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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Marvin on October 15, 2000, at 16:42:57
I tried to post this once, but it didn't seem to work so I'll try again. If it shows up twice, I apologize. I was wondering if anyone could help me with regards to changing SSRIs. I have a history of prolonged situational anxiety attacks which were first treated with psychotherapy, but at age 21 treated with Prozac once my inability to beat the anxiety turned into major depression. I have been on Prozac (40mg) for almost 7 years and have been successful at keeping my anxiety and depression in check. I recently had an episode, however, which caused me extreme anxiety, even adding symptoms to the usual derealization and depersonalization I had felt in the past. This time, the anxiety came with nausea, chills, sweats, etc. Given the debilitating nature of this particular attack, my PDoc upped my Prozac to 60mgs and added Klonopin. I am not happy about being on a benzo, but I must admit that the Klonopin did help me in a time of need. My steady dosage for 4 weeks was 0.75mg and I have now started to taper back (0.50mg). I am concerned, however, that maybe the Prozac was the wrong choice made 7 years ago. I firmly believe that it was my inability to overcome the anxiety which caused the depression, and not that I was merely depressed. As such, I was curious if anyone had made change from Prozac to Paxil for such symptoms? Also, is there any washout period for coming off one SSRI and onto another? I really do not want to take benzos and am hopeful that Paxil may represent a better solution than 60mgs of Prozac and Klonopin combined. Any thoughts? Thank you in advance for your answers.
Posted by JohnL on October 16, 2000, at 3:56:04
In reply to Changing SSRIs, posted by Marvin on October 15, 2000, at 16:42:57
Marvin,
You could switch from Prozac to Paxil without a washout. If you do, you could start the Paxil at 5mg per day for perhaps 4 to 7 days, then increase it by 5mg every 4 to 7 days. Be aware that some Prozac will still be in your system up to 4 weeks after you stop it. It is half gone in one week. That's why it's important to keep the Paxil at conservative doses until the Prozac is all gone.From what you describe, it might be questionable whether serotonin antidepressants are even the right avenue for you. There are multiple systems in the brain that can each cause your symptoms. Low serotonin is just one of them. The percentage of patients who found a complete cure of your symptoms are listed below:
Serotonin antidepressants (low serotonin) 37%
Other antidepressants (low norepinephrine) 11%
Benzodiazapines (low GABA) 24%
Lithium (chemical instability) 22%
Stimulants (norepinephrine/dopamine failure) 14%
Antipsychotics (elevated dopamine) 13%
Depakote (electrical instability) 11%
Tegretol (electrical instability) 3%
Thyroid (even if blood tests were OK) 24%
Beta adrenergic blockers like Inderal were not recorded, but were sometimes helpful, mostly for palpitations.What's interesting is that vague clinical symptoms did NOT justify the use of lithium, stimulants, antipsychotics, or anticonvulsants...regardless, they worked completely with lasting results. Different brain chemistries were at fault. The malfunctioning system was discovered by trying different medication classes. I would guess most people in your shoes would be prescribed antidepressants and benzodiazapines. If that's true, then according to these statistics, that would mean at least 50% of patients would not be satisfied with treatment. I point this out merely to let you know that your ultimate perfect medication could exist in any psychiatric class, not just the ones you are currently trying. Obviously it takes a knowledgeable and open-minded doctor to figure out if it's low serotonin, elevated dopamine, electrical instability, or whatever. Clues from your medication responses can help to figure it out.
I would think the most logical thing right now is to do what you suggested...switch to another SSRI. But if that doesn't help, then the odds increase dramatically that the problem is a different brain chemistry, not serotonin, and that some other medication classes could be tried. Too often we see people beat themselves to a pulp by going through the entire spectrum of medications all within just one class, never considering that the underlying problem might be something else that would respond to a different kind of medication instead.
John
Posted by Bill L on October 16, 2000, at 7:39:29
In reply to Changing SSRIs, posted by Marvin on October 15, 2000, at 16:42:57
Since the Prozac has controlled your depression and anxiety for 7 years, it sounds like it was in fact the correct drug. You said that an "episode" caused you extra anxiety. Was it an isolated episode? If so, maybe you only need anxiety meds for a short time.
