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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by n_shrimpie on February 21, 2012, at 9:03:35
What's the onset of action for Luvox, and do the side effect occur from the beginning even at a low dose? my doctor wants to transition me from prozac to luvox, but i'm going on vacation next week and i'm afraid of suffering through side effects while i'm there. I also have severe anhedonia, and was wondering if the luvox could be helpful for that.
Posted by Phillipa on February 21, 2012, at 10:28:00
In reply to luvox anhedonia/side effects/onset of action, posted by n_shrimpie on February 21, 2012, at 9:03:35
When I first went on it years ago I kept waiting for side effects they never occurred? I also was on ativan at the time. Phillipa
Posted by n_shrimpie on February 21, 2012, at 10:31:15
In reply to Re: luvox anhedonia/side effects/onset of action » n_shrimpie, posted by Phillipa on February 21, 2012, at 10:28:00
Phillipa are you still on it? Did it help with your anhedonia or focus?
Posted by bleauberry on February 21, 2012, at 16:57:52
In reply to luvox anhedonia/side effects/onset of action, posted by n_shrimpie on February 21, 2012, at 9:03:35
I don't know if luvox has less sexual side effect than other ssris, about the same, or more. It is a ssri so the expectation of continued sexual side effects I think would be a realistic expectation. That's just what happens with those meds more often than not.
A diffferent strategy would be to keep prozac as it is and add the missing ingrediets NE and DA. To do that might include nortriptyline, desipramine, savella, ritalin, adderall. They are all quite different but they all focus on balancing out the other transmitters in balance with what prozac is doing. I just think it's better to try a couple add-ons to a previously good med before abandoning.
When my prozac got weak over time I added zyprexa and then shortly after that adrafinil (similar to modafinil) and I was pretty well for about 8 years. That was basically the same strategy....boosting the other transmitters (NE, DA or NE+DA) to balance out the prozac's predominant focus on serotonin.
Luvox will keep the focus primarily on serotonin. The meds do have unique diffferences even though they are in the same family and do basically the same thing, so who knows anything is possible. If you are going away or something it would be a lot easier to add a tiny dose of something new to your existing prozac than it would to do a whole switch. imo
Posted by n_shrimpie on February 21, 2012, at 18:05:54
In reply to Re: luvox anhedonia/side effects/onset of action, posted by bleauberry on February 21, 2012, at 16:57:52
> I don't know if luvox has less sexual side effect than other ssris, about the same, or more. It is a ssri so the expectation of continued sexual side effects I think would be a realistic expectation. That's just what happens with those meds more often than not.
>
> A diffferent strategy would be to keep prozac as it is and add the missing ingrediets NE and DA. To do that might include nortriptyline, desipramine, savella, ritalin, adderall. They are all quite different but they all focus on balancing out the other transmitters in balance with what prozac is doing. I just think it's better to try a couple add-ons to a previously good med before abandoning.
>
> When my prozac got weak over time I added zyprexa and then shortly after that adrafinil (similar to modafinil) and I was pretty well for about 8 years. That was basically the same strategy....boosting the other transmitters (NE, DA or NE+DA) to balance out the prozac's predominant focus on serotonin.
>
> Luvox will keep the focus primarily on serotonin. The meds do have unique diffferences even though they are in the same family and do basically the same thing, so who knows anything is possible. If you are going away or something it would be a lot easier to add a tiny dose of something new to your existing prozac than it would to do a whole switch. imo
>
>
the prozac never worked, only when it was washing out of my system. so we reduced it to 10mg thinking that there was a window of effectiveness, and it's not doing anything. doc wants to titrate me down from prozac while starting the luvox at 25mg but i think i should titrate down without any meds becasue what if the prozac works when it reaches 5mgs? so confused. tried adding abilify and ritalin did nothing. i'm also on 400 mg lamictal, which i've just reduced to 300 because of horrible brain fog and cognitive issues over the past year on the 400 mg. i don't have any sexual side effects on the 10mg prozac. my main depressive symptom is unabating anhedonia and the cognitive issues and sense of spaciness, though that may be due to the lamictal, who knows.
