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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by MixedState66 on April 8, 2013, at 15:08:04
I have been on 50 mg of nortriptyline and .5 of risperdal for about two months. I went to my doctor last week explaining the nortryptiline may not e helping my depression. The risperdal has helped me sleep better and helped to control my obsessive thoughts and anxiety.
He started me on 25 mg of luvox in combination with the nortryptiline and risperdal. I noticed within the first few hours feeling different, a better overall mood, yet this stoned feeling that is impairing my memory and cognitive abilities. This is now day 4 on the Luvox. I am starting a new job in a week and paranoid that I won't get used to this med and go into my next job acting like a complete air head. I understand you need to give these kinds of meds a few weeks to get used to and give a fair trial, but I feel like I made a mistake starting right now.
Could it be that the combination or nortryptiline and Luvox is a very potent combination that may create a seretonin overload? I may start tapering off the nortryptiline, but I did want to be on it while taking the Luvox in order to to single out which med is more effective.... Does anyone have suggestions out there?
Posted by SLS on April 8, 2013, at 17:02:18
In reply to Started Luvox and feeling strange- advice please, posted by MixedState66 on April 8, 2013, at 15:08:04
> I have been on 50 mg of nortriptyline
This is usually too low a dose.
> I went to my doctor last week explaining the nortryptiline may not e helping my depression.
I think your doctor should explore higher dosages of nortriptyline in combination with blood tests to guide dosage adjustments. I take 150 mg/day. 75 mg/day is usually the minimum dosage that people respond to.
I'm not a big fan of Luvox (fluvoxamine) for depression without OCD. It tends to be sedating. I am not impressed by its reported efficacy when treating depression, but this might be an artifact of its being prescribed so infrequently and perhaps that a greater percentage of Luvox users are TRD (treatment resistant depression) cases. If you are determined to continue Luvox treatment, perhaps you can reduce the dosage and titrate more gradually.
Your doctor might be having success prescribing Luvox. I'm sure there is a reason why he uses it.
There is no reason why you cannot combine Luvox with nortriptyline or desipramine, which are secondary amines. Luvox will, however, increase the plasma levels of tertiary amines like imipramine and amitrityline. Nortripytline is primarily noradrenergic, and might act to complement the actions of serotonergic drugs.
- Scott
Posted by Phillipa on April 8, 2013, at 19:23:20
In reply to Started Luvox and feeling strange- advice please, posted by MixedState66 on April 8, 2013, at 15:08:04
That's a very low dose of luvox. Personally it was in favor about 15 years ago and when given it I loved it. Only ad never ever had a side effect to. I took 250mg of it. The first time I took luvox 50mg at night. I keep waiting literally for a side effect and none. So in the am the doc raised it each day till at 250mg. I took ativan with it only benzo that is not potentiated by luvox. Still take 25mg of luvox as my brain loves it. Phillipa
Posted by MixedState66 on April 8, 2013, at 21:36:31
In reply to Re: Started Luvox and feeling strange- advice please » MixedState66, posted by SLS on April 8, 2013, at 17:02:18
I understand I need to give this medication a fair trial rather than giving up after a few days. I notice from user blogs on this site and others that many give up if they experience side effects within the first few days. My only concern and anxiety at this point is that I am starting a new job and hope I have mental clarity in order to give off a good impression.
When I started nortriptyline, not only did I get severe dry mouth the first two weeks, but I felt incoherent and unable to pronounce words or thoughts clearly. I went into an interview during the first week of being on it, and it was a complete disaster - I could not function and had to tell the interviewer to get me a glass of water since my mouth got so dry and I could barely speak.
I should have cut the 25mg of luvox in half for this first week and gradually built it up. I hope this 'stoned' feeling I am experiencing goes away, it is really a strange feeling despite my mood being better at the same time.
Posted by phidippus on April 29, 2013, at 6:05:35
In reply to Started Luvox and feeling strange- advice please, posted by MixedState66 on April 8, 2013, at 15:08:04
No, you will not incur 'seratonin overload'.
A crash course in treating obsessive anxiety(OCD.
It is recommended that the patient with OCD be treated with antidepressants. If there is not enough response to the antidepressant, an atypical antipsychotic is recommended as augmentation therapy.
How this works: those with OCD tend to to have less seratonin in key parts of the brain. By elevating seratonin levels, antidepressants work to correct imbalances in the level of seratonin in the brain.
A key area of the brain, the nucleus accumbens often has increased levels of dopamine in the brains of patients with OCD. Administering a antipsychotic corrects this imbalance.
For me, OCD was a severe mistress. I responded well to some antidepressants, but not enough. That's why I take a combo of antidepressant and antipsychotic: Abilify and Viibryd.
There are other drugs which can help treat OCD and may be added on as a 3rd medication: dextroamphetamine, caffeine, Ondansetron...
Eric
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