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Dr. Bob is Robert Hsiung, MD,
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Posted by emmanuel98 on August 12, 2010, at 19:41:07
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by orbital on August 12, 2010, at 10:22:46
I think people have better luck with older p-docs, who were all trained in dynamic therapy back in the day, and have years and years of experience with really difficult patients. My p-doc is in his early 70s and studied for three years under this world famous therapist and p-doc
Posted by violette on August 13, 2010, at 8:47:02
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by emmanuel98 on August 12, 2010, at 19:41:07
> I think people have better luck with older p-docs, who were all trained in dynamic therapy back in the day, and have years and years of experience with really difficult patients.
I agree Emmanuel! It took me a long time to find this out...
Posted by morgan miller on August 13, 2010, at 9:11:50
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by violette on August 13, 2010, at 8:47:02
I like my pdocs between the ages of 40 and 70, they are still very sharp, lively, and fully connected with their emotions(I feel after 70 people begin to grow a bit numb), while also having plenty of valuable experience. Someone who is very alive and still has a large capacity for empathy and compassion is just too important for me when seeing a therapist. I just think a therapist in their 70s and 80s is less likely to still have everything they once had. The reality is, the brain ages as we age, and with this, we also begin to lose certain emotional components that were once much stronger. JMHO.
Posted by morgan miller on August 13, 2010, at 9:13:31
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by morgan miller on August 13, 2010, at 9:11:50
> I like my pdocs between the ages of 40 and 70, they are still very sharp, lively, and fully connected with their emotions(I feel after 70 people begin to grow a bit numb), while also having plenty of valuable experience. Someone who is very alive and still has a large capacity for empathy and compassion is just too important for me when seeing a therapist. I just think a therapist in their 70s and 80s is less likely to still have everything they once had. The reality is, the brain ages as we age, and with this, we also begin to lose certain emotional components that were once much stronger. JMHO.
OOps, didn't mean to say pdoc. I was only talking about therapists.
Posted by emmanuel98 on August 13, 2010, at 20:52:13
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 13, 2010, at 9:13:31
Well my therapist (also a p-doc) is 71 and sharp as a tack, compassionate, kind, empathic, but also inclines to push me to work and not just look to therapy as a shoulder to cry on. Now maybe once he hits 75 things will change, but he is semi-retired and would probably retire completely if he felt he wasn't doing as good a job as he once did.
Posted by morgan miller on August 13, 2010, at 21:50:19
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by emmanuel98 on August 13, 2010, at 20:52:13
That's great! Yeah there are some people that tend to hold it together much longer than others.
Posted by orbital on August 14, 2010, at 5:58:21
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 13, 2010, at 21:50:19
I quit taking the escitalopram on Monday, with my doctor's approval. So far so good. The fog is definitely lifting, my feelings are returning, I'm starting to feel like myself again. Gradually.
I visited my brother yesterday, I didn't tell him about the withdrawal, he just doesn't keep up with that stuff. Anyway, he was surprised, he told me that something had changed, he said that my sense of humor was back and that I seemed less depressed (gotta love the irony!). I actually felt good.
When I called my doc, she told me that wants me to take a small dose of sertraline, as she thinks that I might still need a boost and quitting SSRIs so abruptly after long term use might cause problems. I asked for Savella instead but she shot it down, at least initially, she feels that it's too activating for someone who suffers from anxiety.
I'll be seeing her in a couple of days, finally, I'm not sure about the Zoloft, but I'm glad she's willing to work with me.
Bye bye escitalopram. It did help me a lot for a long time, but the eventual poop out/emotional blunting was horrendous.
Posted by morgan miller on August 14, 2010, at 22:41:26
In reply to Update - off Lex, posted by orbital on August 14, 2010, at 5:58:21
I think Zoloft is a great drug, but I am biased. I would insist on taking name brand though. I don't think you will have to be concerned about lethargy on Zoloft.
Glad to hear you are feeling better. I think starting Zoloft at a low dose is a good idea, you might not be feeling so great in a week or so without it.
Posted by ed_uk2010 on August 15, 2010, at 7:10:24
In reply to Update - off Lex, posted by orbital on August 14, 2010, at 5:58:21
>I quit taking the escitalopram on Monday, with my doctor's approval. So far so good. The fog is definitely lifting, my feelings are returning, I'm starting to feel like myself again.
