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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by tensor on February 4, 2012, at 4:52:49
Am currently taking Abilify with Remeron and Lexapro, if I replace Abilify with Zyprexa should I switch Lexapro for fluoxetine for greater chance of improvement?
Accordinlgy to the following document there is a significant difference in adding fluoxetine to Zyprexa than either alone: http://www.jfponline.com/pages.asp?aid=4495
Scroll down to: Olanzapine/fluoxetine
What do you think?
Thanks.
Posted by tensor on February 4, 2012, at 5:10:35
In reply to Zyprexa + fluoxetine, posted by tensor on February 4, 2012, at 4:52:49
> Am currently taking Abilify with Remeron and Lexapro, if I replace Abilify with Zyprexa should I switch Lexapro for fluoxetine for greater chance of improvement?
>
> Accordinlgy to the following document there is a significant difference in adding fluoxetine to Zyprexa than either alone: http://www.jfponline.com/pages.asp?aid=4495
>
> Scroll down to: Olanzapine/fluoxetine
>
> What do you think?
>
> Thanks.This is presumably due to the synergistic effect of two 5HT2C blocking agents, a property shared by Remeron, so maybe no need for fluoxetine..
Posted by bleauberry on February 4, 2012, at 5:17:18
In reply to Zyprexa + fluoxetine, posted by tensor on February 4, 2012, at 4:52:49
I was on prozac and zyprexa for 8 years. I think this is one of the all-star combos in the pscyh world....not many combos like that...and I sometimes scratch my head as to why this combo isn't a lot more widely used than it is. My guess is the weight gain thing with zyprexa turns a lot of people away but that's too bad.
What made the combo even better for me was adding adrafanil or modafinil to it.
Anyway, it seems like most people experience poopout with meds but it took almost 8 years for that to happen with this combo when I was on it. Previous to that other ssris pooped out within a few months if they worked at all.
Posted by tensor on February 4, 2012, at 5:26:08
In reply to Re: Zyprexa + fluoxetine, posted by bleauberry on February 4, 2012, at 5:17:18
> I was on prozac and zyprexa for 8 years. I think this is one of the all-star combos in the pscyh world....not many combos like that...and I sometimes scratch my head as to why this combo isn't a lot more widely used than it is. My guess is the weight gain thing with zyprexa turns a lot of people away but that's too bad.
>
> What made the combo even better for me was adding adrafanil or modafinil to it.
>
> Anyway, it seems like most people experience poopout with meds but it took almost 8 years for that to happen with this combo when I was on it. Previous to that other ssris pooped out within a few months if they worked at all.
>
>Thanks for the encouragement. I'm seriously thinking of dropping my current meds for this combo. May I ask what you are taking now? How was your sex life on this combo?
Posted by ed_uk2010 on February 4, 2012, at 10:23:16
In reply to Zyprexa + fluoxetine, posted by tensor on February 4, 2012, at 4:52:49
> Am currently taking Abilify with Remeron and Lexapro, if I replace Abilify with Zyprexa should I switch Lexapro for fluoxetine for greater chance of improvement?
Overall, I don't think fluoxetine + olanzapine would be more effective than escitalopram + olanzapine unless you have previously found fluoxetine to work better than escitalopram. YMMV.
How do you respond to fluoxetine alone? If you prefer it to escitalopram you could swap, but it's generally best to avoid starting/stopping more than one medication at once. It can be very confusing. You end up not knowing what each individual med is doing.
Posted by tensor on February 4, 2012, at 10:33:11
In reply to Re: Zyprexa + fluoxetine » tensor, posted by ed_uk2010 on February 4, 2012, at 10:23:16
> Overall, I don't think fluoxetine + olanzapine would be more effective than escitalopram + olanzapine unless you have previously found fluoxetine to work better than escitalopram. YMMV.
>
> How do you respond to fluoxetine alone? If you prefer it to escitalopram you could swap, but it's generally best to avoid starting/stopping more than one medication at once. It can be very confusing. You end up not knowing what each individual med is doing.
>
>It's over a decade since I tried fluoxetine and I remember it was good for anxiety but had no effect on my depression, so you may be right. Remove Remeron and swap Abilify for Zyprexa? I was thinking of starting low, like 2.5mg.
Best.
Posted by ed_uk2010 on February 4, 2012, at 11:17:04
In reply to Re: Zyprexa + fluoxetine » ed_uk2010, posted by tensor on February 4, 2012, at 10:33:11
>Remove Remeron and swap Abilify for Zyprexa? I was thinking of starting low, like 2.5mg.
I was thinking you might try to taper off Remeron if Zyprexa is effective. If you stop Remeron and start Zyprexa at the same time.... and you don't feel better, you won't know whether the lack of improvement was because you stopped Remeron or because Zyprexa wasn't effective.
I think it makes sense to get a low strength of Zyprexa because it makes it easier to titrate the dose to effect. You could start out with 2.5mg or 5mg at night. Perhaps your doctor might prescribe you a box of 2.5mg tabs and a box of 5mg tabs. I doubt you would need much more than 10mg for efficacy, but it's possible.
