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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by g_g_g_unit on April 13, 2008, at 0:26:16
i guess this is a two-part question. firstly, i was interested in people's personal limits they set when trialling a drug? on 2.5mg of lexapro @ 2 weeks, i've been experiencing: mild sporadic headaches, total sexual numbing, restless leg syndrome and memory loss. i've been told by my psych that i am too impatient in giving up meds, so i just wanted to know how others went about with it? will you usually give an ssri the indicated 8 weeks unless you have like a total seizure? or are you generally quite intolerant? i may go up to 5mg just to see what it's like, but so far things aren't looking up.
which segues into my second question: where i live, the only version of citalopram available is a generic - which also happens to be the last mainstream ssri i haven't tried. i was told as a generic it will be less potent, but also may have less sfx, so was thinking of making the transfer. has anyone ever found their ideal ad counterpart in a generic?
Posted by undopaminergic on April 13, 2008, at 5:08:13
In reply to anyone ever had greater success on a generic?, posted by g_g_g_unit on April 13, 2008, at 0:26:16
> i guess this is a two-part question. firstly, i was interested in people's personal limits they set when trialling a drug? on 2.5mg of lexapro @ 2 weeks, i've been experiencing: mild sporadic headaches, total sexual numbing, restless leg syndrome and memory loss. i've been told by my psych that i am too impatient in giving up meds, so i just wanted to know how others went about with it? will you usually give an ssri the indicated 8 weeks unless you have like a total seizure? or are you generally quite intolerant? i may go up to 5mg just to see what it's like, but so far things aren't looking up.
>I'd usually give up after 4-6 weeks, if no improvement is seen, or sooner if side-effects are unbearable. For example, with sertraline, I didn't care much about the sexual side effects or restless legs, but eventually (after about 4 weeks) I had enough of the loose stools.
>
> i was told as a generic it will be less potent, but also may have less sfx, so was thinking of making the transfer.
>A generic contains the same amount of the same active ingredient. However, different manufacturers may choose different selections of helper ingredients, tablet shapes, film-coating, colouring, etc. While I don't see how the tablet shape could matter, the absence or presence of coating could potentially affect the rate or completeness of absorption, and certain ingredients present in some brands could potentially cause allergic reactions that would not occur with other brands of the medication.
Posted by Phillipa on April 13, 2008, at 12:01:09
In reply to Re: anyone ever had greater success on a generic?, posted by undopaminergic on April 13, 2008, at 5:08:13
Yup that has been my tolerance sometimes l0 days if unbearable. So far luvox only one tolerate in low doses. Loose stools? Boy the side effects I've gotten have been unbearable. I wonder if side effects or the absense of means a med will work or not? Any thoughts on that? Phillipa
Posted by Dopamine123 on April 13, 2008, at 22:00:19
In reply to anyone ever had greater success on a generic?, posted by g_g_g_unit on April 13, 2008, at 0:26:16
>mild sporadic headaches, total sexual numbing, restless leg syndrome and memory loss
Sounds like your experiencing dopamine depletion due to the SSRI. I had similar symptoms to you when I was taking an SSRI.
Sexual dysfunction, restless legs and some of the memory problems may be due to reduced dopamine (an oversimplification obviously but that is the general idea). You might want to augment the SSRI with a drug that increases dopamine, like wellbutrin, ritalin, adderall etc. Otherwise those symptoms probably won't resolve on their own.
>which segues into my second question: where i live, the only version of citalopram available is a generic - which also happens to be the last mainstream ssri i haven't tried. i was told as a generic it will be less potent, but also may have less sfx, so was thinking of making the transfer. has anyone ever found their ideal ad counterpart in a generic?
All the SSRI's have essentially the same mechanism of action (serotonin uptake) so you would probably find the side effect profile to be similar for each. The generics would probably not be much different in their efficacy or side effects either. Most of the difference in the drugs are due to the different dosing levels employed and their half lives.
Posted by g_g_g_unit on April 13, 2008, at 22:18:11
In reply to Re: anyone ever had greater success on a generic?, posted by Dopamine123 on April 13, 2008, at 22:00:19
> >mild sporadic headaches, total sexual numbing, restless leg syndrome and memory loss
>
> Sounds like your experiencing dopamine depletion due to the SSRI. I had similar symptoms to you when I was taking an SSRI.
