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Dr. Bob is Robert Hsiung, MD,
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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.....
Posted by Brainbeard on January 22, 2010, at 14:34:18
In reply to Re: Prozac dosage questions » Brainbeard, posted by paulbwell on January 22, 2010, at 3:03:13
>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.
Prozac inhibits Risperdal's metabolism and increases its blood levels up to tenfold. For 5HT2A-antagonism, you only need a small dose of Risperdal, 0.5mg may be enough. So, if you're on 60mg of Prozac, you would need a needle pin amount of Risperdal..
Posted by Brainbeard on January 22, 2010, at 14:37:45
In reply to Re: Prozac dosage questions, posted by KarenRB53 on January 22, 2010, at 7:46:27
> Is Cymbalta considered Prozac's sister and if so, why? What is the difference between the two?
>Question 1: No.
Question 2: Prozac is an SSRI (Serotonin Reuptake Inhibitor) and a Noradrenaline and Dopamine DisInhibitor (NDDI), Cymbalta is a SNRI (Serotonin and Noradrenaline Reuptake Inhibitor).
Posted by paulbwell on January 24, 2010, at 21:08:50
In reply to Re: Prozac dosage questions » paulbwell, posted by conundrum on January 22, 2010, at 10:30:01
> Are you taking the generic mnethylphenidate or brand ritalin?
Took a locally made generic 10mgIR for years, i didn't know what i was missing. Now it's only Brand name Ritalin SR20s which are actually quite a bit smaller than the gen IR10s-shows how much crap is in them-20s smoother, calmer, more effective-WORD!
Posted by KarenRB53 on January 25, 2010, at 8:25:42
In reply to Re: Prozac dosage questions, posted by Brainbeard on January 22, 2010, at 14:37:45
>
> > Is Cymbalta considered Prozac's sister and if so, why? What is the difference between the two?
> >
>
> Question 1: No.
>
> Question 2: Prozac is an SSRI (Serotonin Reuptake Inhibitor) and a Noradrenaline and Dopamine DisInhibitor (NDDI), Cymbalta is a SNRI (Serotonin and Noradrenaline Reuptake Inhibitor).
>
>
What is the difference between a reuptake inhibitor and a reuptake disinhibitor?Thanks, Karen
Posted by paulbwell on January 25, 2010, at 8:28:34
In reply to Re: Prozac dosage questions, posted by Brainbeard on January 22, 2010, at 14:34:18
> >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.
>
> Prozac inhibits Risperdal's metabolism and increases its blood levels up to tenfold. For 5HT2A-antagonism, you only need a small dose of Risperdal, 0.5mg may be enough. So, if you're on 60mg of Prozac, you would need a needle pin amount of Risperdal..
So taking 0.5mg Risperdal with 60mg Prozac COULD result in the equal of 5mgs Risperdal? scary
>
>
Posted by janejane on January 25, 2010, at 9:04:17
In reply to Re: Prozac dosage questions, posted by Brainbeard on January 22, 2010, at 14:37:45
Question for Brainbeard/others:
I've been taking the herb rhodiola rosea for about a month and not getting complete remission of depression. At first I felt a significant (though not complete) improvement, but feelings of despair and being overwhelmed have resurfaced, though they're not as bad. I'm not sure whether it's pooping out or not, but I'm inclined to keep it on board for a while since I do think it offers some benefit compared to my baseline.
I took 20 mg prozac in the past and it worked on the depression but caused apathy, anhedonia, amotivation, insomnia, daytime sleepiness, lethargy, headache. I'm hoping adding a small dose of prozac to the rhodiola will help eliminate the stubborn despair without causing the side effects. Does this seem like a sound strategy? Would 5 mg be too little to get a serotonin boost?
Thanks!
Posted by Phillipa on January 25, 2010, at 19:31:04
In reply to Re: Prozac dosage questions » Brainbeard, posted by janejane on January 25, 2010, at 9:04:17
Jane I don't think so it's so stimulating at least for me. Love Phillipa
Posted by Brainbeard on January 26, 2010, at 4:09:17
In reply to Re: Prozac dosage questions » Brainbeard, posted by KarenRB53 on January 25, 2010, at 8:25:42
> What is the difference between a reuptake inhibitor and a reuptake disinhibitor?
