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Dr. Bob is Robert Hsiung, MD,
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Posted by terrysb on June 18, 2009, at 15:35:28
In reply to Re: Luvox for Depression, posted by Brainbeard on June 18, 2009, at 3:29:14
> Good luck in riding it out. Just keep in mind that it's the price you pay for the lessening of fear after these anxiety circuits in your brain have been desensitized.I'm on day 7 which is a new record for me for trying to start an SSRI. I had a bit of trouble getting to sleep last night but managed with some additional Klonopin and Ambien. Actually, today, my mood is more uplifted than it has been since coming off the Imipramine. I'm only up to 18.75mg of Luvox for the past 4 days. I plan to increase to 25mg tonight. Maybe for me a much lower dose will be possible to get an AD effect.
Posted by Phillipa on June 18, 2009, at 20:25:26
In reply to Re: Luvox for Depression » Brainbeard, posted by terrysb on June 18, 2009, at 15:35:28
Seriously good luck have been on it for many years. Phillipa
Posted by Brainbeard on June 19, 2009, at 4:10:18
In reply to Re: Luvox for Depression » Brainbeard, posted by terrysb on June 18, 2009, at 15:35:28
I'm all for lower dosages and believe that the conventional strategy of upping the dose when a med fails can be a shabby one. On the other hand, there has been an evidence-based minimum effective dose established for fluvoxamine (Luvox), which is 50mg a day. The average therapeutical dose is 125-150mg.
Nevertheless, therapeutic effects might be gained by lower doses. Apart from being a serotonin reuptake inhibitor, fluvoxamine is also a relatively strong sigma-1 receptor agonist, which is thought to account for its capability to lift depression and/or anxiety in the beginning of treatment when the therapeutic benefits of serotonin reuptake inhibition still have to come off the ground.
Still, because of the ban on caffeine, I would personally like to have, if not maximum, than at the very least significant therapeutic benefit from this drug. Giving up on coffee was a huge sacrifice for me!
Posted by terrysb on June 19, 2009, at 15:09:20
In reply to Re: Luvox for Depression, posted by Brainbeard on June 19, 2009, at 4:10:18
At the rate I am increasing dosage it could still be a week or more before I am at 50mg. I increased last night to 25mg. The only noticeable difference was a slight elevation in anxiety level mid-day today. I'm assuming that until I stabilize at a particular dose that this is to be expected.
Posted by Brainbeard on June 20, 2009, at 9:06:25
In reply to Re: Luvox for Depression, posted by terrysb on June 19, 2009, at 15:09:20
> (.....) elevation in anxiety level (.....) I'm assuming that until I stabilize at a particular dose that this is to be expected.
Not really. Once the serotonergic circuits involved have been desensitized, anxiety won't flare up when upping the dose. This is both my theory and my experience. After the therapeutic effect kicked in for me at 125mg, I could go up to 200mg without experiencing any related anxiety.
It just takes a couple of weeks, and I suspect that dose doesn't matter that much. Though you would probably have more initial anxiety if you'd start out on a higher dose. And the initial anxiety MIGHT last longer if you titrate up slowly.
Posted by terrysb on June 20, 2009, at 16:18:51
In reply to Re: Luvox for Depression, posted by Brainbeard on June 20, 2009, at 9:06:25
> It just takes a couple of weeks, and I suspect that dose doesn't matter that much. Though you would probably have more initial anxiety if you'd start out on a higher dose. And the initial anxiety MIGHT last longer if you titrate up slowly.
>
>I am getting closer to the 2 week mark. For the past couple of days the anxiety has been very low level and doesn't kick in until mid afternoon with no real peaks. Would you recommend titrating up more quickly so that I can get to the therapeutic level?
Posted by Brainbeard on June 21, 2009, at 5:21:57
In reply to Re: Luvox for Depression » Brainbeard, posted by terrysb on June 20, 2009, at 16:18:51
> Would you recommend titrating up more quickly so that I can get to the therapeutic level?
That was the route I tried to follow when I started sertraline (aka Zoloft) a couple of weeks ago. My idea was that titrating up slowly would only stretch out the start-up anxiety. I did have a pretty hard time though with the anxiety it gave me in the first two weeks. And after that I impulsively and prematurely quit, just when the drug was beginning to have some therapeutic effects. I still think of going back.
So, I don't know: going up a bit faster might give you some harder to digest anxiety, but on the other hand you might already have reached the spot where anxiety starts subsiding. I have my doubts about the latter possibility though, since 25mg is a very low dose.
If I were you, I would just take my chances and jump up to 50mg and stay there for at least a week. See what it does for you. If it's not enough, I would go to 100. If that turns out to be too rough, an intermediate 75. Or perhaps 75 would be your tailor-fit therapeutic dose.
