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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Phillipa on May 31, 2005, at 22:06:52
It seems that a lot of posters are taking very low doses of AD's like prozac for depression. I've noticed it with cymbalta too. How did you discover that they worked better than the recommended doses of the drugs? I always thought you needed the recommended dose for them to work. And then sometimes higher. Thanks, Phillipa
Posted by Paulbwell on June 1, 2005, at 5:01:32
In reply to When Did People Discover Low Doses of AD's Work?, posted by Phillipa on May 31, 2005, at 22:06:52
> It seems that a lot of posters are taking very low doses of AD's like prozac for depression. I've noticed it with cymbalta too. How did you discover that they worked better than the recommended doses of the drugs? I always thought you needed the recommended dose for them to work. And then sometimes higher. Thanks, Phillipa
Many people only need 5mgs of Prozac for Antidepressant relief,
I have known people who were started off on one 20mg Capsule-felt completly overwhelmed, and gave it up. Many knowledgeable PsyDocs will start ppl off on 2.5-5mgs of prozac in liquid form, until they adapt to the SEs then raise to a standard level of 10 or 20mg or higher if needed.My good friend even felt nothing from 80mgs 4 caps, while that dose would blow my head off.:(
Cheers
Posted by Phillipa on June 1, 2005, at 16:46:25
In reply to Re: When Did People Discover Low Doses of AD's Work?, posted by Paulbwell on June 1, 2005, at 5:01:32
That's what happened to me when prozac first came out. 20mg capsules. Day l wallpapered the foyer, Day 2 anxiety. Day 3 panic all day. Quit them and 3 days of xanax to calm down. The pdoc said I had such a dramatic response to take them every 3 days. I refused. If they had known about the low doses maybe I would be well today. Fondly, Phillipa
Posted by linkadge on June 1, 2005, at 17:31:19
In reply to Re: When Did People Discover Low Doses of AD's Work? » Paulbwell, posted by Phillipa on June 1, 2005, at 16:46:25
Low doses hmm. Not only do you have the novelty of taking an antidepressant, as well you always have that psychological leverage that you could increase your dose if things get bad.
Linkadge
Posted by Paulbwell on June 2, 2005, at 3:36:46
In reply to Re: When Did People Discover Low Doses of AD's Work?, posted by Paulbwell on June 1, 2005, at 5:01:32
> > It seems that a lot of posters are taking very low doses of AD's like prozac for depression. I've noticed it with cymbalta too. How did you discover that they worked better than the recommended doses of the drugs? I always thought you needed the recommended dose for them to work. And then sometimes higher. Thanks, Phillipa
>
> Many people only need 5mgs of Prozac for Antidepressant relief,
> I have known people who were started off on one 20mg Capsule-felt completly overwhelmed, and gave it up. Many knowledgeable PsyDocs will start ppl off on 2.5-5mgs of prozac in liquid form, until they adapt to the SEs then raise to a standard level of 10 or 20mg or higher if needed.
>
> My good friend even felt nothing from 80mgs 4 caps, while that dose would blow my head off.:(
>
> CheersThat was a hugh selling point for Eli Lilly when Prozac came out, the one size fits all of 1 20mg capsule.
People could start out on a full threaputic dose from the start (never mind that this greatly over-stimulated many people) and stay on this dose, a seemingly great advantage to TCAs where a low and slow build up had to occur, with people taking 4-12 pills as opposed to the 1 for Prozac.
Prozac, AKA bottled sunshine-circa 1993
Posted by Phillipa on June 2, 2005, at 16:30:52
In reply to Re: When Did People Discover Low Doses of AD's Work? » Paulbwell, posted by Phillipa on June 1, 2005, at 16:46:25
So since my depression was probably just dysthemia at the time, low dose prozac could have kept me from where I am today? Fondly, Phillipa
Posted by blueberry on June 2, 2005, at 19:49:00
In reply to When Did People Discover Low Doses of AD's Work?, posted by Phillipa on May 31, 2005, at 22:06:52
I discovered that low dose prozac was effective when I first started it, because I ignored the instructions and used the mix-it-in-orange-juice trick instead. The first day I took about a 5mg sip, and that was plenty. I couldn't imagine doing 20mg. Eventually, months later, I did work up to 20mg. I can do fine at 10mg, but 20mg is overall better for me. But when I first started, I could definitely feel 5mg big time.
Posted by FredPotter on June 2, 2005, at 20:06:12
In reply to Re: When Did People Discover Low Doses of AD's Work? » Phillipa, posted by Phillipa on June 2, 2005, at 16:30:52
Hi Phillipa this is a good thread. I'm taking my Celexa at half dose to see if I can get a bit of energy back into my life. So far so good, and it's nice to feel sexual awareness returning. I've always got Xanax if panic attacks return. My evening dread problem only seems to happen if I relax. If I keep busy, esp if I meet up with people, I'm usually OK. Not much of a way to live though
Fred
Posted by Phillipa on June 2, 2005, at 20:39:30
In reply to Re: When Did People Discover Low Doses of AD's Work? » Phillipa, posted by FredPotter on June 2, 2005, at 20:06:12
That's why I'm only taking 25mg of zoloft. But it doesn't work. About 5mths later. Fondly, Phillipa
Posted by Larry Hoover on June 2, 2005, at 21:40:34
In reply to When Did People Discover Low Doses of AD's Work?, posted by Phillipa on May 31, 2005, at 22:06:52
> It seems that a lot of posters are taking very low doses of AD's like prozac for depression. I've noticed it with cymbalta too. How did you discover that they worked better than the recommended doses of the drugs? I always thought you needed the recommended dose for them to work. And then sometimes higher. Thanks, Phillipa
The recommended dose is an average dose. There are always people who don't fit into the concept of average.
