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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by incessant void on September 9, 2004, at 4:33:01
Hi I just joined the boards here. I've seen a lot of archived posts linked to from various other websites/threads but have finally got around to registering. I know that no one can tell me what meds are right for me, etc etc. but I am just asking for the intelligent and experienced opinions of those of you who have been on many anti-depressants.
Currently my med regime (excluding anything non-psych-related) is as follows:
Prozac 140mg - 1x daily
Adderall 20mg - 4x daily
Trazodone 150mg - 1x daily*
Neurontin 600mg - 1x daily before bed
Ambien 30mg - 1x daily before bed***I am thinking of discontinuing this as I notice no response -- often I forget to take it and when I do I feel the same as I do if I remember to take it...
**Doc just switched me to Seroquel to see if it helped me sleep better than Ambie, but I haven't started it yet.
I've been in Prozac for the past 8 months. It's my second trial of Prozac actually, but the first time I was never above 40mg before quitting so thought I would give it a proper trial this time... got up to 100mg rather quickly (3 weeks) and was at that dose for 2 months before moving up to 120, and then 140. I have been at this dose (140mg/day) for the past 3 months. My depression (it's been ongoing for the last 6 years) has only gotten worse, especially lately, and I'm wondering if I should can the Prozac since I seem to be at the max dosage, or very close to it, with no help. It seemed to help me a little when I was at 100mg, but the effects were short-lived, hence the increase. Also I think that was related to a change in atmosphere that was a positive one for me (a past hospitalization).. and not so much the drugs I was on at the time.
The Adderall is prescribed for ADD, which I have the inattentive, non-hypractive type. My (undiagnosed until adulthood) ADD lead to depression, which then lead to an eating disorder (anorexia purging type). Currently though I'd say depression and ADD are more the issue than the E.D. as it's pretty much under control, but the more depressed I get, the more it has a tendency to flare-up.
I've been on Effexor (up to 450mg before I decided to go off it because I was left even more emotionally numb than before and that lead to severe worsening of my eating disorder), Paxil (no response), Zoloft (couldn't tolerate it; was constantly nauseous), Celexa & Lexapro (also no response). I have not tried Wellbutrin yet, which I might respond to, but my doctor will not prescribe it because of my eating disorder, fearing that it may get bad again (tho it is not at the moment).
Sorry for the length of this post. I'm terrible at getting my point across... basically I am just wondering if my thoughts that it's time to try something else (and my thinking is NOT another SSRI) are valid or not...
Should I try a TCA? Would it be premature to try an MAOI? I've read the dietary limitations and think I could follow that very easily. I just feel like I can't wait another year or more of trying meds that are getting me nowhere. I feel so hopeless. I don't know why I've hung on at all to be honest. I've got nothing to show for it. The worst feeling I think is knowing that no one in my family understands how horrible I feel every day, and instead just thinks I am lazy.
Any response is appreciated.
Posted by Bill LL on September 9, 2004, at 9:40:18
In reply to Prozac 140mg - no improvement - time to switch?, posted by incessant void on September 9, 2004, at 4:33:01
You said that you were terible at getting your point across, but actually you were very good at it. You gave a lot of information in a clear fashion.
Maybe you are right about stopping the trazodone. I think that very few people use it for depression, mainly just for sleep. I think that the dose for depression is a lot higher than 150 mg, and even then it doesn't usually work as well as other antidepressants.
I'm wondering if Provigil (modafinil) would be a good choice for you.
As for the Prozac, I would probably start to think of replacing it with something else. There is a promising new antidepressant that just went on the market called Cymbalta (duloxetine).
Shock therapy is a great option for people who are not helped by medications. Here is some information I pasted from the following website:
http://holisticonline.com/Remedies/Depression/dep_treatment_ECT.htm
"Electro Convulsive Therapy (ECT)
Electro Convulsive therapy (ECT or shock therapy) involves the application of an electric shock of about 80 volts passed through electrodes placed on the head. The shock is not felt by the patient, who is under anesthesia. Despite a bad reputation, ECT is a safe and effective therapy for depression. The patient avoids side effects that are frequently encountered with antidepressants, although amnesia and/or dizziness and confusion are possible. Many people who cannot tolerate any other form of treatment may respond well to ECT.ECT is especially useful for psychotic mood disorders, people who need a really fast response, medication nonresponders, and for those who cannot tolerate antidepressant medication. ECT is indicated when rapid results are vital, as with suicidal patients or those who refuse to eat or drink. ECT has a higher response rate (80 to 90 percent versus the 65 to 70 percent achieved by medication combinations) and also works more rapidly.