>
> Thanks, KarenA reuptake inhibitor blocks the reuptake of a neurotransmitter in the synapse, making more of the neurotransmitter hang around in the synaptic cleft, which means that receptors sensitive to that neurotransmitter will be flooded by it. So, a serotonin reuptake inhibitor basically makes your brain soak in serotonin. The consequences are an even more complicated story.
There doesn't exist such a thing as a reuptake disinhibitor. Prozac and other drugs are a dopamine and noradrenaline disinhibitor. It means that by 'antagonizing', which means blocking, certain receptor subtypes, they block the brake on certain neurotranmitters. Prozac is a 5HT2C-antagonist. 5HT2C receptors are a serotonin receptor subtype (5HT=serotonin) that put a brake on dopamine and noradrenaline. So if you block the functioning of these receptors (i.e. 5HT2C-antagonism), they can no longer put a brake on dopamine and noradrenaline and hence these neurotransmitters are 'disinhibited', i.e. they are boosted.
Posted by KarenRB53 on January 26, 2010, at 10:50:38
In reply to Re: Prozac dosage questions, posted by Brainbeard on January 26, 2010, at 4:09:17
> > What is the difference between a reuptake inhibitor and a reuptake disinhibitor?
> >
> > Thanks, Karen
>
> A reuptake inhibitor blocks the reuptake of a neurotransmitter in the synapse, making more of the neurotransmitter hang around in the synaptic cleft, which means that receptors sensitive to that neurotransmitter will be flooded by it. So, a serotonin reuptake inhibitor basically makes your brain soak in serotonin. The consequences are an even more complicated story.
>
> There doesn't exist such a thing as a reuptake disinhibitor. Prozac and other drugs are a dopamine and noradrenaline disinhibitor. It means that by 'antagonizing', which means blocking, certain receptor subtypes, they block the brake on certain neurotranmitters. Prozac is a 5HT2C-antagonist. 5HT2C receptors are a serotonin receptor subtype (5HT=serotonin) that put a brake on dopamine and noradrenaline. So if you block the functioning of these receptors (i.e. 5HT2C-antagonism), they can no longer put a brake on dopamine and noradrenaline and hence these neurotransmitters are 'disinhibited', i.e. they are boosted.
>
>Thanks for explaining so I could understand. I believe that part of my problem is that my pdoc keeps putting me on SSRI's and I think that I need some Norepinephrine also. I've checked out what norepinephrine does and I think that seratonin alone is causing some of m problems with depression, anxiety, lack of motivation etc. I'm wondering if it would be best to add something to the Celexa that would give me the Norepinephrine or to switch to another AD that affects both seratonin and norepinephire. I do become hypo easily so I have to be careful of that. Any suggestions appreciated.
Thanks, Karen
Posted by conundrum on January 26, 2010, at 12:09:29
In reply to Re: Prozac dosage questions » Brainbeard, posted by janejane on January 25, 2010, at 9:04:17
i found that if i took a 10mg tablet and broke it in half and then took a half every other day prozac helped motivate me, probably from increase norepinephrine. If I took it every day i became apathetic and blunted from too much serotonin.
Posted by janejane on January 26, 2010, at 13:47:01
In reply to Re: Prozac dosage questions » janejane, posted by conundrum on January 26, 2010, at 12:09:29
> i found that if i took a 10mg tablet and broke it in half and then took a half every other day prozac helped motivate me, probably from increase norepinephrine. If I took it every day i became apathetic and blunted from too much serotonin.
Interesting. I think I need more serotonin, so I think I'll try 10 mg per day, every day. (That's what I took this morning.) I guess if I start feeling apathetic, I can cut down to every other day. Thanks!
Posted by Brainbeard on January 26, 2010, at 16:13:23
In reply to Re: Prozac dosage questions » Brainbeard, posted by KarenRB53 on January 26, 2010, at 10:50:38
> Any suggestions appreciated.