So why does your doctor want you to take sertraline (Zoloft)? It sounds like you are doing well without medication. Sertraline can cause all of the typical SSRI adverse effects. It's a decent medication - but is it what you need right now?
Posted by morgan miller on August 15, 2010, at 10:06:34
In reply to Re: Update - off Lex » orbital, posted by ed_uk2010 on August 15, 2010, at 7:10:24
> >I quit taking the escitalopram on Monday, with my doctor's approval. So far so good. The fog is definitely lifting, my feelings are returning, I'm starting to feel like myself again.
>
> So why does your doctor want you to take sertraline (Zoloft)? It sounds like you are doing well without medication. Sertraline can cause all of the typical SSRI adverse effects. It's a decent medication - but is it what you need right now?
>
>I agree that orbital may want to wait a good month to see how he feels.
The doc wants to start Zoloft because they are concerned that in a week or so, when any therapeutic effects of Lexapro wear off, orbital may not be feeling so good. It is quite common to come off a drug and initially feel better. But then a little time passes and the person finds themselves feeling worse in some ways than when they were on the drug-very very common.
Posted by ed_uk2010 on August 15, 2010, at 13:39:03
In reply to Re: Update - off Lex, posted by morgan miller on August 15, 2010, at 10:06:34
Hi Morgan,
>It is quite common to come off a drug and initially feel better. But then a little time passes and the person finds themselves feeling worse in some ways than when they were on the drug-very very common.
Oh I agree, I just thought that orbital wanted to try without SSRIs for a while. All SSRIs have the potential to cause emotional numbness - which seems to have become such a problem for orbital.
Posted by orbital on August 15, 2010, at 13:47:29
In reply to Re: Update - off Lex, posted by morgan miller on August 15, 2010, at 10:06:34
I'll be seeing my doctor tomorrow, I'm quite unsure as to what to do next. Right now I'm tempted to ask for a short course of Prozac to /hopefully/ ward off rebound depression, and reassess my situation further on. I feel so much better now but I agree with Morgan, it might be too soon to tell.
Im not complaining of course, if push comes to shove, it's reassuring to know I have options :)) Maybe this beast is in remission.
Posted by ed_uk2010 on August 15, 2010, at 14:41:11
In reply to Re: Update - off Lex, posted by orbital on August 15, 2010, at 13:47:29
>I'll be seeing my doctor tomorrow, I'm quite unsure as to what to do next. Right now I'm tempted to ask for a short course of Prozac to /hopefully/ ward off rebound depression, and reassess my situation further on. I feel so much better now but I agree with Morgan, it might be too soon to tell.
You could ask your doctor if she would be willing to prescribe a small amount of Prozac. You don't have to take it immediately, but you could keep it on standby. If you notice any signs of your depression returning, you can start taking it. If you continue to do well, you might decide not to take it at all.
Posted by Huxley on August 15, 2010, at 19:21:36
In reply to Re: Update - off Lex » orbital, posted by ed_uk2010 on August 15, 2010, at 14:41:11
I have been doing alot of research on SSRI withdrawal and from ancedotal reports, a big problem that alot of people run into is Anhedonia
http://en.wikipedia.org/wiki/Anhedonia
From what I have read this can last for months and years after discontinuation.
I personally think that alot of people seem to get into a helpless state from long term SSRI use. They continue to take them long after the drugs have stopped working because discontinuing them is almost impossible because of the withdrawal. The negative effects of long term SSRI use is diagnosed as another mental illness and additional medications are added to your reigme.
Slow and steady is the way to go, discontinue it over a year or two.Sudden SSRI withdrawl is a disaster in my books. Even once you get over the 2-4 weeks of horrible physical withdrawal you will be in emotional turmoil for a long time.
Posted by orbital on August 15, 2010, at 21:44:48
In reply to Re: Update - off Lex » orbital, posted by ed_uk2010 on August 15, 2010, at 14:41:11
> You could ask your doctor if she would be willing to prescribe a small amount of Prozac. You don't have to take it immediately, but you could keep it on standby. If you notice any signs of your depression returning, you can start taking it. If you continue to do well, you might decide not to take it at all.
>
Well, at this point, my reasoning for taking Prozac is to keep any possible post-SRRI rebound depression at bay. Do you think I'm being overly cautious?FWIW, I don't seem to be suffering from any major W/D symptoms, mentally I feel fine, physically... I'm a bit tired, my sleep is somewhat bit restless, and I have some nausea, but that's about it. I'd slowly weaned myself down to 5mg of escitalopram during the past few weeks before quitting, though.
