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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 43. Go back in thread:
Posted by myco on April 12, 2009, at 18:59:26
In reply to Re: Buspar or Celexa for extreme GAD » myco, posted by bleauberry on April 12, 2009, at 18:55:21
Lookin at augmenting for added energy/stimulation. Nardil is still great on anxiety but I'm missing my get up and go kick it used to give me.
> > Hi Bleuberry,
> >
> > Any evidence youve come across, either through studies or second hand experience, that buspar can be combined safely with Nardil?
> >
> > thnx
> > m
>
> I have never looked into this. My first guess would be it is ok, but then again, I have some doubts. For example, there have been cases of serotonin sydrome with buspar combined with ssris. Very rare, but it has happened. The other thing is that buspar's metabolite turns into an alpha antagonist, which stimulates the release of norepinephrine. I don't know if that would be a problem with an MAOI or not, but I think it has the potential.
>
> All that said, the combination has probably been done before. I just can't recall ever hearing of it or seeing any contraindications for it.
>
> You might want to start a new thread on that question. Others may come in with some better answers for you.
>
> I guess if you are considering buspar, then anxiety must be an issue despite nardil? If so, I just wanted to comment that at places like askapatient.com, revolutionhealth.com, patientslikeme.com, and such, a well liked combo is Parnate+Klonopin.
>
Posted by linkadge on April 12, 2009, at 20:02:40
In reply to Re: Buspar or Celexa for extreme GAD-Bleauberry » Cseagraves, posted by bleauberry on April 12, 2009, at 18:47:12
I don't know if I'd agree with the notion that antidepressants will decrease cortisol.
A number of studies suggest the SSRI's (esp fluoxetine and sertraline) increase cortisol.
The only antidepressnats that have somewhat of a documented anti-cortisol effect are remeron and doxepine / amitriptyline. Some of the antipsychotics also decrease cortisol.
Linkadge
Posted by linkadge on April 12, 2009, at 20:07:38
In reply to Re: Buspar or Celexa for extreme GAD » linkadge, posted by myco on April 12, 2009, at 18:05:51
>Hi Link,
>What's your current med regime?Nothing.
I have been prescribed citalopram but I don't want to go that route again. I end up losing more than I gain.
Linkadge
Posted by myco on April 12, 2009, at 20:10:29
In reply to Re: Buspar or Celexa for extreme GAD, posted by linkadge on April 12, 2009, at 20:07:38
Link:
You once mentioned nortip/zoloft together. Do you have previous with that combo? Was it quite energizing and easy on anxiety?
myco
> >Hi Link,
> >What's your current med regime?
>
> Nothing.
>
> I have been prescribed citalopram but I don't want to go that route again. I end up losing more than I gain.
>
>
>
> Linkadge
>
Posted by linkadge on April 13, 2009, at 6:41:19
In reply to Re: Buspar or Celexa for extreme GAD » linkadge, posted by myco on April 12, 2009, at 20:10:29
I've never taken nortrip/sertraline. I took a combination of clomipramine and sertraline which was pretty good.
Linkadge
Posted by linkadge on April 13, 2009, at 6:43:16
In reply to Re: Buspar or Celexa for extreme GAD » linkadge, posted by myco on April 12, 2009, at 20:10:29
Clomipramine was vastly superior to SSRI's in terms of AD efficacy IMHO. I couldn't take high doses because of rapid heartbeat. So I think I ended up on about 50mg clomipramine and 25-50 mg of sertaline which was fairly effective.
I stoped because of the genotoxic potential of clomipramine. I don't think nortiptyline is genotoxic which is why I'd like to try it in combination with a low dose of SSRI.
Linkadge
Posted by SLS on April 13, 2009, at 7:22:37
In reply to Re: Buspar or Celexa for extreme GAD, posted by linkadge on April 13, 2009, at 6:43:16
> I stoped because of the genotoxic potential of clomipramine. I don't think nortiptyline is genotoxic
Yes. Those TCAs that have a carbon atom in the 5th position of the center ring are genotoxic. The only TCAs that are structured this way are imipramine, desipramine, trimipramine, and clomipramine.
- Scott
Posted by myco on April 13, 2009, at 11:19:18
In reply to Re: Buspar or Celexa for extreme GAD, posted by linkadge on April 13, 2009, at 6:43:16
Since being on nardil is so difficult with respect to changing dr's and getting proper advice from dr's...I had interest in the nortrip/zoloft combo...is that combo controversial..do you know? I dont know if its regularly used...if its not it's gonna scare canadian gps (family dr's)
> Clomipramine was vastly superior to SSRI's in terms of AD efficacy IMHO. I couldn't take high doses because of rapid heartbeat. So I think I ended up on about 50mg clomipramine and 25-50 mg of sertaline which was fairly effective.