Often, ECT is a treatment of last resort when nothing else works."
Posted by King Vultan on September 9, 2004, at 9:53:04
In reply to Prozac 140mg - no improvement - time to switch?, posted by incessant void on September 9, 2004, at 4:33:01
Your dosages of Prozac and Ambien are extremely high; AFAIK, the recommended maximums for each drug are 80 mg/day and 10 mg/day respectively. If the Ambien doesn't work at 10 mg/day, my thought would have been to try something else rather than increase the dosage beyond 10. The same would be true of the Prozac at 80 mg/day, but I am not a doctor.
Yes, a TCA might be worth trying, particularly, considering that you would have a very long wait before being able to go on an MAOI. Your dosage of Prozac is so high, and this drug has such a long half life that you would probably want to wait six to eight weeks in between the last dose of Prozac and the first of an MAOI to avoid any chance of suffering serotonin syndrome. It would probably be more expedient to try a tricyclic, which would involve less of a wait. The two that are often recommended are nortriptyline or desipramine because these have the fewest side effects in the tricyclic class. Nortriptyline is the one that my pdoc tends to favor in certain cases where a person hasn't responded well to the SSRIs or Effexor. This is a moderately sedating drug that is selective for blocking norepinephrine reuptake. Desipramine is more activating, with an even stronger effect on norepinephrine. Either one might be worth considering.
Todd
Posted by irishcatholic on September 9, 2004, at 11:51:22
In reply to Prozac 140mg - no improvement - time to switch?, posted by incessant void on September 9, 2004, at 4:33:01
That's a stout dose, and I guess it just shows how different we all are.
20 mg Proz every other day is enough to keep me on the "turbo" setting, with some Xanax XR thrown in at night.
Posted by sexylexy on September 9, 2004, at 12:57:58
In reply to Prozac 140mg - no improvement - time to switch?, posted by incessant void on September 9, 2004, at 4:33:01
Hi All!
I just went and my OBGYN who is also an Endinochronogilst. I wanted some help with my crazy hormones and was wondering about the weight gain from Lexapro. The Dr. asked me if I would try Sarafem which is just prozac colored in pink and purple.
I have seen ok results with the lexapro but am ready to kick this depression once and for all...I do however, have anxiety problems and wonder if the prozac will help that too???
Anyone out there a prozac fan????Thanks!!!
Lexy
Posted by 4WD on September 9, 2004, at 21:00:09
In reply to Prozac 140mg - no improvement - time to switch?, posted by incessant void on September 9, 2004, at 4:33:01
> Hi I just joined the boards here. I've seen a lot of archived posts linked to from various other websites/threads but have finally got around to registering. I know that no one can tell me what meds are right for me, etc etc. but I am just asking for the intelligent and experienced opinions of those of you who have been on many anti-depressants.
>
> Currently my med regime (excluding anything non-psych-related) is as follows:
>
> Prozac 140mg - 1x daily
> Adderall 20mg - 4x daily
> Trazodone 150mg - 1x daily*
> Neurontin 600mg - 1x daily before bed
> Ambien 30mg - 1x daily before bed**
>
> *I am thinking of discontinuing this as I notice no response -- often I forget to take it and when I do I feel the same as I do if I remember to take it...
>
> **Doc just switched me to Seroquel to see if it helped me sleep better than Ambie, but I haven't started it yet.
>
> I've been in Prozac for the past 8 months. It's my second trial of Prozac actually, but the first time I was never above 40mg before quitting so thought I would give it a proper trial this time... got up to 100mg rather quickly (3 weeks) and was at that dose for 2 months before moving up to 120, and then 140. I have been at this dose (140mg/day) for the past 3 months. My depression (it's been ongoing for the last 6 years) has only gotten worse, especially lately, and I'm wondering if I should can the Prozac since I seem to be at the max dosage, or very close to it, with no help. It seemed to help me a little when I was at 100mg, but the effects were short-lived, hence the increase. Also I think that was related to a change in atmosphere that was a positive one for me (a past hospitalization).. and not so much the drugs I was on at the time.