Posted by morgan miller on August 16, 2010, at 0:55:54
In reply to Re: Update - off Lex, posted by orbital on August 15, 2010, at 13:47:29
> I'll be seeing my doctor tomorrow, I'm quite unsure as to what to do next. Right now I'm tempted to ask for a short course of Prozac to /hopefully/ ward off rebound depression, and reassess my situation further on. I feel so much better now but I agree with Morgan, it might be too soon to tell.
>
> Im not complaining of course, if push comes to shove, it's reassuring to know I have options :)) Maybe this beast is in remission.If you do feel the need to try Zoloft, I believe that with time and with the right dose, it is less likely to give you the unwanted effects you have experienced with other SSRIs.
Good luck and hope you continue to feel well!
Morgan
Posted by morgan miller on August 16, 2010, at 1:00:03
In reply to Re: Update - off Lex, posted by Huxley on August 15, 2010, at 19:21:36
> I have been doing alot of research on SSRI withdrawal and from ancedotal reports, a big problem that alot of people run into is Anhedonia
>
> http://en.wikipedia.org/wiki/Anhedonia
>
> From what I have read this can last for months and years after discontinuation.
>
> I personally think that alot of people seem to get into a helpless state from long term SSRI use. They continue to take them long after the drugs have stopped working because discontinuing them is almost impossible because of the withdrawal. The negative effects of long term SSRI use is diagnosed as another mental illness and additional medications are added to your reigme.
>
>
> Slow and steady is the way to go, discontinue it over a year or two.
>
> Sudden SSRI withdrawl is a disaster in my books. Even once you get over the 2-4 weeks of horrible physical withdrawal you will be in emotional turmoil for a long time.
>I don't necessarily agree with this. Does it happen with some people, sure, but I believe those are the people who you are reading reports on such things happening. What you don't read about or find on the internet, are those thousands of people that have discontinued SSRIs and are doing just fine. I have 3 friends that have discontinued SSRIs without any long term withdrawal syndrome or emotional/mental issues.
Posted by ed_uk2010 on August 16, 2010, at 15:04:15
In reply to Re: Update - off Lex, posted by orbital on August 15, 2010, at 21:44:48
>Well, at this point, my reasoning for taking Prozac is to keep any possible post-SSRI rebound depression at bay. Do you think I'm being overly cautious?
How long were you planning on taking Prozac for, and at what dose?
>I'd slowly weaned myself down to 5mg of escitalopram during the past few weeks before quitting....
>I don't seem to be suffering from any major W/D symptoms.....Given that you tapered fairly slowly, I don't think you're likely to experience rebound depression ie. depression as a withdrawal symptom. If your depression starts to return in a few weeks' time, that would be a relapse, not a rebound. Rebound depression normally refers to a depressive episode which occurs quite quickly after stopping an antidepressant, and is often accompanied by pronounced withdrawal symptoms. Gradual tapering can prevent rebound depression, but it can't prevent a relapse from occuring several weeks or months later.
Before you decide whether or not to take Prozac, I think you need to be clear in your mind about what you are actually taking it for.
A short course of Prozac at a low dose (eg. 5mg/day) might reduce your withdrawal symptoms. A very low dose of Lexapro (eg. 2.5mg) for a couple of weeks would probably have a similar effect. Since you're not experiencing much in the way of withdrawal symptoms anyway, I'm not sure that this would be worthwhile. If you're finding the nausea and disturbed sleep to be a problem, it might help.
A short course of Prozac isn't likely to affect your long term risk of relapse. Only if you take Prozac on a long term basis will it achieve this.
If I were you I'd probably ask for a small amount of Prozac and put it away in a drawer. If you notice any signs of your depression returning, you can start the Prozac straight away. Otherwise, you might not need it. The thing about Prozac is that it can cause all of the typical SSRI side effects. All SSRIs have the potential to cause emotional numbness, even though some may be worse than others. I think it makes sense to have Prozac on standby rather than Zoloft, since you mentioned above that you had to stop taking Zoloft due to weight loss. You didn't mention any problems with Prozac.
Take care.
Posted by Phillipa on August 16, 2010, at 19:00:42
In reply to Re: Update - off Lex, posted by morgan miller on August 16, 2010, at 1:00:03
Daughter and next door neighbor are two of them. Phillipa
Posted by orbital on August 17, 2010, at 7:07:41
In reply to Re: Update - off Lex, posted by morgan miller on August 16, 2010, at 0:55:54
> If you do feel the need to try Zoloft, I believe that with time and with the right dose, it is less likely to give you the unwanted effects you have experienced with other SSRIs.
