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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 SpratNZ on January 11, 2014, at 3:52:25
Short history - agoraphobia for 25 years - treated really well with SSRIs - except they keep pooping out on me after about 3 years. Escitalopram has just done that, so I've done all the SSRIs now. My PDoc wants to add in an anti-psychotic which I'm REALLY not keen on. And benzos just make me want to nap all the time. (Which was fine when I was in an office job, but not great when you're at home with a 3 year old). I'm wondering if perhaps adding in a different AD (like a tricyclic, or Remeron) would help - has anyone had success with this kind of combo? Am seeing my pdoc in a week so will talk with him about it then.
Thx
Sprat
Posted by bleauberry on January 11, 2014, at 5:52:58
In reply to Combining SSRI with alt AD after poop-out?, posted by SpratNZ on January 11, 2014, at 3:52:25
Antipsychotics are a good idea to revive a pooped out ssri, especially either abilify or zyprexa. Zyprexa brought new life to my prozac some years ago and lasted 8 years total.
The best way to keep an ssri going, in my opinion anyway, just based on my own observations, is to add a TCA antidepressant.
Nortriptyline is usually a first choice. Desipramine possible.Savella sort of does the same thing, all in one, but I prefer the multi-angle multi-mechanism approach of the SSRI+TCA better, because I believe it has the potential to be more thorough, and you can adjust the doses of both sides of the equation separately.
Anyway, poop out is a common problem and I am really sorry you are experiencing that. 25 years in 3 year chunks. Not bad. You did pretty good actually compared to some other people. I think once you decide what to do you will get some more good years. I'm not sure there is any way to totally prevent poop out, because our brains are constantly changing, in motion, not static, and the genes are always going to attempt to do what their original instructions were, which is going to involve somehow undoing whatever the med molecule is doing. It's a foreign uninvited intruder as far as the genes are concerned.
Some people have gone 10 years or more on either zoloft or prozac, so poop out doesn't always happen.
Posted by Phillipa on January 11, 2014, at 9:26:31
In reply to Combining SSRI with alt AD after poop-out?, posted by SpratNZ on January 11, 2014, at 3:52:25
How high a dose of benzos were you on and for how long? Phillipa
Posted by Christ_empowered on January 11, 2014, at 10:19:30
In reply to Re: Combining SSRI with alt AD after poop-out? » SpratNZ, posted by Phillipa on January 11, 2014, at 9:26:31
There are numerous combo strategies. Right now, pdocs are pushing atypials on people.
There's also: buspar, pindolol, lithium, stimulants (probably not for you, lol), TCAs, Remeron, Wellbutrin, etc.
So, yeah, you can add in a TCA. You have to be careful. TCAs can turn toxic if you mix with the wrong ssri because of serotonin syndrome and increased blood levels from drug-drug interactions.
Have you tried Lyrica? Its supposed to be the non-benzo benzo or something. A lot like Neurontin, but better (no, really!). Its approved in the EU for anxiety.
I would think that a low dose of zyprexa or maybe Seroquel/Seroquel xr would help, but...I'm not your doc.
I know what you mean about not wanting an AP. I'd recommend that you take antioxidants to prevent TD and watch out for metabolic issues. Also, try to keep the dose low, if you can. Probably easier with Seroquel (lower potency, so you have more room to adjust your dosage) than with the more potent AP drugs.
Have you tried BuSpar? I'm not doc, obviously, but it does boost antidepressants and it can help with anxiety. I don't think there's a significant TD risk, and its very cheap.
Also...get ready for this...Orthomolecular! I push it on everybody. Really helped me. High dose of niacin or niacinamide act kinda sorta like benzos, without too much sedation or cognitive impairment. The B3 has to be mixed with high dose C and a b complex. Taurine also helps some people with anxiety, and its quite cheap.
Oh...and...Surmontil just popped into my mind. Its a weird TCA. Supposed to be soothing.
Anyway, good luck to you!
Posted by SpratNZ on January 11, 2014, at 13:00:48
In reply to Re: Combining SSRI with alt AD after poop-out? » SpratNZ, posted by Phillipa on January 11, 2014, at 9:26:31
I can't remember how much I was on of klonopin in the past, but at the moment I'm on 1.25mg and I've been on that for about 6 weeks.
Posted by SpratNZ on January 11, 2014, at 14:03:15
In reply to Re: Combining SSRI with alt AD after poop-out?, posted by bleauberry on January 11, 2014, at 5:52:58
Thanks for the info bleauberry - I should clarify that whilst I've agorahobia for 25 years, I've only been on meds for 15 years. Paxil, citalopram and escitalopram all worked well, but pooped out. The other SSRIs didn't work at all for me.