Posted by Phillipa on February 21, 2012, at 20:28:17
In reply to Re: luvox anhedonia/side effects/onset of action, posted by n_shrimpie on February 21, 2012, at 18:05:54
Luvox is not stimulating as prozac was for me. That and ativan lifted up and relieved anxiety so I felt well. I still take 50mg of luvox body won't let me off it. So evidently something in my brain needs this. Difference to me is more sedating and less stimulating and with an ocd type anxiety stimulation is the least of what I need. Phillipa
Posted by bleauberry on February 22, 2012, at 4:22:48
In reply to Re: luvox anhedonia/side effects/onset of action, posted by n_shrimpie on February 21, 2012, at 18:05:54
Ok that's helpful. Based on everything you have said, odds are very strong that ssris are not the way to go for you. That includes prozac, luvox, paxil, zoloft, celexa, lexapro, pristiq, effexor, cymbalta. None of those are anti-anhedonia meds, and in fact usually make anhedonia worse.
That said, any of them can behave entirely different when combined with a norepinephrine med, such as nortriptyline, desipramine, savella. Anhedonia almost by definition points a finger at norepinephrine and/or dopamine. It's more complicated than that obviously, but that's the basic landscape.
Anhedonia was my biggest thing too. Probably the single most effective med I had for that was Savella low dose.
And this suggestion really could work.....as you are continuing to reduce prozac, go ahead and add in Rhodiola Rosea. This herb is quite fascinating in multiple ways and happens to be fairly specific for your profile.
Lamictal probably isn't doing any favors either. The emotional spectrum is usually squashed on mood stabilizers.
The clues from your experience with ritalin and prozac suggest to me that the primary suspect in this case may be norepinephrine more than dopamine.
There WILL be weirdness as prozac washes out and especially as lamictal comes down. It could be fairly mild or it could be rather scary. Try to be in touch with it so you can know the difference between the withdrawal stuff and the actual disease stuff. As lamictal comes down the brain fog should improve but depression could temporarily show up as well....not disease depression but withdrawal depression. They are different but feel the same.
Back to your original question, is luvox a good choice when anhedonia is a primary concern? Not! That doesn't mean it couldn't work because in this game anything is possible, but the odds are not likely.
Any run of the mill GP might have had you on Wellbutrin instead. I mean, that one even though I think it is not a very good med, it is more specific for anhedonia. So if I were in your shoes making a list of where to go from here, my list would include: Rhodiola Rosea, Savella, Zoloft+Nortriptyline, Wellbutrin, Parnate.
> > I don't know if luvox has less sexual side effect than other ssris, about the same, or more. It is a ssri so the expectation of continued sexual side effects I think would be a realistic expectation. That's just what happens with those meds more often than not.
> >
> > A diffferent strategy would be to keep prozac as it is and add the missing ingrediets NE and DA. To do that might include nortriptyline, desipramine, savella, ritalin, adderall. They are all quite different but they all focus on balancing out the other transmitters in balance with what prozac is doing. I just think it's better to try a couple add-ons to a previously good med before abandoning.
> >
> > When my prozac got weak over time I added zyprexa and then shortly after that adrafinil (similar to modafinil) and I was pretty well for about 8 years. That was basically the same strategy....boosting the other transmitters (NE, DA or NE+DA) to balance out the prozac's predominant focus on serotonin.
> >
> > Luvox will keep the focus primarily on serotonin. The meds do have unique diffferences even though they are in the same family and do basically the same thing, so who knows anything is possible. If you are going away or something it would be a lot easier to add a tiny dose of something new to your existing prozac than it would to do a whole switch. imo
> >
> >
> the prozac never worked, only when it was washing out of my system. so we reduced it to 10mg thinking that there was a window of effectiveness, and it's not doing anything. doc wants to titrate me down from prozac while starting the luvox at 25mg but i think i should titrate down without any meds becasue what if the prozac works when it reaches 5mgs? so confused. tried adding abilify and ritalin did nothing. i'm also on 400 mg lamictal, which i've just reduced to 300 because of horrible brain fog and cognitive issues over the past year on the 400 mg. i don't have any sexual side effects on the 10mg prozac. my main depressive symptom is unabating anhedonia and the cognitive issues and sense of spaciness, though that may be due to the lamictal, who knows.
