Posted by bleauberry on January 23, 2010, at 18:34:54
In reply to I'm on Zoloft and Symbyax-questions/concerns, posted by morganator on January 23, 2010, at 1:51:28
I found the combination of prozac and zyprexa to be quite good, keeping me pretty well for almost 8 years. Not quite remission, but close. Certainly no depression at all, just some mild to moderate ssri apathy stuff. The addition of one pill of adrafinil fixed a lot of that though nothing ever worked completely. If you don't get complete satisfaction with what you are doing, I would try adding modafinil. And if that didn't work, then ritalin. Ritalin and prozac go real well together, and zyprexa smooths out any rough edges.
Prozac and zoloft are different. Prozac has some serotonin receptor antagonism which stimulates increased dopamine and norepinephrine. Zoloft has unknown effects on the sigma-1 receptors, and very weak effect as a dopamine reuptake inhibitor. The mechanisms are basically the same, but with some unique differences.
The combination of prozac and zyprexa significantly increases dopamine and norepinephrine (up to 300%), while not increasing serotonin much more than prozac alone. It has been tested for treatment resistant depression. I am a fan of prozac+zyprexa and am stumped why it is not used more often than it is.
Serotonin syndrome toxicity is a risk even with ssri monotherapy, and of course more so when multiple serotonin agents of differing mechanisms are combined. In your case, the mechanisms of zoloft and prozac are not that much different, so I wouldn't suspect a high risk.
Whatever works. Eventually weaning off zoloft sounds like a reasonable plan.
If your continuing symptoms are in the apathy/motivation department, then addition of a noradrenergic agent would be a good choice...savella, nortriptyline, ritalin, maybe modafinil.
You mentioned 3 mg zyprexa. I think the pubmed studies that showed the NE/DA increases used 5mg and 10mg. I personally found 5mg to be right, anything less was not enough. Prozac 20mg.
I like the idea of taking prozac and zyprexa separately so you can have control over the doses of each. With symbyax you can't do that. The advantage of symbyax is that it forces your insurance company to give you brand name prozac, which is what is in symbyax. If you get prozac serparately, I've seen plenty of accounts, including myself, of generic prozac being crap, changing a response into deterioration. So no matter what you do...insist on brand prozac.
poster:bleauberry
thread:934761
URL: http://www.dr-bob.org/babble/20100122/msgs/934804.html