Posted by SLS on January 11, 2014, at 14:41:51
In reply to Re: Combining SSRI with alt AD after poop-out? » bleauberry, posted by SpratNZ on January 11, 2014, at 14:03:15
> Thanks for the info bleauberry - I should clarify that whilst I've agorahobia for 25 years, I've only been on meds for 15 years. Paxil, citalopram and escitalopram all worked well, but pooped out. The other SSRIs didn't work at all for me.
Do you have panic attacks?
What about imipramine or Effexor? I'm sure you know that, before the advent of SSRIs, imipramine was the standard first line drug for treating agoraphobia with panic attacks. It has a lower risk of poop-out than the SSRIs.
- Scott
Posted by SpratNZ on January 11, 2014, at 18:49:43
In reply to Re: Combining SSRI with alt AD after poop-out? » SpratNZ, posted by SLS on January 11, 2014, at 14:41:51
> > Thanks for the info bleauberry - I should clarify that whilst I've agorahobia for 25 years, I've only been on meds for 15 years. Paxil, citalopram and escitalopram all worked well, but pooped out. The other SSRIs didn't work at all for me.
>
> Do you have panic attacks?
>
> What about imipramine or Effexor? I'm sure you know that, before the advent of SSRIs, imipramine was the standard first line drug for treating agoraphobia with panic attacks. It has a lower risk of poop-out than the SSRIs.
>
>
> - Scott
Yes I do get panic attacks. I have tried imipramine, it didn't really work but I suspect I was still going through paxil withdrawal at the time. And I was going to suggest to my pDoc effexor, i think it's a good possibility.Thanks
Sprat
Posted by Phillipa on January 11, 2014, at 21:28:23
In reply to Re: Combining SSRI with alt AD after poop-out? » Phillipa, posted by SpratNZ on January 11, 2014, at 13:00:48
Would your pdoc try Xanax instead? Has also a slight antidepressant effect. Short acting. Try .25mg first. I would find 1.5mg of klonopin also very sedating. Phillipa
Posted by SpratNZ on January 12, 2014, at 0:23:29
In reply to Re: Combining SSRI with alt AD after poop-out? » SpratNZ, posted by Phillipa on January 11, 2014, at 21:28:23
> Would your pdoc try Xanax instead? Has also a slight antidepressant effect. Short acting. Try .25mg first. I would find 1.5mg of klonopin also very sedating. Phillipa
Would honestly prefer to avoid benzos altogether - esp short acting ones like Xanax. The thought of being somewhere and not having my mid-day dose with me whilst the morning one wears off freaks me out.
Posted by SpratNZ on January 12, 2014, at 0:26:12
In reply to Re: Combining SSRI with alt AD after poop-out?, posted by Christ_empowered on January 11, 2014, at 10:19:30
> There are numerous combo strategies. Right now, pdocs are pushing atypials on people.
>
> There's also: buspar, pindolol, lithium, stimulants (probably not for you, lol), TCAs, Remeron, Wellbutrin, etc.
>
> So, yeah, you can add in a TCA. You have to be careful. TCAs can turn toxic if you mix with the wrong ssri because of serotonin syndrome and increased blood levels from drug-drug interactions.
>
> Have you tried Lyrica? Its supposed to be the non-benzo benzo or something. A lot like Neurontin, but better (no, really!). Its approved in the EU for anxiety.
>
> I would think that a low dose of zyprexa or maybe Seroquel/Seroquel xr would help, but...I'm not your doc.
>
> I know what you mean about not wanting an AP. I'd recommend that you take antioxidants to prevent TD and watch out for metabolic issues. Also, try to keep the dose low, if you can. Probably easier with Seroquel (lower potency, so you have more room to adjust your dosage) than with the more potent AP drugs.
>
> Have you tried BuSpar? I'm not doc, obviously, but it does boost antidepressants and it can help with anxiety. I don't think there's a significant TD risk, and its very cheap.
>
> Also...get ready for this...Orthomolecular! I push it on everybody. Really helped me. High dose of niacin or niacinamide act kinda sorta like benzos, without too much sedation or cognitive impairment. The B3 has to be mixed with high dose C and a b complex. Taurine also helps some people with anxiety, and its quite cheap.
>
> Oh...and...Surmontil just popped into my mind. Its a weird TCA. Supposed to be soothing.
>
> Anyway, good luck to you!
Lyrica is an anti-convulsant right? My Pdoc tried adding on sodium valproate to my SSRI and it made things a LOT worse - which is weird because there shouldn't be any interaction between the meds. But that shouldn't rule out all anti-convulsants should it?sprat
Posted by jono_in_adelaide on January 12, 2014, at 4:11:26
In reply to Combining SSRI with alt AD after poop-out?, posted by SpratNZ on January 11, 2014, at 3:52:25
I would start by adding notriptyline, start with 25mg at bedtime, and increase to 75-150mg depending on blood levels and response
Remeron would also be an option, it can be extremely effective, but it can be quite sedating initially.
This is the end of the thread.
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