Shown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by garnet71 on June 30, 2009, at 19:36:58
Is Prozac one of those drugs you can take small doses of, or do you have to work up to the maximum/recommended dose for efficiacy?
I'm thinking of trying it again (for anxiety).
I can't deal with the seratonin affects on dopamine, but had read Prozac isn't as bad in that department like Zoloft, for example, and even may have a small but positive effect on dopamine. Any knowledge?I want to continue buspirone and maybe take a small does of Prozac with it, maybe 5-10 mg. of Prozac to see if it helps control my anxiety and definitely get rid of the Xanax.
Last time I took Prozac, I had severe anxiety and it completely took away the anxiety within a few days, but I was scared of the side effects. One of my pupils is larger than the other shortly after taking Prozac (could be just coincidence--but the size difference was confirmed by my opthamologist who measured my pupils). And it made my urine cloudy-which really freaked me out too. That can be a sign of neurological damage, although it could be minor kidney things too. But adding the 2 symptoms together....was too much of a coincidence. My pupil sizes are still mismatched and I have had distorted vision ever since. I had also wondered if Prolactin levels can do that? Need to go to more doctors....
However, I don't think there are too many good choices out there for me right now and am willing to try Prozac again.
Posted by Phillipa on July 1, 2009, at 0:37:08
In reply to Prozac dosage questions, posted by garnet71 on June 30, 2009, at 19:36:58
You can take small doses of prozac. If you have anxiety how could you handle it as took 20mg when first out. Wallpapered a foyer the first day lots of energy, day two anxiety didn't have then, third day shear panic all day. Dumped them I was on .25 of xanax at time took three days to get back to normal as I was working and feeling great at the time. Sure that buspar is doing wierd things to you. Google it and see. Love Phillipa
Posted by morganpmiller on July 1, 2009, at 2:19:45
In reply to Prozac dosage questions, posted by garnet71 on June 30, 2009, at 19:36:58
http://biopsychiatry.com/fluoxdopnor.htm
If you don't want to try Nardil for anxiety, I would go with Prozac. I experienced the one pupil dilating more that the other fairly recently when I took Cymbalta, Prozac's sister. I don't think this is abnormal. Over time, if you find a dose that works for you, I would not be too concerned with side effects. Chronically feeling bad is more likely to cause more damage to your brain and body than Prozac will.
See what your p doc thinks..not like he will have all the answers.
So did you try zoloft before? just curious..
You could try tianeptine(Stablon), but you would have to order it through an overseas pharmacy and take it 3 times a day.
Posted by Larry Hoover on July 1, 2009, at 9:34:20
In reply to Prozac dosage questions, posted by garnet71 on June 30, 2009, at 19:36:58
Prozac (and the generic in Canada, at least) is available as a liquid formulation, generally for pediatric use. I think mine was 1 mg/mL concentration. I was supplied with a dosing syringe, so I could select a precise dose, and titration schedule that suited me.
Lar
Posted by bleauberry on July 4, 2009, at 19:53:02
In reply to Prozac dosage questions, posted by garnet71 on June 30, 2009, at 19:36:58
I have known people that did well with prozac in a range of 5mg to 10mg. The 90mg per week dose version of prozac averages out to slightly more than 10mg per day. I liked 2.5mg for quite a while before later going higher.
If side effects are scaring you in the early going, then the dose is too high. Doesn't matter what the dose actually is...it is too high, whatever it is.
Prozac is easy to custom dose. Dump the contents of a capsule in orange juice, stir it well (it won't dissolve), then drink a custom dose. Example, 1/4 of a 10mg glass is 2.5mg. A sip of just a half of that 1/4 would be just slightly more than 1mg. Store in the fridge for up to a week. Stir it well each time. Very easy and convenient. Excellent way to manage early side effects and allow your body to get acclamated without any traumatic experiences.
Posted by bearfan on July 5, 2009, at 3:45:13
In reply to Re: Prozac dosage questions, posted by bleauberry on July 4, 2009, at 19:53:02
Actually, due to the delayed response, the 90mg weekly version is very close to the Standard 20mg dose.
