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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Charles on July 7, 2000, at 20:43:11
Has anyone been on Prozac 20mg/day for a month and not experienced any major changes?
Posted by Sascha on July 8, 2000, at 2:03:21
In reply to Prozac, posted by Charles on July 7, 2000, at 20:43:11
> Has anyone been on Prozac 20mg/day for a month and not experienced any major changes?
yes, I have too, so finally my doc upped it to 40, which I'm starting today - you can also alternate 20-40-20 because of the long half life (so he told me). I was kinda disappointed too, but he says to stick with it for now.
Posted by SueG on July 9, 2000, at 19:46:24
In reply to Prozac, posted by Charles on July 7, 2000, at 20:43:11
> Has anyone been on Prozac 20mg/day for a month and not experienced any major changes?
I am in my fourth week on 20mg and have noticed some good effects, however, I am wondering if they seem to be wearing off a little. I don't really want to increase the dose because I am afraid of the sexual side-effects. I have noticed a delay in achieving orgasm at this doese but at least it is manageable. Afraid if i increase the dose that I might lose the ability altogether.
I have noticed a definite mood stabilising effect on 20mg and am a bit more social and outgoing.
I started to feel more interest in things but this seems to have reverted back to apathy and lethargy (not quite as bad as before though). My concentration is better.
I also seem to be alternating between insomnia and sleepiness. (I take temazepam at night if i can't sleep).
I am wondering if i need to augment my Prozac with something else, to give me some drive and motivation. I've heard good things about Prozac and wellbutrin in combination (and that this may also help the sexual problems) and also reboxetine, adrafinil and amisulpride, although i don't know anything about combining these with Prozac (also I'm in Australia and all of these are unavailable here so i would have to convince my doc that they would be useful).Anyone have any thoughts?
As far as your dose of Prozac goes, it is probably time to increase the dose. Have you noticed any effect at all, good or bad?
Sue.
Posted by Bronte on July 13, 2000, at 23:28:18
In reply to Re: Prozac, posted by SueG on July 9, 2000, at 19:46:24
> > Has anyone been on Prozac 20mg/day for a month and not experienced any major changes?
>
> I am in my fourth week on 20mg and have noticed some good effects, however, I am wondering if they seem to be wearing off a little. I don't really want to increase the dose because I am afraid of the sexual side-effects. I have noticed a delay in achieving orgasm at this doese but at least it is manageable. Afraid if i increase the dose that I might lose the ability altogether.
> I have noticed a definite mood stabilising effect on 20mg and am a bit more social and outgoing.
> I started to feel more interest in things but this seems to have reverted back to apathy and lethargy (not quite as bad as before though). My concentration is better.
> I also seem to be alternating between insomnia and sleepiness. (I take temazepam at night if i can't sleep).
> I am wondering if i need to augment my Prozac with something else, to give me some drive and motivation. I've heard good things about Prozac and wellbutrin in combination (and that this may also help the sexual problems) and also reboxetine, adrafinil and amisulpride, although i don't know anything about combining these with Prozac (also I'm in Australia and all of these are unavailable here so i would have to convince my doc that they would be useful).
>
> Anyone have any thoughts?
>
> As far as your dose of Prozac goes, it is probably time to increase the dose. Have you noticed any effect at all, good or bad?
>
> Sue.I would be interested in finding out how many people have found that at 20 mgs. they have little or no desire to do things. My mood is much better than when I was on Wellbutrin, but I just don't seem to have the energy to get things done. This is different than when I was depressed, as I would be upset when I didn't feel like doing things. Now, it doesn't really matter to me if they get done or not. When I was on Wellbutrin I became terribly irritable and would go on OCD binges where things had to get done, sacrificing sleep in the process. Now, all I want to do is sleep. Has anyone had the same experience, and if so, was there something that helped? I've considered augmenting the Prozac with Wellbutrin, as I did find it energizing at 200 mgs but not terribly helpful with the depression. Is there something else that can be recommended? I'm an active and busy person, and this fatigue and apathy are becoming a problem.
Posted by JohnL on July 14, 2000, at 4:33:27
In reply to Re: Prozac and apathy, posted by Bronte on July 13, 2000, at 23:28:18
I think this apathy and/or anhedonia phenomenon is much more common with all of the serotonin enhancing medications than is admitted by most physicians. While the SSRIs are indeed wonder meds, they very often leave the patient in an undepressed yet unmotived state, characterized by lack of motivation and lack of joy. The SSRIs do very often relieve the lows, but they also very often chop off the highs, leaving us in a very limited emotional range. That's a welcome relief to someone who has been in a deep depression, but can be a real handicap once the person has begun to recover.
