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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on December 4, 2013, at 8:59:11
In reply to Re: Safest tricyclics?, posted by Lamdage22 on December 4, 2013, at 3:37:28
> Thanks, i will keep that in mind.
>
> Its good to know that other SSRIs are still an option.
>Zoloft, Celexa and Lexapro have the fewest drug interactions amongst the SSRIs, which is useful if you're on multiple meds. Given your previous reaction to Zoloft, a low starting dose of any SSRI would be essential eg. Lexapro 5mg in the morning, or Celexa 10mg in the morning. You could even take less for the first few days if you prefer, just to make sure you're OK with it, and then increase up to a more normal dose over a period of a few weeks. No more than 40mg of Celexa or 20mg of Lexapro should be taken per day. Some people do take higher doses off-label, but it's not safe when you're on other drugs which may prolong the QT interval.
After an initial low starting dose, 'standard' therapeutic doses are 20mg Celexa or 10mg Lexapro, but individual adjustment may be needed. To be honest, it might be best not to exceed these doses while taking Seroquel, unless it's unavoidable. I do not think it would be a good idea to take either Celexa or Lexapro while still on two antipsychotics, since the effect on the QT interval may be additive. Once you've tapered off Zyprexa you have more options. It is possible (thought not entirely clear) than Lexapro may be slightly more effective than Celexa. It is unfortunately a lot more expensive, and not everyone prefers it. Overall, they are very similar meds.
Zoloft has no effect on the QT interval, but it sounds like you tolerated it badly so I guess it's a no-go.
Prozac and Paxil have very little, if any, cardiac effects, but they do have a lot of drug interactions which can make med combinations awkward. I do not believe that either of these drugs interact greatly with Seroquel, however. On the other hand, they do tend to cause slightly more side effects than Celexa or Lexapro.
Have you considered mirtazapine (Remeron)? It may be a useful AD. It does not appear to prolong the QT interval and it may improve depression and insomnia when coming off Zyprexa. You could consider starting Remeron after (very slowly) reducing your dose of Zyprexa.
Any idea what your doc thinks about all this? Stopping Zyprexa is a major event because there is a risk of relapse and withdrawal anxiety/insomnia.
Posted by Lamdage22 on December 5, 2013, at 2:10:03
In reply to Safest trycyclics?, posted by Lamdage22 on November 24, 2013, at 10:10:19
Im thinking about aurorix though after cymbalta.
Posted by Lamdage22 on December 5, 2013, at 4:25:22
In reply to Safest trycyclics?, posted by Lamdage22 on November 24, 2013, at 10:10:19
I read that paxil induces suicidality. I want it to do the opposite :(
Posted by phidippus on December 5, 2013, at 17:07:39
In reply to Safest trycyclics?, posted by Lamdage22 on November 24, 2013, at 10:10:19
Most TCAs are fine on the heart, but if large doses are applied, they can cause QT problems which can lead to death.
Posted by Lamdage22 on December 7, 2013, at 5:58:33
In reply to Re: Safest trycyclics? » Lamdage22, posted by phidippus on December 5, 2013, at 17:07:39
Since Sertraline worked instantly and remarkably, does that mean there is a good chance that another Ssri works as well?
Sertraline gave me horrible akathisia.
So far i had Effexor and it worked minimally. Currently im on Cymbalta and it doesnt work yet.
Posted by ed_uk2010 on December 8, 2013, at 2:03:15
In reply to Re: Safest trycyclics?, posted by Lamdage22 on December 5, 2013, at 2:10:03
> Im thinking about aurorix though after cymbalta.
Aurorix is a novel one. You'll need to wait until Cymbalta is fully out of your system before starting it, or else severe side effects will occur. Since Cymbalta is a short-acting drug, it is normally fully out of your body within 4 days after your very last dose. Your doctor may advise leaving a gap of one week for increased safety. Remember, the dose of Cymbalta often needs to be reduced gradually to prevent withdrawal symptoms.
Posted by ed_uk2010 on December 8, 2013, at 2:08:08
In reply to Paxil suicide thoughts, posted by Lamdage22 on December 5, 2013, at 4:25:22
> I read that paxil induces suicidality. I want it to do the opposite :(
This is nothing specific to Paxil. Some people react this way to all SSRIs and sometimes other ADs such as Effexor. The risk is much higher in children and moderate in people under the age of 25. It is much less common in people over 25, except that agitation can also in some bipolar or schizoaffective pts on antidepressants. You may have experienced this before with other meds.
People who suffer from anxiety may feel restless and agitated if the starting dose of an AD is too high. This is most common in people who have panic attacks, in which case the starting dose should be half the usual starting dose.
Of course, anyone can potentially react badly to any medication. It's not easy to predict. The best way is to avoid high initial doses of meds which you have not previously taken, especially if you are on other psych meds as well.
Posted by ed_uk2010 on December 8, 2013, at 2:13:42
In reply to Re: Safest trycyclics?, posted by Lamdage22 on December 7, 2013, at 5:58:33
> Since Sertraline worked instantly and remarkably, does that mean there is a good chance that another Ssri works as well?
