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Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) ed_uk2010

Posted by tensor on June 5, 2020, at 13:43:38

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) tensor, posted by ed_uk2010 on June 5, 2020, at 12:43:34

Hi Ed, it's been a while :)

It's been a couple of rough weeks, especially anxiety-wise, I went with fluoxetine and now I'm at 20mg. Will take a while to assess each dosage due to its long half-life. Kind of okay energy-wise, relatively speaking that is, only enough for some photography a few times a week, but I have accepted it and have managed to embrace my depression and the life-style that follows with it.
No I haven't mentioned it anywhere, it's one of those setbacks that come and go, I'm so used to it that I normally just ride it out without changing medications, however, the anxiety level started to rise about a year ago, it's like escitalopram just isn't (wasn't) cutting it anymore, 30mg could possibly have fixed it but the cardiac side effects prohibits dose increase and my doctor won't allow it.
I was thinking of venlafaxine, but my prior experience is night-time sweating, and not lightly either, but the sheets completely soaked, I remember having to put towels in the bed when I woke up in the night just to let me finish my sleep.
I opted for fluoxetine because it had such a nice anxiolytic effect back in the days, I really only quit it because I couldn't perform optimally in bed, which was a big deal back then :D
Currently, my brain zaps from messing with serotonin have finally reduced to a point that it doesn't interfere with whatever I'm doing. My doctor will call me on Monday. I only take 12.5mg of nortriptyline since I was afraid it would increase in the blood, my doctor insisted that any downward dose adjustment was unwarranted and that I should stay on 25mg. I brought up the enzyme problem but said it wouldn't be a problem. She may be right, I don't know, but I want to be cautious. If I start to feel grumpy I will just drop it.

Thanks for your message, how's life treating you? :)

Best,
M

> Hi M,
>
> Nice to see your post. Sorry to hear things aren't too good.
>
> Although it's not something you mentioned....
>
> Potentially, I'd consider:
>
> 1. Tapering and stopping nortriptyline over a few weeks.
> 2. Cross-tapering off escitalopram and over to venlafaxine. Increasing venlafaxine from 75mg/day up to 150mg-225mg fairly rapidly, then increasing to 300-375mg in future if necessary.
>
> Venlafaxine has efficacy in both anxiety and depression over a very wide dose range, which is potentially useful for those with treatment-resistance.
>
> I recall that you experienced uro-gential adverse effects previously, due to NRIs with unopposed alpha blockade. Although these are usually minor with the SNRI venlafaxine in comparison with the likes of reboxetine, it would be possible to remedy them if necessary with a low dose of an alpha blocker, such as doxazosin 1mg at night. I would avoid tamsulosin for this purpose, since it tends to impair ejaculation.
>
> What do you think?
>
>


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