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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by Paul on Long Island on May 10, 2006, at 7:14:49
Hey Guys. Just a quick note. I'm now in day 9 of the 14 days I have to wait from going off Emsam to going back on Prozac. The combination of lithium, klonopin and xanax wasn't helping much at all. Yesterday, I got the doctor to switch me from the klonopin and xanax to just Ativan to go with the lithium, as my sister has always had a good response to Ativan. Well, I'm not quite ready to sound the trumpets and declare it miraculous, yesterday afternoon was definitely better than it has been. This morning so far seems a bit better too. Hopefully it will continue to improve. And thanks for the support and prayers of all of you.
Here are my two questions: On Monday, I will be starting back on Prozac at 20 mg. Considering the way I've felt lately, and that 20 mgs. always worked well for me, I'm not going to try to get the doctor to lower the level to begin with. I am wondering first off if anyone has had any experience with prozac in conjunction with ativan. I've taken the prozac with the xanax in the past and it worked, but since the ativan has given me what feels like a mild antidepressant effect along with the anti-anxiety effect, I'm wondering if this might be a good plan to discuss with my doctor.
The other half of the question has to do with the low dose prozac I've been reading here on the boards. I suffer from depression, anxiety, add and ocd. I personally have found that all those things are helped for me at 20 mg. I'm wondering if anyone has had any experience with the 5 or 10 mg who also has Obsessive Compulsive Disorder, and what their results might be. If I could take the 5 mg or even the 10 mg and avoid the harshest of the weight gain and sexual side effects and STILL have the depression, anxiety and OCD in check, it would be a gift from God. Please, does anyone have any experience with this? Thanks....Paul
Posted by john berk on May 10, 2006, at 11:39:22
In reply to Low Dose Prozac with OCD, posted by Paul on Long Island on May 10, 2006, at 7:14:49
Hi Paul,
I have gotten over my major depression, but still have ocd, [since i was 12] and dysthmia, [low grade depression] and I am doing well on 10 mgs. of prozac, I actually did go back up to 20, but with my klonopin and ambien at night, I felt too tired, and 20 seems to make me feel too apathetic, I don't have the same zest for exercise, or just things in general.so hopefully 10 mgs. will be enough, so far, so good, i've been on 10 mgs. for almost a month, I think with CBT, low dose prozac can help OCD...john
Posted by Larry Hoover on May 10, 2006, at 12:01:20
In reply to Low Dose Prozac with OCD, posted by Paul on Long Island on May 10, 2006, at 7:14:49
You can ask your doctor to prescribe dissolved Prozac. The standard version is 20 mg/5 mL. 5 mL is one teaspoon. With the oral solution, dose is proportional to the volume you swallow. To get exactly 8 mg Prozac, you would need to take 2 mL of the solution. 10 mg is 2.5 mL. And so on. 4 mg/mL is the concentration of the pediatric oral Prozac, but, I think it comes in generic forms now. That should be much cheaper.
With the liquid, you can take exactly the dose you want, without worrying about breaking pills or any of that.
Lar
Posted by Phillipa on May 10, 2006, at 13:00:08
In reply to Re: Low Dose Prozac with OCD » Paul on Long Island, posted by Larry Hoover on May 10, 2006, at 12:01:20
Isn't the liquid more expensive? I've heard that some are opening the capsules if it even comes in capsule form anymore and measuring that out. Love Phillipa
Posted by paul on long island on May 10, 2006, at 14:33:05
In reply to Re: Low Dose Prozac with OCD » Paul on Long Island, posted by Larry Hoover on May 10, 2006, at 12:01:20
> You can ask your doctor to prescribe dissolved Prozac. The standard version is 20 mg/5 mL. 5 mL is one teaspoon. With the oral solution, dose is proportional to the volume you swallow. To get exactly 8 mg Prozac, you would need to take 2 mL of the solution. 10 mg is 2.5 mL. And so on. 4 mg/mL is the concentration of the pediatric oral Prozac, but, I think it comes in generic forms now. That should be much cheaper.
>
> With the liquid, you can take exactly the dose you want, without worrying about breaking pills or any of that.
