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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by freedom2001 on November 4, 2002, at 6:36:41
Dear,
I'm currently on prozac+deanxit (a type of neuroleptic)+xanax+trazodone.
They aren't doing a good job of managing my OCD, turning some of my days into hell.
I admit I made the mistake of taking a choline+inositol supplement that worsens my OC symptoms as choline is bad for OCD.
Should I augment prozac with another drug or switch to a different SSRI (i suspect the generic prozac doesn't work)....
If I switch to eg. celexa and later change back to prozac again, is it true that 20% of the people won't respond back to the same drug?
PLEASE HELP!!!!
I FELT BAD!
Posted by Fenny3 on November 4, 2002, at 20:54:55
In reply to AUGMENT PROZAC OR SWITCH SSRI, posted by freedom2001 on November 4, 2002, at 6:36:41
Hi there! How are you doing overall? Have you been trying any behaviour modification? Also, is it possible you've become a little obsessed with the OCD? Yes, I'm serious, funny as it sounds. Can you try to remind yourself that "yes I have OCD, now let's move on!" Cut yourself some slack about it, it's ok you know. Try not to put too much pressure on yourself and make a note of your good "times", even if you don't have entirely good days.
How much prozac? I've heard the same thing about switching meds and becoming non-responsive to the first. However, I've not heard this about prozac.
If you feel your current regime isn't working, it's worth a try.
Take care!
Fenny
Posted by hiba on November 4, 2002, at 22:36:15
In reply to AUGMENT PROZAC OR SWITCH SSRI, posted by freedom2001 on November 4, 2002, at 6:36:41
I am on prozac for a long time, and if you are asking whether a poop out effect is possible, my answer will be yes. I began on 20 mg daily and has reached 40 mg now. Still I feel the inadequacy of dosage occassionally. But switching to celexa and coming back to prozac is definitely not a good idea. Try to augment prozac with visken (pindolol). Or simply adding a low dose of tofranil (imipramine) will also help, as tricyclics can augment the serotonin effects of ssris.
HIBA
Posted by freedom2001 on November 5, 2002, at 6:48:15
In reply to Re: AUGMENT PROZAC OR SWITCH SSRI, posted by hiba on November 4, 2002, at 22:36:15
> I am on prozac for a long time, and if you are asking whether a poop out effect is possible, my answer will be yes. I began on 20 mg daily and has reached 40 mg now. Still I feel the inadequacy of dosage occassionally.
Hi, are you taking the dosage for OCD? If for OCD, it seems low.
But switching to celexa and coming back to prozac is definitely not a good idea.
You mean you have tried this method before and the consequences are bad?
Try to augment prozac with visken (pindolol).
I read that pindolol takes out the depression but is not anti-OCD. Have you tried pindolol? How's it?
Or simply adding a low dose of tofranil (imipramine) will also help, as tricyclics can augment the serotonin effects of ssris.
Did you try this as well? What about adding anafranil instead?
> HIBA
Posted by freedom2001 on November 5, 2002, at 6:58:23
In reply to Re: AUGMENT PROZAC OR SWITCH SSRI » freedom2001, posted by Fenny3 on November 4, 2002, at 20:54:55
> Hi there! How are you doing overall? Have you been trying any behaviour modification?
Hi, good day! for more info, pls look at another thread called "I FEEL ALIVE TONIGHT!"
But also read my replies here....
Also, is it possible you've become a little obsessed with the OCD? Yes, I'm serious, funny as it sounds.
Yes, I think I can get obsess with this OCD thing as well!
Can you try to remind yourself that "yes I have OCD, now let's move on!" Cut yourself some slack about it, it's ok you know. Try not to put too much pressure on yourself and make a note of your good "times", even if you don't have entirely good days.
