Psycho-Babble Medication Thread 226333

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After Prozac - which SSRI to try

Posted by Babysnakes on May 13, 2003, at 12:29:51

Brief history: 35 years old. Realize now that I've been dysthymic most (all?) of my life - but last five years I've completely stalled in both my personal and professional life. Definitely slipping into a periodic depression that is much worse than normal. Eating and sleeping more than normal, and completely avoidant of almost any other activity that would be considered by most to be productive and/or pleasurable, but I am still capable of having a good time should something actually stumble into my path (atypical depression?).

In addition - there is a strong history of bipolar in my family with two suicides (grandfather and uncle) and I strongly suspect one parent with undiagnosed bp. Though to the best of my knowledge, I've never experienced a manic or even sustained hypomanic phase in my 35 years.

Finally, in my early twenties, I started to have periodic anxiety attacks. Bad ones at first. I went to a cardiologist when I thought I was going to have a heart attack and he correctly diagnosed panic and started me on Xanax. The panic attacks are mostly under control and I use Xanax only occasionally (0.25 - 0.5mg once every couple of weeks to couple of months) just to prevent a bad night or very rarely, to escape the day to day pressure of life (like someone else might have a drink or smoke a joint).

OK, so I went to a PDoc and gave the above history. I have tried talk thereapy already and found it to be expensive and not very helpful. I wanted to try an AD. Given family history of BP, Pdoc suggested starting with Wellbutrin and I concurred. Found it to be way to stimulating for me. So after 3 weeks as a low dosage, I gave it up. PDoc and I discussed going to SSRI. His first suggesstion was Paxil. But after reading all the horror stories on the internet I opted for Prozac, knowing that it may be too activating at first.

And well, it is. At least for now, I've been on 10 mg/day for a week now and the only way I can get to sleep is to take a Xanax, which makes me feel sedated for much of the following morning. Plus, I really don't want to become addicted to the Xanax that I've been able to use for long time (over 10 years) without abuse.

Although I intend to give Prozac a full month to adjust to, I'm thinking of switch SSRI's already and the question is which one to try next given the above history. I am willing to try the Paxil - but don't want to feel like a space cadet and I guess would be a little nervous about the withdrawal symptoms that some people seem to have. But I'm open to ideas on the others as well. Has anyone else tried prozac - found it to be too activating and switched to another SSRI that they are happy with. Or, has anyone found Prozac to be too activating at first, but eventually adapted to it. Also, will eventually consider Serzone, but I'm putting that one further down on my list for now.
Sorry for the long post, but it all seems like important information.

Thanks in advance.

 

Re: After Prozac - which SSRI to try

Posted by Jack Smith on May 13, 2003, at 13:09:41

In reply to After Prozac - which SSRI to try, posted by Babysnakes on May 13, 2003, at 12:29:51

Celexa I found to be the perfect ssri. Less sedating than Paxil. Less activating than Zoloft. Minimal withdrawls. I would give that a go IF prozac does not work but I suspect that you will adjust to it, just give it some time, give it more than a month if you can tolerate it and move to a higher dose if you are not getting a good response. Don't bother with Lexapro, try Celexa first. Most Pdocs seem to agree that Celexa is better than Lex.

By the way, I would not worry about xanax addiction if you are using .25-.5 a night. Someone may disagree but I think that is way too low to get addicted to it.

JACK

 

Re: After Prozac - which SSRI to try

Posted by Ame Sans Vie on May 13, 2003, at 13:50:19

In reply to Re: After Prozac - which SSRI to try, posted by Jack Smith on May 13, 2003, at 13:09:41

Of course, different people respond differently to each of the SSRIs. I've tried all six of them and found Celexa to be an absolute nightmare, while Lexapro is virtually side-effect free. Prozac, Serzone, and Effexor had no effect on me, good or bad. Paxil... well, let me just put it this way--I still have withdrawal symptoms three years after quitting it. Same thing with Luvox, only much worse. Zoloft made me violent, suicidal, and homicidal. Remeron did nothing but put me to sleep... and Wellbutrin exacerbated my anxiety.

If you're not absolutely set on trying an SSRI/SNRI/atypical, I might suggest you consider a dopamine agonist, esp. Mirapex or Requip. I take Mirapex for dysthymia, and it's working beautifully so far--and I'm only on my second day. It gives me so much motivation and allows me to get pleasure out of life. BTW, I take it with Lexapro (40mg) and Klonopin (6mg), and many studies support the idea of augmenting an antidepressant with a DA agonist.