Another thing is that both drugs you mention depend, at least in part, on a liver enzyme (2D6) for metabolizing the drug....a liver enzyme that some people do not have a functional copy of. Those "poor metabolizers" have a harder time getting the drug out of their system. And, they have different metabolite ratios. The ratio of parent drug to metabolite(s) has a strong bearing on side effects.
Combine that with natural differences in pharmacokinetics....the peak blood concentration from a 20 mg dose of Prozac varies by a factor of four! It's like one person took four times as much as the other already. The half-life varies by a factor of three. That suggests that people can vary by a factor of twelve (4 X 3) on their pharmocokinetics alone.
I couldn't tolerate 20 mg of Prozac. I felt over-dosed, and I truly believe I was. And I met a woman who was half my weight who was complaining that 100 mg Prozac did nothing. No side-effects. No main effects. Nothing.
You can get liquid Prozac (and generic versions). That way, if you want, you can titrate the dose right down to the miligram, with excellent precision.
If I ever think I might need an SSRI again, that's what I'm going to ask for. A bottle of liquid Prozac, and I'll titrate it myself.
Lar
Posted by 4WD on June 2, 2005, at 22:30:02
In reply to Re: When Did People Discover Low Doses of AD's Work? » Phillipa, posted by FredPotter on June 2, 2005, at 20:06:12
> Hi Phillipa this is a good thread. I'm taking my Celexa at half dose to see if I can get a bit of energy back into my life. So far so good, and it's nice to feel sexual awareness returning. I've always got Xanax if panic attacks return. My evening dread problem only seems to happen if I relax. If I keep busy, esp if I meet up with people, I'm usually OK. Not much of a way to live though
> Fred
I take a half dose of Celexa too. ANd when I was on Prozac I took 20mg 2-3 times a week. The most Effexor I ever took was 50mg (1/3 of a 150 mg cap). I'm thinking of bringing the Celexa down to 5mg and see hpw that works.
Posted by med_empowered on June 3, 2005, at 2:25:58
In reply to Re: When Did People Discover Low Doses of AD's Work?, posted by 4WD on June 2, 2005, at 22:30:02
Dosing psychiatric drugs is tricky, and it seems as if shrinks have historically acted by first using mega-doses or one-size-fits all doses, and then coming to their senses and using a med sensibly later on. Take Thorazine for instance. In the US in particular, docs went crazy with it--people were being prescribed 1500, 2000mgs a day! With Haldol, 20mgs used to be a standard dose. Now, when old drugs are used, they're used in lower doses. The excessive dosing of old school anti-psychotics is one reason the new ones look so appealing; compared to the mega-doses of hardcore old drugs, smallish doses of the new ones are pretty harmless. When you adjust the dosage, though, there are fewer differences in side-effects; 4-8mgs/day of Haldol, for instance, compares pretty well with Risperdal over the long haul. With antidepressants, particularly the new one, one of the big selling points, as another responder pointed out, was that a doc could start someone off on an effective dose and then work up or add on as needed. Plus, the doses were pretty standardized. While a patient on Tofranil might take anywhere from 100mgs a day to 200+ outpatient, and up to 600 in patient (I would *hate* to be that patient, though), Prozac started at 20 and usually capped out at 60-80. Docs are still kinda crazy with the ADs though. Like, when I started Zoloft, my doc started at 100mgs, then upped it to 150mgs a few days later. It worked, but it was kinda heavy-handed.
Posted by ed_uk on June 3, 2005, at 8:26:01
In reply to Re: When Did People Discover Low Doses of AD's Wor, posted by med_empowered on June 3, 2005, at 2:25:58
Hi!
>4-8mgs/day of Haldol
Lower doses can be effective for psychosis in some patients eg. 0.5-2.5mg/day.
Ed.
Posted by Paulbwell on June 4, 2005, at 23:21:02
In reply to Re: When Did People Discover Low Doses of AD's Wor » med_empowered, posted by ed_uk on June 3, 2005, at 8:26:01
> Hi!
>
> >4-8mgs/day of Haldol
>
> Lower doses can be effective for psychosis in some patients eg. 0.5-2.5mg/day.
>
> Ed.I think Prozac is a very effective AD despite, perhaps because of, the fact it is not really very Serotonin selective (as compared to Celexa which is VERY serotonin clean) I found the differences in effects AND SEs very different, it does boost Dopamine and others, but i think it's crazy to START on 20mg straight off, 5mgs would be the most i would do straight off, then if needed, go up weekly, by 5 mgs.
You would have to empty a 20mg capsule into 20ml OJ to do this, or get Prozac liquid.
Cheers
Posted by PianoPlayer131 on June 5, 2005, at 11:15:51
In reply to Prozac 20mgs--too much straight off., posted by Paulbwell on June 4, 2005, at 23:21:02
> I think Prozac is a very effective AD despite, perhaps because of, the fact it is not really very Serotonin selective (as compared to Celexa which is VERY serotonin clean) I found the differences in effects AND SEs very different, it does boost Dopamine and others, but i think it's crazy to START on 20mg straight off, 5mgs would be the most i would do straight off, then if needed, go up weekly, by 5 mgs.
>
> You would have to empty a 20mg capsule into 20ml OJ to do this, or get Prozac liquid.
>
> CheersFYI, there is a generic version of Fluoxetine that comes in 10mg tablets that can be split in two.
This is the end of the thread.
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