>
> The Adderall is prescribed for ADD, which I have the inattentive, non-hypractive type. My (undiagnosed until adulthood) ADD lead to depression, which then lead to an eating disorder (anorexia purging type). Currently though I'd say depression and ADD are more the issue than the E.D. as it's pretty much under control, but the more depressed I get, the more it has a tendency to flare-up.
>
> I've been on Effexor (up to 450mg before I decided to go off it because I was left even more emotionally numb than before and that lead to severe worsening of my eating disorder), Paxil (no response), Zoloft (couldn't tolerate it; was constantly nauseous), Celexa & Lexapro (also no response). I have not tried Wellbutrin yet, which I might respond to, but my doctor will not prescribe it because of my eating disorder, fearing that it may get bad again (tho it is not at the moment).
>
> Sorry for the length of this post. I'm terrible at getting my point across... basically I am just wondering if my thoughts that it's time to try something else (and my thinking is NOT another SSRI) are valid or not...
>
> Should I try a TCA? Would it be premature to try an MAOI? I've read the dietary limitations and think I could follow that very easily. I just feel like I can't wait another year or more of trying meds that are getting me nowhere. I feel so hopeless. I don't know why I've hung on at all to be honest. I've got nothing to show for it. The worst feeling I think is knowing that no one in my family understands how horrible I feel every day, and instead just thinks I am lazy.
>
> Any response is appreciated.Hi. I definitely think that after no response on 140mg of Prozac for eight months it is time to switch. You could try Cymbalta if you live in the U.S. I recently switched from Effexor to Cymbalta partly because I hated the emotional numbness from Effexor. So far the Cymbalta isn't causing that.
I also have an eating disorder which is currently in remission (bulimia - binge and purge). Effexor helped with that (though not as much as Celexa). I've been on Cymbalta for a week now and am not feeling any urge to binge. If I can help you in any way, please let me know and I will give you my email address. There are a few of us here on this board with the depression/eating disorder combo and we can help each other.
I agree with you about people not understanding. Even people who *should* understand simply do not have the ability to know what depression/compulsion feels like.
All my best wishes,
Marsha
Posted by Joy on September 10, 2004, at 13:39:26
In reply to Prozac?, posted by sexylexy on September 9, 2004, at 12:57:58
Hi,
I find Prozac to work very well for me [40 mgs a day in my case] but I still get anxiety sometimes and then take .5 mgs of Xanax [alazopram] which works well. I have found Prozac to have the least side effects, and the generic works well. My husband takes the same dose of Prozac and it has totally cleared his thinking. I do take .5 mgs Xanax for sleeping, and rarely need a daytime dosage; but Prozac has really helped with depression. Regards,
Joy
Posted by Daisy Elizabeth on September 10, 2004, at 19:21:42
In reply to Prozac 140mg - no improvement - time to switch?, posted by incessant void on September 9, 2004, at 4:33:01
I don't know if your pdoc has brought this up with you, but sometimes higher doses of meds, such as Prozac, can actually make you feel MORE depressed. I experienced this myself w/ Prozac (I was taking it along w/ Wellbutrin and Neurontin). I was pretty depressed at 30 mg, so we went to 40 and I was worse, and then to 50 and i became so out of it and depressed.
Also, about the Neurontin, my understanding is that usually you have to take it about 3x/day b/c it moves through your system very quickly. I think you said that you just take it at night?
Hope that this is helpful!
