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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by jerseygal1 on September 14, 2011, at 18:09:06
I was put on Pristiq 50 mg. back in May. It didn't do anything for me so the doc added zyprexa starting at 2.5 mg. increasing to 10 mg. That didn't work either so he upped the Pristiq to 100 mg. I've been at this dose for about 17 days and still no response. Is 17 days a long enough trial to see if there will be a response? If the pristiq isn't going to work, I'd like to move on though I don't know what my options will be. Prozac pooped out on me, lexapro didn't work, and now it seems pristiq isn't working. Is it still worthwhile to try the other SSRI's or cymbalta? Or does this mean I'll have to go the route of a tricyclic or MAOI?
Posted by jono_in_adelaide on September 14, 2011, at 18:58:32
In reply to Fair trial of Pristiq 100 mg?, posted by jerseygal1 on September 14, 2011, at 18:09:06
My gut feel would be to try an SSRI (say Zoloft 100mg/day) plus either Welbutrin 300mg/day or Nortriptyline 75mg/day
Posted by SLS on September 14, 2011, at 19:04:16
In reply to Fair trial of Pristiq 100 mg?, posted by jerseygal1 on September 14, 2011, at 18:09:06
> I was put on Pristiq 50 mg. back in May. It didn't do anything for me so the doc added zyprexa starting at 2.5 mg. increasing to 10 mg. That didn't work either so he upped the Pristiq to 100 mg. I've been at this dose for about 17 days and still no response. Is 17 days a long enough trial to see if there will be a response?
Not quite. I don't think it is worth the gamble to abort a trial of Pristiq at this juncture. If you can give it another week, you might see something. If not, then that would be the point at which you move on to other things. Some people who fail to respond to Effexor (the parent compound of Pristiq), will go on to respond to Cymbalta. I know someone who experienced poop-out with Effexor, but is doing marvelously with Pristiq.
> Or does this mean I'll have to go the route of a tricyclic or MAOI?
Pills from hell? They are not so bad. I prefer the side effect profile of nortriptyline to those of SSRIs.
Perhaps you can give Viibryd (vilazodone) a try before moving on to TCA or MAOI. It's an interesting drug with a clinical profile different from SSRIs, even though they both share the property of serotonin reuptake inhibition. Viibryd adds serotonin 5-HT1a receptor partial agonism (stimulation); a property that is unique among antidepressants.
Good luck with whatever you choose to do.
- Scott
Posted by Phillipa on September 14, 2011, at 21:11:36
In reply to Re: Fair trial of Pristiq 100 mg? » jerseygal1, posted by SLS on September 14, 2011, at 19:04:16
Scott what is that different serotonin? I have no idea of chemical perperties other than most basic. Phillipa
Posted by SLS on September 14, 2011, at 22:22:11
In reply to Re: Fair trial of Pristiq 100 mg? » SLS, posted by Phillipa on September 14, 2011, at 21:11:36
> Scott what is that different serotonin? I have no idea of chemical perperties other than most basic. Phillipa
Wow. That's a big question. Linkadge would be best suited to answer it. Perhaps I can write further on this tomorrow.
Time for bed.
- Scott
Posted by floatingbridge on September 15, 2011, at 1:10:10
In reply to Fair trial of Pristiq 100 mg?, posted by jerseygal1 on September 14, 2011, at 18:09:06
JerseyGal,
I was very much thinking of you tonight. I'm glad you posted.
So zyprexa is completely out?
Regarding pristiq 100mg, I would, in my opinion only, see about giving it more time. Pristiq at 50mg has a notoriously delayed response time for some. I wonder if there is a similar (hopefully shorter!) delay in going to 100mg.
Let me ask you. How are you experiencing the 100mg? Are you having sides? I am also wondering if experiencing less increase sides predicts a better outcome. But I have nothing but a hunch to base that last statement on.
Good luck.
My fingers are still crossed for you.
