience (which basically consists of having talked to a lot of people of different ages and even dating a few of them) is that men do "peak" in their early 20s and are less interested (and capable) by 40. Young women, on the other hand, often have a hard time reaching orgasm, which can improve with age, to a certain point: menopause can really wreak havoc with a woman's sex drive and ability to be aroused. (ERT seems to help some with this.)
> Who wants to take meds that will make you basically sexually crippled?
Well, my experience with men on SSRIs is that they usually can find something to counteract the side effects. They may not be as responsive as they were before the SSRIs, but they are certainly ready, willing, and able. My experience, however, has been with young (mid-20s) men (n = 2, not a very large sample -- I don't specifically seek out men on Prozac to test my theories < g >). The decrease in functioning and interest may be harder to treat if you've also experienced a decline in sex drive due to age.
Of course, if you're one of those unlucky men (or women) who can't find anything that overrides this side effect, then SSRIs are pretty much out. Like you say, it just doesn't make sense.
Whether or not it's treatable, it's good to have an understanding partner who you can talk to about it. One of the 2 men I mentioned above, who was taking Wellbutrin to counteract the sexual side effects of Prozac but still had occasional difficulties (sometimes reversed with Ritalin), had been a close friend years before we became sexually involved, and he knew I take antidepressants too, so I think he found it easy to talk to me about the problem.
-elizabeth
Posted by Snowie on June 12, 2001, at 6:54:51
In reply to Re: wb » Snowie, posted by Dr. Bob on June 10, 2001, at 23:59:46
Thanks! Nice to see many of the old faces ... and new ones! :-)
Snowie
> > I understand where you and others are coming from...
>
> Hey, long time no see, welcome back! :-)
>
> Bob
Posted by milo on October 6, 2003, at 19:04:08
In reply to Re: Question for Elizabeth, posted by gilbert on June 8, 2001, at 22:19:32
Hi All,
I just wanted to say that i have found all of your comments very interesting. I had taken XTC every other weekend and had become dependent on it. I used the above benzos to come off my love of the drug but have found a liking for them instead. Activan (lorazepam) is my favourite and i would like to be able to enjoy it occasionaly but find myself dipping into the pill box most days. I have found that Valium is making me depressed especially if i mix it with i mix it with xanax to get more out of it and i love xanax. Klonopin is smooth but still hasn't got the kick the lorazepam has. I donot want to get into a rut with these drugs as they are expensive (especially klonopin) can anyone out there offer me advise on what actions i can take to become an occasional user rather thatn a Kaner of Benzos.Does anyone else love drinking wine on them as well?
regards
Milo
Posted by Viridis on October 7, 2003, at 4:22:46
In reply to Xanax, Activan, Klonopin and Diazepam, posted by milo on October 6, 2003, at 19:04:08
If you're in the minority that enjoys benzos, I'd be really careful. They're very helpful meds for people with anxiety disorders, but using them recreationally could get you into trouble. Benzos are quite safe on their own, but when you mix them with alcohol, all bets are off -- among other things, this can cause you to stop breathing. Not worth the risk, in my opinion.
Your comment that they're expensive suggests that you're not using them under prescription (since generics are dirt-cheap), so you could be risking your life here. It's great that you've been able to get off X, but don't build another habit that could also ruin or end your life.
Posted by kishor on December 19, 2003, at 11:45:14
In reply to Xanax vs. Klonopin, posted by Greg on June 6, 2001, at 17:39:42
I had been taking Oxazepam for about 2 years.
Recently I "tolerated out". My Dr. gave me Rxs
of both Klonpin and Xanax to try.
I thought they would be just like Oxy or Valium,
which have a very calming effect on me.
But instead the K drove me up the wall - very
anxious, tense, like caffiene. I've never seen any reference to that reaction from anyone on this chat forum. What the heck is going on?The X is not bad, but not as calming as Oxy or V.
I'd like to try Ativan, but it has mention of
nervousness and exitability as a reaction also.
Any thoughts on that? I guess I'm just real sensitive to anything with the possibility of stimulants in them. I've tried all the SSRIs - man they drove me up the wall. I'm glad I have Ambien to get down from some of these. But, I have noticed that the K and X almost cancel out the Ambien. I have lots of weird reactions don't I? Especially getting insomnia from Klonopin. Most people seem to get sedated from it.
Posted by squids on December 20, 2003, at 23:46:06
In reply to Re: Xanax vs. Klonopin, posted by kishor on December 19, 2003, at 11:45:14
I've been on xanax for 2 years, valium for 8. For depression with anxiety. I found the xanax had an antidepressant action, but didn't calm me down as much as the valium. I find that X is more addictive; it made me feel really good while I was taking .5mg 3x/day for a year, but it causes physical dependence and produces some pretty unpleasant withdrawals - that I've found.
5mg V 2x/day for 8 years worked pretty well. V's still had a "feel good" component to them, much less than X, and would sometimes make me a bit too sedated.
However I turned to hard drugs - was a heavy opiate user for 5 years, just recently gotten clean from that. The addictive behavior appears to be the result of my ADD which was not diagnosed until this year.
My pdoc knows about my drug problems and will only prescribe me klonopin now - no V or X. I don't get any euphoria from the K and it's not that sedating; but I find that it really does work well for my social anxiety. Calms me down without giving me a "high" - which at this point is a good thing for me. I take it on occasion and really find it beneficial.
I've never heard of K doing anything like you mention.
Best of luck with everything. My only word of caution is to watch out for the addictive properties of xanax - and I don't just mean wanting to pop them. IMHO X produces physical dependence fairly quickly, and the withdrawals are worse than any other benzo. Nothing as bad as coming off opiates, but extremely unpleasant nonetheless. Stopping 8 years of 10mg valium a day was nothing in comparison to 1 year of 3 .5mg xanax/day.
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