Posted by ed_uk on April 15, 2005, at 9:43:29
In reply to Re: Panic, posted by sukarno on April 15, 2005, at 2:04:40
Hi Paul!
>My imipramine level was monitored once by my psychiatrist and she had said it was low.
Some people only need low levels :-)
>Later on, evidence has been shown that SSRIs increase by 7 times the risk of haemorrhaging in the GI tract. I'm not sure how they do that.
It's thought that it might be related to the effects that SSRIs can have on platelet aggregation. Since SSRIs inhibit the uptake of serotonin into platelets, platelet function is disturbed and the risk of bleeding may be increased.
'A case-control study has suggested that treatment with SSRIs produces a moderately increased risk of upper gastrointestinal bleeding (adjusted relative risk 3.0).'
>I also had developed a rash and fevers during that time.
It certainly sounds like some kind of hypersensitivity reaction. Prozac has been associated with vasculitis. What starts out as a rash can turn into a very serious condition if Prozac is continued.
>After that experience I never tried another SSRI since my pdoc was afraid that all of other SSRIs could provoke similar reactions.
Since the various SSRIs are chemically/structurally unrelated, it seems unlikely that you would be hypersensitive to another SSRI. Rarely, cross-sensitivity has been reported...........
Ann Pharmacother. 2002 Apr;36(4):631-3.
Cross-sensitivity between paroxetine and sertraline.Warnock CA, Azadian AG.
Department of Pharmaceutical Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. caroline_warnock@camh.net
OBJECTIVE: To report a case of possible cross-sensitivity between selective serotonin-reuptake inhibitors (SSRIs). CASE SUMMARY: A 20-year-old Southeast Asian man developed a maculopapular rash soon after starting paroxetine. Following resolution of this rash, another skin reaction with the same distribution and appearance occurred after sertraline therapy was started. DISCUSSION: Cross-reactivity between drugs with similar structures has been reported; however, cross-reactivity among SSRI antidepressants is unexpected given their differences in chemical structure. CONCLUSIONS: The possibility of cross-reactivity between SSRI antidepressants should be considered by clinicians who wish to switch from one SSRI to another due to a dermatologic reaction.
>It is possible it could have been an ingredient in the elixir and not the Prozac which caused the allergy........
AFAIK, quite a lot of hypersensitivity reactions to fluoxetine (capsules) have been reported. I think you probably reacted to the fluoxetine itself.
>I wonder if the "zaps" are evidence of neurotoxicity rather than true withdrawal reactions?
I once had withdrawal symptoms (mild vertigo) after taking paroxetine 20mg for only five days! I didn't taper, I wasn't expecting withdrawal symptoms after I'd only been on it for five days!
Previously, after taking 40-60mg/day paroxetine for several years, I didn't have any withdrawal symptoms when I withdrew. I tapered to 20mg and then subsituted fluoxetine 20mg without a washout period. I didn't have any withdrawal symptoms when I abruptly d/ced the fluoxetine several months later. It would have been nice to have some fluoxetine caps lying around when I was having withdrawal symptoms from venlafaxine!
>Maybe I should try nortriptyline at 10mg/day and see what happens.
Perhaps you could start at 5mg/day, especially if you want to combine it with tianeptine. I don't expect that they'll interact but I don't think their interaction (or absense of interaction) has been studied.
>Is there a way to find out if I am a slow metaboliser?
I wondered whether you had low CYP2D6 activity.
There are many different variants of the CYP2D6 gene- genetic tests can be performed to identify which gene is present. These genetic tests can identify poor metabolisers.
Another way to find out whether a person is a poor metaboliser (in relation to CYP2D6) is to administer a 'probe' drug such as debrisoquine, dextromethorphan, metoprolol or sparteine. After the drug has been given, a urine sample is collected. The urine is assayed for the parent drug and metabolites. The ratio of parent drug to metabolite can be calculated in order to determine whether the person is a........
Poor metabolizer,
Intermediate metabolizer,
Extensive (normal) metabolizer,
Ultrarapid metabolizer.Even if a person is taking medication which affects CYP2D6, the genetic test is still accurate. The 'probe drug' test only works if a person is not taking any medication which affects CYP2D6.
>Even if the benzos do raise your liver enzymes, do you think it is ok to continue on them?
If you were able to take diazepam and clorazepate for many years without developing any signs of liver disease, I would imagine that it would be safe for you to take them in future. I'm not sure though. If you were to take either of these drugs in future, it might be best to have your liver function assessed by a specialist.
>Is it fair to compare caffeine to amphetamine?
Not really, their effects can differ considerably.
>Have you ever tried Survector or other CNS stimulants?
No, stimulants are rarely prescribed in the UK, I would like to try one though. Most adult psychiatrists in the UK never prescribe stimulants at all. The number of people taking prescribed stimulants is VASTLY greater in American than it is in the UK.
>Don't amphetamines make you more nervous or anxiety-prone than caffeine, or do you think caffeine is worse?
People respond very variably. Some people certainly find stimulants very anxiogenic. Certain people on this board have apparantly found amphetamines helpful in the treatment of social anxiety disorder. Several people have told me that they find methylphenidate more anxiety-inducing than amphetamines such as Dexedrine.
>Somehow I think marketing is what influenced doctors to prescribe Xanax for panic attacks as PRN, since Xanax is of much slower onset than Valium.
LOL, many doctors are very susceptible to marketing!
>How much Frisium did you try?
I tried 10mg, 20mg and 30mg doses.
>Have you ever tried Rivotril (Klonopin)?
I once took 2mg, I think it made me a bit drowsy but that's about it!
>I wonder if they are similar since they are both anticonvulsants.
Many of the major benzodiazepines are anticonvulsants. Diazepam and lorazepam are very powerful anticonvulsants, at least in the short term. Tolerance to the anticonvulsant properties of benzos often develops quite fast.
When clonazepam was introduced, Roche, the manufacturer, already marketed several benzos for anxiety and insomnia- why not invent another benzo to sell as an anticonvulsant lol!
Diazepam, clonazepam, lorazepam and clorazepate are 1,4-benzodiazepines. Clobazam (Frisium) is a 1,5-benzodiazepine, it is structurally different from the other benzos. Clobazam is claimed to cause less drowsiness than the other benzos. I didn't like it- you might like it though!
>Here in Indonesia I am not sure who makes it...
I think it would be a good idea to find out whether amineptine is still being manufactured in Indonesia. It has been discontinued in most countries but stocks may still remain.
If you are interested in the effects of amineptine, you could email Dave at HedWeb. He lives in the UK but has been importing amineptine for some time. He combines it with selegiline. I don't know what he's going to do when he can't get hold of amineptine anymore :-S
>I wanted to try Dostinex (cabergoline) as an antidepressant because I've heard good things about it and it is good for low-libido...but maybe that's anecdotal. Seems to have a favourable side-effect profile but isn't available in Indonesia.
You could consider trying an alternative dopamine agonist such as ropinirole or pramipexole. Are they available in Indonesia?
>Here you can buy prescription drugs without a prescription at some pharmacies....
I wish it was like that here, I've given up on NHS psychiatrists. All they are willing to do is prescribe another SSRI or venlafaxine. I don't have any intention of going back on an SSRI or venlafaxine!
>My email is hunstad2@yahoo.com
Mine is edward@stablefordbirkby.fsnet.co.uk
Kind regards,
Ed.
poster:ed_uk
thread:474445
URL: http://www.dr-bob.org/babble/20050413/msgs/484594.html