About the dosing: for some reason, Luvox is advised to be given in separate doses on higher dosages. I've experimented with both once (evening) and twice a day (morning and evening) dosing. For me, a single evening dose turned out to work best. The morning dose would make me too sedated. 'Maileage may vary', if you allow me to throw in the cliché most worn out on medication forums.
Good luck and let us know what happens (if you like).
Posted by terrysb on June 21, 2009, at 21:06:40
In reply to Re: Luvox for Depression, posted by Brainbeard on June 21, 2009, at 5:21:57
> So, I don't know: going up a bit faster might give you some harder to digest anxiety, but on the other hand you might already have reached the spot where anxiety starts subsiding. I have my doubts about the latter possibility though, since 25mg is a very low dose.>
> Good luck and let us know what happens (if you like).Since I have been at 25mg the past few days I will move up to 37.5mg tonight and get to 50mg by mid week. So far the start-up anxiety has been present but relatively mild. It tends to elevate mid afternoon.
I want to get past this stage sooner rather than later. I'll keep posting progress. I know that I'm experiencing the normal ramp up onto an SSRI. I think staying at 50mg for a longer period is a good idea.
Posted by Phillipa on June 21, 2009, at 21:54:39
In reply to Re: Luvox for Depression, posted by terrysb on June 21, 2009, at 21:06:40
Are you taking it once or twice a day? As it has a short half life. Maybe divide dose morning and night or if not at night morning and late afternoon. Phillipa
Posted by terrysb on June 21, 2009, at 23:23:18
In reply to Re: Luvox for Depression » terrysb, posted by Phillipa on June 21, 2009, at 21:54:39
I'm taking one dose at night. I'll see how the next day or so goes. It does seem that the anxiety comes at about the half-life point of around 15-17 hours. So maybe splitting the dose makes sense here.
Posted by terrysb on June 22, 2009, at 17:57:10
In reply to Re: Luvox for Depression, posted by Brainbeard on June 21, 2009, at 5:21:57
I increased the dosage last night to 37.5mg. I don't know if this is a result of the increased dosage or just an isolated event but I woke up after about 4 hours and wasn't able to get back to sleep. However, today there has been no real increase in anxiety or peak in the afternoon. I'm debating whether to stay at 37.5 or give 25 a little bit longer before I push up the dosage.
Posted by Phillipa on June 22, 2009, at 20:03:01
In reply to Re: Luvox for Depression, posted by terrysb on June 22, 2009, at 17:57:10
Since normal starting dose is 50mg I'd stick to the 37.5. spit if need be. Usually if you go above l00mg to l50. l00mg at night 50mg am. Phillipa
Posted by TruffleMomma on June 25, 2009, at 23:18:49
In reply to Re: Luvox for Depression, posted by terrysb on June 22, 2009, at 17:57:10
I have been on Luvox for 6 years now. It is HORRIBLE if you try to come off it or run out. I vary between 150 and 300 mg a day. I also take Adderall XR and the occasional Clonazepam.
The Luvox is for OCD. Adderall for ADHD.
I don't have any issues with Luvox and caffeine. With the ADHD the caffiene just puts me to sleep.
Yes, I have a flattened affect. It has cost me some friendships and some jobs. I am a teacher by profession and my coworkers would see me as not caring about things, and to a great extent, they are right. I don't understand what there is to get so worked up about. That flattened affect helps a lot with kids though. My tolerance is amazing and the kids know I never yell.
I found this site looking for info on some generics available. I have quit my comfy teaching job to go back to school full time in another state leaving my family behind for the time being. No more health insurance!
If you have any issues with Luvox, I would be happy to provide my experiences- good and bad.
Posted by terrysb on June 26, 2009, at 9:52:05
In reply to Re: Luvox for Depression, posted by TruffleMomma on June 25, 2009, at 23:18:49
I have now been at 50mg/d for the past several days. I am starting to feel some AD effect at this dose but I think that I will need to step it up to 75mg. The mid-afternoon anxiety and anxiety peaks that I was experiencing initially have subsided.
Posted by terrysb on June 26, 2009, at 11:33:14
In reply to Re: Luvox for Depression, posted by TruffleMomma on June 25, 2009, at 23:18:49
> If you have any issues with Luvox, I would be happy to provide my experiences- good and bad.
>
Sure, any experiences you are willing to sure would be most appreciated.
Posted by Phillipa on June 26, 2009, at 19:28:30
In reply to Re: Luvox for Depression, posted by terrysb on June 26, 2009, at 9:52:05
Thats great sounds like luvox is working for you. Phillipa
Posted by Brainbeard on June 27, 2009, at 4:54:17
In reply to Re: Luvox for Depression, posted by TruffleMomma on June 25, 2009, at 23:18:49
>That flattened affect helps a lot with kids though. My tolerance is amazing and the kids know I never yell.
