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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by davv on November 23, 2005, at 18:06:13
After many years on partially succesful treatment with high dose ssris I changed to phenelzine in desperation. about 60mg for one and a half year for ocd with excellent results especially when combined with at least 1mg of clonazepam. however i kept going seriously manic and high and i could not sleep. my partner threatened to leave. However i came off this cold and decided to start an ssir again. my depression within 2 weeks was back and my ocd was out of control again. I stopped the ssri after 12 weeks of not working 9a little early i know) and was desperate for phenelzine for relief. However the same has happened again and i know i cant spend the rest of my life on phenelzine. even though i know of the dangers, I cant go through that again. i have decided, and you may think it careless to initiate an ssri slowly and come off the phenelzine slowly without any approval. So I started at phen 3.625 tablets and 6mg of fluvoxamine as I was scared of interactions. (my intention is to come off phenelzine but i cant risk that serious dip. 5 days have past and i have gently uppe the fluvoxamine to 20mg through to today and have been slowly dropping the phenelzine and this is now 3 and a third of tablets. I feel fine in my body etc no symptoms of this serotonin syndrome.. does anyone think i could possibly have a fatal reaction on these dosages. my plan is to keep making micro changes over 4 months to both drugs so i end up on a thereupeuatic dose of fluvoxamine (about 350mg) and no phenelzine at all. call me stupid if you like but if i stop phenelzine for two whole weeks and wait possibly four months for an ssri to take effect then suicide could possibly result anyway. has anyone ever done this in this manner. and if anyone knows what dosages of an ssri and an maoi used together have been know to kill a man. If i keep dropping the phenelzine slowly etc i feel i would be ok. if i go even more slowly with the ssri.
PS please no criticism.
Posted by linkadge on November 23, 2005, at 21:12:45
In reply to maoi and ssri combination, posted by davv on November 23, 2005, at 18:06:13
If nardil is working but making you manic, have you considered taking it with a mood stabalizer.
You could take a lower dose of nardil with depakote.
Linkadge
Posted by FredPotter on November 23, 2005, at 21:17:16
In reply to maoi and ssri combination, posted by davv on November 23, 2005, at 18:06:13
Hi why can't you stay on phenelzine (Nardil?) if it works so well? Perhaps helped by something like Zyprexa if mania's a problem, but I don't necessarily know what I'm talking about. I know what you mean about the wash-out period. Going a month to 6 weeks without any medication can be very dangerous for a person with depression. I feel some doctors don't realise what they're expecting you to do
Fred
Posted by davv on November 27, 2005, at 15:16:26
In reply to Re: maoi and ssri combination » davv, posted by FredPotter on November 23, 2005, at 21:17:16
> Hi why can't you stay on phenelzine (Nardil?) if it works so well? Perhaps helped by something like Zyprexa if mania's a problem, but I don't necessarily know what I'm talking about. I know what you mean about the wash-out period. Going a month to 6 weeks without any medication can be very dangerous for a person with depression. I feel some doctors don't realise what they're expecting you to do
> FredHi lads I have tried quetiapine and it worked a little but i gained 2 stone in 3 months. i did not eat at all and i excersised like hell. my breasts were like a womans totally swollen body and a blocked nose, however it stopped nardil working well also. i have experimented with depakote also and it makes me clinicaly worse within days of taking it even at small doses. I am now down to 45mg of phenelzine and up to 40mg of fluvoxamine and monitoring very closely. What should i look out for? my aim is to completely come off Phenelzine and work my way up to a high dose of luvox. I am so worried however that I will have a serious reaction but more worried about becoming depressed again and commiting suicide.
Posted by zeugma on November 27, 2005, at 16:00:13
In reply to Re: maoi and ssri combination, posted by davv on November 27, 2005, at 15:16:26
I'm glad to see you're still here, as I feared the worst when I read your original post. I would encourage you to tell your pdoc or someone of your plight. The MAOI-SSRI combination is a disaster waiting to happen.
-z
Posted by davv on November 28, 2005, at 13:27:10
In reply to Re: maoi and ssri combination » davv, posted by zeugma on November 27, 2005, at 16:00:13
Im now on 41.25mg (2 and three quaters of a tablet) of phenelzine and 50mg of luvox. im coming off phenelzine slowly and moving up luvox really slowly. Could this amount kill me. If i keep droppin g the phenelzine and upping the luvox what could happen?. Can serotonin syndrome cause death at these doses. Phenelzine will not go any higher at all only lower!
Posted by zeugma on November 28, 2005, at 18:50:05
In reply to Re: maoi and ssri combination, posted by davv on November 28, 2005, at 13:27:10
I honestly don't know the answers to your questions. I understand the concern about not being able to survive or function without meds, but the phenelzine-fluvoxamine cross-taper does not sound wise. According to the table I have, a 10-14 day washout period is recommended for switching from phenelzine to fluvoxamine.
The symptoms of serotonin syndrome are listed as follows: excitement, diaphoresis (sweating), rigidity, raised temperature, speeded heart rate, lowered blood pressure. Although not listed, I believe shivering is also a symptom of serotonin syndrome.
Best of luck, please keep posting.-z
Posted by davv on November 29, 2005, at 7:32:58
In reply to Re: maoi and ssri combination » davv, posted by zeugma on November 28, 2005, at 18:50:05
The thing is. All of those symptoms happened on a high dose of ssri for me nearly all the time. So possibly i could have had the serotonin syndrome at least a little for many years.
Posted by zeugma on November 30, 2005, at 18:05:45
In reply to Re: maoi and ssri combination, posted by davv on November 29, 2005, at 7:32:58
> The thing is. All of those symptoms happened on a high dose of ssri for me nearly all the time. So possibly i could have had the serotonin syndrome at least a little for many years.>>
But you find those symptoms tolerable?
Is the cross-taper going well?
-z
This is the end of the thread.
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