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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by cole on September 6, 2001, at 16:19:17
I thought I'd ask a few ?'s for my boyfriend while I'm around. He was put on Celexa 20mg about 7 weeks ago to manage depression/ rage secondary to Tourette's and OCD. He seems to drink to manage anxiety, when feeling esp. bad he'll drink heavily (4 or more drinks/ day) about 5 days per week. Moderate drinking for him is drinking only 2 drinks in a day at least every other day, but still drinking excessively once every 1-2 weeks.
When he started with Celexa he had a great initial response-- mood brightened, drinking decreased, and rages substantially decreased for about the first 3 weeks.
He's been on it for 7 weeks now, and his drinking has increased again, as have the rages, and he's having substantial mood swings. My pdoc thought that the alcohol could be undermining the efficacy of the med, but I'm also wondering if he isn't drinking because he is no longer responding to the med. He also smokes and recently quit chewing tobacco, and I read on the tips page that tobacco use can inhibit the effects of SSRIs.
He'll be seeing the GP who is managing his meds under consultation with his neurologist. Any ideas? I looked around on tips and thought that either an increase to 30 or 40 might help, or augmentation. Naltrexone might be a good idea with the drinking problem, but I don't know how that would affect the Tourette's or whether a GP would feel comfortable prescribing such a drug.Any ideas?
Thanks,
cole
Posted by cb on September 6, 2001, at 20:08:14
In reply to Celexa and alcohol, Tourette's and OCD, posted by cole on September 6, 2001, at 16:19:17
> My son, who is bipolar, also had great responses to SSRIs initially. But they quickly lost effectiveness and he ended up getting manic or hypomanic while on them - especially as the doses were increased in an effort to improve things - and this led to more rages and substance abuse. So my advice (for what it's worth!) is to be careful when upping the SSRI doses.
Posted by cole on September 7, 2001, at 20:21:28
In reply to Re: Celexa and alcohol, Tourette's and OCD, posted by cb on September 6, 2001, at 20:08:14
> > My son, who is bipolar, also had great responses to SSRIs initially. But they quickly lost effectiveness and he ended up getting manic or hypomanic while on them - especially as the doses were increased in an effort to improve things - and this led to more rages and substance abuse. So my advice (for what it's worth!) is to be careful when upping the SSRI doses.
Thanks for the heads up, I'll try to monitor how the increase goes, if that's what his doc advises on monday.
cole
Posted by AVR on September 7, 2001, at 21:52:40
In reply to Re: Celexa and alcohol, Tourette's and OCD, posted by cb on September 6, 2001, at 20:08:14
People with tourrets seem to loose ssri affectiveness after a while and become hypomanic. Paxil lost affectiveness in me also. I too became hypomanic and then abused street drugs.
I also have tourrets syndrome. I think the alcohol is wipeing the celexa out of his system; alcohol being an depressant and all.
Posted by SLS on September 8, 2001, at 8:56:49
In reply to Celexa and alcohol, Tourette's and OCD, posted by cole on September 6, 2001, at 16:19:17
> I thought I'd ask a few ?'s for my boyfriend while I'm around. He was put on Celexa 20mg about 7 weeks ago to manage depression/ rage secondary to Tourette's and OCD. He seems to drink to manage anxiety, when feeling esp. bad he'll drink heavily (4 or more drinks/ day) about 5 days per week. Moderate drinking for him is drinking only 2 drinks in a day at least every other day, but still drinking excessively once every 1-2 weeks.
> When he started with Celexa he had a great initial response-- mood brightened, drinking decreased, and rages substantially decreased for about the first 3 weeks.
> He's been on it for 7 weeks now, and his drinking has increased again, as have the rages, and he's having substantial mood swings. My pdoc thought that the alcohol could be undermining the efficacy of the med, but I'm also wondering if he isn't drinking because he is no longer responding to the med. He also smokes and recently quit chewing tobacco, and I read on the tips page that tobacco use can inhibit the effects of SSRIs.
> He'll be seeing the GP who is managing his meds under consultation with his neurologist. Any ideas? I looked around on tips and thought that either an increase to 30 or 40 might help, or augmentation. Naltrexone might be a good idea with the drinking problem, but I don't know how that would affect the Tourette's or whether a GP would feel comfortable prescribing such a drug.
>
> Any ideas?
>
> Thanks,
> cole
Hi Cole.A number of years ago, Zoloft was the the SSRIs most often chosen to treat pathological aggression. This selective use of Zoloft might have resulted from the tendency for doctors to choose it first for depression at that time. Also, Celexa had not been approved yet. However, Zoloft is really the most gentle of the SSRIs at the serotonin neuron. If Zoloft really is superior for aggression, this might be the reason why. If this is the case, then Paxil and Celexa would not be the best candidates to fill the role of an antiaggressive. If you are considering changing SSRIs, I would consider either Zoloft or Luvox as the next choice. Although Zoloft seems to be the most effective in treating aggression, Luvox is probably more effective for treating OCD.