>
> I stoped because of the genotoxic potential of clomipramine. I don't think nortiptyline is genotoxic which is why I'd like to try it in combination with a low dose of SSRI.
>
> Linkadge
Posted by myco on April 13, 2009, at 11:22:30
In reply to Re: Buspar or Celexa for extreme GAD, posted by SLS on April 13, 2009, at 7:22:37
Are you familiar with the nortrip/zoloft combo Scott, either from personal experience or second hand? Just seeking general knowledge here. Effectiveness on anxiety/dep/likelihood of obtaining etc
> > I stoped because of the genotoxic potential of clomipramine. I don't think nortiptyline is genotoxic
>
> Yes. Those TCAs that have a carbon atom in the 5th position of the center ring are genotoxic. The only TCAs that are structured this way are imipramine, desipramine, trimipramine, and clomipramine.
>
>
> - Scott
Posted by SLS on April 13, 2009, at 12:08:14
In reply to Re: Buspar or Celexa for extreme GAD » SLS, posted by myco on April 13, 2009, at 11:22:30
> Are you familiar with the nortrip/zoloft combo Scott, either from personal experience or second hand? Just seeking general knowledge here. Effectiveness on anxiety/dep/likelihood of obtaining etc.
I have had first hand experience with combining nortriptyline with various SRI drugs, Zolft being one of them. For me, nortriptyline enhanced the response in a stable manner. Unfortunately, at the time, my doctor was convinced that 75mg of nortriptyline was the right dosage for me. In reality, it is 150mg. I could legitimately argue that I could revisit all of my nortriptyline + SRI combinations with my true therapeutic dosage of nortriptyline.
I find nortriptyline to be a very clean drug. It may not start out that way, but most of the side effects have completely disappeared. I still have an elevated heart rate, but a severe depression can cause this to happen as well. Right now, I am at 96 bpm. I have never been one to worry about antidepressant-induced elevated heart rate. I had too much to gain if any of these drugs worked. With tricyclics, you have to understand that it is part of the deal, although it does tend to moderate over time.
Stephen Stahl has recently voice an opinion that using desipramine or nortriptyline in conjunction with SSRIs makes a lot of sense.
- Scott
Posted by myco on April 13, 2009, at 12:33:31
In reply to Re: Buspar or Celexa for extreme GAD » myco, posted by SLS on April 13, 2009, at 12:08:14
Thank you for that. exactly what I was looking for
> > Are you familiar with the nortrip/zoloft combo Scott, either from personal experience or second hand? Just seeking general knowledge here. Effectiveness on anxiety/dep/likelihood of obtaining etc.
>
> I have had first hand experience with combining nortriptyline with various SRI drugs, Zolft being one of them. For me, nortriptyline enhanced the response in a stable manner. Unfortunately, at the time, my doctor was convinced that 75mg of nortriptyline was the right dosage for me. In reality, it is 150mg. I could legitimately argue that I could revisit all of my nortriptyline + SRI combinations with my true therapeutic dosage of nortriptyline.
>
> I find nortriptyline to be a very clean drug. It may not start out that way, but most of the side effects have completely disappeared. I still have an elevated heart rate, but a severe depression can cause this to happen as well. Right now, I am at 96 bpm. I have never been one to worry about antidepressant-induced elevated heart rate. I had too much to gain if any of these drugs worked. With tricyclics, you have to understand that it is part of the deal, although it does tend to moderate over time.
>
> Stephen Stahl has recently voice an opinion that using desipramine or nortriptyline in conjunction with SSRIs makes a lot of sense.
>
>
> - Scott
Posted by bleauberry on April 13, 2009, at 17:08:31
In reply to Re: Buspar or Celexa for extreme GAD-Bleauberry, posted by linkadge on April 12, 2009, at 20:02:40
Yes I believe you are correct. To take it even further, I think the whole issue is more complicated than it looks. We only know a fraction of what these meds do. What I meant in general is that antidepressants tend to smooth out the peaks and valleys in cortisol curves, which is sometimes a good thing and sometimes not. And you are correct, it varies from one med to the other, and from person to person.
> I don't know if I'd agree with the notion that antidepressants will decrease cortisol.
>
> A number of studies suggest the SSRI's (esp fluoxetine and sertraline) increase cortisol.
>
> The only antidepressnats that have somewhat of a documented anti-cortisol effect are remeron and doxepine / amitriptyline. Some of the antipsychotics also decrease cortisol.
>
> Linkadge
Posted by bleauberry on April 13, 2009, at 17:14:10
In reply to Re: Buspar or Celexa for extreme GAD » myco, posted by SLS on April 13, 2009, at 12:08:14
> Stephen Stahl has recently voice an opinion that using desipramine or nortriptyline in conjunction with SSRIs makes a lot of sense.
