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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by rjlockhart37 on June 3, 2021, at 14:45:27
I've been on 80 for about couple years. They have used 120mg for treatment resistant depression, I really want to go to 120, i've taken it before and yes it has a bit more stronger antidepressant effect, not much but you can notice. Medical maximum dosage is 80. I need to find a shrink that will allow 120, because it does have good antidepressant effects at that dose. Prozac i've read is lesser effective than other SSRI's. 1 because it takes 6 weeks or more to work, it's not as potent because it's the 'least' selective on serotonin sites. But if the dose was bumped up it may have more potent effects
Posted by rjlockhart37 on June 3, 2021, at 14:51:04
In reply to 120mg of fluoxetine, posted by rjlockhart37 on June 3, 2021, at 14:45:27
my doctor defeintly would not go to 120. It's above the medical max but .... i don't know it's good antidepressant effects at that dose.
Posted by rjlockhart37 on June 3, 2021, at 15:00:16
In reply to 120mg of fluoxetine, posted by rjlockhart37 on June 3, 2021, at 14:45:27
"Doses up to 120 mg/day, if tolerated, may be necessary in some patients for optimal response (Phillips 2018)"
https://www.localhealthrx.com/drugs/fluoxetine-hydrochloride/
still that's pretty high
Posted by linkadge on June 5, 2021, at 15:27:48
In reply to Re: 120mg of fluoxetine, posted by rjlockhart37 on June 3, 2021, at 15:00:16
Have you tried augmenting with something else (i.e. nortriptyline)?. I'm not sure how effective going from 80mg to 120mg of fluoxetine will be.
Linkadge
Posted by SLS on June 6, 2021, at 22:08:43
In reply to 120mg of fluoxetine, posted by rjlockhart37 on June 3, 2021, at 14:45:27
> I've been on 80 for about couple years. They have used 120mg for treatment resistant depression, I really want to go to 120, i've taken it before and yes it has a bit more stronger antidepressant effect, not much but you can notice. Medical maximum dosage is 80. I need to find a shrink that will allow 120, because it does have good antidepressant effects at that dose. Prozac i've read is lesser effective than other SSRI's. 1 because it takes 6 weeks or more to work, it's not as potent because it's the 'least' selective on serotonin sites. But if the dose was bumped up it may have more potent effects
Anything that works for you is potent enough, whether it is 37.5 mg of Effexor or 120 mg/day of Prozac.
You never know what you will eventually arrive at that turns the switch on. I had success reviewing which drugs helped and which didn't. In moving forward with drug trials, I ended up choosing drugs with little regard to the minutia of psychopharmacology. I am not taking away anything from your study and research of the brain and how various compounds affect it. However, when it comes to the brain - and medicine in general - the empirical is sometimes more important than the theoretical. For people like us, thinking outside the box is critical. If your pursuit of a cure is based solely on what neuroscience says today, consider what neuroscience said 20-40 years ago. If you were to rely solely on the norepinephrine theory of depression in 1980, where would that get you today? I brought in dopamine to my doctors at Columbia and asked them for Wellbutrin. My dopamine hypothesis and desire to try bromocriptine earned me laughter by Wilma Harrison, who later sought out to prove that vitamin-B6 could cure premenstrual "tension". She ended up on the team to get sertraline to market. In the mid-1980s came serotonin. When Prozac came out, I had already been on 3 novel serotoninergic drugs from France. With the marketing of Prozac came the loss of norepinephrine from memory overnight. How many compounds have been synthesized since then? How many receptors and sub-receptors have been discovered since? Of course, one day, this will all be figured out, but perhaps not in your lifetime. This understanding must incorporated an explanation for the interindividual heterogeneity of people's divergent responses to the same drug. I imagine somewhere there exists a Venn diagram for how to combine the use theoretical possibilities with life-charting one's factual history of treatments and their results.
All of the four drugs that I benefit from were available to be combined in 1996. I was only 36 then. That's a bitter pill to swallow. Very big. It wasn't until 2020 that they were tried together at the right dosages. I got very close in 2009. I was taking all four of the right drugs, but at the wrong dosages. Nortriptyline was too high and lamotrigine was too low. I followed some of my doctor's suggestions. He has been extremely open-minded all the way. But these drugs and the dosages I felt would work were cobbled together by me - not through theory, but through the results of past empirical experimentation. If you could allow yourself to be dumb for just a couple of minutes, identify all of the drugs that helped - even a little. Identify all of the drugs that made you moderately to severely worse. Take your list of good ones and evaluate which ones are compatible in combination, but are different enough to be complementary rather than synergistic.
This is not a recipe meant to cure everyone. It is not even a recipe that is necessary to cure anyone except for me. However, I think this approach might be overlooked sometimes when we get too caught up with trying to figure out the most complex object in the universe.
Just a few thoughts. I hope someone get lucky using them.
- Scott
Posted by undopaminergic on June 7, 2021, at 7:24:38
In reply to Re: 120mg of fluoxetine, posted by SLS on June 6, 2021, at 22:08:43
>
> Take your list of good ones and evaluate which ones are compatible in combination, but are different enough to be complementary rather than synergistic.
>I think synergy is the ideal; it means the sum is greater than its parts. Usually that involves drugs with complementary effects -- it is hard to imagine achieving synergy with purely additive mechanisms such as SSRI+SSRI.
Anyway, your thoughts are interesting. Eg. you mention lamotrigine... I'm on 200 mg, without effect; do you think 300 or 400 mg might be dramatically different?
I'm glad you found a working combination after all this time.