This phenomenon happened with me on Paxil, Zoloft, Prozac, Celexa, Serzone, and Effexor. It wasn't until I branched out and away from these serotonin meds that I discovered apathy is a totally different beast that responds very well to other meds, such as stimulants, some antipsychotics, or tricyclic antidepressants. Sometimes they work well when combined with an ongoing SSRI, and sometimes they work better without the SSRI. We all have different chemistries and will respond differently. I wish there was some substitute for personal trial, but it hasn't yet been discovered.
I just wanted to confirm that your comments on Prozac are very real and probably a lot more common than we would like to think.
JohnLp.s. my ultimate solution was found with Adrafinil. You may want to consider Ritalin, Adderall, Adrafinil, Zyprexa, Risperdal, Stelazine, Desipramine, Nortriptyline. I know that's a lot to choose from. From what you've described though, I think you'll find dramatically better results with one of those than with either Wellbutrin or Prozac. I would start with Ritalin and then Adderall, since they work in 24 to 72 hours. No long trials needed. Then, if they don't work, move on to the others. But Ritalin and Adderall are often added to SSRIs for the very reasons you mentioned...apathy, fatigue.
Posted by Cindy W on July 14, 2000, at 8:54:35
In reply to Re: Prozac and apathy, posted by JohnL on July 14, 2000, at 4:33:27
>
>
> I think this apathy and/or anhedonia phenomenon is much more common with all of the serotonin enhancing medications than is admitted by most physicians. While the SSRIs are indeed wonder meds, they very often leave the patient in an undepressed yet unmotived state, characterized by lack of motivation and lack of joy. The SSRIs do very often relieve the lows, but they also very often chop off the highs, leaving us in a very limited emotional range. That's a welcome relief to someone who has been in a deep depression, but can be a real handicap once the person has begun to recover.
>
> This phenomenon happened with me on Paxil, Zoloft, Prozac, Celexa, Serzone, and Effexor. It wasn't until I branched out and away from these serotonin meds that I discovered apathy is a totally different beast that responds very well to other meds, such as stimulants, some antipsychotics, or tricyclic antidepressants. Sometimes they work well when combined with an ongoing SSRI, and sometimes they work better without the SSRI. We all have different chemistries and will respond differently. I wish there was some substitute for personal trial, but it hasn't yet been discovered.
>
> I just wanted to confirm that your comments on Prozac are very real and probably a lot more common than we would like to think.
> JohnL
>
> p.s. my ultimate solution was found with Adrafinil. You may want to consider Ritalin, Adderall, Adrafinil, Zyprexa, Risperdal, Stelazine, Desipramine, Nortriptyline. I know that's a lot to choose from. From what you've described though, I think you'll find dramatically better results with one of those than with either Wellbutrin or Prozac. I would start with Ritalin and then Adderall, since they work in 24 to 72 hours. No long trials needed. Then, if they don't work, move on to the others. But Ritalin and Adderall are often added to SSRIs for the very reasons you mentioned...apathy, fatigue.just wanted to add my 2 cents worth--I took Prozac 60 mg/day for about l0 years, and felt like a zombie at times. I had no good or bad feelings at all. After a certain point, I didn't care about anything, but could function well in everyday life. Have experienced this especially with Prozac. With other SSRI's, I didn't feel the affective flattening but did have sexual dysfunction (Luvox, Zoloft). Serzone didn't do any of those bad things. Effexor-XR is working for me, with some very slight delay in reaching orgasm. And it doesn't make me feel like a zombie or affectless.
Posted by Bronte on July 14, 2000, at 14:25:04
In reply to Re: Prozac and apathy, posted by Cindy W on July 14, 2000, at 8:54:35
Thanks for the input, John and Cindy. I will talk to my Pdoc when he gets back from vacation (not until the end of July - yipes!) I'm feeling so frustrated right now. At least when I was on the Wellbutrin I was accomplishing things. Now, my house looks like a bomb hit it, and I just don't care. Emotionally, I feel rather flat - better than the dark place, but still ...
I am curious to see if a stimulant such as Ritalin will work, as I am still experiencing concentration difficulties that the Prozac has not helped. For the time being, I am considering going back on the WB in addition to the Prozac, to see if it will help with the fatigue. At least until my Pdoc gets back.
Argh!
Posted by dove on July 15, 2000, at 10:20:55
In reply to Re: Prozac, posted by SueG on July 9, 2000, at 19:46:24
Prozac was an experiment in paradoxes for me. The doc added Prozac 20 mgs to a combination of Adderall (CNS Stim-like Ritalin) and Amitriptyline (Elavil) already in place. During that same time period, the doc added Wellbutrin at noon and afternoon. I had a minor meltdown which almost ended with inpatient, but it was during the holiday season (Thanksgiving, Christmas, New Years) and that may have added to the volatility.