>
> Sexual dysfunction, restless legs and some of the memory problems may be due to reduced dopamine (an oversimplification obviously but that is the general idea). You might want to augment the SSRI with a drug that increases dopamine, like wellbutrin, ritalin, adderall etc. Otherwise those symptoms probably won't resolve on their own.
>i was considering adding wellbutrin to reverse the sexual sfx anyway. the thing is, though, i have a lot of engrained (and usually unfounded) 'baggage' that i've brought to the issue of taking anti-depressants, one strain of which is a fear that augmenting drugs will just cause a pile-up of sfx. if i'm feeling dumb enough on lexapro, will adding wellbutrin just compound the problem? or is its action on dopamine relatively independent from what the lexapro's doing?
Posted by Dopamine123 on April 14, 2008, at 19:59:39
In reply to Re: anyone ever had greater success on a generic? » Dopamine123, posted by g_g_g_unit on April 13, 2008, at 22:18:11
>if i'm feeling dumb enough on lexapro, will adding wellbutrin just compound the problem?
Usually, increasing dopamine is pro-cognitive functioning. Wellbutrin has utility for attention deficit disorder. Increasing dopamine/norepinephrine tends to increase concentration so it would probably counteract what you feel on the lexapro. I have tried SSRI's and have found that my attention span and memory got worse on them. Wellbutrin dramatically improved those drug induced side effects in my case. Or you could try Cymbalta or Effexor. Both those drugs may have fewer cognitive effects than an SSRI since they also increase norepinephrine.
"one strain of which is a fear that augmenting drugs will just cause a pile-up of sfx"
Well if you don't want to take antidepressants you could alway try some over the counter supplements.
1000 mg of EPA is supposed to be good. You can buy this omega-3 fatty acid over the counter at a store that sells supplements. Just make sure you only get the EPA and not the other fatty acids. 1000 mg per day sounds like the right dose that is needed. Omega 3 might have a beneficial effect on cognition in contrast to an SSRI.
"Fluoxetine and EPA appear to be equally effective in controlling depressive symptoms."
(omega-3 fatty acid eicosapentaenoic acid)
http://www.ncbi.nlm.nih.gov/pubmed/18247193?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumS-adenosyl-L-methionine (SAMe) is another supplement that might be worth a try too. It increases dopamine and could improve concentration and depressive symptoms.
http://www.ncbi.nlm.nih.gov/pubmed/15538131?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumOther supplements you could take can be found at this site.
http://www.qualitycounts.com/fpdepression.html
Posted by undopaminergic on April 14, 2008, at 22:20:32
In reply to Re: anyone ever had greater success on a generic?, posted by Dopamine123 on April 13, 2008, at 22:00:19
> >mild sporadic headaches, total sexual numbing, restless leg syndrome and memory loss
>
> Sounds like your experiencing dopamine depletion due to the SSRI. I had similar symptoms to you when I was taking an SSRI.
>
> Sexual dysfunction, restless legs and some of the memory problems may be due to reduced dopamine (an oversimplification obviously but that is the general idea). You might want to augment the SSRI with a drug that increases dopamine, like wellbutrin, ritalin, adderall etc. Otherwise those symptoms probably won't resolve on their own.
>Especially the motor symptoms tend to get better. By the time that I quit sertraline (at 200 mg/day), they were no longer a problem.
The sexual side effects are perhaps the most reliable effects of SSRIs. They are not so much a result of dopamine deficits as hyperprolactinemia, but nevertheless, peripheral dopamine receptors in the pituitary inhibit prolactin release, so a dopamine agonist (pramipexole, ropinirole, etc.) can be an efftive remedy. One can also learn to live with these side effects: a simple way of managing them is to cut down on orgasms to one per week or one per two weeks.
It has been suggested that upregulation of the dopaminergic system is the mechanism of antidepressive action of SSRIs, and the gradual nature of such upregulation could account for the slow onset the therapeutic benefits of SSRIs. Assuming that's correct, adding dopaminergic agents could potentially interfer with the process, because such agents could potentially remove the stimulus for upregulation. This is just speculation, however.