>
> LarLarry, I appreciate all that information, although I'm not currently in the right state of mind to do the math myself :) The thing that I wanted to know mostly is whether anyone has had any experience with lower doses of prozac in regard to the OCD. I've read where a lot of people seem to feel that their depression is treated equally successfully with 5 or 10 mgs, but I need to know what effect the lower dosages will have on my ocd. Any info you could give would be greatly appreciated. I've heard many good things about you from Phillipa, and so far, she seems to be right. Thanks.....Paul
Posted by Larry Hoover on May 10, 2006, at 14:50:27
In reply to Re: Low Dose Prozac with OCD, posted by paul on long island on May 10, 2006, at 14:33:05
> Any info you could give would be greatly appreciated. I've heard many good things about you from Phillipa, and so far, she seems to be right. Thanks.....Paul
Paul, I can only speculate. I think you might very well have positive results at a lower dose. Yes, 5 or 10 or 15 mg/day might work, yet still avoid the adverse effects. I simply have not done such an experiment. If I must resort again to an SSRI, that would be my next experiment. To test the low-dose Prozac regime. I believe in it. I cannot predict the outcome with any certainty. It certainly could work, just as you imagine it might.
Lar
P.S. If you go with the liquid, I can help you with the dosing.
L
Posted by john berk on May 10, 2006, at 15:31:48
In reply to Re: Low Dose Prozac with OCD, posted by Larry Hoover on May 10, 2006, at 14:50:27
Larry,
Because of the extended half-life of prozac, is it possible to take one 20 mg. capsule every 4 days to get a 5 mg. dosage, or is that too bumpy of a ride? I have been taking 20 mgs. every other day to get ten per day, i hope i am doing the right thing...john
Posted by Larry Hoover on May 10, 2006, at 16:39:59
In reply to Re: Low Dose Prozac with OCD » Larry Hoover, posted by john berk on May 10, 2006, at 15:31:48
>
> Larry,
> Because of the extended half-life of prozac, is it possible to take one 20 mg. capsule every 4 days to get a 5 mg. dosage, or is that too bumpy of a ride? I have been taking 20 mgs. every other day to get ten per day, i hope i am doing the right thing...johnI wouldn't exceed 48 hour intervals between doses (the average of a highly variable rate). 20 mg every other day is fine, IMHO. 10 mg every other day to get 5 average is verging on a different issue, IMHO. I don't know that rates are interpolatable down to zero. In other words, if half-life laws hold absolutely in lower dose realms. I just don't know. I wouldn't go below 10 every other day. If I wanted lower than that, I would use daily dosing.
Lar
Posted by john berk on May 10, 2006, at 16:44:59
In reply to Re: Low Dose Prozac with OCD » john berk, posted by Larry Hoover on May 10, 2006, at 16:39:59
Posted by blueberry on May 10, 2006, at 17:37:15
In reply to Re: Low Dose Prozac with OCD » Larry Hoover, posted by john berk on May 10, 2006, at 15:31:48
You can take prozac 20mg every other day to get the same as 10mg a day. Strange though, when I used to do that, I always felt a little different on the days I skipped doses and didn't sleep as well either. For some strange reason the daily doses made a difference for me.
Posted by blueberry on May 10, 2006, at 17:40:49
In reply to Low Dose Prozac with OCD, posted by Paul on Long Island on May 10, 2006, at 7:14:49
Not sure about low dose prozac for OCD. Try it and see. I think I actually developed more OCD symptoms at 20mg that weren't there at 10mg.
For daily dosing you can do the orange juice trick. Dump a 20mg capsule in orange juice, or water, stir it or shake it well, then drink 1/2 of it. Put the rest in the fridge. It will keep for at least a week. For the next dose, stir well again (prozac settles to the bottom) and drink.
Posted by ed_uk on May 10, 2006, at 18:32:55
In reply to Re: Low Dose Prozac with OCD, posted by Larry Hoover on May 10, 2006, at 14:50:27
Hi everyone
Fluoxetine (Prozac) comes as a once-weekly capsule: PROZAC WEEKLY. The only difference between normal fluoxetine and Prozac Weekly is that Prozac weekly caps are enteric coated (which causes a slight delay in release) and contain 90mg fluoxetine instead of the common 20mg. I imagine the enteric coat is supposed to reduce the risk of nausea.
http://www.rxlist.com/cgi/generic3/prozac_weekly.htm
Fluoxetine can only be taken once weekly after a patient has been stabilised on daily/alternate day fluoxetine for several weeks or more. Normal fluoxetine caps can also be taken weekly, you don't have to buy Prozac Weekly. A person taking 10mg fluoxetine per day (70mg per week) could attempt to switch to 60-80mg once weekly. Single weekly doses of fluoxetine > 90mg have not been studied.