Posted by Brainbeard on July 10, 2009, at 5:34:09
In reply to Prozac dosage questions, posted by garnet71 on June 30, 2009, at 19:36:58
Here's the pharmacology behind the effectiveness of low doses of Prozac: Prozac actually is a very strong 5HT2C-antagonist (blocker). The 2C serotonin receptor subtype normally inhibits dopamine (DA) and noradrenaline (NA) release. When these receptors are themselves blocked, they cannot inhibit DA and NA release. So, what happens when Prozac blocks 5HT2C-receptors? DA and NA release is 'disinhibited', which is a fancy way of saying they're boosted!
Prozac's 5HT2C-antagonism is so strong that at low doses of the drug (<5mg), 5HT2C-antagonism is probably all it does. At higher doses (~>5mg), serotonin reuptake inhibition comes into play, reaching full therapeutic effectivity at 20mg (stretched over a longer period of time of course due to accumulation of blood levels of the drug. With Prozac, always take into account that the drug has this ridiculously long half-life of about ONE TO TWO WEEKS, which measn it takes longer than A MONTH for the drug to leave your system). What counts for 5HT2C receptors, also counts for 5HT2A receptors. (There are differences, but the main mechanism is the same). Here, Prozac as well as all other SSRIs actually have a counterproductive mechanism: through raising serotonin levels, they ACTIVATE 5HT2A-receptors instead of blocking them. This may acutely lead to hightened anxiety and restlessness, and in the longer term to apathy, loss of libido, etcetera, which are all signs of a hypodopaminergic state [= too little dopamine].
It would be ideal to combine Prozac or any other SRI-therapy with a 5HT2A-blocker. Most TCA's (the older tricyclic antidepressants) have moderate 5HT2A-blockade. Most AAP's (the newer atypical antipsychotics) have strong 5HT2A-blockade. I have some Geodon coming my way which I mean to use low dose (5-20mg) for its strong 5HT2A-antagonism, in combination with an SSRI (Prozac or Zoloft, probably).A big part of the above is taken from Stahl; see: http://books.google.nl/books?id=cWbYxSfKN3cC&pg=PA532&lpg=PA532&dq=stahl+fluoxetine+5ht2c+antagonist&source=bl&ots=NpDHGZ0phR&sig=hZ-DC5qmtqj6lHgdwzN9nNgIELc&hl=nl&ei=fxNXSu_TE9Hw-Qb3jNjIDQ&sa=X&oi=book_result&ct=result&resnum=1; see also: http://www.google.nl/search?q=Are+All+Atypical+Antipsychotics+Equal+for+the+Treatment+of+Cognition+and+Affect+in+Schizophrenia%3F%3A+Schizophrenia%3A+From+Circuits+to+Symptoms&sourceid=navclient-ff&ie=UTF-8&rlz=1B3GGGL_nlNL255NL258 (this is a link to the reuslts of a Google search; click on the first search result - the article can't be reached through a direct link because it is a page for which you have to be subscribed).
Several other mechanisms also play a role with Prozac, and they have been neatly summarized (including links to the relevant research abstracts) by someone on a forum here: http://www.socialanxietysupport.com/forum/f30/some-interesting-stuff-i-just-read-about-fluoxetine-prozac-64674/
Hope this was helpful. Sorry for being elaborate. My meds made me do it! I've just started taking 10mg of Prozac myself, combined with Buspar. Buspar helps raising DA and NA levels even more (http://cat.inist.fr/?aModele=afficheN&cpsidt=2585906, confirmed by Stahl). I've been on 5mg of Prozac with 15-30mg of Buspar before, and this was a stimulating and antidepressant combo. I did have rapid weight gain though, presumably caused by the 5HT2C-antagonism..
Posted by metafunj on September 12, 2009, at 1:40:45
In reply to Re: Prozac dosage questions, posted by Brainbeard on July 10, 2009, at 5:34:09
Have you considered Remeron? It blocks 5 ht2a and 5 ht2c receptors as well as 5 ht3 receptors.
If you take it in a higher dose and take it at night it might not be to sedating.