Posted by tensor on February 4, 2012, at 11:23:59
In reply to Re: Zyprexa + fluoxetine » tensor, posted by ed_uk2010 on February 4, 2012, at 11:17:04
> >Remove Remeron and swap Abilify for Zyprexa? I was thinking of starting low, like 2.5mg.
>
> I was thinking you might try to taper off Remeron if Zyprexa is effective. If you stop Remeron and start Zyprexa at the same time.... and you don't feel better, you won't know whether the lack of improvement was because you stopped Remeron or because Zyprexa wasn't effective.
>
> I think it makes sense to get a low strength of Zyprexa because it makes it easier to titrate the dose to effect. You could start out with 2.5mg or 5mg at night. Perhaps your doctor might prescribe you a box of 2.5mg tabs and a box of 5mg tabs. I doubt you would need much more than 10mg for efficacy, but it's possible.Sounds like a plan, thanks Ed for your insight and clever advices. I will talk to my pdoc on monday, I will let you know the outcome.
/M
Posted by ed_uk2010 on February 4, 2012, at 11:52:13
In reply to Re: Zyprexa + fluoxetine » ed_uk2010, posted by tensor on February 4, 2012, at 11:23:59
>I will talk to my pdoc on monday, I will let you know the outcome.
Thanks M, I hope your appointment goes well :)
Posted by Zyprexa on February 4, 2012, at 22:38:43
In reply to Zyprexa + fluoxetine, posted by tensor on February 4, 2012, at 4:52:49
I think that fluoxetine just makes the zyprexa more potent. You could just take a higher dose if necessary. I didn't like fluoxetine, but love zyprexa. The remeron might make you too sedate, so I would stop that one at the same time as starting zyprexa. Or a difference of a few days, so you know which is which. but titerate the two, up on one down on the other, and so on. Zyprexa and celexa worked well for me for a while so lexapro might be a good combo. I later switched to zoloft. I would also titerate the abilify. The withdraw can be awful for a little while.
Posted by bleauberry on February 5, 2012, at 7:17:06
In reply to Re: Zyprexa + fluoxetine » bleauberry, posted by tensor on February 4, 2012, at 5:26:08
> > What made the combo even better for me was adding adrafanil or modafinil to it.
> >
> > Anyway, it seems like most people experience poopout with meds but it took almost 8 years for that to happen with this combo when I was on it. Previous to that other ssris pooped out within a few months if they worked at all.
> >
> >
>
> Thanks for the encouragement. I'm seriously thinking of dropping my current meds for this combo. May I ask what you are taking now? How was your sex life on this combo?Right now I take rhodiola rosea, resveratrol made from polygonum, cod liver oil, and a very good vitamin/mineral. I do still need help and when it gets bad I rely on vicodin and/or ritalin to get me through the crisis. That happens but not on a regular basis. I am seriously thinking of taking on a new med, it has been several years without, but my choices are few.
Sex on prozac+zyprexa was a bit blunted, as might be expected with any ssri or antipsychotic. That said, it was far less blunted than any other ssri or antipsychotic. Desire was still there, just not as frequently as it used to be. I had desire maybe once or twice a week instead of every day. Anorgasmia was not bad at all, and sometimes the finish was actually too soon. I think prozac in my experience is about the friendliest of all the ssris when it comes to sex, or should I say, least offensive to sex. My doses were fairly low....20mg prozac 5mg zyprexa. I didn't really need Viagra, but discovered by accident when I tried it that sex was a lot better. It helped with both desire and execution. So for either a male or a female on antidepressants I am a fan of at least giving viagra a few trials in bed to see what happens.
Posted by tensor on February 5, 2012, at 8:42:08
In reply to Re: Zyprexa + fluoxetine, posted by bleauberry on February 5, 2012, at 7:17:06
> Right now I take rhodiola rosea, resveratrol made from polygonum, cod liver oil, and a very good vitamin/mineral. I do still need help and when it gets bad I rely on vicodin and/or ritalin to get me through the crisis. That happens but not on a regular basis. I am seriously thinking of taking on a new med, it has been several years without, but my choices are few.
>
> Sex on prozac+zyprexa was a bit blunted, as might be expected with any ssri or antipsychotic. That said, it was far less blunted than any other ssri or antipsychotic. Desire was still there, just not as frequently as it used to be. I had desire maybe once or twice a week instead of every day. Anorgasmia was not bad at all, and sometimes the finish was actually too soon. I think prozac in my experience is about the friendliest of all the ssris when it comes to sex, or should I say, least offensive to sex. My doses were fairly low....20mg prozac 5mg zyprexa. I didn't really need Viagra, but discovered by accident when I tried it that sex was a lot better. It helped with both desire and execution. So for either a male or a female on antidepressants I am a fan of at least giving viagra a few trials in bed to see what happens.
>
>I've tried almost all SSRIs and I must say escitalopram has the least interference with my sexlife, it feels very clean. Have had no problems with Seroquel nor Abilify but then again I have always taken Remeron with them, which is prosexual, atleast for me.
Ed meant I should stay on escitalopram because it could be as effective in combination with Zyprexa as fluoxetine, which I plan to do, if my pdoc is with me on this Zyprexa thing. Thanks for your input!
This is the end of the thread.
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