Like Larry said, I think it's normally better to take fluoxetine more frequently. Large gaps between doses lead to troughs in the blood level, which may be a problem - it might reduce efficacy and allow withdrawal symptoms to emerge between doses. If a high dose of fluoxetine is taken once weekly, peak blood levels may be high, increasing the risk of side effects. Personally, I would not recommend taking fluoxetine once weekly. Alternate day dosing is just fine though.
Ed
Posted by Phillipa on May 10, 2006, at 18:37:53
In reply to Re: Low Dose Prozac with OCD, posted by ed_uk on May 10, 2006, at 18:32:55
Ed you're up late. Love PJ O
Posted by sam86 on May 23, 2006, at 14:36:51
In reply to Re: Low Dose Prozac with OCD » ed_uk, posted by Phillipa on May 10, 2006, at 18:37:53
I'm new to this thread. I was recently taken off of Lexapro 10mg qd because it seemed to have loss its effectiveness, prior med was Cymbalta (I won't even begin to talk about that stuff!!!) Anyway, the doctor put me on 20mg about a week ago and I feel so blah, tired and cranky. I am not motivated to do any of my normal activities. I suffer from depression, not severe except for during PMS times, the rest of the time is like a very mild rollercoaster. Any hints out there? Maybe 20mg q other day?...
Posted by pulse on May 23, 2006, at 15:29:58
In reply to Low Dose Prozac with OCD, posted by Paul on Long Island on May 10, 2006, at 7:14:49
i found that 10 mg prozac worked better for me for both mdd and ocd. more energizing; less apathy by far. less (er) GI side-effects.
my last ever p-doc (mr. NPD) did, once in a rare while, get a few things right: he said that there is much literature to support that 10 mg. works better for a sizeable number of folks. sorry, i no longer have any links.
if you happen to have any upper GI problems, avoid like the plague the liquid form, because plain or flavored ALL contain peppermint = very bad for GERD (reflux).
pulse
Posted by theo on May 25, 2006, at 12:11:36
In reply to Re: Low Dose Prozac with OCD, posted by pulse on May 23, 2006, at 15:29:58
Do you take name brand or generic Prozac?
Posted by pulse on May 25, 2006, at 14:37:46
In reply to Re: Low Dose Prozac with OCD » pulse, posted by theo on May 25, 2006, at 12:11:36
> Do you take name brand or generic Prozac?
in past, took brand mostly. last time, i switched to generic, and i found, as one other poster on this forum recently said, that generic prozac is one (perhaps the only one, imo), where you can switch, with no lessening of efficacy. BUT, you have to, imo, check out the particular maker of the generic. for instance, merk medco was not good (for me), while PAR pharmaceuticals was fine.
pulse
Posted by pulse on May 25, 2006, at 14:42:20
In reply to Re: Low Dose Prozac with OCD » theo, posted by pulse on May 25, 2006, at 14:37:46
forgot to repeat in this thread that i must take only the tablet form (GI problems with gelatin in capsules).
also, fyi, the brand 10 mg. prozac tablet has recently stopped being made.
pulse
Posted by theo on May 25, 2006, at 14:51:36
In reply to Re: Low Dose Prozac with OCD, posted by pulse on May 25, 2006, at 14:42:20
Posted by Phillipa on May 25, 2006, at 18:10:10
In reply to Re: Low Dose Prozac with OCD, posted by pulse on May 25, 2006, at 14:42:20
Why did they discontinue the brand name prozac? Love Phillipa
Posted by pulse on May 26, 2006, at 7:10:28
In reply to Re: Low Dose Prozac with OCD, posted by Phillipa on May 25, 2006, at 18:10:10
They only stopped making brand name Prozac in the 10 mg. TABLETS.
Best guess it was a $ issue - (the usual!) - most people being able to tolerate the 10 mg. capsules.
pulse
Posted by saturn on May 28, 2006, at 21:55:53
In reply to Re: Low Dose Prozac with OCD, posted by Larry Hoover on May 10, 2006, at 14:50:27
>> If I must resort again to an SSRI, that would be my next experiment. To test the low-dose Prozac regime. I believe in it. I cannot predict the outcome with any certainty. It certainly could work, just as you imagine it might.
