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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Seraphine on July 9, 2009, at 12:25:01
It can be hard to know if I am giving up on a medication too soon. How do you know when you need to stick it out and when to follow your gut that says this is not feeling right.
I started fluoxetine 11 days ago. Still only at 10 mg (though have taken 5 on some days and havent taken since Tuesday). I have taken sertraline in the past with success and I tolerated it well. But I noticed that even at a low dose my clarity of thought was compromised (I know now this to be a common side effect of SSRIs). Since Id only ever tried one SSRI, we decided to try fluoxetine (after being off completely for many months).
Ive noticed that when the fluox kicks in I feel terribly inert. Dull, unmotivated, complete bump on a log. And worse, I feel sadder, a little unreal, and cant think to save my life (oddly though the inability to think is mostly subjective (though severe), objectively I could tend to tasks that required thought). I called my doc yesterday to discuss (left a message, we havent spoken yet) and I just sat with the phone in my hand for many minutes before calling. I had a hard time formulating sentences while leaving the message. Again, I probably sounded normal. But my internal experience was anything but.
I take SSRIs for anxiety/ADD/mild depression. Its not clear what the most salient or primary problem is, but probably anxiety. It manifests most obviously as *relentless* thinking, black-and-white thinking, being extremely over analytical. (that might not sound like much, but it destroys my quality of life!)
At any rate, my main question is how you know when you are being too quick to judge a drug, and when you should stick it out. Its only been 11 days. When I start to feel relief/better as the drug begins to leave my body, I tend to feel Ive made the right decision. Im tempted to go back to the devil I know (sertraline, helpful devil ;-) rather than wait and see with the one I dont. With sertraline I had some strange sensations at times early on, and some increased anxiety, but nothing like the mental/emotional discomfort of trying to stick with fluoxetine.
Your 2 cents?
Posted by Phillipa on July 9, 2009, at 12:44:50
In reply to fluoxetine + following your gut ..., posted by Seraphine on July 9, 2009, at 12:25:01
Welcome to babble see you're new. But question if off the zoloft for a while and no meds. Did you decide to change meds or doc? If zoloft still works why not go back on it? Just a quesiton. Phillipa
Posted by Seraphine on July 9, 2009, at 13:51:47
In reply to Re: fluoxetine + following your gut ... » Seraphine, posted by Phillipa on July 9, 2009, at 12:44:50
Well, I might, as I said. Zoloft was the only SSRI I'd ever taken, and even at a low dose I noticed less clarity of thought. I wanted to try a different one. My doctor was on board with the idea.
I have tended to go off and on zoloft, with my Doctor's support. It may go against conventional wisdom, but it absolutely works for me to do so (as I get benefits from being on AND from being off).
> Welcome to babble see you're new. But question if off the zoloft for a while and no meds. Did you decide to change meds or doc? If zoloft still works why not go back on it? Just a quesiton. Phillipa
Posted by Phillipa on July 9, 2009, at 13:56:49
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 9, 2009, at 13:51:47
How high has your dose been? Why any idea sure you've had discussions with pdoc why try another one do you need energy? I found prozac stimulating. Phillipa
Posted by Seraphine on July 9, 2009, at 13:59:17
In reply to Re: fluoxetine + following your gut ... » Seraphine, posted by Phillipa on July 9, 2009, at 13:56:49
Again, I was trying another hoping I would not have the side effect of reduced clarity of thought.
When I first took zoloft 15 years ago my dose was up to 100. Way too much for me. When I have taken it since then the max is 50.
> How high has your dose been? Why any idea sure you've had discussions with pdoc why try another one do you need energy? I found prozac stimulating. Phillipa
Posted by Alexanderfromdenmark on July 9, 2009, at 14:43:53
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 9, 2009, at 13:59:17
> Again, I was trying another hoping I would not have the side effect of reduced clarity of thought.
>
> When I first took zoloft 15 years ago my dose was up to 100. Way too much for me. When I have taken it since then the max is 50.
