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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Rebecca on October 24, 2000, at 19:21:03
I've been taking Celexa since December. At first, it was great, and then I got depressed again, so the dose was increased. This cycle of increase-good results-diminished results-increase has been continuing since then.
The dose was increased to 80 mg in August, and while it was great for a while, my mood is crashing again. I go back to my pdoc in a couple weeks, and he always seems to ask me what I think should be done with meds. it's nice that he respects that I do my research, but I'm stumped on this one.
I don't want another med change--I've been through prozac, zoloft, effexor, and wellbutrin before the celexa, and I don't want to deal with unknown side effects again.
I'm also taking 100 mg seroquel, having tried zyprexa and risperdal.
what would the logical next step be? more celexa?
I thought I was pretty sensitive to medications (I'm really sensitive to alcohol, for example), so I'm surprised to make it up to this high a dose.
Ideas?
Posted by MK1 on October 24, 2000, at 19:44:58
In reply to Diminishing SSRI effects--what now?, posted by Rebecca on October 24, 2000, at 19:21:03
I have the same problem. Up to 80 mg celexa only to poop out. I've added Serzone (300 mg) and it seems to help a little but I don't feel "well".
It's frustrating but know you're not alone, I wonder if this happens more frequently with celexa.
I guess both of have two choices. Augment with Lithium, Thyroid medicines, Naltrexone(I've only heard about this on this board) or change SSRI's. I'm reluctant to drop the celexa since it still helps some but I may give something like Zoloft a try unless my doctor wants to try Lithium. I'm a little afraid of Lithium, will it make me even more emotionally flat? If the celexa is still helping some I would try augmenting it or adding another antidepressant before ditching it altogether.My prayers are with you,
MK1
Posted by B Day on October 24, 2000, at 20:45:29
In reply to Diminishing SSRI effects--what now?, posted by Rebecca on October 24, 2000, at 19:21:03
Rebecca,
MK1 may be right on the money suggesting that an augmentation for Celexa might be worth trying. On this board it seems that some folks have had success combining Celexa with one of the non-SSRI ADs such as Wellbutrin, Serzone, Effexor, etc. or one of the meds used as mood stabilizers such as Lithium, Depakote or Neurontin, etc.
It seems that in some instances such combinations work well where monotherapy has failed or pooped out although being new to this information myself, I couldn't say any more than that. I believe there's some info regarding this in the tips section of this web site as well.
I've also read in a number of sources that usually doses of Celexa above 40mg and especially above 60mg are increasingly ineffective in depression relief. The usual dosing is 20 to 40mg. Perhaps at those levels the addition another, appropriate med might bolster Celexa's effectiveness for you. Being a novice of course, I'm speculating here.
I suppose it might be possible that persons with a similar experiences to your own might have non psychiatric medical or other issues working as contributors to their unpleasant conditions as well.
From he who knows little, good luck with this.
B
Posted by LISABECK on October 24, 2000, at 22:21:30
In reply to Diminishing SSRI effects--what now?, posted by Rebecca on October 24, 2000, at 19:21:03
REBECCA, WHAT ARE YOU TAKING CELEXA FOR? IS IT ONLY FOR DEPRESSION? I HAVE ALSO TAKEN PROZAC, EFFEXOR AND ZOLOFT FOR PANIC DISORDER AND IT'S ACCOMPANYING DEPRESSION. I'VE ALSO TAKEN PAXIL,WHICH MADE ME WORSE. HAVE NEVER TRIED WELLBRUTIN..I'V BEEN THRU THIS FOR SO LONG WITH MY DOCTOR. THEY ALWAYS INCREASE THE MEDICATION. WELL, HEY, WHERE DOES IT STOP? TO ME, IF A MEDICATION IS RIGHT FOR YOU, THEN IT SHOULDN'T HAVE TO CONSTANTLY BE INCREASED. I THINK I WOULD TRY SOMETHING ELSE. I WAS JUST GIVEN TOPAMAX (SEE MY POST) FOR PANIC DISORDER. I'LL LET YOU KNOW HOW THIS ONE WORKS...LISA
Posted by TED on October 24, 2000, at 22:40:44
In reply to Diminishing SSRI effects--what now?, posted by Rebecca on October 24, 2000, at 19:21:03
A friend told me his pdoc said that for "problem" cases he uses a combo of wellbutrin + effexor and has "never" had a failure.
In general, I have read that wellbutrin is a good augmenting medication, especially for SSRIs. So... either stay on celexa or switch to zoloft, and add wellbutrin to whichever SSRI you choose.
BTW: both my wife and I are on zoloft + wellbutrin and it works for us (my wife better than me just now, but I have bipolar disorder while my wife has depression + social phobia).
Good luck
Ted
Posted by danf on October 25, 2000, at 7:45:45
In reply to Diminishing SSRI effects--what now?, posted by Rebecca on October 24, 2000, at 19:21:03
one augmentation possible is pindolol, a beta blocker.
it works quickly & by literature reports about 50% of the time. it is inexpensive & also blocks tremor & shakes if those are a problem.
I am taking it with celexa & have no significant side effects from the pindolol.
Dr Bob has a link in the tips section.
good luck
Posted by JohnL on October 25, 2000, at 16:02:16
In reply to Diminishing SSRI effects--what now?, posted by Rebecca on October 24, 2000, at 19:21:03
Rebecca,
It sounds like Zyprexa and Risperdal were good choices. Too bad it didn't work out. Damn. I hate it when that happens!Anyway, here are some ideas. 300mg to 900mg Lithium might be your best bet. This is a pretty mild dose, nothing to fear. I suggest it for two reasons. First, in a survey of psychiatrists it was the most common augmentation strategy favored. Second, in statistics showing what percentage of patients got well with what medications in a whole variety of different symptoms, Lithium always seemed to be right up there as being one of the better performing drugs (salt, actually) in just about any psychiatric condition you could name. It is well known as a good augmentor. It is also well known for restoring the original effectiveness of your medicine.