If the Prozac is still working for the depression, I would stay on it. You may want to try to go back to 40 mg and see how that works. If you need more, you can go back to 60. Some people take 80 mg. There is a good chance that Paxil could make you feel tired.
I take Celexa. I used to take Prozac. Prozac worked for me only for a year at 20mg. I never tried increasing the dose because even at 20 mg it made me feel wired. The Celexa is working so far. It's less activating than Prozac.
> I tried to post this once, but it didn't seem to work so I'll try again. If it shows up twice, I apologize. I was wondering if anyone could help me with regards to changing SSRIs. I have a history of prolonged situational anxiety attacks which were first treated with psychotherapy, but at age 21 treated with Prozac once my inability to beat the anxiety turned into major depression. I have been on Prozac (40mg) for almost 7 years and have been successful at keeping my anxiety and depression in check. I recently had an episode, however, which caused me extreme anxiety, even adding symptoms to the usual derealization and depersonalization I had felt in the past. This time, the anxiety came with nausea, chills, sweats, etc. Given the debilitating nature of this particular attack, my PDoc upped my Prozac to 60mgs and added Klonopin. I am not happy about being on a benzo, but I must admit that the Klonopin did help me in a time of need. My steady dosage for 4 weeks was 0.75mg and I have now started to taper back (0.50mg). I am concerned, however, that maybe the Prozac was the wrong choice made 7 years ago. I firmly believe that it was my inability to overcome the anxiety which caused the depression, and not that I was merely depressed. As such, I was curious if anyone had made change from Prozac to Paxil for such symptoms? Also, is there any washout period for coming off one SSRI and onto another? I really do not want to take benzos and am hopeful that Paxil may represent a better solution than 60mgs of Prozac and Klonopin combined. Any thoughts? Thank you in advance for your answers.
Posted by R.Anne on October 17, 2000, at 14:48:21
In reply to Changing SSRIs, posted by Marvin on October 15, 2000, at 16:42:57
I have had much better luck (if you want to call it that!)with Paxil than Prozac. Prozac made me extremely nervous and nauseated even after the side effects should have worn off. I have had luck with OCD with Paxil and Effexor with depression. This combo. is at the doses of 20 mgs. of Paxil and 37.5 mg. of Effexor. I also try to pick myself up by trying to adhere to my daily routines (making bed, doing dishes, straightening things out)and do something nice for myself like a going out to a movie (even alone), reading helpful things for my illnesses. I have tried many different medicines and I found that I must also get my butt in gear and do things for myself. The medicine is not a cure all in other words. Good luck!
> I tried to post this once, but it didn't seem to work so I'll try again. If it shows up twice, I apologize. I was wondering if anyone could help me with regards to changing SSRIs. I have a history of prolonged situational anxiety attacks which were first treated with psychotherapy, but at age 21 treated with Prozac once my inability to beat the anxiety turned into major depression. I have been on Prozac (40mg) for almost 7 years and have been successful at keeping my anxiety and depression in check. I recently had an episode, however, which caused me extreme anxiety, even adding symptoms to the usual derealization and depersonalization I had felt in the past. This time, the anxiety came with nausea, chills, sweats, etc. Given the debilitating nature of this particular attack, my PDoc upped my Prozac to 60mgs and added Klonopin. I am not happy about being on a benzo, but I must admit that the Klonopin did help me in a time of need. My steady dosage for 4 weeks was 0.75mg and I have now started to taper back (0.50mg). I am concerned, however, that maybe the Prozac was the wrong choice made 7 years ago. I firmly believe that it was my inability to overcome the anxiety which caused the depression, and not that I was merely depressed. As such, I was curious if anyone had made change from Prozac to Paxil for such symptoms? Also, is there any washout period for coming off one SSRI and onto another? I really do not want to take benzos and am hopeful that Paxil may represent a better solution than 60mgs of Prozac and Klonopin combined. Any thoughts? Thank you in advance for your answers.
This is the end of the thread.
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