Posted by jerseygal1 on September 15, 2011, at 15:45:13
In reply to Fair trial of Pristiq 100 mg?, posted by jerseygal1 on September 14, 2011, at 18:09:06
Thank you everyone for your responses. Floating bridge, thank you for thinking of me. I am still taking zyprexa but, if anything, I think it has made me worse instead of better. Before zyprexa, I would start to feel better toward the end of the day and evening. Now I'm not even getting that break from all this. And I'm finding that I want to stay in bed more and hide under the covers. I see my pdoc next week so we'll see how that goes. I have a feeling he's going to want to try something other than the pristiq.
Posted by floatingbridge on September 18, 2011, at 10:30:53
In reply to Re: Fair trial of Pristiq 100 mg?, posted by jerseygal1 on September 15, 2011, at 15:45:13
Good luck with the doc next (this) week and for any treatment plans you may have in mind.
I am still on risperidone, but it is very low, and pdoc says only a few months at most in my situation.
Please keep us updated when you can. I'd like to know how you are doing.
Posted by jerseygal1 on September 18, 2011, at 16:28:18
In reply to Re: Fair trial of Pristiq 100 mg? » jerseygal1, posted by floatingbridge on September 18, 2011, at 10:30:53
Is risperidone also an atypical? I'm wondering if changing zyprexa to a different atypical would help?
Posted by floatingbridge on September 18, 2011, at 16:36:52
In reply to Re: Fair trial of Pristiq 100 mg?, posted by jerseygal1 on September 18, 2011, at 16:28:18
Yes. It's brand name is risperdal. I believe it is only mildly sedative compared to zyprexa. That really is the full extent of my knowledge. Oh, and that it may be less likely to evoke the sides of zyprexa, like diabetes and other things. But I'm not really very sure.
I take 0.5mg nightly. It is mildly sedating. That is the highest dose he says he wants me on. (I believe the dosage amounts are different between risperdal and zyprexa.)
Wiki has entries on both meds.
Posted by SLS on September 18, 2011, at 20:05:59
In reply to Re: Fair trial of Pristiq 100 mg? » jerseygal1, posted by floatingbridge on September 18, 2011, at 16:36:52
> Yes. It's brand name is risperdal. I believe it is only mildly sedative compared to zyprexa.
Zyprexa 15mg doesn't sedate me in the slightest. Risperdal 0.5mg slows me down and just feels yucky. Except for moderate weight-gain, Abilify is without side effects for me. Individual reactions to APs are quite variable.
- Scott
Posted by Phillipa on September 18, 2011, at 20:13:13
In reply to Re: Fair trial of Pristiq 100 mg?, posted by SLS on September 18, 2011, at 20:05:59
Wow I guess so. Phillipa
Posted by floatingbridge on September 18, 2011, at 20:51:33
In reply to Re: Fair trial of Pristiq 100 mg?, posted by SLS on September 18, 2011, at 20:05:59
> > Yes. It's brand name is risperdal. I believe it is only mildly sedative compared to zyprexa.
>
> Zyprexa 15mg doesn't sedate me in the slightest. Risperdal 0.5mg slows me down and just feels yucky. Except for moderate weight-gain, Abilify is without side effects for me. Individual reactions to APs are quite variable.
>
>
> - ScottI am surprised. Reactions can be very individual. On charts I have seen zyprexa rated as much more sedating. Personally, I would not know. Wow, risperidone feels yucky to you. Well, interesting indeed. I reacted adversely to abilfy and seroquel so much so that I just about had a brick over trying risperidone. Both of them were agitating and overly stimulating for me.
Does seroquel sedate you, Scott?
Posted by Phillipa on September 18, 2011, at 21:25:27
In reply to Re: Fair trial of Pristiq 100 mg? » SLS, posted by floatingbridge on September 18, 2011, at 20:51:33
FB think it could be because you have anxiety and Scott doesn't? I don't know just thinking Phillipa
Posted by SLS on September 18, 2011, at 22:17:48
In reply to Re: Fair trial of Pristiq 100 mg? » SLS, posted by floatingbridge on September 18, 2011, at 20:51:33
Hi FB.
> Does seroquel sedate you, Scott?
I tried Seroquel perhaps ten years ago. It made me irritable and uncomfortable. I doubt I took it for more than a week. It was not sedating, though.
- Scott
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