Posted by Brainbeard on September 12, 2009, at 6:34:02
In reply to Re: Prozac dosage questions, posted by metafunj on September 12, 2009, at 1:40:45
> Have you considered Remeron? It blocks 5 ht2a and 5 ht2c receptors as well as 5 ht3 receptors.
>
> If you take it in a higher dose and take it at night it might not be to sedating.Who, me? Well, I think Remeron's sedation + weight gain are too much for me to swallow. I would be interested to know if anyone has been able to dodge the sedation at higher doses.
The 5HT2C-antagonism, however helpful, usually guarantees massive weight gain.
Posted by metafunj on September 12, 2009, at 13:22:53
In reply to Re: Prozac dosage questions, posted by Brainbeard on September 12, 2009, at 6:34:02
I gradually gained about 65(29.5) pounds on Prozac. When i came off, I lost it in a couple months.
I actually don't care so much about the weight gain, anything is better than being numb. I might have the motivation to eat well and exercise then.
Posted by sowhysosad on September 12, 2009, at 15:49:08
In reply to Re: Prozac dosage questions, posted by Brainbeard on September 12, 2009, at 6:34:02
>I would be interested to know if anyone has been able to dodge the sedation at higher doses.
I went up to 30mg at night and still felt rather dozy most of the following day.
Posted by metafunj on September 12, 2009, at 19:07:34
In reply to Re: Prozac dosage questions » Brainbeard, posted by sowhysosad on September 12, 2009, at 15:49:08
How long were you on 30mg and did you ever get used to it?
I've never taken an antihistamine before so I have no clue what the effect is like.
Posted by manic 666 on September 13, 2009, at 2:30:57
In reply to Re: Prozac dosage questions » garnet71, posted by Phillipa on July 1, 2009, at 0:37:08
i took 20mg all the time ,odd times 40mg but got no more reaction, when it started pooping i upped the med an it made me worse, but 20mg was cool for 2 years
Posted by metafunj on September 13, 2009, at 9:14:38
In reply to Re: Prozac dosage questions, posted by manic 666 on September 13, 2009, at 2:30:57
I took 20mg for 4 years and it worked fine until I stopped it and started freaking out. I remember the anhedonia and anxiety hit after about 3 weeks off. I tried going back on but it just made me feel spacey as if nothing was real and I still had anhedonia. I increased the dosage to 40 and that made my heart beat really fast and made me nervous again.
I recently tried Lexapro to see if maybe I still need an SSRI and it just made me foggy and decreased my libido at 10mg. 5mg still had some foggy, in a fishbowl feeling but not a whole lot. More than worth tolerating for a drug that was doing nothing for me.
Posted by KarenRB53 on January 18, 2010, at 13:13:33
In reply to Re: Prozac dosage questions, posted by Brainbeard on July 10, 2009, at 5:34:09
> Here's the pharmacology behind the effectiveness of low doses of Prozac: Prozac actually is a very strong 5HT2C-antagonist (blocker). The 2C serotonin receptor subtype normally inhibits dopamine (DA) and noradrenaline (NA) release. When these receptors are themselves blocked, they cannot inhibit DA and NA release. So, what happens when Prozac blocks 5HT2C-receptors? DA and NA release is 'disinhibited', which is a fancy way of saying they're boosted!
> Prozac's 5HT2C-antagonism is so strong that at low doses of the drug (<5mg), 5HT2C-antagonism is probably all it does. At higher doses (~>5mg), serotonin reuptake inhibition comes into play, reaching full therapeutic effectivity at 20mg (stretched over a longer period of time of course due to accumulation of blood levels of the drug. With Prozac, always take into account that the drug has this ridiculously long half-life of about ONE TO TWO WEEKS, which measn it takes longer than A MONTH for the drug to leave your system). What counts for 5HT2C receptors, also counts for 5HT2A receptors. (There are differences, but the main mechanism is the same). Here, Prozac as well as all other SSRIs actually have a counterproductive mechanism: through raising serotonin levels, they ACTIVATE 5HT2A-receptors instead of blocking them. This may acutely lead to hightened anxiety and restlessness, and in the longer term to apathy, loss of libido, etcetera, which are all signs of a hypodopaminergic state [= too little dopamine].