>
Posted by n_shrimpie on February 22, 2012, at 6:07:35
In reply to Re: luvox anhedonia/side effects/onset of action » n_shrimpie, posted by bleauberry on February 22, 2012, at 4:22:48
The Lamictal isn't dulling my emotions, in fact, when i started taking it years ago, for the first time in my life i went into %100 remission, even the anhedonia was gone. This, of course, was amazing for about 6 mos until it pooped out, so i kept upping the doses, and while the increased dosages help my depression, they caused horrid memory issues and brain fog. I even left my beloved dog tied up outside a store one day, which scared the sh*t out of me. every time i'd try to reduce the dose the withdrawal would force me to return to my prior dosage. now i'm forcing myself to stick out the withdrawal and am down to 300 from 400. Cognitive problems remain but i suspect that's a function of temporary withdrawal so i'm going to suffer through it for now. i've tried wellbutrin, but the irritability it caused was intolerable. It's been tough to gauge because at times my mood has been fine, but the brain fog was horrid, and that's what i was trying to treat with meds like wellbutrin, pristiq etc but nothing cut through it, which leads me to believe it's lamictal overdose that's causing the cognitive problems, and maybe not depression. sometimes i can't even find my way around when i'm driving familiar routes. My mood is sinking as i reduce the lamictal, but it may be temporary withdrawal, as lamictal's effectiveness as an ad is supposed to cap out at 200mg. I'm atypical, and tried parnate years ago but couldn't tolerate the initial side effects, ie passing out and bad chills. maybe i should try it again. nardil worked well, (but not for the anhedonia) but the associated insomnia, daytime napping and weight gain made it much less than ideal. my doctor seems to want to exhaust the ssri's before trying selegeline, but i never picked up the luvox, and am going to explain to her why today. I just ordered omegabrite fish oil, and i'm considering ordering the enada NADH. Is savella a prescription drug?
Posted by SLS on February 22, 2012, at 6:52:21
In reply to Re: luvox anhedonia/side effects/onset of action, posted by n_shrimpie on February 22, 2012, at 6:07:35
The combination of Lamictal and Abilify can produce an improvement in people who fail to respond to Lamictal alone. However, you might opt for an antidepressant to be coadministered.
- Scott
Posted by n_shrimpie on February 22, 2012, at 6:58:32
In reply to Re: luvox anhedonia/side effects/onset of action » n_shrimpie, posted by SLS on February 22, 2012, at 6:52:21
Scott i meant to tell you that i've been titrating the lamictal down as you suggested, and i ALMOST went for the bottle yesterday during withdrawal but now i'm at 300mg and i have MUCH more clarity today than i have for the first time in over a year. I'ms going to try to get down to 200mg. My cognitive problems typically gets worse as the day continues and it's early so we'll see how it goes but i can tell it's better already. Went off the abilify due to weight gain.
Posted by Phillipa on February 22, 2012, at 19:29:21
In reply to Re: luvox anhedonia/side effects/onset of action, posted by n_shrimpie on February 22, 2012, at 6:58:32
How did you make out at the doc's today? What did he/say? Phillipa
Posted by n_shrimpie on February 22, 2012, at 19:43:16
In reply to Re: luvox anhedonia/side effects/onset of action » n_shrimpie, posted by Phillipa on February 22, 2012, at 19:29:21
Hi Phillipa,
Since I haven't had any luck with the SSRI's I decided not to take the luvox. She put me on Deplin as an adjunct to my 10mg prozac. I've also lowered my lamictal to 250mg which has increased my depression and made me somewhat tired but cleared some of my memory issues.
Posted by Phillipa on February 22, 2012, at 20:21:22
In reply to Re: luvox anhedonia/side effects/onset of action, posted by n_shrimpie on February 22, 2012, at 19:43:16
You have the 15mg correct? It can't hurt you and should be no side effects as basically a nutrient. Good luck on the combo and lowering the lamictal. As you mentioned before 200mg seems to be what is highest for unipolar depression. Please post your response to the new combo. Phillipa
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