>
> How much prozac? I've heard the same thing about switching meds and becoming non-responsive to the first. However, I've not heard this about prozac.I'm still on 80mg prozac, 1 deanxit and 1 xanax, and 1 trazodone at night. I wonder whether it is a good idea or not to take 90 mg prozac.........
>
> If you feel your current regime isn't working, it's worth a try.
>
> Take care!
>
> Fenny
>
>
Posted by hiba on November 6, 2002, at 0:29:44
In reply to Re: AUGMENT PROZAC OR SWITCH SSRI » hiba, posted by freedom2001 on November 5, 2002, at 6:48:15
I am taking prozac for depression which was a consequence of severe obsessive rumination. So my diagnosis will probably be Obsessive depression, or depression with obsession. I began on 20 mg daily and it was helpful for sometimes. But gradually I lost the grip and had to double the dose.
I have tried pindolol at the initial stages and it definitely had an augmenting effect. The caution should be exercised when you switch to another drug, because the new drug shouldn't necessarily be as effective as the old one. Besides prozac takes a long time to have an effect and this duration could be much longer for the second time. It is my experience.
Tofranil, as a tricyclic will augment the effects of prozac but I don't think anafranil (clomipramine) is a good choice. Though a tricyclic, anafranil mainly targets serotonin and adding it to SSRIs will probably cause a serotonin syndrome. Prior to SSRIs Anafranil was the treatment of choice for OCD and still it is being hailed as the most effective OCD medication. But anti-cholinergic and sedative effects make its clinical indication lesser than SSRIs. If you are ready to bear those bothersom anti-cholinergic and sedative effects you can switch to anafranil with the consent of your treating physician. It is a highly effective OCD medication.
HIBA
Posted by freedom2001 on November 6, 2002, at 1:14:50
In reply to Re: AUGMENT PROZAC OR SWITCH SSRI » freedom2001, posted by hiba on November 6, 2002, at 0:29:44
> I am taking prozac for depression which was a consequence of severe obsessive rumination. So my diagnosis will probably be Obsessive depression, or depression with obsession.
I think the correct term should still be OCD, as it is the obsession that is the primary factor that causes the depression. I have exactly the same condition as you. The thing is, if our obsessions are gone, the depression will lift up automatically.
I began on 20 mg daily and it was helpful for sometimes. But gradually I lost the grip and had to double the dose.
For severe rumination, you need to up your dose to 60-80 mg. This is the dose to tackle OCD.
>
> I have tried pindolol at the initial stages and it definitely had an augmenting effect.I think it lifts your depression, but not the OCD. According to studies that I read, pindolol lifts depression, but is not anti-OCD to be precise.
Correct me if I'm wrong.
The caution should be exercised when you switch to another drug, because the new drug shouldn't necessarily be as effective as the old one.
Agreed. I don't think celexa or any other drug is guaranteed to be more effective than prozac.
Besides prozac takes a long time to have an effect and this duration could be much longer for the second time. It is my experience.
What do you mean? you mean when you switched from prozac to another SSRI and back to prozac again, it takes much longer for the 2nd trial of prozac to have any effect?
This is important to me.
> Tofranil, as a tricyclic will augment the effects of prozac but I don't think anafranil (clomipramine) is a good choice. Though a tricyclic, anafranil mainly targets serotonin and adding it to SSRIs will probably cause a serotonin syndrome.
What does tofranil target and how does it augment prozac?
Prior to SSRIs Anafranil was the treatment of choice for OCD and still it is being hailed as the most effective OCD medication. But anti-cholinergic and sedative effects make its clinical indication lesser than SSRIs. If you are ready to bear those bothersom anti-cholinergic and sedative effects you can switch to anafranil with the consent of your treating physician. It is a highly effective OCD medication.