Posted by incessant void on September 11, 2004, at 21:58:42
In reply to Re: Prozac 140mg - no improvement - time to switch?, posted by Daisy Elizabeth on September 10, 2004, at 19:21:42
thanks to everyone for the kind and helpful replies. i wish i had checked the board sooner but just didn't feel up to it, like everything else. i realized now, re-reading my post, that i made a mistake in my medications. i am NOT taking 150mg of trazodone -- i meant to say topamax. i used to be on trazodone for sleep and have no idea why i wrote that *rolls eyes* maybe being awake for 2 days had my confused. anyway sorry about that. thanks again for all the help. i hope i can try an MAOI soon. this is a long post because there are individual notes to people:
*Bill LL -- thank you for understanding my long explanations :) i think i should post more at this board; people seem to be more clear (which to me requires more length) than at other message boards where a long post would just be skipped. i would definitely agree that trazodone should be discontinued if was on 150mg!! i am a zombie as it is, and that dosage knocks me out... a horrible pdoc once put me on 200mg to sleep at night while i was in residential treatment, and i had a horrible "panic-attack-like" episode as a result -- heart rate in the 150s, blood pressure dropped to the 80s systolic -- thought i was going to die! FYI this doc was at rogers memorial hospital and if anyone want's his name i'd be happy to supply it ;)
i also have considered provigil, but was thinking i would most likely experience the tolerance that many people are having with it. i was thinking it would probably be just like the stimulants for me that require higher and higher dosages to have any reaction. why am i so apt at becoming tolerant to things?! i seem to build tolerance for everything and huge dosages of things don't affect me as they should. i'm a rather small person which is even weirder...
i've read scott's cymbalta thread and am afraid to go on it due to the sleepiness. i really need a stimulating drug which is why i want to try parnate. i've also been thinking a lot about ECT. thank you for that link. i was thinking that most doctors would want to try me on more meds before doing ECT though. what do you think?
*King Vultan -- i have heard that 80mg is the "maximum" dose of prozac but that it was the highest *suggestion* of a "therapeutic dose" and have seen posts suggesting the max is more like 160mg. i didn't give a thought to going above 100mg because i had 3 different doctors keep me on 100mg or more without a word on 80 being the max. but i wish they hadn't, because i could have been switched a long time ago instead of wasting all this time. like i said to Bill LL i seem to have such a high tolerance to drugs and i'm thinking that is why i can be on so much prozac and literally not notice when i take it and when i don't. i can stop it cold-turkey without any side effects of withdrawl. i could do the same with effexor, 450mg, which i have seen so many posts on this board about terrible withdrawl -- i left my meds at home once on a trip and had to go cold-turkey. i only got moderate headaches that advil cured. considering all this, would i really have to wait 6-8 weeks, after stopping prozac completely (didn't even take it today), to try an MAOI? that is so disappointing... i can't imagine having a problem with serotonin syndrome because it doesn't even seem to be affecting me. the prozac, that is. how long would i have to wait to go on desipramine? i really need a drug that is not at all sedating.
*irishcatholic -- i wish i were more med-sensitive like you are... "turbo setting" from prozac, 20mg?! i wish! i can take it right before i go to sleep lol.
*sexylexy -- well, obviously, i am not a prozac "fan" but the drug has helped many other people. i wouldn't want to tell you to try it or not try it, just based on my experience.
*4WD -- thanks marsha for the suggestion. are you experiencing the sedating effects from cymbalta? i was so emotionally numb on effexor, too. well, that is the only way i can describe it, but it was sort of different... it's funny that you had such relief from bulimia while on it, because for me, i went from anorexia with moderate purging to full-blown bulimia symptoms while on effexor. thank you for being so open. i understand bulimia well as i often exhibit all the symptoms, but the docs like to generalize everything into "anorexia" no matter what symptoms i am having that week/month. bulimia is even harder to have, in my opinion, because people understand it even less and think you can "just stop" -- SO FRUSTRATING.
*Joy -- thanks. i agree about side effects; i have had none from the beginning except this excessive yawning problem.
*Daisy Elizabeth -- maybe you became more depressed on prozac at a higher dosage because it wasn't the right drug for you, like me? i get the same response from 20mg as i do from 140.
Posted by sexylexy on September 13, 2004, at 11:43:42
In reply to Re: Prozac? » sexylexy, posted by Joy on September 10, 2004, at 13:39:26
Joy!
Thanks for the input, I took about 10mg yesterday and did not have any side effects at all so will try moving to 20 on Wendesday. Strangely, I woke today feeling better than I had in sometime, realizing I was not thinking about what mood I was in...I have been on lexapro since January of 04 and felt better but never "forgot" what depression felt like or "forgot" to think about what mood I was in..Anyway, I am praying this is the one that will get me over the hump!
keep in touch!