Lithium would fall under the category of chemical stabilizer. Other choices might include Depakote first, and then Tegretol second. These are electrical stabilizers, or smoothers. Any of these stabilizers can restore a drugs's original effectiveness.
My hometown general practitioner's favorite strategy is to add in a small dose of a tricyclic like Nortriptyline. Kind of along the same lines would be a small dose of Remeron.
I think since it worked once, it's best to work with it and 'stabilize' it to its original effectiveness, rather than do a complete switch. The above ideas are probably the best options I could think of right now. Something to consider anyway.
John
Posted by Rebecca on October 25, 2000, at 16:57:03
In reply to Re: Diminishing SSRI effects--what now?, posted by JohnL on October 25, 2000, at 16:02:16
Thanks for the suggestions.
I'm trying to remember what people suggested to reply, but I don't know who said what. but here's what's happened in the past with some of the things that people suggested.
Effexor--I was on effexor monotherapy for a while. all it did was make me very constipated. I'm not sure if the stuff was ending up in my bloodstream or my stool.
Zoloft--helped the depression, but made me very zonked and dizzy, to the point where I didn't think I should drive more than short distances. Not acceptable.
Wellbutrin--didn't do anything for me, as far as I remember. I was on it right before celexa, and was on both for a little while, but the wellbutrin was then tapered off.
Prozac--made me an anxious insomniac. it was awful--I'd never had anxiety before then.
Zyprexa and Risperdal--I'm allergic to zyprexa, and had side effect problems with risperdal. so they're both out.
I seem to be doing a lot better in the past 1 1/2 days, so I'm not sure what the med efficacy situation is now.
Posted by JohnL on October 25, 2000, at 17:11:43
In reply to Re: Diminishing SSRI effects--what now?, posted by Rebecca on October 25, 2000, at 16:57:03
I doubt you should spend any more time considering other antidepressants. Stay where you are. Consider adding Lithium, Depakote, or Tegretol instead. It sounds like your good initial response has destabilized, either chemically or electrically. One of these three drugs stands a very good chance of regaining the good effect. It's not uncommon for a medicine to destabilize. But it can be fixed without having to switch to something else. Lithium is probably the best bet, Depakote 2nd best, Tegretol next.
If you had never had a good response to begin with, we would be talking a completely different game. But since you did have a good response, yet it faded, that points in the direction of the three medicines mentioned here.
John
Posted by JahL on October 26, 2000, at 13:22:54
In reply to pindolol ? » Rebecca, posted by danf on October 25, 2000, at 7:45:45
> one augmentation possible is pindolol, a beta blocker.
>
> it works quickly & by literature reports about 50% of the time. it is inexpensive & also blocks tremor & shakes if those are a problem.
>
> I am taking it with celexa & have no significant side effects from the pindolol.
>
> Dr Bob has a link in the tips section.
>
I have just unsuccessfully tried augmenting Serzone with Pindolol (5mg t.i.d. + Buspirone 10mg t.i.d.) Nothing after a month.I think more recent and more controlled studies have cast doubt upon Pindolol's usefulness in treating affective disorders.
Still, it won't harm you to take it!
Jah.
Posted by danf on October 26, 2000, at 14:07:43
In reply to Re: pindolol ?, posted by JahL on October 26, 2000, at 13:22:54
I would be surprised if pindolol worked with serzone.
The little known about pindolol & mechanisms, suggests that it blocks adaptation of the synapse to higher levels of serotonin. This adaptation has been postulated as the reason for partial response & then later failure of SSRIs. If the primary AD does not work by increasing synaptic serotonin levels, one would guess that pindolol would not have a high likelyhood of working.
Since serzone is a potent serotonin agonist ( which means it simulates higher levels of serotonin ), serzone may block the receptor that pindolol works on, or it may not. Since pindolol only works about 50% of the time, it is not a perfect answer. Also one would expect it to fail 1/2 of the time.
Controlled studies have shown pindolol to be effective about 50% of the time in retrieving an SSRI failure after an initial partial response of the SSRI.
There has not been a report that pindolol works in combination with non-SSRI anti-depressants in a regular consistant way.
It is most effective in blocking physical effects of anxiety. The 5mg TID dosage mentioned above also may be too low. An indicator of this may be if there remained physical signs of anxiety, such as increased heart rate, etc
Posted by JahL on October 26, 2000, at 16:18:49
In reply to Re: More about pindolol , posted by danf on October 26, 2000, at 14:07:43
> I would be surprised if pindolol worked with serzone.
Wow. Thanks danf, you certainly know more than me on this subject. Can't get my head round pharmokinetics due to inpenetrable & unremitting brain fog!
Maybe I will try again with, say, Luvox (only SSRI I'm yet to try) and a higher dose.
Will report any success,
ta,
Jah.
Posted by JohnL on October 26, 2000, at 16:25:32
In reply to Re: pindolol ?, posted by JahL on October 26, 2000, at 13:22:54
Clinical studies on Pindolol certainly do look promising. But in the real world, I dunno. My doctor has tried it dozens of times with different patients, and has had zero success. Zero. Including me.
One study I read about did combine Serzone+Pindolol and somehow this combo was particularly impressive for amazingly quick response and amazingly full response, more than we usually see in average clinical studies. But the population was a small one, and I don't think it has been duplicated in a larger test. On paper it looks good, but in real life it's hard to find anyone that's actually done well with it.
John
This is the end of the thread.
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