>
> > How high has your dose been? Why any idea sure you've had discussions with pdoc why try another one do you need energy? I found prozac stimulating. Phillipa
>
>Hmm, I would follow my gut feeling if I were you and try something else. Since you have ADD, I don't think most ADD's are a good choice for you. Zoloft probably works better than most SSRI's for you since it has the highest dopamine reuptake.
Posted by morganpmiller on July 9, 2009, at 17:10:10
In reply to fluoxetine + following your gut ..., posted by Seraphine on July 9, 2009, at 12:25:01
>I noticed that even at a low dose my clarity of thought was compromised (I know now this to be a common side effect of SSRIs)
Maybe it was that low dose or just not finding the right dose that gave you cognitive issues.
>I take SSRIs for anxiety/ADD/mild depression. Its not clear what the most salient or primary problem is, but probably anxiety. It manifests most obviously as *relentless* thinking, black-and-white thinking, being extremely over analytical. (that might not sound like much, but it destroys my quality of life!)
Ever thought of therapy, group and individual, as a way to unravel the causes and begin to find solutions to your anxiety and the thinking that may result from it. I personally believe that your thinking may cause you anxiety. And sometimes your anxiety may be a cause for you thinking. Either way, the underlying causes/roots for both are probably more involved and complex than maybe you realize. Biology definitely has it's role, hence the necessary use of medication. I just think it would not be a bad Idea to find a really good therapist that works in a practice where there is group therapy conducted by two qualified therapists.
I would not be so quick to quit on Prozac. You would be surprised how time and dosage can contribute to the efficacy of a medication. Many of us feel worse on AD's like Prozac before we feel better. I would at least talk to your doc and give it a good 4 to 6 weeks(many psychiatrist will say that 8 wks is necessary) for you body to adjust and to hopefully find the right dosage. In the meantime, I seriously doubt you that you are doing any kind of permanent damage to your brain. I could be wrong, but I seriously doubt it.
Like the earlier poster said, Zoloft at higher doses can begin to inhibit the reuptake of dopamine enough for some to notice a difference. This may benefit you since you have ADD symptoms. And, since it worked before, it may be the best option for you if Prozac does not work out. One thing we have to understand about our AD is that they will hardly ever completely relieve us of our symptoms. We have to do all the other things in order to achieve this. Is this why you did not stick with Zoloft?
Posted by morganpmiller on July 9, 2009, at 17:17:12
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 9, 2009, at 13:59:17
How was 100 mgs of Zoloft too much for you and how long did you stick with 100 mgs? Is it clarity of thought that you were suffering from with Zoloft? Again, how long were you on Zoloft? Was your clarity of thought impaired at all before you started Zoloft or Prozac? Do you know that chronic depression/anxiety causes brain damage? Are you sure that you were not already having issues with clarity of thought and then attributed the problem to the antidepressant you started taking? If the antidepressant is causing any of this, it is possible that with time and doing other things, like exercise(increases blood flow and oxygen in the brain and promotes neurogenesis in the hippocampus-the part of the brain that suffers damage due to depression/anxiety), the cognitive symptoms will subside quite a bit.
Posted by Seraphine on July 9, 2009, at 17:30:37
In reply to Re: fluoxetine + following your gut ..., posted by morganpmiller on July 9, 2009, at 17:10:10
I have a well-rounded, holistic approach to dealing with my "issues"... therapy, and a very healthy lifestyle. I have a good handle on the role of medication in my life, and a great relationship with my doctor. Right now I am just struggling with whether to stick with the prozac now or go back to what I know. I don't think I am going to stick it out; I can tolerate a lot, but not feeling significantly worse emotionally and mentally!
> >I noticed that even at a low dose my clarity of thought was compromised (I know now this to be a common side effect of SSRIs)
>
> Maybe it was that low dose or just not finding the right dose that gave you cognitive issues.