What dose did you take and were you on other meds at the same time? High doses of sertraline are more likely to cause restlessness. 25mg is a suitable starting dose for anyone at risk.
Escitalopram (Lexapro/Cipralex) and citalopram (Celexa) seem to have a somewhat lower risk of 'overstimulation' than sertraline.
Since you've not responded well to Effexor and Cymbalta, Aurorix may turn out to work for you, since it works in a different way. Aurorix is not usually a very potent antidepressant, but it can work for some people. It does not prolong the QT interval.
I can't remember whether you said you'd tried mirtazapine (Remeron/Zispin)as an AD. This medication may work for you when SSRIs haven't. It does cause weight gain.... but less than Zyprexa!
Posted by Lamdage22 on December 8, 2013, at 3:10:32
In reply to Re: Safest trycyclics? » Lamdage22, posted by ed_uk2010 on December 8, 2013, at 2:13:42
Thanks Ed for your insight!
I am still trying Cymbalta.. im at half the effective dosage so it remains to be seem if i respond.
I thought about trying Paxil next and then Moclobemide.
Im concerned about Moclobemide pooping out.
Posted by ed_uk2010 on December 8, 2013, at 11:19:33
In reply to Re: Safest trycyclics?, posted by Lamdage22 on December 8, 2013, at 3:10:32
>I'm concerned about moclobemide pooping out.
There's always a risk but I'm not aware of a special problem with moclobemide.
Posted by Lamdage22 on December 9, 2013, at 4:35:36
In reply to Re: Safest tricyclics?, posted by ed_uk2010 on December 8, 2013, at 11:19:33
Moclobemide appears to be "effective for at least one year", just like ssri and tricyclics.
It sucks that it isnt more. But i will use 5-htp if it loses efficacy.
Posted by Lamdage22 on December 9, 2013, at 10:10:43
In reply to Re: Safest trycyclics?, posted by Lamdage22 on November 29, 2013, at 10:44:56
Seriously i have suicide thoughts almost 24/7. Chronic suicide thoughts.
It sucks. I wish the doctors would treat me more agressively with meds.
Cymbalta turned out to give me utter anorgasmia, so now well be headed for Remeron Paxil or Moclobemide.
Posted by ed_uk2010 on December 10, 2013, at 14:20:39
In reply to Re: Safest trycyclics?, posted by Lamdage22 on December 9, 2013, at 10:10:43
> Seriously i have suicide thoughts almost 24/7. Chronic suicide thoughts.
>
> It sucks. I wish the doctors would treat me more agressively with meds.
>
> Cymbalta turned out to give me utter anorgasmia, so now well be headed for Remeron Paxil or Moclobemide.Paxil causes anorgasmia frequently. Remeron and moclobemide do not.
Posted by Lamdage22 on December 11, 2013, at 3:19:11
In reply to Re: Safest trycyclics? » Lamdage22, posted by ed_uk2010 on December 10, 2013, at 14:20:39
Im scared of the Remeron withdrawal..
Posted by ed_uk2010 on December 12, 2013, at 15:01:18
In reply to Re: Safest trycyclics?, posted by Lamdage22 on December 11, 2013, at 3:19:11
>I'm scared of the Remeron withdrawal.
It can happen, but problems seem to be reported less frequently on stopping Remeron than with say.... Cymbalta, Effexor, Paxil or Zyprexa.
Moclobemide doesn't seem to be too bad in terms of withdrawal, but experience is limited.
Posted by Lamdage on December 13, 2013, at 0:52:04
In reply to Re: Safest trycyclics? » Lamdage22, posted by ed_uk2010 on December 12, 2013, at 15:01:18
What can i say. Im sitting here, been awake since 5:30. Im on Remeron now.
And i feel some normal already. This whole Nardil thing.. while it was fun in the beginning, it wasnt necessarily ME. I did some crazy *ss stuff and some embarassing stuff as well in the past 3 years.
Now after 3 nights of 7.5 and one with 15mg i feel better. I no longer want to die.. i want to proceed with my life. It wont be easy but i will have the support of a rehab place. Not drug rehab but rehab from hospitalization. The place is made for folks who no longer require hospitalization but need a step in between hospital and "normal life" to get there.
> >I'm scared of the Remeron withdrawal.
>
> It can happen, but problems seem to be reported less frequently on stopping Remeron than with say.... Cymbalta, Effexor, Paxil or Zyprexa.
>
> Moclobemide doesn't seem to be too bad in terms of withdrawal, but experience is limited.
>
>
Posted by Lamdage on December 13, 2013, at 1:00:22
In reply to Feeling somewhat more normal on Remeron now, posted by Lamdage on December 13, 2013, at 0:52:04
New signature.
Remeron to be upped until blood level is right in therapeutic level.
Seroquel is in therapeutic level.
Zyprexa is to be discontinued and is already below therapeutic range.
Long term: Seroquel is to be reduced to, say, 400mg or 300mg.Thanks for the support. I hope i indirectly help some other folks, too as they will google the responses.
I have been very busy with my own plight. But i like this place and i will stay around.
