Posted by bob on May 20, 2000, at 0:26:00
In reply to Re: Prozac - any experience/info you can share?, posted by Racer on May 19, 2000, at 22:30:24
To chime in along with Racer -- you never see those "Prozac saved my life!" sites because (I'm projecting just a bit here) people for whom ADs work so dramatically tend to have better things to do than create web sites and sing its praises. Besides, the web is full of "personal complaint sites" -- whether its psych meds or local governments or Coca Cola all the way up to various hate-mongering sites. I'm sure you could easily find some "Neo-Luddite" sites screaming about how bad technology is for us as well (it's not the medium--it's the message ;^). Unhappy people have a ready medium with a huge potential audience here.
A lot of people seem to find both prozac and wellbutrin, individually, too "activating" to handle. Strangely enough, they're prescribed in combination quite often.
I was actually on both for a while. My AD response to SSRIs was generally poor as was my AD response to wellbutrin, but the two together didn't do all that bad. Prozac plus lithium was a better combination for me, but again I just don't respond well enough to SSRIs for lithium to have made a big enough difference in augmenting my response.
As for a cocktail horror story -- I was initially on monotherapy with wellbutrin. Once I got up to 450mg SR/d, I wasn't just irritable -- I was close to psychotic. We're talking unprovoked, nearly-uncontrollable almost-mindless rage. And when it *was* provoked, even slightly? Fuggedabowdit! Anyway, my pdoc is really high on wellbutrin and he wanted me to stick with it, so we decided (quickly!!) to treat the rage side effect with a neuroleptic, perphenazine. I guess for truly psychotic individuals, doses can get very high and Tardive Dyskinesia is a very real threat, but I was on a rather light dose of 4mg/d. The stuff knocked me out, but the rage disappeared.
When I didn't really respond all that well to 600mg wellbutrin SR, we added the prozac. Over the next 1.5 months, I became more and more paranoid, agoraphobic, extremely emotionally dependent on my girlfriend, and I had more and more muscle rigidity ... a lot of cogwheeling. It happened gradually enough, though, that the only person who really noticed the difference was my therapist, who picked up on the cogwheeling. I started having panic attacks again -- I'd leave work at noon (midtown Manhattan) and was so terrified of being away from home, of the subway, and of having to walk out in these skyscraper canyons to get to the subway that I'd just take a cab to my apartment in Brooklyn ($20 a ride). I'd get home, turn the air conditioner on max, and curl up in a ball on my bed and shake (not at all from the cold) till my girlfriend got home from work/school. The worst thing about it was I was convinced I was getting better--my girlfriend and I had been having a lot of difficulties and I was interpreting this anxiety-driven dependence as devotion. It made me think I could live with the rest of it. Eventually, I had such a traumatic panic attack while at my therapist's, she took me into the ER. The attending psychiatrist recognized what was wrong immediately ...
As it turns out, prozac blocks a liver enzyme that is responsible for metabolizing perphenazine. My pdoc was aware of this, but the literature talks about it happening at those much higher dosage levels for perphenazine and there was nothing out there about it being much of a threat at low levels. So, apparently, I wasn't getting ANY of the perphenazine out of my system and I was highly sensitive to it ... it was getting toxic at fairly low levels.
So stay away from neuroleptics if you go on prozac -- that's my advice.
I do have to admit that once I dropped the wellbutrin and the perphenazine, two really good things happened. #1, my pdoc put me on klonopin and its been the most effective med I've taken (but, of course, for my anxiety and not my depression =^( ). #2, I actually lost ten pounds on prozac as my sole AD. Wound up gaining it back plus another forty when I switched to zoloft four months later, but that's another story.
cheers,
bob
poster:bob
thread:34071
URL: http://www.dr-bob.org/babble/20000517/msgs/34088.html