 

Re: After Prozac - which SSRI to try » Ame Sans Vie

Posted by Jack Smith on May 13, 2003, at 14:14:46

In reply to Re: After Prozac - which SSRI to try, posted by Ame Sans Vie on May 13, 2003, at 13:50:19

> If you're not absolutely set on trying an SSRI/SNRI/atypical, I might suggest you consider a dopamine agonist, esp. Mirapex or Requip.

Don't you think someone should first try conventional antidepressants before moving on to experimental treatments?!?! If you read his post, he has not yet given any antidepressant an adequate trial.


 

Re: After Prozac - which SSRI to try

Posted by Ame Sans Vie on May 13, 2003, at 15:28:31

In reply to Re: After Prozac - which SSRI to try » Ame Sans Vie, posted by Jack Smith on May 13, 2003, at 14:14:46

Just because these other drugs are more frequently prescribed doesn't mean they have any advantage over "experimental" drugs. Think of all the social phobics, for example, who may be saved years of suffering by being given the option of trying an MAOI right off the bat.

And the dopamine agonists are no more experimental for dysthymia than, say, Depakote is for bipolar disorder. Studies have been conducted comparing these drugs to the standard AD's, and so far I've yet to read a study that didn't amaze me.

Not to mention the biggest advantage--MUCH more tolerable side effects (for most people) with dopaminergic drugs. None of that SSRI apathy. No sexual side effects. No amotivational behavior. These drugs are even prescribed to reverse those side effects of SSRIs, which raises the question--in those using SSRIs for depression/dysthymia who experience the aforementioned adverse effects... why not go with the more benign (and quite possibly more effective) pro-dopaminergic class of medications?

 

Re: After Prozac - which SSRI to try » Babysnakes

Posted by Ritch on May 14, 2003, at 9:10:40

In reply to After Prozac - which SSRI to try, posted by Babysnakes on May 13, 2003, at 12:29:51

> Brief history: 35 years old. Realize now that I've been dysthymic most (all?) of my life - but last five years I've completely stalled in both my personal and professional life. Definitely slipping into a periodic depression that is much worse than normal. Eating and sleeping more than normal, and completely avoidant of almost any other activity that would be considered by most to be productive and/or pleasurable, but I am still capable of having a good time should something actually stumble into my path (atypical depression?).
>
> In addition - there is a strong history of bipolar in my family with two suicides (grandfather and uncle) and I strongly suspect one parent with undiagnosed bp. Though to the best of my knowledge, I've never experienced a manic or even sustained hypomanic phase in my 35 years.
>
> Finally, in my early twenties, I started to have periodic anxiety attacks. Bad ones at first. I went to a cardiologist when I thought I was going to have a heart attack and he correctly diagnosed panic and started me on Xanax. The panic attacks are mostly under control and I use Xanax only occasionally (0.25 - 0.5mg once every couple of weeks to couple of months) just to prevent a bad night or very rarely, to escape the day to day pressure of life (like someone else might have a drink or smoke a joint).
>
> OK, so I went to a PDoc and gave the above history. I have tried talk thereapy already and found it to be expensive and not very helpful. I wanted to try an AD. Given family history of BP, Pdoc suggested starting with Wellbutrin and I concurred. Found it to be way to stimulating for me. So after 3 weeks as a low dosage, I gave it up. PDoc and I discussed going to SSRI. His first suggesstion was Paxil. But after reading all the horror stories on the internet I opted for Prozac, knowing that it may be too activating at first.
>
> And well, it is. At least for now, I've been on 10 mg/day for a week now and the only way I can get to sleep is to take a Xanax, which makes me feel sedated for much of the following morning. Plus, I really don't want to become addicted to the Xanax that I've been able to use for long time (over 10 years) without abuse.
>
> Although I intend to give Prozac a full month to adjust to, I'm thinking of switch SSRI's already and the question is which one to try next given the above history. I am willing to try the Paxil - but don't want to feel like a space cadet and I guess would be a little nervous about the withdrawal symptoms that some people seem to have. But I'm open to ideas on the others as well. Has anyone else tried prozac - found it to be too activating and switched to another SSRI that they are happy with. Or, has anyone found Prozac to be too activating at first, but eventually adapted to it. Also, will eventually consider Serzone, but I'm putting that one further down on my list for now.
> Sorry for the long post, but it all seems like important information.
>
> Thanks in advance.