-undopaminergic
Posted by rjlockhart37 on June 7, 2021, at 20:32:36
In reply to Re: 120mg of fluoxetine, posted by SLS on June 6, 2021, at 22:08:43
SLS,
thank you for response. I take Prozac, Lamictal, and zyprexa. They seem to synergy with eachother but i don't quite like the zyprexa. I was put on it long ago, because of an emerency at psych hospital. I just stayed on it but the first couple years i gained weight, and it also made me passive, and sometimes low motivation. I was calm most of the time, but it gave away that spontaneous motivation your suppost to have. Lamcital i take 400mg in morning - at the psych they said one at morninig and one at evening, i didnt do it that way. I told my doctor, and i take 400 in the moorning with 80mg Prozac. Both at max medical although lamotragine can go up to 800mg in siezure cases.
The Prozac - it makes things seem 'ok' but it's hard to describe. I can defeintly feel prozac's serotonin producing effect and also some norephinehrine but it's not a SNRI. Prozac from I've read is lesser effective SSRI, because it's the longest to take to work, and least selective oon serotonin sites. But it's half life is incredibly long, like 2-3 days. 80mg was only worked on me, my doctor was reluctant to use 80. But 120mg of prozac, i've ... taken it before because i accidnetly took 1 at bedtime. It's nothing like a major noticeable effect, but it keeps me up from being depressed, and synergy'd with lamictal that combination seems to work. I was just ... wondering 120mg would have an effect , because they use it for treatment resistant depression. Most doctors do not exceed medical maximum dose, although there's some that vigiously work with the patient, maybe they would explore that. Not my doctor....lol no.
37.5mg of effexor can have a similar effect to 80mg of prozac. Effexor is superior to prozac in treating depression, i've read that numerous times. We had to max the prozac to get an effect. So...don't really know what else to say, but lamotragine does work with fluoxetine.
Posted by SLS on June 7, 2021, at 21:32:28
In reply to Re: 120mg of fluoxetine » SLS, posted by undopaminergic on June 7, 2021, at 7:24:38
Hi UD.
> > Take your list of good ones and evaluate which ones are compatible in combination, but are different enough to be complementary rather than synergistic.
> >
>
> I think synergy is the ideal; it means the sum is greater than its parts. Usually that involves drugs with complementary effects -- it is hard to imagine achieving synergy with purely additive mechanisms such as SSRI+SSRI.
>
> Anyway, your thoughts are interesting. Eg. you mention lamotrigine... I'm on 200 mg, without effect; do you think 300 or 400 mg might be dramatically different?
>
> I'm glad you found a working combination after all this time.
>
> -undopaminergic
>For me, 200 mg/day of Lamictal helped, but didn't really kick-in until I went to 300 mg/day. In 2009, I was on these same four drugs, but with 200 mg/day of Lamictal instead of 300 mg/day. 12 years lost. My mistake. I was so close. I wish I had thought to ask my doctor to go higher. He would have - obviously. 12 years. I was reluctant to go higher with Lamictal because I was concerned about memory and cognitive impairments. I was too smart for my own good. If you do go to 300 mg/day, be patient with any sensation of brain-fog or memory difficulties. With me, these things resolved within a week or two.
Interestingly, 75 mg/day of Nardil doesn't work, but 90 mg/day does. That's not the interesting part, though. I lose my improvement in depression when I go to 105 mg/day or higher. My doctor saw this with another one of his patients. By comparison, there is no such window with me for Parnate. 80 helps. 150 mg/day helps, too. Parnate just gives me more energy without touching anhedonia or global depression.
Three more comments regarding Nardil and my experience with it.
1. It can take as long as three months to begin responding. Of course, that's only 12 weeks. For some reason, 12 weeks sounds shorter to me than 3 months. It took me less than 3 months, but longer than 1 month.
2. Keep in mind that some people have a remarkably hard and narrow dosage window.
3. Starting at 7.5 mg/day (half a pill) and increasing the dosage gradually might avoid or mitigate side effects. It was an experiment. As many times as I have been on Nardil, I experienced orthostatic hypotension to the point of feinting. The dizziness never subsided, even after months and months. I thought that if I avoided triggering the side effects in the first place, they might not develop, or be transient if they did. I think I had two orthostatic episodes since last summer, and they were mild.
- Scott
Posted by SLS on June 7, 2021, at 21:35:44
In reply to Re: 120mg of fluoxetine » SLS, posted by undopaminergic on June 7, 2021, at 7:24:38
> >
> > Take your list of good ones and evaluate which ones are compatible in combination, but are different enough to be complementary rather than synergistic.
> >
>
> I think synergy is the ideal; it means the sum is greater than its parts. Usually that involves drugs with complementary effects -- it is hard to imagine achieving synergy with purely additive mechanisms such as SSRI+SSRI.Yes. Complementary is the key. I misspoke. I was probably looking for the word "additive".
Thanks for pointing that out.
- Scott
Posted by rjlockhart37 on June 9, 2021, at 20:50:11
In reply to Re: 120mg of fluoxetine, posted by SLS on June 7, 2021, at 21:35:44
i wrote fluoxetine at least 8-9 times in the post lol, i don't knowo why that's strange... but me and prozac have been good friends since 2005
Posted by rjlockhart37 on June 9, 2021, at 20:52:17
In reply to Re: 120mg of fluoxetine, posted by rjlockhart37 on June 9, 2021, at 20:50:11
SLS did you ever try fluoxetine when it was released in 1987
This is the end of the thread.
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