>
> >I take SSRIs for anxiety/ADD/mild depression. Its not clear what the most salient or primary problem is, but probably anxiety. It manifests most obviously as *relentless* thinking, black-and-white thinking, being extremely over analytical. (that might not sound like much, but it destroys my quality of life!)
>
> Ever thought of therapy, group and individual, as a way to unravel the causes and begin to find solutions to your anxiety and the thinking that may result from it. I personally believe that your thinking may cause you anxiety. And sometimes your anxiety may be a cause for you thinking. Either way, the underlying causes/roots for both are probably more involved and complex than maybe you realize. Biology definitely has it's role, hence the necessary use of medication. I just think it would not be a bad Idea to find a really good therapist that works in a practice where there is group therapy conducted by two qualified therapists.
>
> I would not be so quick to quit on Prozac. You would be surprised how time and dosage can contribute to the efficacy of a medication. Many of us feel worse on AD's like Prozac before we feel better. I would at least talk to your doc and give it a good 4 to 6 weeks(many psychiatrist will say that 8 wks is necessary) for you body to adjust and to hopefully find the right dosage. In the meantime, I seriously doubt you that you are doing any kind of permanent damage to your brain. I could be wrong, but I seriously doubt it.
>
> Like the earlier poster said, Zoloft at higher doses can begin to inhibit the reuptake of dopamine enough for some to notice a difference. This may benefit you since you have ADD symptoms. And, since it worked before, it may be the best option for you if Prozac does not work out. One thing we have to understand about our AD is that they will hardly ever completely relieve us of our symptoms. We have to do all the other things in order to achieve this. Is this why you did not stick with Zoloft?
Posted by morganpmiller on July 10, 2009, at 3:30:12
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 9, 2009, at 17:30:37
Sorry to hear you are feeling so badly on prozac. There are some recent threads here that talk about a very low dose of prozac being effective.
I don't blame you for wanting to dump it so soon. Did you talk to your p doc about what is going on? Yeah going into the second week feeling so bad maybe it is not worth sticking it outs, even at a low dose like 2.5 or lower. There are those cases where upping the dose makes the side effects subside significantly. Doesn't sound like this would be the case with you, especially so early in the game.
Can I ask you again how long you were on Zoloft? I think you mentioned 1OO was too much. How long were you on 100 and how was it too much? I know, I know, I asked you this already. Also, Did you try 75?
Anyway, hope you feel better no matter what you do.
Posted by Seraphine on July 10, 2009, at 10:50:26
In reply to Re: fluoxetine + following your gut ..., posted by morganpmiller on July 10, 2009, at 3:30:12
I was probably on zoloft @ 100 for 4-5 months. It was the first time I'd ever taken an AD, and it was in the "heyday" (early 90's) of celebrating the effectiveness of these new drugs (ie i've never had a doc suggest i go up to 75 ot 100 since then). I was on 75 briefly before 100. Not sure why we went up to 100 - It's hard to remember as it's been so long.
"Too much" is subjective of course, but for me, I get all the benefits I need at 50, with minimal side effects.
Regarding prozac, my doc and I talked and I am going to give 15 mg a try for a few days, if I still have all the bad cognitive and emotional effects then I will stop. I'm a little annoyed with myself for even wanting to try another drug, when I know zoloft so well. Argh. What was I thinking?
Thanks for your well wishes :)
> Can I ask you again how long you were on Zoloft? I think you mentioned 1OO was too much. How long were you on 100 and how was it too much? I know, I know, I asked you this already. Also, Did you try 75?
>
> Anyway, hope you feel better no matter what you do.
Posted by morganpmiller on July 10, 2009, at 14:31:15
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 10, 2009, at 10:50:26
>Regarding prozac, my doc and I talked and I am going to give 15 mg a try for a few days, if I still have all the bad cognitive and emotional effects then I will stop. I'm a little annoyed with myself for even wanting to try another drug, when I know zoloft so well. Argh. What was I thinking?