>
>
> - ScottAnd though he doesn't have the international clout of Stahl, Dr Gillman of psychotropical.com has treated 1000s of patients with these being his favorite meds, in the order that it appears he favors them:
Parnate
Clomipramine
Zoloft+Nortriptyline
NardilEven if I got the order wrong, it is clear that the ssri+tca combo is in his Top 4.
Posted by myco on April 13, 2009, at 18:20:51
In reply to Re: Buspar or Celexa for extreme GAD-Bleauberry » linkadge, posted by bleauberry on April 13, 2009, at 17:08:31
What do you think about the idea that high cortisol levels are in indication of an increased probability of AD failure or non-response?
I throw in this study, even though it's somewhat "iffy" in feel with me, as a reference.
m
------------------------------
J Clin Psychiatry. 1987 Dec;48(12):480-2.Pretreatment dexamethasone suppression test as a predictor of response to phenelzine.
Janicak PG, Pandey GN, Sharma R, Boshes R, Bresnahan D, Davis JM.
Illinois State Psychiatric Institute, Chicago.Twenty inpatients who met Research Diagnostic Criteria and DSM-III criteria for depression underwent a 2-week washout period before the administration of a pretreatment dexamethasone suppression test (DST); the patients then received the monoamine oxidase inhibitor (MAOI) phenelzine. The mean MAO inhibition level achieved during treatment was greater than 80%. On the basis of clinical global evaluation and changes in Hamilton Rating Scale for Depression scores, 7 of the 9 baseline DST suppressors were classified as responders, 1 as a partial responder, and 1 as a nonresponder; of the 11 baseline DST nonsuppressors, 3 were responders, 1 a partial responder, and 7 nonresponders. The Mann-Whitney U test yielded p less than .02, indicating that an abnormally high pretreatment level of cortisol in response to the DST appeared to be predictive of nonresponse to phenelzine.
--------------------------------> Yes I believe you are correct. To take it even further, I think the whole issue is more complicated than it looks. We only know a fraction of what these meds do. What I meant in general is that antidepressants tend to smooth out the peaks and valleys in cortisol curves, which is sometimes a good thing and sometimes not. And you are correct, it varies from one med to the other, and from person to person.
>
> > I don't know if I'd agree with the notion that antidepressants will decrease cortisol.
> >
> > A number of studies suggest the SSRI's (esp fluoxetine and sertraline) increase cortisol.
> >
> > The only antidepressnats that have somewhat of a documented anti-cortisol effect are remeron and doxepine / amitriptyline. Some of the antipsychotics also decrease cortisol.
> >
> > Linkadge
>
>
Posted by myco on April 13, 2009, at 18:23:59
In reply to Re: Buspar or Celexa for extreme GAD » SLS, posted by bleauberry on April 13, 2009, at 17:14:10
bonus. thanks :o)
>
> > Stephen Stahl has recently voice an opinion that using desipramine or nortriptyline in conjunction with SSRIs makes a lot of sense.
> >
> >
> > - Scott
>
> And though he doesn't have the international clout of Stahl, Dr Gillman of psychotropical.com has treated 1000s of patients with these being his favorite meds, in the order that it appears he favors them:
> Parnate
> Clomipramine
> Zoloft+Nortriptyline
> Nardil
>
> Even if I got the order wrong, it is clear that the ssri+tca combo is in his Top 4.
>
>
Posted by linkadge on April 13, 2009, at 19:04:21
In reply to Re: Buspar or Celexa for extreme GAD » bleauberry, posted by myco on April 13, 2009, at 18:23:59
I don't see why zoloft + nortripyline would necessarily be more effective than a general SSRI + TCA combo.
Linkadge
Posted by myco on April 13, 2009, at 19:09:29
In reply to Re: Buspar or Celexa for extreme GAD, posted by linkadge on April 13, 2009, at 19:04:21
It may be more effective for me...ideally if it focused more on the SAD and anxiety side of things...which, I think, zoloft sees some efficacy for.
> I don't see why zoloft + nortripyline would necessarily be more effective than a general SSRI + TCA combo.
>
> Linkadge
Posted by Cseagraves on April 13, 2009, at 19:52:51
In reply to Re: Buspar or Celexa for extreme GAD » linkadge, posted by myco on April 13, 2009, at 19:09:29
Myco,
You've got me worrying again.
CS
Posted by myco on April 13, 2009, at 20:04:20
In reply to Re: Buspar or Celexa for extreme GAD, posted by Cseagraves on April 13, 2009, at 19:52:51
whatcha mean hun...torrrrk to me
> Myco,
>
> You've got me worrying again.