>
> Good luck and hope you continue to feel well!
>
> MorganThanks Morgan. My Doctor really pushed the Zoloft (surprise!) but we settled on a short course of Prozac instead. If the need arises in the future -I hope it won't, of course- Zoloft does seem like the way to go.
Thanks so much!
Posted by orbital on August 17, 2010, at 7:17:41
In reply to Re: Update - off Lex » orbital, posted by ed_uk2010 on August 16, 2010, at 15:04:15
Thanks, Ed. I agree with your opinion. My doctor gave me Prozac, I'll take 10mg for a week, then taper off that and see how it goes.
I hope to be done with SSRIs. I wouldn't hesitate to take them again if needed, but I do think my doc should have revaluated me ages ago instead of continuing to dispense them indiscriminately. My mood has been stunted for so long, I can't believe she never made the connection and that I had to *beg* to come off the AD. I'm tempted to switch doctors, as I'm still on Klonopin and Lamictal, but unfortunately I'm pretty sure they're all pretty much the same.
Oh well.. Thank you so much, I really do appreciate your interest. Take care :)
> >Well, at this point, my reasoning for taking Prozac is to keep any possible post-SSRI rebound depression at bay. Do you think I'm being overly cautious?
>
> How long were you planning on taking Prozac for, and at what dose?
>
> >I'd slowly weaned myself down to 5mg of escitalopram during the past few weeks before quitting....
> >I don't seem to be suffering from any major W/D symptoms.....
>
> Given that you tapered fairly slowly, I don't think you're likely to experience rebound depression ie. depression as a withdrawal symptom. If your depression starts to return in a few weeks' time, that would be a relapse, not a rebound. Rebound depression normally refers to a depressive episode which occurs quite quickly after stopping an antidepressant, and is often accompanied by pronounced withdrawal symptoms. Gradual tapering can prevent rebound depression, but it can't prevent a relapse from occuring several weeks or months later.
>
> Before you decide whether or not to take Prozac, I think you need to be clear in your mind about what you are actually taking it for.
>
> A short course of Prozac at a low dose (eg. 5mg/day) might reduce your withdrawal symptoms. A very low dose of Lexapro (eg. 2.5mg) for a couple of weeks would probably have a similar effect. Since you're not experiencing much in the way of withdrawal symptoms anyway, I'm not sure that this would be worthwhile. If you're finding the nausea and disturbed sleep to be a problem, it might help.
>
> A short course of Prozac isn't likely to affect your long term risk of relapse. Only if you take Prozac on a long term basis will it achieve this.
>
> If I were you I'd probably ask for a small amount of Prozac and put it away in a drawer. If you notice any signs of your depression returning, you can start the Prozac straight away. Otherwise, you might not need it. The thing about Prozac is that it can cause all of the typical SSRI side effects. All SSRIs have the potential to cause emotional numbness, even though some may be worse than others. I think it makes sense to have Prozac on standby rather than Zoloft, since you mentioned above that you had to stop taking Zoloft due to weight loss. You didn't mention any problems with Prozac.
>
> Take care.
Posted by morgan miller on August 17, 2010, at 9:16:04
In reply to Re: Update - off Lex » ed_uk2010, posted by orbital on August 17, 2010, at 7:17:41
I'd be just as concerned about klonopin and lamictal, unless you really feel pretty good while taking them.
As far as transitioning off an SSRI, low dose Prozac is definitely the way to go. I would even start with 5 mg and go from there. I'm sure you will be down to 5 soon enough.
Good Luck!
Morgan
Posted by ed_uk2010 on August 17, 2010, at 14:19:44
In reply to Re: Update - off Lex » ed_uk2010, posted by orbital on August 17, 2010, at 7:17:41
> My doctor gave me Prozac, I'll take 10mg for a week, then taper off that and see how it goes.
You could take 10mg per day for the first couple of days......but I do think that 10mg per day is probably more than you need (to prevent withdrawal symptoms). After all, you tapered right down to 5mg of Lexapro before stopping completely - and you aren't experiencing any major withdrawal symptoms. Have you got the 10mg fluoxetine capsules, or perhaps the tablets? I am unsure as to which formulations of fluoxetine are available in the US.