You might ask about 10mg scored Prozac tabs (if you haven't already) and halve the dose to 5mg every day and see if you sleep better. My older sister has panic disorder and she can't sleep on 20mg/day, but she can OK on 10mg/day. Your pdoc's idea about jumping to Paxil (likely to be the most sedative choice or possibly Luvox), might be a good idea, but you may just be med sensitive and your dose is too high. If the lowered Prozac dose doesn't help and you are worried that the Paxil will zonk you out too much you might suggest a "midland" switch to maybe 10mg of Celexa. Celexa would make it a *little* tough to get to sleep, but I tended to sleep better on that one than the others overall, and wake feeling fairly decent.

 

Re: After Prozac - which SSRI to try » Babysnakes

Posted by Ron Hill on May 14, 2003, at 10:32:05

In reply to After Prozac - which SSRI to try, posted by Babysnakes on May 13, 2003, at 12:29:51

Babysnakes,

> I've been on 10 mg/day for a week now and the only way I can get to sleep is to take a Xanax, which makes me feel sedated for much of the following morning.

Did you begin to feel the effects of Prozac within the first day or two (as opposed to the more typical two week delay period)? Could it be that the insomnia is an early sign of SSRI induced hypomania?

-- Ron

 

Re: After Prozac - which SSRI to try

Posted by Babysnakes on May 14, 2003, at 11:20:05

In reply to Re: After Prozac - which SSRI to try » Babysnakes, posted by Ron Hill on May 14, 2003, at 10:32:05

> Babysnakes,
>
> > I've been on 10 mg/day for a week now and the only way I can get to sleep is to take a Xanax, which makes me feel sedated for much of the following morning.
>
> Did you begin to feel the effects of Prozac within the first day or two (as opposed to the more typical two week delay period)? Could it be that the insomnia is an early sign of SSRI induced hypomania?
>
> -- Ron
Other than being stimulated - equivalent to drinking a cup or two of coffee - there have been no effects. Well, okay, one effect, definite decrease in libido - though I can still perform. Just no drive to do so. Only on day 7 though. I'm still hoping this is a med I can settle into rather than have to switch. I intend to give it a month. Celexa is creeping up to the top of the list of next choice. Any feedback would be greatly appreciated.

Thanks, and I'll definitely continue to look for signs of mania or hypo mania.

 

Re: After Prozac - which SSRI to try

Posted by Caleb462 on May 17, 2003, at 3:02:20

In reply to Re: After Prozac - which SSRI to try, posted by Babysnakes on May 14, 2003, at 11:20:05

Here's my personal experience with SSRIs-
In no way do would I expect you or other people to react the exact same way to these meds, just sharing my experience.

Zoloft (50 mg a day for 1 1/2 months, 100 mg day for 1/2 month. Prescribed primarily for OCD) - I don't recall much, though I believe the effects were rather mild, likely because the dose was too low. Mild sexual dysfunction was most prominent side effect.

Paxil (40 mg a day for 2 months, 60 mg a day for 1 month, 80 mg for a few days, prescribed primarily for OCD) - Very noticeable decrease in social anxiety, and somewhat of a decrease in general anxiety. No help with OCD. Main side effects were excessive sweating, constipation, severe sexual dysfunction. As is usual with SSRIs, there was a definite "emotional-blunting" effect. Yet at the same time, I was fairly euthymic throughout this med trial, and this short period was a pretty good time in my life.

Celexa (40 mg for 2 months, 60 mg for 2-3 weeks, prescribed primarily for OCD)

My least favorite SSRI I've tried. Sedation, apathy, emotion-blunting, anhedonia, and moderate to severe sexual dysfunction were prevalent. Around a 40% decrease in general anxiety, but no reduction in social anxiety, and no reduction in OCD symptoms. Basically, it was a drag. Stopped cold turkey and experienced a fairly disturbing withdrawl (flu-like symptoms and extreme dysphoria/panic).

And now.. I know it's not an SSRI, but it's close so

Effexor XR (75 mg a day for 3 months, 150 mg a day for 3 months, have been on 225 mg for close to two weeks now. Prescribed for OCD, General Anxiety, Social Anxiety, Major Depression)

Experienced a mild but noticeable anti-depressant effect with 75 mg, with little side effects. A more pronounced anti-depressant as well as anti-anxiety effect appeared with 150 mg, but dissapeared within 2 months. No OCD help. Side effects at this dose - headaches (initially), insomnia (initially), constipation, sexual impairment (mild), possibly weight gain - though I have a poor diet so it's hard to say. Have been on 225 mg for about 2 weeks now, so I'm still waiting for a response. Have noticed increased constipation and drastically increased sexual problems at this dose, as well as increased sweating.


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