Posted by undopaminergic on April 14, 2008, at 22:31:42
In reply to Re: anyone ever had greater success on a generic? » undopaminergic, posted by Phillipa on April 13, 2008, at 12:01:09
> I wonder if side effects or the absense of means a med will work or not? Any thoughts on that? Phillipa
>The side effects demonstrate that the medication has effects, but the effects may or may not be necessary for the therapeutic action. In the case of SSRIs, I don't think the stimulation of the gastrointestinal system (for example) has any relevance to antidepressant efficacy, but it's probably inevitable, as serotonin is a major neurotransmitter in the enteric system. A synonym of serotonin is enteramine...
Posted by g_g_g_unit on April 14, 2008, at 23:19:41
In reply to Re: anyone ever had greater success on a generic?, posted by Dopamine123 on April 14, 2008, at 19:59:39
> >if i'm feeling dumb enough on lexapro, will adding wellbutrin just compound the problem?
>
> Usually, increasing dopamine is pro-cognitive functioning. Wellbutrin has utility for attention deficit disorder. Increasing dopamine/norepinephrine tends to increase concentration so it would probably counteract what you feel on the lexapro. I have tried SSRI's and have found that my attention span and memory got worse on them. Wellbutrin dramatically improved those drug induced side effects in my case. Or you could try Cymbalta or Effexor. Both those drugs may have fewer cognitive effects than an SSRI since they also increase norepinephrine.Cymbalta not available where i live yet, and am scared of Effexor withdrawal, though will probably consider that next if current regime fails . . .
>
> "one strain of which is a fear that augmenting drugs will just cause a pile-up of sfx"
> Well if you don't want to take antidepressants you could alway try some over the counter supplements.you mean as opposed to the wellbutrin specifically, or anti-depressants in general? latter's probably not an option as this stage as i'm in the midst of a tough battle w/ ocd . .
>
> 1000 mg of EPA is supposed to be good. You can buy this omega-3 fatty acid over the counter at a store that sells supplements. Just make sure you only get the EPA and not the other fatty acids. 1000 mg per day sounds like the right dose that is needed. Omega 3 might have a beneficial effect on cognition in contrast to an SSRI.
> "Fluoxetine and EPA appear to be equally effective in controlling depressive symptoms."
> (omega-3 fatty acid eicosapentaenoic acid)
> http://www.ncbi.nlm.nih.gov/pubmed/18247193?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
>
> S-adenosyl-L-methionine (SAMe) is another supplement that might be worth a try too. It increases dopamine and could improve concentration and depressive symptoms.
> http://www.ncbi.nlm.nih.gov/pubmed/15538131?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumis sam-e safe to take w/ an ssri?
>
> Other supplements you could take can be found at this site.
> http://www.qualitycounts.com/fpdepression.html
>
Posted by rvanson on April 15, 2008, at 0:43:25
In reply to anyone ever had greater success on a generic?, posted by g_g_g_unit on April 13, 2008, at 0:26:16
> i guess this is a two-part question. firstly, i was interested in people's personal limits they set when trialling a drug? on 2.5mg of lexapro @ 2 weeks, i've been experiencing: mild sporadic headaches, total sexual numbing, restless leg syndrome and memory loss. i've been told by my psych that i am too impatient in giving up meds, so i just wanted to know how others went about with it? will you usually give an ssri the indicated 8 weeks unless you have like a total seizure? or are you generally quite intolerant? i may go up to 5mg just to see what it's like, but so far things aren't looking up.
>
> which segues into my second question: where i live, the only version of citalopram available is a generic - which also happens to be the last mainstream ssri i haven't tried. i was told as a generic it will be less potent, but also may have less sfx, so was thinking of making the transfer. has anyone ever found their ideal ad counterpart in a generic?Overall, being a M/H consumer for 26 years, the generics are usually less potent then their brand name drug.
For me, the switch from Celexa to the generic Citalopram made a huge difference in the effect profile. Also, the Alprazolam, that is the generic for Xanax can vary widely by the maker, unlike the brand name Xanax, which is much more steady, but also much more expensive.