Yeah I know what you mean. I wonder if you require a different dosage of Zoloft now. 4-5 montsh on 100 is plenty long enough to know if it was going to work for you then.
Hope you feel better on 15mgs and then 20 maybe. If not, hopefully the transition back to zoloft, if that is what you do, is a successful one.
Posted by Seraphine on July 10, 2009, at 14:35:33
In reply to Re: fluoxetine + following your gut ..., posted by morganpmiller on July 10, 2009, at 14:31:15
100 mgs worked. But it was overkill. 50 mgs was plenty (is what I was trying to get across!)
:)
Diana>Regarding prozac, my doc and I talked and I am going to give 15 mg a try for a few days, if I still have all the bad cognitive and emotional effects then I will stop. I'm a little annoyed with myself for even wanting to try another drug, when I know zoloft so well. Argh. What was I thinking?
>
> Yeah I know what you mean. I wonder if you require a different dosage of Zoloft now. 4-5 montsh on 100 is plenty long enough to know if it was going to work for you then.
>
> Hope you feel better on 15mgs and then 20 maybe. If not, hopefully the transition back to zoloft, if that is what you do, is a successful one.
Posted by morganpmiller on July 10, 2009, at 15:53:17
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 10, 2009, at 14:35:33
Gotchya
Posted by Brainbeard on July 10, 2009, at 17:08:16
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 10, 2009, at 10:50:26
Actually, Prozac can take between a day and MORE THAN THREE MONTHS to kick in as an 'S'SRI.
Alternatively, you might consider LOWERING your dose (≤5mg), so that Prozac leaves serotonin alone and boosts dopamine and noradrenaline only (through 5HT2C-antagonism).
Posted by Brainbeard on July 10, 2009, at 17:08:50
In reply to Re: fluoxetine + following your gut ..., posted by Brainbeard on July 10, 2009, at 17:08:16
(SMALLER THAN OR EQUAL TO 5MG)
Posted by Seraphine on July 10, 2009, at 21:21:44
In reply to Re: fluoxetine + following your gut ..., posted by Brainbeard on July 10, 2009, at 17:08:16
I think actually I need the S in the SSRI. I haven't had good luck with either wellbutrin or strattera (the former I took for many months, but eventually I was acting normal, yet feeling very 'dark' inside. when I went off of it I was completely relieved of that feeling. Strattera I took for only day.)
I just feel strange on prozac. That's about the best descriptor I have at the moment. I have subtly strange thoughts and feelings. Bleh.
> Actually, Prozac can take between a day and MORE THAN THREE MONTHS to kick in as an 'S'SRI.
>
> Alternatively, you might consider LOWERING your dose (≤5mg), so that Prozac leaves serotonin alone and boosts dopamine and noradrenaline only (through 5HT2C-antagonism).
Posted by morganpmiller on July 10, 2009, at 21:43:17
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 10, 2009, at 21:21:44
Yeah it's just hitting areas of your brain you are not used to triggering thoughts and feeling you are not used to having. I had a lot of success with Zoloft but it took me a while to find my sweet spot. If I was not there, I felt similar to how you do I think. Prozac could be great, it could be o.k, or it may never work at all and you will always feel this way on it no matter what dose or amount of time is given.
Posted by morganpmiller on July 10, 2009, at 21:50:35
In reply to Re: fluoxetine + following your gut ..., posted by Seraphine on July 9, 2009, at 13:51:47
I would also add that if you find a med that works for you, be it zoloft, prozac or whatever, you may want to consider just staying on it for good and trying to stick it out through the "poop outs" depending on how bad your depression/anxiety is. I just don't think it's a good idea for a few reasons to be getting off and back on. Your AD is there to protect you from your depression, which is known to possibly do some damage to your brain. Also, if you get off, you may not have the same response after getting on. I'm not saying you are doing this, I'm just saying. I'm no doc, so what do I know.
This is the end of the thread.
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