>
> Thanks, KarenHave you tried the TCA's yet? Clomipramine, imipramine or amitriptyline. They all do both SRI and N[oradrenaline]RI. Clomipramine has strong SRI and strong NRI, imipramine medium SRI and strong NRI, and amitriptyline moderate S- and NRI. Amitriptyline is the least likely to make you hyper, perhaps unless you're bipolar.
If you're really desperate, you could try high dose Effexor, but coming off of that stuff can be pure hell.
Posted by KarenRB53 on January 26, 2010, at 18:40:39
In reply to Re: Prozac dosage questions, posted by Brainbeard on January 26, 2010, at 16:13:23
> > Any suggestions appreciated.
> >
> > Thanks, Karen
>
> Have you tried the TCA's yet? Clomipramine, imipramine or amitriptyline. They all do both SRI and N[oradrenaline]RI. Clomipramine has strong SRI and strong NRI, imipramine medium SRI and strong NRI, and amitriptyline moderate S- and NRI. Amitriptyline is the least likely to make you hyper, perhaps unless you're bipolar.
>
> If you're really desperate, you could try high dose Effexor, but coming off of that stuff can be pure hell.
>
>
What is your opinion on Cymbalta or Pristiq, they're both SNRI's aren't they? In your opinion would the TCA's be a better way to go than the Cymbalta or Pristiq?Karen
Posted by Brainbeard on January 27, 2010, at 8:22:38
In reply to Re: Prozac dosage questions » Brainbeard, posted by KarenRB53 on January 26, 2010, at 18:40:39
> What is your opinion on Cymbalta or Pristiq, they're both SNRI's aren't they? In your opinion would the TCA's be a better way to go than the Cymbalta or Pristiq?
Both Cymbalta and Pristiq are likely to have horrible withdrawal syndromes.
Cymbalta (generic name duloxetine) doesn't seem to be much special, it may lack some of the typical side-effects of TCA's (dry mouth, constipation, cognitive debilitation, cardiac burden) but it has its own bizarre list of potential side-effects. It may be a good choice for some people who are both depressed an in pain.
Pristiq, which is practically identical to Effexor (generic name venlafaxine), is in its own league. Some people get chronically happy on it. It seems to be a unique drug, even thoug its pharmacological profile doesn't seem all that unique. Trouble is, you might never get off it or get off it and be in greater misery than when you started. (Of course the latter is a problem with all SSRI's too.)
So yeah, I would be more inclined to try TCA's first and see how well you can tolerate them and how well they work. If you go TCA, build doses up slow to avoid premature disappointment because of the side-effects. TCA's have some incovenient side-effects, but they have a lot to offer.
Oh my... Off-topic.
Posted by KarenRB53 on January 27, 2010, at 8:57:30
In reply to Re: Prozac dosage questions - SORRY, WAY OFF TOPIC, posted by Brainbeard on January 27, 2010, at 8:22:38
> > What is your opinion on Cymbalta or Pristiq, they're both SNRI's aren't they? In your opinion would the TCA's be a better way to go than the Cymbalta or Pristiq?
>
> Both Cymbalta and Pristiq are likely to have horrible withdrawal syndromes.
>
> Cymbalta (generic name duloxetine) doesn't seem to be much special, it may lack some of the typical side-effects of TCA's (dry mouth, constipation, cognitive debilitation, cardiac burden) but it has its own bizarre list of potential side-effects. It may be a good choice for some people who are both depressed an in pain.
>
> Pristiq, which is practically identical to Effexor (generic name venlafaxine), is in its own league. Some people get chronically happy on it. It seems to be a unique drug, even thoug its pharmacological profile doesn't seem all that unique. Trouble is, you might never get off it or get off it and be in greater misery than when you started. (Of course the latter is a problem with all SSRI's too.)
>
> So yeah, I would be more inclined to try TCA's first and see how well you can tolerate them and how well they work. If you go TCA, build doses up slow to avoid premature disappointment because of the side-effects. TCA's have some incovenient side-effects, but they have a lot to offer.
>
> Oh my... Off-topic.
I'm sorry for asking that question in this thread. But I appreciate your helpful information.Karen
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