If you have some 10mg tablets, you could take half a tablet per day for one week then switch to alternate day dosing. Fluoxetine has a much longer duration of action than any of the other SSRIs. It is the only SSRI which can be tapered by increasing the dosage interval, this really doesn't work well with any of the others. For example, you could take fluoxetine on alternate days for a couple of weeks, then twice a week for a couple of weeks then stop.
I hope you have enough fluoxetine so that you can re-initiate treatment if your depression starts to relapse.
Best of luck.
> I hope to be done with SSRIs. I wouldn't hesitate to take them again if needed, but I do think my doc should have revaluated me ages ago instead of continuing to dispense them indiscriminately. My mood has been stunted for so long, I can't believe she never made the connection and that I had to *beg* to come off the AD. I'm tempted to switch doctors, as I'm still on Klonopin and Lamictal, but unfortunately I'm pretty sure they're all pretty much the same.
>
> Oh well.. Thank you so much, I really do appreciate your interest. Take care :)
>
> > >Well, at this point, my reasoning for taking Prozac is to keep any possible post-SSRI rebound depression at bay. Do you think I'm being overly cautious?
> >
> > How long were you planning on taking Prozac for, and at what dose?
> >
> > >I'd slowly weaned myself down to 5mg of escitalopram during the past few weeks before quitting....
> > >I don't seem to be suffering from any major W/D symptoms.....
> >
> > Given that you tapered fairly slowly, I don't think you're likely to experience rebound depression ie. depression as a withdrawal symptom. If your depression starts to return in a few weeks' time, that would be a relapse, not a rebound. Rebound depression normally refers to a depressive episode which occurs quite quickly after stopping an antidepressant, and is often accompanied by pronounced withdrawal symptoms. Gradual tapering can prevent rebound depression, but it can't prevent a relapse from occuring several weeks or months later.
> >
> > Before you decide whether or not to take Prozac, I think you need to be clear in your mind about what you are actually taking it for.
> >
> > A short course of Prozac at a low dose (eg. 5mg/day) might reduce your withdrawal symptoms. A very low dose of Lexapro (eg. 2.5mg) for a couple of weeks would probably have a similar effect. Since you're not experiencing much in the way of withdrawal symptoms anyway, I'm not sure that this would be worthwhile. If you're finding the nausea and disturbed sleep to be a problem, it might help.
> >
> > A short course of Prozac isn't likely to affect your long term risk of relapse. Only if you take Prozac on a long term basis will it achieve this.
> >
> > If I were you I'd probably ask for a small amount of Prozac and put it away in a drawer. If you notice any signs of your depression returning, you can start the Prozac straight away. Otherwise, you might not need it. The thing about Prozac is that it can cause all of the typical SSRI side effects. All SSRIs have the potential to cause emotional numbness, even though some may be worse than others. I think it makes sense to have Prozac on standby rather than Zoloft, since you mentioned above that you had to stop taking Zoloft due to weight loss. You didn't mention any problems with Prozac.
> >
> > Take care.
>
>
Posted by Phillipa on August 17, 2010, at 19:52:53
In reply to Re: Update - off Lex » orbital, posted by ed_uk2010 on August 17, 2010, at 14:19:44
My next door neighbor told me today her friend had to wean off paxil and had to use liquid paxil and even with that it took a year. I'm finding ad's harder than benzos to decrease. Phillipa
Posted by creepy on August 19, 2010, at 11:48:30
In reply to Off Lexapro? - apathy syndrome //Help!, posted by orbital on August 8, 2010, at 15:49:57
Lexapro was almost like taking an antipsychotic for me. It killed my drive to do anything at all. The one GOOD thing it did for me was stopping the anger / rage I get with PTSD.
I went to celexa for a while since it was cheaper. Now Ive been off of all SSRIs for a few weeks.
What I am noticing now, is that these drugs have a profound effect on the endocrine systems. Thats probably what causes the appetite, the fatigue, the muscle weakness, etc. and thats ultimately the reason I dropped it.
I still have wicked fatigue and without a small amount of desipramine and my ADD meds I am totally useless. I think I have some sort of neuroendocrine balance issue now. Hopefully it is not permanent.
If you experience these side effects, or lasting symptoms after taking an SSRI it may be worthwhile to consult with an endocrinologist.
There seems to be a lot of overlap in psychopharm and endocrinology, I wish more pdocs were aware of these issues.
This is the end of the thread.
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