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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by rainbowlight on April 26, 2002, at 1:25:16
Hi 3 Beers. I have been reading many of your posts. You seem to be the resident Zoloft expert so I could really use your advice. I am Bipolar II with OCD and GAD. I take Lamictal, Remeron and a small dose of Risperdal (for anxiety). I recently added Zoloft for the OCD/anxiety. It is working well (less anxiety, not so much OCD). I started at 25 mgs. now I take 37.5 mgs. I tried 50 but I feel really depressed/disconnected so I took it back down. My goal is to get rid of the Remeron and replace it with the Zoloft? Do you think that is a good idea? I have tried to slightly lower my Remeron and I start to get the discontinuation symptoms (been there, done that, don't want to go through it again). Do you think I will feel better on a higher dose of Zoloft or should I just stay at the 37.5 mgs? Any advice you might have would be greatly appreciated. Thanks!
Posted by 3 Beer Effect on April 26, 2002, at 23:30:48
In reply to 3 Beers - I need your advice, posted by rainbowlight on April 26, 2002, at 1:25:16
I've read that both Zoloft & Prozac have a higher tendency to make Bipolars manic or hypomanic than most other anti-depressants since they are so activating. In the PDR & in the drug prescribing info for both Zoloft & Prozac the percent of patients who experienced an activation of mania/hypomania are artificially low just like the numbers for sexual side effects. Clinical experience in real life has proven those numbers wrong & so good psychiatrists don't give Bipolar patients Zoloft or Prozac not only because of the greater chance for a manic switch, but also because of the insomnia & nervousness/anxiety that is common to those two medications, which are two side effects Bipolars are probably more sensitive to than the rest of the population- If you notice, most of the mood stabilizer meds- Lithium, Depakote, Topomax (with the exception of Lamictal) are very sedating & basically turn you into a Zombie.
Psychiatrists usually use Paxil, Remeron, or Wellbutrin SR in patients with Bipolar since these 3 anti-depressants have the least tendency to cause mania.
Since you have anxiety & don't like the Remeron, taking Paxil instead of Zoloft would probably be a good idea. Everyone always complains about the short half-life & terrible withdrawl of Paxil but they have recently released Paxil CR (Controlled Release). If I were you I would pay the extra money & use this new version of Paxil since it is probably smoother in its onset of action & less likely to cause anxiety & other side effects.
Here is a link to the prescribing info for Paxil CR:
http://www.paxil.com/paxilcr/
Posted by rainbowlight on April 27, 2002, at 0:04:40
In reply to Bipolars shouldn't take Zoloft /Prozac try PaxilCR, posted by 3 Beer Effect on April 26, 2002, at 23:30:48
Thanks for the info. I just finished a trial of Paxil. It made me a zombie and I gained 12 pounds in two weeks, unfortunately. The Zoloft is working well for the anxiety so far and so far no real mood swings. Do you think it will cause mood swings at higher doses? or as more gets into my system? My pdoc prescribed it for me because the other OCD drugs I have tried (Paxil and Luvox) were too sedating. Thanks for your help. I had to laugh, in one of your posts you described the feeling of Zoloft as "the 2 beer effect", that is EXACTLY how I had described the med to my hubby!
Posted by 3 Beer Effect on April 27, 2002, at 9:05:05
In reply to Thanks 3 Beers, more..., posted by rainbowlight on April 27, 2002, at 0:04:40
I'm not sure since everyone is different & you are also taking Lamictal & Bipolar is a complicated disorder. From my own experience 50 mg made me sleepy (would basically knock me out for a few hours) and didn't work for me as an anti-depressant. I was on no other meds at the time & I stopped taking it after 3 months.
The next time I took 100 mg, and after 3 weeks everything was wonderful, I was actually happy, it was the most effective anti-depressant I had ever taken, but after a few months I couldn't sleep at night at all, sometime for 3 days at a time, which snowballed into a self-destructive manic switch/episode.
I don't even have Bipolar disorder, just Depression & ADD, but even a normal person can have a "drug induced mania" from a drug (e.g. methamphetamine, crack cocaine would probably make anyone manic). Most people don't have manic switches from Zoloft, I think that is a relatively rare side effect (2-3%), but I wouldn't take a chance on higher dose Zoloft (75+ mg) since you have Bipolar & are predisposed to a much higher rate of manic switch of anti-depressants.
Since you take Lamictal that complicates things since it is supposed to be a mood stabilizer, so it may prevent Zoloft mania even at higher doses. You would probably be safe with 50 mg, just have yourself & your husband look out for any signs of mania. Many doctors criticized the makers of Zoloft since that starting dose of 50 mg was too low, often ineffective & not equal in efficacy to the starting dose of Prozac 20 mg.
It might be better to stay at either your current Zoloft dose or perhaps 50 mg with extra caution & just use the Lamictal as an anti-depressant by upping (titrating max 25 mg 1-2 weeks at a time) the dose if you aren't having a response to it, it is supposed to be an effective one at doses of 150 mg & higher although it takes longer than most other anti-depressants to work.
One thing to remember is not to self medicate with SAM-E. Bipolars should never ever take SAM-E since its rate of inducing mania is ridiculously high, much higher than the SSRIs.
This is the end of the thread.
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