It's true, flattened affect isn't all bad. Eye-opener.
Posted by terrysb on June 29, 2009, at 11:29:56
In reply to Re: Luvox for Depression, posted by Brainbeard on June 27, 2009, at 4:54:17
I am now approaching the 3-week mark. For the past 5 days I've been managing well at 50mg. I can feel an AD effect at this dosage now but it is very mild and not where I need to be. I upped the dosage to 62.5mg last night and this morning got hit with some rather nasty anxiety. I used some Klonopin and that effectively eliminated it. My target for the week is to get to 75mg and then hold there to see what that does.
Posted by Phillipa on June 29, 2009, at 19:52:03
In reply to Re: Luvox for Depression, posted by terrysb on June 29, 2009, at 11:29:56
Good for you!!!! Keep posting. Love Phillipa
Posted by Brainbeard on June 30, 2009, at 9:48:40
In reply to Re: Luvox for Depression, posted by terrysb on June 29, 2009, at 11:29:56
> I can feel an AD effect at this dosage now but it is very mild and not where I need to be.
Excellent. It's doing something, so you're not going through this all for nothing; and since you're still at a fairly low dose, this might be promising of its therapeutic effects at a higher dose. Be aware though that full therapeutic effects, even on a higher dose, take some four weeks to three months (especially for OCD) to take effect. So you might wanna consider, for instance, staying on 75mg a bit longer. The choice is up to you of course.
Personally, I'm considering to stay away from full serotonin reuptake inhibition because of the antidopaminergic side-effects; on the other hand, when I don't get enough relief from my anxious depression, I might just need to go full SRI after all.--------------------------------------------------------------------------------------------------------------
Current meds: imipramine 12.5mg + amitriptyline 6mg at bedtime; sertraline 12.5mg + ondansetron 2mg + modafinil 50mg in the morning'Some of the Magic Syrup was Preserved'
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Posted by terrysb on June 30, 2009, at 11:39:19
In reply to Re: Luvox for Depression, posted by Brainbeard on June 30, 2009, at 9:48:40
> Excellent. It's doing something, so you're not going through this all for nothing; ... Be aware though that full therapeutic effects, even on a higher dose, take some four weeks to three months (especially for OCD) to take effect. So you might wanna consider, for instance, staying on 75mg a bit longer. <Thanks, today is my second day on 62.5mg and although I had a little bit of extra anxiety in the morning it was no where close to yesterday and
I was able to manage without Klonopin. Tonight I'll increase to 75mg. Unless I really don't get enough of an effect at 75mg I plan to stay there for awhile. Since this is for depression only I'm hoping the full therapeutic effect will kick in sooner rather than later.
Posted by Brainbeard on July 1, 2009, at 4:47:56
In reply to Re: Luvox for Depression, posted by terrysb on June 30, 2009, at 11:39:19
>I'm hoping the full therapeutic effect will kick in sooner rather than later.
Luvox can kick in sooner than some other SSRIs because apart from SRI it also does some sigma-1 agonism, which has antidepressant and anti-anxiety (plus anti-delusional) effects for some people. That might just be you.
Posted by sowhysosad on July 2, 2009, at 5:26:14
In reply to Re: Luvox for Depression, posted by Brainbeard on July 1, 2009, at 4:47:56
Just been to see my UK NHS pdoc about unipolar depression with OCD-like leanings and asked about fluvoxamine.
Apparently they just don't prescribe it in this country. Ever. I wonder why.
Posted by terrysb on July 2, 2009, at 11:00:52
In reply to Re: Luvox for Depression, posted by sowhysosad on July 2, 2009, at 5:26:14
> Just been to see my UK NHS pdoc about unipolar depression with OCD-like leanings and asked about fluvoxamine.
>
> Apparently they just don't prescribe it in this country. Ever. I wonder why.<Strange, because it is definitely marketed in the UK under the brand name Fevarin and licensed for both OCD and Depression. In the US it is available as a generic and approved for OCD by the FDA but is also used "off label" for depression.
Posted by sowhysosad on July 3, 2009, at 5:26:05
In reply to Re: Luvox for Depression, posted by terrysb on July 2, 2009, at 11:00:52
Hmmmm. Just checked the NICE guidelines and there's nothing forbidding its use.
It just says it's less commonly prescribed because of a higher incidence of nausea.
Could just be a policy of this particular mental health trust (Leeds) or the supervising pdoc.
> > Just been to see my UK NHS pdoc about unipolar depression with OCD-like leanings and asked about fluvoxamine.
> >
> > Apparently they just don't prescribe it in this country. Ever. I wonder why.<
>
> Strange, because it is definitely marketed in the UK under the brand name Fevarin and licensed for both OCD and Depression. In the US it is available as a generic and approved for OCD by the FDA but is also used "off label" for depression.
>
>
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