The paradox part: My doc warned me ahead of time about Prozac's tendency to cause weight gain, make sleep difficult or unfruitful, sexual side-effects, lack of motivation, and so on. The first thing I noticed was weight loss, lots of weight loss, and energy. My house was organized and clean for the first time in my life, I was running from dawn till dusk cleaning, cooking, doing.
So, it did the opposite of what my doc expected or wanted. Except for the clean house part, he viewed that as a great bonus and didn't want to remove the Prozac for that exact reason. Instead of feeling flat I felt wired, pulled taut. The Adderall and Wellbutrin really haven't helped me in the mood department unfortunately. Adderall makes me ravenous, 30-45 minutes after taking it my stomach literally screams for food. I feel flat and somewhat numb when the Adderall is working. I cry very easily and zone out into space, no mind at all.
I also found great sexual difficulties while on Prozac. And I definitely fluctuated between insomnia and super sleep (unable to really move out of the lethargic brain-dead all day sleep mode). I was on the full 20mgs for at least 5 weeks (would have to look up old posts and calendars to be sure) but my doc never let me quit a med unless I went the full 4-6 weeks. I also have trouble with tolerance, but only to TCA's and SSRI's as far as I can tell.
Wellbutrin Prozac combo has been said to be very stimulating. My hands shook really bad while I was taking them both (w/ Amitriptyline and Adderall too). Reality was unreal, like my mind was so caught up with its own newly discovered chaotic motion that it couldn't grasp the physical material world around it.
Considering your symptoms, Prozac and Wellbutrin might be a good combo to try, just watch for those pesky sexual side-effects. And a stimulating TCA might be a good option too, unless you've already been down that road? Serzone (Nefazodone) can be added to TCA's and is awesome in regard to sexual difficulties. The first couple weeks on Serzone can be tough, but it really truly improves all those missed orgasms like no other med I'm familiar with.
I do know that increasing Prozac's dosage will probably invigorate the sexual difficulties and other unlovable side-effects. My best wishes and thoughts are with you :-)
dove
Posted by Sunnely on July 15, 2000, at 18:08:16
In reply to Re: Prozac and apathy, posted by Bronte on July 13, 2000, at 23:28:18
>Is there something else that can be recommended? I'm an active and busy person, and this fatigue and apathy are becoming a problem.
One late-emergent side effect with the SSRIs is a cluster of "frontal lobe" symptoms such as apathy, indifference, affective dullness, and occasional disinhibition. This side effect can be mistaken for loss of effectiveness or a return of depression. When such symptoms occur, think about going down with the dose as well as going up (not an easy call).
In cases like this, your idea of combining Prozac with Wellbutrin is really not a bad one. A couple of concerns (probably uncommon but has been reported). A case of myoclonus (muscle) jerkiness that progressed to delirium (acute confusional state) has been reported with this combination. A case of catatonic episode was reported with this combination. Nighttime panics with this combination have also been reported. Also, be aware that certain liver enzymes that Wellbutrin depend on for metabolism (break down) are inhibited by Prozac. This may lead to an usually high blood level of Wellbutrin. If you stick with the lowest effective dose for Wellbutrin, this is most likely not going to be a problem. As you may be aware, significantly high blood level of Wellbutrin may lead to seizures. BTW, ask for the SR (sustained-release) preparation. It avoid too high peaks in blood concentration thereby, avoiding possible seizures. Of course, Wellbutrin is not to be taken by those with seizure disorder or eating disorder. It should not be used with a MAOI (Parnate, Nardil, Marplan). It should be taken at least 6 hours apart, if given more than once a day. It should not exceed more than 150 mg per dose. It should not exceed more than 450 mg/day. These dosing recommendations are important to avoid the occurrence of seizures. Of course, you should not combine Wellbutrin and Zyban (smoking cessation). One is the spitting image of the other. Only their brand names are different. Again, high risk for seizures if combined.
Thyroid supplement with Prozac is also not a bad idea. Cytomel (T3) and Synthroid (T4) are the usual drugs used. Thyroid augmentation seems to benefit more the depressed women.
Other potential SSRI augmentation agents include (not arranged in any particular order):
1) lithium
2) buspirone (BuSpar)
3) trazodone (Desyrel)
4) tricyclic antidepressants
5) anticonvulsants (Tegretol, Depakote, Lamictal)
6) antipsychotics (atypical)
7) estrogen/testosterone
8) psychostimulants
Mirapex (pramipexole), an antiparkinsonian drug, is periodically reported may have antidepressant effect. Don't know much about this drug.
This is the end of the thread.
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