>
> CS
Posted by desolationrower on April 14, 2009, at 1:24:19
In reply to Re: Buspar or Celexa for extreme GAD » odon, posted by myco on April 12, 2009, at 12:36:51
> Ive read studies showing that high levels of cortisol are a "predicter" of "poor response" to AD's (I think the study used MAOI's as an example). This provides an interesting correlation for your question there. The answer is it's possible for sure....research a lil if you have time - literature support for your idea is out there to aid in a line of argument.
>
> :o)
>high cortisol depression is more typical of melancholy, so TCA treatment would be preferred...
-d/r
Posted by desolationrower on April 14, 2009, at 1:41:45
In reply to Re: Buspar or Celexa for extreme GAD » Cseagraves, posted by myco on April 13, 2009, at 20:04:20
Courtney, the MAOI will be great, don't worry, myco is just being professory
-d/r
Posted by mogger on April 15, 2009, at 0:36:57
In reply to Buspar or Celexa for extreme GAD, posted by Cseagraves on April 11, 2009, at 20:50:51
I am on 90mg of buspar which helps me greatly. I also take Inositol 18 grams a day for anxiety/ocd which is very powerful.
Posted by KarenRB53 on May 11, 2009, at 19:06:06
In reply to Re: Buspar or Celexa for extreme GAD, posted by linkadge on April 12, 2009, at 18:02:53
> Nardil has a strong serotonergic effect. If SSRI's don't help anxiety (or make it worse), you might want to try a gabaergic drug like gabapentin or perhaps low dose of seroquel.
>
> LinkadgeI tried Lexapro for 3 months which increased anxiety and have now switched to Celexa for past 10 days. I take Lorazepam also. But my anxiety is awful. I have gone up to 20mg Celexa for past 3 days. Just wondering if you thing Seroquel would help anxiety and is it ok to take it with lorazepam. If I took a low dose at night would it help me throughtout the day also? I was on Prozac for many years and it stopped working as well so thats why the switch to Lexapro and now Celexa. But have to say that Prozac probably helped me better than both of these so far. I mostly have depression but anxiety seems to be moving right up there!!
Thanks for any suggestions.Karen
Posted by KarenRB53 on May 28, 2009, at 20:38:08
In reply to Re: Buspar or Celexa for extreme GAD, posted by KarenRB53 on May 11, 2009, at 19:06:06
> > Nardil has a strong serotonergic effect. If SSRI's don't help anxiety (or make it worse), you might want to try a gabaergic drug like gabapentin or perhaps low dose of seroquel.
> >
> > Linkadge
>
> I tried Lexapro for 3 months which increased anxiety and have now switched to Celexa for past 10 days. I take Lorazepam also. But my anxiety is awful. I have gone up to 20mg Celexa for past 3 days. Just wondering if you thing Seroquel would help anxiety and is it ok to take it with lorazepam. If I took a low dose at night would it help me throughtout the day also? I was on Prozac for many years and it stopped working as well so thats why the switch to Lexapro and now Celexa. But have to say that Prozac probably helped me better than both of these so far. I mostly have depression but anxiety seems to be moving right up there!!
> Thanks for any suggestions.
>
> KarenIf I take a low dose of Seroquel at night does it stay in my system and help with anxiety throughout the day? Can I continue taking Ativan as well prn? Celexa seems to be causing my anxiety to increase. I've been on it for 1 month and anxiety is no better.
Karen
Posted by desolationrower on May 29, 2009, at 0:25:11
In reply to Re: Buspar or Celexa for extreme GAD, posted by KarenRB53 on May 28, 2009, at 20:38:08
> > > Nardil has a strong serotonergic effect. If SSRI's don't help anxiety (or make it worse), you might want to try a gabaergic drug like gabapentin or perhaps low dose of seroquel.
> > >
> > > Linkadge
> >
> > I tried Lexapro for 3 months which increased anxiety and have now switched to Celexa for past 10 days. I take Lorazepam also. But my anxiety is awful. I have gone up to 20mg Celexa for past 3 days. Just wondering if you thing Seroquel would help anxiety and is it ok to take it with lorazepam. If I took a low dose at night would it help me throughtout the day also? I was on Prozac for many years and it stopped working as well so thats why the switch to Lexapro and now Celexa. But have to say that Prozac probably helped me better than both of these so far. I mostly have depression but anxiety seems to be moving right up there!!
> > Thanks for any suggestions.
> >
> > Karen
>
>
>
> If I take a low dose of Seroquel at night does it stay in my system and help with anxiety throughout the day?probably, especially if you get the extended release. i'm not too big on neuroleptics. i might try risperdone first.
>Can I continue taking Ativan as well prn?
yes
>Celexa seems to be causing my anxiety to increase. I've been on it for 1 month and anxiety is no better.
>
> Karend/r
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