Needless to say, some of the side-effects will be less on a generic, since the potency is less as well.
Overall, its a better deal to stay on the brand name med, but that is almost impossible to do in the USA and other countries, due to the high cost.
Posted by Phillipa on April 15, 2008, at 18:59:46
In reply to Re: anyone ever had greater success on a generic?, posted by undopaminergic on April 14, 2008, at 22:31:42
Never had any gastrointestional effects from theraputic doses of SSRI's or SNRI's so what does that mean? Phlllipa
Posted by undopaminergic on April 16, 2008, at 13:04:46
In reply to Re: anyone ever had greater success on a generic? » undopaminergic, posted by Phillipa on April 15, 2008, at 18:59:46
> Never had any gastrointestional effects from theraputic doses of SSRI's or SNRI's so what does that mean? Phlllipa
>I suppose it means you're lucky in that respect.
Posted by Phillipa on April 16, 2008, at 19:39:01
In reply to Re: anyone ever had greater success on a generic?, posted by undopaminergic on April 16, 2008, at 13:04:46
So it's not a way to judge whether a med may work or not? Absense of symptoms absolutely none 0 is what I experienced with luvox. And for two weeks at high doses worked well. As a matter of fact that was the second time first time was working well the pdoc took me off as he wanted me in a celexa trial new med at the time. And I felt great on the luvox then a higher dose and ativan or xanax don't remember which. Phillipa
Posted by undopaminergic on April 18, 2008, at 5:12:42
In reply to Re: anyone ever had greater success on a generic? » undopaminergic, posted by Phillipa on April 16, 2008, at 19:39:01
> So it's not a way to judge whether a med may work or not?
>No, I had very few side effects from most of the drugs that worked best for me. If only they had worked well in the long run...
Posted by g_g_g_unit on April 21, 2008, at 7:23:13
In reply to Re: anyone ever had greater success on a generic?, posted by undopaminergic on April 18, 2008, at 5:12:42
sorry to keep assaulting with questions - i feel so pedantic - but i just thought i'd update:
i tried taking 5mg of lexapro and fell asleep in the late afternoon, which seems to be a recurring theme with me and anti-depressants (even on moclobemide & st john's wort); it's like by the time 5pm rolls round, it's impossible for me to stay awake. the headaches are persisting, and two this week have been really bad. RSL also doesn;t show any signs of abating. the thing is tho, aside from some memory problems, cognitive functioning seems to have emerged relatively unscathed. it's hard to tell if it's because my dose is low, but it's enough reason for me to keep going for a little while at least to see if things improve. the thing is though, taking the lex at night doesn't seem to make me tired. so i thinking of maybe trying to take the 5mg in the afternoon, or maybe trying 10mg at night to see if that's more sedating?
i also have a prescription now for wellbutrin to hopefully deal w/ the RSL, memory problems, etc. but i'm kinda nervous because i've never augmented. is it a wise idea to bump lex up to 10mg at the same time as starting wellbutrin? also, is it possible for wellbutrin to have an effect on the headaches? because if not i'm wondering if it might be better just give wellbutrin a shot on its own , , i donno ... sorry if this is kinda scatterbrained .. my mind is just overrun with possibilities . .
Posted by Phillipa on April 21, 2008, at 19:01:16
In reply to lexapro +wellbutrin, posted by g_g_g_unit on April 21, 2008, at 7:23:13
One change at a time. Have you been taking lexapro in am? As it reved me up and wellbutrin and me did not get along at all. Phillipa
Posted by g_g_g_unit on April 21, 2008, at 21:16:29
In reply to Re: lexapro +wellbutrin » g_g_g_unit, posted by Phillipa on April 21, 2008, at 19:01:16
i was taking it in the am @ 2.5mg and didn't notice much effect either way. then @ 5mg the first day i felt really sedated, so switched to night but that sedating effect seems to have worn off; so today i switched to am again and lo and behold i feel really agitated. guess i'll continue taking it in the morning for a bit to see what happensk, and refrain from adding the wellbutrin for now ..
This is the end of the thread.
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