Posted by ed_uk2010 on February 9, 2012, at 13:18:14
In reply to Re: Thyroid levels and Serotonin, posted by Maisey on February 8, 2012, at 19:37:49
Hi again,
>Ugh! My whole post just did not show up! Maybe it is how I formatted it.
It must be because you clicked on the box where it says 'no message, just post above subject'. That's why it says nm (no message) after your subject line. It's easy to click the box by accident when you're typing a post.
>My doctor knew about this too so it makes me mad but only $10 down the drain.
Given the price difference and the similarity to Lexapro, it's good that you tried citalopram. It's a shame it didn't work out.
>I thought it may be good to be on Paxil for this reason; its the only SSRI approved for OCD.In the US, fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox) and paroxetine (Paxil) are all FDA approved for OCD. Escitalopram (Lexapro) is approved for OCD in the UK and elsewhere but not in the US, presumably because the manufacturer hasn't yet submitted the necessary data to the FDA. In practice, all SSRIs can be effective for OCD, including citalopram - which is not approved. Some patients may respond better to one than another but efficacy in OCD is a 'class effect' of the SSRI group of antidepressants. Another drug used for OCD is clomipramine (Anafranil), which is chemically related to amitriptyline.
Like you said, trichotillomania is not OCD, but might be related in some way, at least in some cases. It is sometimes referred to an an impulse-control disorder. SSRI drugs are sometimes tried but their effectiveness is less well established than in OCD. The recommended treatment is usually CBT, cognitive behavioural therapy. CBT can be expensive but there are various self help books you can buy and a lot of information on the internet. You can do most of the exercises at home. If you search for CBT, or CBT for trichotillomania you should find some good websites.
>It is amitriptyline HCL. I think one has an anti-histamine, and one doesnt? Ive been taking it for 10 years. Ive taken as much as 50mg and as little as 12.5, but Ive done 25mg for the past 2 years or so. Im sure my doctor said its ok to take it with Lexapro, though with Citalopram, I read they shouldnt be mixed.
Amitriptyline hydrochloride (HCl) is the form of amitriptyline used in all tablet formulations, but it's usually just called amitriptyline. Amitriptyline has a strong antihistamine effect, which is part of the reason it causes drowsiness.
Amitriptyline was one of the earliest antidepressants to be discovered. It can work well if you can tolerate the side effects. For depression, higher doses are needed eg. 75mg to 150mg per day, adjusted according to response. The dose is always increased gradually. You could try a higher dose of amitriptyline instead of trying an SSRI.
>Thats another reason why Ive balked about SSRIs. I know ones like Paxil.
Amitriptyline is more likely to cause weight gain than any of the SSRIs. If you can take amitriptyline without gaining weight it is probably a good sign!
Paroxetine (Paxil) does sometimes causes weight gain, possibly slightly more frequently than other SSRIs, but not everyone is affected by any means. Weight gain rarely occurs early in treatment. Some patient lose weight initially and then put it on after several months. With SSRIs, metabolic problems (eg. high cholesterol) are mainly a problem in patients who gain a lot of weight, and not otherwise. Most of the western population has borderline high cholesterol, so I wouldn't worry about that particularly. If you are a healthy weight, your BP is normal and you don't smoke you should be fine. Mildly elevated cholesterol in the absence of any other cardiac risk factors is not very important.
The main issue with paroxetine (Paxil) is that it interacts with amitriptyline. Fluoxetine (Prozac) also interacts with amitriptyline. Both drugs block a liver enzyme called CYP 2D6 which is needed for the metabolism of amitriptyline. Taking Paxil or Prozac with amitriptyline can substantially increase the level of amitriptyline in your blood. This can cause an adverse reaction.
Among the SSRIs, citalopram, escitalopram (Lexapro) and sertraline (Zoloft) interact minimally with amitriptyline. These drugs can be used with amitriptyline unless the amitriptyline dose is very high, which yours is not. Since you don't respond well to citalopram and Lexapro is too expensive, generic sertraline (Zoloft) might be a good choice. Since you've had side effects with SSRIs before, you could start with half a 50mg tablet before going up to a full tablet.
Although it's reassuring that you didn't have any major side effects with Lexapro, it doesn't sound like it was very effective for you... but it was very expensive. This is why I think generic sertraline is worthy of consideration. It's up to you and your doctor of course. All antidepressants can aggravate bipolar disorder in some cases, but I know you don't have a diagnosis. Some people get manic on antidepressants, or become agitated and experience rapid changes in mood. Have you had any manic symptoms in the past? Examples include elevated mood, excitement, talking quickly, racing thoughts, reduced need for sleep, impulsive behaviour....
If you decide to try Paxil, you will need to reduce your amitriptyline dose, but the extent of the reduction is basically trial and error. You could reduce your dose from 25mg to about 10mg initially. Paxil causes more severe withdrawal symptoms than other SSRIs, and needed to be tapered gradually if you decide to stop.
>Thanks for your responses. I really appreciate them. :)
You're welcome.
poster:ed_uk2010
thread:854446
URL: http://www.dr-bob.org/babble/20120202/msgs/1009826.html