> HIBA
Posted by hiba on November 6, 2002, at 5:28:35
In reply to Re: AUGMENT PROZAC OR SWITCH SSRI » hiba, posted by freedom2001 on November 6, 2002, at 1:14:50
Hello Freedom,
<What do you mean? you mean when you switched from prozac to another SSRI and back to prozac again, it takes much longer for the 2nd trial of prozac to have any effect?>That is exactly what I mean. If you quit prozac and try another one, the newer one shouldn't always necessarily be as effective as prozac. So if you want to come back to prozac again, it will take longer time for the 2nd trial to have an effect. Besides there are rare reports of non-compliance also for the second time, though it is not that convincing.
Tofranil mainly targets norepinephrine and though much weaker than anafranil, it has got some serotonergic properties. It could be the reason of its role in prozac augmentation. But anafranil itself is very potent in its serotonergic action, so it shouldn't be mixed with SSRIs. It could be like mixing prozac with zoloft or paxil. Anyway I am not a doc and can't give you a conclusive reply. So seek professional help in such cases.
HIBA
Posted by freedom2001 on November 6, 2002, at 7:49:19
In reply to Re: AUGMENT PROZAC OR SWITCH SSRI » freedom2001, posted by hiba on November 6, 2002, at 5:28:35
> Hello Freedom,
>
>
> <What do you mean? you mean when you switched from prozac to another SSRI and back to prozac again, it takes much longer for the 2nd trial of prozac to have any effect?>
>
> That is exactly what I mean. If you quit prozac and try another one, the newer one shouldn't always necessarily be as effective as prozac. So if you want to come back to prozac again, it will take longer time for the 2nd trial to have an effect. Besides there are rare reports of non-compliance also for the second time, though it is not that convincing.
> Tofranil mainly targets norepinephrine and though much weaker than anafranil, it has got some serotonergic properties. It could be the reason of its role in prozac augmentation. But anafranil itself is very potent in its serotonergic action, so it shouldn't be mixed with SSRIs. It could be like mixing prozac with zoloft or paxil. Anyway I am not a doc and can't give you a conclusive reply. So seek professional help in such cases.
> HIBAI think if we mix a low dose 50-75 mg of anafranil to 60-80 mg prozac, it may work....
Posted by henryO on November 7, 2002, at 22:44:14
In reply to Re: AUGMENT PROZAC OR SWITCH SSRI » freedom2001, posted by hiba on November 6, 2002, at 0:29:44
I have used Pindolol (aka Visken) as an augmentation to Prozac and for me it worked very well and (to my amazement) within hours. Its part of the cocktail now.
Posted by Dave1 on November 9, 2002, at 20:27:30
In reply to Re: AUGMENT PROZAC , Pindolol (Visken) Hiba, posted by henryO on November 7, 2002, at 22:44:14
I tried to get my pdoc to give me PINDOLOL augmentation but he said no. Getting any doctor to use any augmentation has been difficult. I got them to give me lithium, but practically had to beg.
I live in Maryland, maybe where you live its different.
Dave
Posted by freedom2001 on November 10, 2002, at 20:48:36
In reply to Re: AUGMENT PROZAC , Pindolol (Visken) Hiba, posted by Dave1 on November 9, 2002, at 20:27:30
> I tried to get my pdoc to give me PINDOLOL augmentation but he said no. Getting any doctor to use any augmentation has been difficult. I got them to give me lithium, but practically had to beg.
>
> I live in Maryland, maybe where you live its different.Hi,
Why did your doc refuse to augment your drug? what SSRI are you on now and are you taking it for depression or OCD?>
> Dave
>
>
Posted by HIBA on November 10, 2002, at 22:54:42
In reply to Re: AUGMENT PROZAC , Pindolol (Visken) Hiba » Dave1, posted by freedom2001 on November 10, 2002, at 20:48:36
Hi,
I tried anafranil 25 mg at night with my prozac 40 mg. It only helped me to sleep well. I just did it for a couple of nights, and can't say what will happen in long run. Is there anyone with experience in mixing SSRIs with anafranil? Or mixing prozac with low dose of zoloft? paxil?
HIBA
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