Lexy
Posted by flipsactown on September 13, 2004, at 19:04:56
In reply to Prozac 140mg - no improvement - time to switch?, posted by incessant void on September 9, 2004, at 4:33:01
I have also taken 140mg of Prozac which is 60mg greater than recommended 80mg max dose, but my pdoc would only RX 100mg which pooped out after 7 years. I had taken 80mg Prozac for 2 years and after that my pdoc added Desipramine. I had taken various combos of Prozac with Wellbutrin, Remeron, Lamictal and Lithium. I had also taken Zoloft in combo with the above AD's. Other AD's I have taken were Celexa, Paxil, Elavil and Effexor.
I decided that I needed to change AD's and my pdoc agreed and since I wanted to try something totally different, I started taking Nardil, an MAOI. Nardil worked in relieving my depression, but after 3 months of being unable to sleep, I asked my pdoc to switch me to Lexapro. Currently, I am depression (unipolar, no mania)free. It took 45 days for Lex to kick in, but when it kicked in, I was as depression free as I was when I first took Prozac 11 years ago.
FST
> Hi I just joined the boards here. I've seen a lot of archived posts linked to from various other websites/threads but have finally got around to registering. I know that no one can tell me what meds are right for me, etc etc. but I am just asking for the intelligent and experienced opinions of those of you who have been on many anti-depressants.
>
> Currently my med regime (excluding anything non-psych-related) is as follows:
>
> Prozac 140mg - 1x daily
> Adderall 20mg - 4x daily
> Trazodone 150mg - 1x daily*
> Neurontin 600mg - 1x daily before bed
> Ambien 30mg - 1x daily before bed**
>
> *I am thinking of discontinuing this as I notice no response -- often I forget to take it and when I do I feel the same as I do if I remember to take it...
>
> **Doc just switched me to Seroquel to see if it helped me sleep better than Ambie, but I haven't started it yet.
>
> I've been in Prozac for the past 8 months. It's my second trial of Prozac actually, but the first time I was never above 40mg before quitting so thought I would give it a proper trial this time... got up to 100mg rather quickly (3 weeks) and was at that dose for 2 months before moving up to 120, and then 140. I have been at this dose (140mg/day) for the past 3 months. My depression (it's been ongoing for the last 6 years) has only gotten worse, especially lately, and I'm wondering if I should can the Prozac since I seem to be at the max dosage, or very close to it, with no help. It seemed to help me a little when I was at 100mg, but the effects were short-lived, hence the increase. Also I think that was related to a change in atmosphere that was a positive one for me (a past hospitalization).. and not so much the drugs I was on at the time.
>
> The Adderall is prescribed for ADD, which I have the inattentive, non-hypractive type. My (undiagnosed until adulthood) ADD lead to depression, which then lead to an eating disorder (anorexia purging type). Currently though I'd say depression and ADD are more the issue than the E.D. as it's pretty much under control, but the more depressed I get, the more it has a tendency to flare-up.
>
> I've been on Effexor (up to 450mg before I decided to go off it because I was left even more emotionally numb than before and that lead to severe worsening of my eating disorder), Paxil (no response), Zoloft (couldn't tolerate it; was constantly nauseous), Celexa & Lexapro (also no response). I have not tried Wellbutrin yet, which I might respond to, but my doctor will not prescribe it because of my eating disorder, fearing that it may get bad again (tho it is not at the moment).
>
> Sorry for the length of this post. I'm terrible at getting my point across... basically I am just wondering if my thoughts that it's time to try something else (and my thinking is NOT another SSRI) are valid or not...
>
> Should I try a TCA? Would it be premature to try an MAOI? I've read the dietary limitations and think I could follow that very easily. I just feel like I can't wait another year or more of trying meds that are getting me nowhere. I feel so hopeless. I don't know why I've hung on at all to be honest. I've got nothing to show for it. The worst feeling I think is knowing that no one in my family understands how horrible I feel every day, and instead just thinks I am lazy.
>
> Any response is appreciated.
This is the end of the thread.
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