> It would be ideal to combine Prozac or any other SRI-therapy with a 5HT2A-blocker. Most TCA's (the older tricyclic antidepressants) have moderate 5HT2A-blockade. Most AAP's (the newer atypical antipsychotics) have strong 5HT2A-blockade. I have some Geodon coming my way which I mean to use low dose (5-20mg) for its strong 5HT2A-antagonism, in combination with an SSRI (Prozac or Zoloft, probably).
>
> A big part of the above is taken from Stahl; see: http://books.google.nl/books?id=cWbYxSfKN3cC&pg=PA532&lpg=PA532&dq=stahl+fluoxetine+5ht2c+antagonist&source=bl&ots=NpDHGZ0phR&sig=hZ-DC5qmtqj6lHgdwzN9nNgIELc&hl=nl&ei=fxNXSu_TE9Hw-Qb3jNjIDQ&sa=X&oi=book_result&ct=result&resnum=1; see also: http://www.google.nl/search?q=Are+All+Atypical+Antipsychotics+Equal+for+the+Treatment+of+Cognition+and+Affect+in+Schizophrenia%3F%3A+Schizophrenia%3A+From+Circuits+to+Symptoms&sourceid=navclient-ff&ie=UTF-8&rlz=1B3GGGL_nlNL255NL258 (this is a link to the reuslts of a Google search; click on the first search result - the article can't be reached through a direct link because it is a page for which you have to be subscribed).
>
> Several other mechanisms also play a role with Prozac, and they have been neatly summarized (including links to the relevant research abstracts) by someone on a forum here: http://www.socialanxietysupport.com/forum/f30/some-interesting-stuff-i-just-read-about-fluoxetine-prozac-64674/
>
> Hope this was helpful. Sorry for being elaborate. My meds made me do it! I've just started taking 10mg of Prozac myself, combined with Buspar. Buspar helps raising DA and NA levels even more (http://cat.inist.fr/?aModele=afficheN&cpsidt=2585906, confirmed by Stahl). I've been on 5mg of Prozac with 15-30mg of Buspar before, and this was a stimulating and antidepressant combo. I did have rapid weight gain though, presumably caused by the 5HT2C-antagonism..Hi: Just found your post. I was on Prozac for years and it worked very well except it did cause some hypomania at times and always felt kind of driven....would taking Prozac with Geodon take that inner driven feeling away?
Thanks, Karen
Posted by Brainbeard on January 18, 2010, at 14:46:24
In reply to Re: Prozac dosage questions » Brainbeard, posted by KarenRB53 on January 18, 2010, at 13:13:33
> Hi: Just found your post. I was on Prozac for years and it worked very well except it did cause some hypomania at times and always felt kind of driven....would taking Prozac with Geodon take that inner driven feeling away?
>
> Thanks, KarenAre you the same Karen as on the Crazy Meds board?
The answer is: no, probably not, since Geodon in itself is likely to cause akathisia - unfortunately. Mirtazapine (Remeron) MAY be a better option.
Posted by conundrum on January 19, 2010, at 6:07:11
In reply to Re: Prozac dosage questions, posted by Brainbeard on January 18, 2010, at 14:46:24
Im not sure why Stahl believes prozac to be a stronger 5 ht2c antagonist than a reuptake inhibitor. I had found a study that showed the Ki values for prozacs binding sites. It was 60 fairly weak for 5 h2c receptors and 1.6 for the serotonin transporter, much stronger.
On the other hand i found that taking 5 mg prozac every other day with a little bit of buspar helped with motivation, but nothing to write home about.
Posted by Brainbeard on January 19, 2010, at 14:27:23
In reply to Re: Prozac dosage questions » Brainbeard, posted by conundrum on January 19, 2010, at 6:07:11
> Im not sure why Stahl believes prozac to be a stronger 5 ht2c antagonist than a reuptake inhibitor. I had found a study that showed the Ki values for prozacs binding sites. It was 60 fairly weak for 5 h2c receptors and 1.6 for the serotonin transporter, much stronger.