> What can i say. Im sitting here, been awake since 5:30. Im on Remeron now.
>
> And i feel some normal already. This whole Nardil thing.. while it was fun in the beginning, it wasnt necessarily ME. I did some crazy *ss stuff and some embarassing stuff as well in the past 3 years.
>
> Now after 3 nights of 7.5 and one with 15mg i feel better. I no longer want to die.. i want to proceed with my life. It wont be easy but i will have the support of a rehab place. Not drug rehab but rehab from hospitalization. The place is made for folks who no longer require hospitalization but need a step in between hospital and "normal life" to get there.
>
>
> > >I'm scared of the Remeron withdrawal.
> >
> > It can happen, but problems seem to be reported less frequently on stopping Remeron than with say.... Cymbalta, Effexor, Paxil or Zyprexa.
> >
> > Moclobemide doesn't seem to be too bad in terms of withdrawal, but experience is limited.
> >
> >
>
>
Posted by SLS on December 13, 2013, at 6:31:08
In reply to Re: Feeling somewhat more normal on Remeron now, posted by Lamdage on December 13, 2013, at 1:00:22
Good luck, Lamdage! I hope you found your magic potion. In the future, should you need to make a change, you might try drugs with pro-norepinephrine (NE) effects. Remeron + TCA might work. The TCA would substitute for the Seroquel (quetiapine). It turns out that the Seroquel metabolite, norquetiapine, has NE reuptake inhibition properties similar to TCA that the parent molecule does not. Nortriptyline would be my choice to switch to because, like Seroquel, it acts as an antagonist to 5-HT2a receptors in addition to NE reuptake inhibition.
If it ain't broken, don't fix it...
- Scott
Posted by ed_uk2010 on December 13, 2013, at 14:26:51
In reply to Feeling somewhat more normal on Remeron now, posted by Lamdage on December 13, 2013, at 0:52:04
Excellent. Glad to hear you're feeling better. But beware of one thing, Zyprexa should be reduced very slowly. Do not make the mistake of assuming that stopping a 'subtherapeutic dose' will be uneventful, Zyprexa is a powerful medication and the process must still be gradual. The daily dose is best reduced in steps of 2.5mg every few weeks until you reach 2.5mg per day. You may then wish to cut the 2.5mg tablets in order to reduce more gradually before stopping altogether. If you feel unwell at any stage, increase the dose by 2.5mg and contact your doctor. If you do it this way, you will probably be fine :)
Posted by Lamdage22 on December 15, 2013, at 7:37:46
In reply to Re: Feeling somewhat more normal on Remeron now » Lamdage, posted by ed_uk2010 on December 13, 2013, at 14:26:51
So im back to were i was before Remeron.
I really want to take Parnate again, with 700mg Seroquel and Solian perhaps.
As long as the Antipsychotics dont induce depression (Abilify, Seroquel, Solian), then i feel fine to use them to balance away Parnates Dopamine effect.
F*ck, one Psychiatrist wanted to force me onto 600mg Seroquel and 40mg Parnate perhaps. I left the hospital.
And guess what im still in hospital unable to live alone or work.
I will talk to my dr today to get me back on MAOI street. Mocblobemide and if that fails Parnate.
Posted by Lamdage22 on December 15, 2013, at 8:00:34
In reply to Effect gone, posted by Lamdage22 on December 15, 2013, at 7:37:46
Im so pissed off the Psychiatrists cant simply do as i say.
Like 5 month ago i could have been on Jatrosom and high dose Seroquel. I gained two pounds a day though. I wanted metformin, didnt get it. Doctor said no.
I left.
Why does my life have to wait until a damn Psychiatrist does the right thing EVENTUALLY????
WTF man.
Posted by Lamdage22 on December 15, 2013, at 8:02:39
In reply to Re: Effect gone, posted by Lamdage22 on December 15, 2013, at 8:00:34
Im going to invent side effects until i get what i want.
F*ck!!!
Posted by ed_uk2010 on December 15, 2013, at 9:52:35
In reply to Effect gone, posted by Lamdage22 on December 15, 2013, at 7:37:46
>So im back to were i was before Remeron.
You need to give it a couple of weeks before you can expect any consistency of effect.
As far moclobemide, it's not very potent compared with the likes of Parnate. Fewer side effects. Could be worth a try but you should probably give Remeron a chance, unless you really do experience some side effects of course.
Posted by ed_uk2010 on December 15, 2013, at 9:54:02
In reply to Im going to invent SE to get a damn MAOI, posted by Lamdage22 on December 15, 2013, at 8:02:39
> Im going to invent side effects until i get what i want.
>
> F*ck!!!Why not try 2 weeks on 30mg and see if you're any better? Take each day at a time, because you will not feel good every day at this stage. If there's no improvement after 2 weeks, reconsider your treatment.
Posted by Lamdage22 on December 15, 2013, at 13:59:25
In reply to Re: Im going to invent SE to get a damn MAOI, posted by ed_uk2010 on December 15, 2013, at 9:54:02
I have suicide thoughts, BAD nighmaires, agression and sedation.
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Dr. Bob is Robert Hsiung, MD,
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