>
> LarHey Lar, I'm considering Prozac at 5 mg/day.
May I ask if this is in the dose range you're talking about?
Might low dose prozac take longer to reach a theapeutic effect than the normal 4-6 weeks, or possible have less potential for poopout?
Lastly, is there a specific reason you 'believe in' the low-dose Prozac regimen? Ed mentioned that 5 mg worked in the intial clinical trials.
Peace
Sat
Posted by ed_uk on May 29, 2006, at 4:10:17
In reply to Re: Low Dose Prozac with OCD » Larry Hoover, posted by saturn on May 28, 2006, at 21:55:53
Hi Saturn,
One of the initial clinical trials for fluoxetine examined the effectiveness of 5mg, 20mg and 40mg in the treatment of depressive illness. 354 patients were included in this trial. Effectiveness was assessed using the HAM-D rating scale. The trial lasted 6 weeks. In this trial, 5mg, 20mg and 40mg were all more effective than placebo. There was no evidence that the higher doses were more effective than 5mg.
The efficacy of 20mg fluoxetine has been studied in a greater number of patients than 5mg, which is why the manufacturer decided that 20mg would be the 'standard dose'.
Ed
Posted by saturn on May 29, 2006, at 9:01:33
In reply to Re: Low Dose Prozac for DEPRESSION » saturn, posted by ed_uk on May 29, 2006, at 4:10:17
>>The efficacy of 20mg fluoxetine has been studied in a greater number of patients than 5mg, which is why the manufacturer decided that 20mg would be the 'standard dose'.Thanks Ed--I really appreciate the info.
Posted by Larry Hoover on May 29, 2006, at 9:34:34
In reply to Re: Low Dose Prozac with OCD » Larry Hoover, posted by saturn on May 28, 2006, at 21:55:53
> Hey Lar, I'm considering Prozac at 5 mg/day.
>
> May I ask if this is in the dose range you're talking about?Yes, right in around 5. The thing is, if you use a liquid form, i.e. a fluoxetine solution, you can precisely determine the dose, down to decimal points.
Even though the label on the pediatric solution might say 20 mg/5 mL, I betcha that you can assume that 20.0 mg is in each 5.0 mL. So, if you want to take 4.2 mg fluoxetine, you solve this equation:
X mL = (4.2 mg)(5.0 mL)/ 20.0 mg
X mL = 1.05 mLThe equation itself is derived by doing the cross-product on the ratios. 20.0 mg is to 5.0 mL as 4.2 mg is to X mL. The cross product gives (20 mg)(X mL) = (4.2 mg)(5.0 mL). Divide both sides by (20 mg), and you have isolated the variable you wish to determine the algebraic value for.
Ignoring the significant figures issue for a second, your challenge is in measuring out 1.05 mL exactly. You can calibrate an eye-dropper, and probably get very very close to that volume. Once you know how much drug is in one drop, you can change the dose by that increment. Moreover, if you get good at using an eyedropper, you can get very close to exactly half a drop. Even a quarter of a drop, if you learn how.
> Might low dose prozac take longer to reach a theapeutic effect than the normal 4-6 weeks, or possible have less potential for poopout?No, it would not take longer to reach therapeutic effect, if it is the right dose for that individual.
I believe there would be less potential for poopout, not more. Your body would not be escalating its detox mechanisms to get rid of the "toxin", if it was the right dose for you. At least, the detox mechanisms would be the minimum achievable for that drug.
> Lastly, is there a specific reason you 'believe in' the low-dose Prozac regimen? Ed mentioned that 5 mg worked in the intial clinical trials.
>
> Peace
> SatA low dose is perfect for some people, and a high dose is perfect for others. There is a threshold effect. If you're below the ideal dose, for your unique body, the only solution is to take more medication. For those people for whom 20 mg is not enough, the solution is to increase the dose. But, 20 mg is not the therapeutic dose, it is the *median* therapeutic dose. You have to realize that just as many people have a personal therapeutic dose that is less than 20, as there are people for whom it is more.
Half the population is on the low side of the bell curve.
Lar
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