>
> On the other hand i found that taking 5 mg prozac every other day with a little bit of buspar helped with motivation, but nothing to write home about.The key to understanding why Prozac is a more potent 5HT2C antagonist than an SSRI at low doses, is that for succesful 5HT2C antagonism, you only need little receptor binding, while for serious SRI you need a lot. So you really can't compare the Ki values at an equal par. See one of my posts elsewhere on the board for a more elaborate discussion: http://www.dr-bob.org/babble/neuro/20091104/msgs/931609.html
Posted by conundrum on January 19, 2010, at 19:23:15
In reply to Re: Prozac dosage questions, posted by Brainbeard on January 19, 2010, at 14:27:23
Ah you replied to my other thread and I didnt even see it! How do find all this stuff, you must be a good surfer.
I guess that explains why I did better on a dose lower than 5 mgs. As soon as I got to 5mg I lost the desire to eat. Interestingly after starting lexapro I was very hungry for a few days. It was the opposite.
Maybe I will try 2.5 mg per day again. It seemed to help a little with motivation.
Posted by Brainbeard on January 20, 2010, at 3:55:19
In reply to Re: Prozac dosage questions » Brainbeard, posted by conundrum on January 19, 2010, at 19:23:15
> How do find all this stuff, you must be a good surfer.
A good surfer - thanks! :)
Or - an obsessive surfer. A fanatic surfer. A surfer who only gives up long, long after most people would have given up.
Posted by conundrum on January 20, 2010, at 9:33:10
In reply to Re: Prozac dosage questions, posted by Brainbeard on January 20, 2010, at 3:55:19
At one point I had stumbled upon an study that showed the SERT remains downregulated after chronic SSRI treatment is discontinued. Any chance you could find it? I´ve searched all over for it. Should have bookmarked it. :-/
Posted by paulbwell on January 22, 2010, at 3:03:13
In reply to Re: Prozac dosage questions, posted by Brainbeard on July 10, 2009, at 5:34:09
"It would be ideal to combine Prozac or any other SRI-therapy with a 5HT2A-blocker."
"Most AAP's (the newer atypical antipsychotics) have strong 5HT2A-blockade"Hey!
I take Prozac and felt the anhedonia, which has diminished with Ritalin. I have Risperdal which is said to have 5HT2A-antagonist++ effect, what dosage would be good with 60mg Prozac? and would 60mg be too high anyways. very interesting comments.Thanks
Posted by KarenRB53 on January 22, 2010, at 7:46:27
In reply to Re: Prozac dosage questions, posted by morganpmiller on July 1, 2009, at 2:19:45
> http://biopsychiatry.com/fluoxdopnor.htm
>
> If you don't want to try Nardil for anxiety, I would go with Prozac. I experienced the one pupil dilating more that the other fairly recently when I took Cymbalta, Prozac's sister. I don't think this is abnormal. Over time, if you find a dose that works for you, I would not be too concerned with side effects. Chronically feeling bad is more likely to cause more damage to your brain and body than Prozac will.
>
> See what your p doc thinks..not like he will have all the answers.
>
> So did you try zoloft before? just curious..
>
> You could try tianeptine(Stablon), but you would have to order it through an overseas pharmacy and take it 3 times a day.
Is Cymbalta considered Prozac's sister and if so, why? What is the difference between the two?
Thanks
Posted by conundrum on January 22, 2010, at 10:30:01
In reply to Re: Prozac dosage questions » Brainbeard, posted by paulbwell on January 22, 2010, at 3:03:13
Are you taking the generic mnethylphenidate or brand ritalin?
Posted by JayBTV2 on January 22, 2010, at 11:39:05
In reply to Prozac dosage questions, posted by garnet71 on June 30, 2009, at 19:36:58
> One of my pupils is larger than the other shortly after taking Prozac (could be just coincidence--but the size difference was confirmed by my opthamologist who measured my pupils). And it made my urine cloudy-which really freaked me out too. That can be a sign of neurological damage, although it could be minor kidney things too. But adding the 2 symptoms together....was too much of a coincidence. My pupil sizes are still mismatched and I have had distorted vision ever since. I had also wondered if Prolactin levels can do that? Need to go to more doctors....
>I got the different sized pupil thing from Rhodiola rosea. Apparently very few things cause it (some can be serious) so I was happy it went away after stopping that herb.....
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