Something else to take into consideration is that SSRIs can sometimes make Tourette's and tic movements worse. I should think that Paxil and Celexa would be the worst. If the Tourette's is somehow biologically linked with the aggression - I really don't know enough about it - perhaps SSRIs would ultimately be counterproductive and make both things worse if not combined with other drugs (clonidine or neuroleptics). SSRIs are often combined with a neuroleptic (dopamine-blocking antipsychotics) to treat comorbid Tourette's and OCD. Zyprexa or Risperdal should be considered, as their effects on serotonin receptors (5-HT2a) is likely to contribute to a reduction of aggression.
I'm wondering if Neurontin or Depakote would be of any use. These two drugs are anticonvulsants (anti-epileptics), and are often chosen for psychiatric conditions. Neurontin is showing itself to be quite effective for things like generalized anxiety disorders, panic disorder, ands bipolar disorder (manic depression).
So, all of this silliness boils down to using
(Zoloft or Luvox) + Zyprexa + Neurontin.
This stuff will most likely take care of the alcohol thing. I don't think naltrexone would be indicated unless the alcohol thing remains after the other things are remedied.
I ain't no expert. I'm just throwing out some ideas that were the result of brainstorming with very little information or education to work with. It should not be taken too seriously.
I'm hoping that you can at least ask your doctor some targeted questions that would prompt him to do some brainstorming of his own.
Good luck.
- Scott
Posted by SLS on September 8, 2001, at 8:56:50
In reply to Celexa and alcohol, Tourette's and OCD, posted by cole on September 6, 2001, at 16:19:17
> I thought I'd ask a few ?'s for my boyfriend while I'm around. He was put on Celexa 20mg about 7 weeks ago to manage depression/ rage secondary to Tourette's and OCD. He seems to drink to manage anxiety, when feeling esp. bad he'll drink heavily (4 or more drinks/ day) about 5 days per week. Moderate drinking for him is drinking only 2 drinks in a day at least every other day, but still drinking excessively once every 1-2 weeks.
> When he started with Celexa he had a great initial response-- mood brightened, drinking decreased, and rages substantially decreased for about the first 3 weeks.
> He's been on it for 7 weeks now, and his drinking has increased again, as have the rages, and he's having substantial mood swings. My pdoc thought that the alcohol could be undermining the efficacy of the med, but I'm also wondering if he isn't drinking because he is no longer responding to the med. He also smokes and recently quit chewing tobacco, and I read on the tips page that tobacco use can inhibit the effects of SSRIs.
> He'll be seeing the GP who is managing his meds under consultation with his neurologist. Any ideas? I looked around on tips and thought that either an increase to 30 or 40 might help, or augmentation. Naltrexone might be a good idea with the drinking problem, but I don't know how that would affect the Tourette's or whether a GP would feel comfortable prescribing such a drug.
>
> Any ideas?
>
> Thanks,
> cole
Hi Cole.A number of years ago, Zoloft was the the SSRIs most often chosen to treat pathological aggression. This selective use of Zoloft might have resulted from the tendency for doctors to choose it first for depression at that time. Also, Celexa had not been approved yet. However, Zoloft is really the most gentle of the SSRIs at the serotonin neuron. If Zoloft really is superior for aggression, this might be the reason why. If this is the case, then Paxil and Celexa would not be the best candidates to fill the role of an antiaggressive. If you are considering changing SSRIs, I would consider either Zoloft or Luvox as the next choice. Although Zoloft seems to be the most effective in treating aggression, Luvox is probably more effective for treating OCD.
Something else to take into consideration is that SSRIs can sometimes make Tourette's and tic movements worse. I should think that Paxil and Celexa would be the worst. If the Tourette's is somehow biologically linked with the aggression - I really don't know enough about it - perhaps SSRIs would ultimately be counterproductive and make both things worse if not combined with other drugs (clonidine or neuroleptics). SSRIs are often combined with a neuroleptic (dopamine-blocking antipsychotics) to treat comorbid Tourette's and OCD. Zyprexa or Risperdal should be considered, as their effects on serotonin receptors (5-HT2a) is likely to contribute to a reduction of aggression.
I'm wondering if Neurontin or Depakote would be of any use. These two drugs are anticonvulsants (anti-epileptics), and are often chosen for psychiatric conditions. Neurontin is showing itself to be quite effective for things like generalized anxiety disorders, panic disorder, ands bipolar disorder (manic depression).
So, all of this silliness boils down to using
(Zoloft or Luvox) + Zyprexa + Neurontin.
This stuff will most likely take care of the alcohol thing. I don't think naltrexone would be indicated unless the alcohol thing remains after the other things are remedied.
I ain't no expert. I'm just throwing out some ideas that were the result of brainstorming with very little information or education to work with. It should not be taken too seriously.
I'm hoping that you can at least ask your doctor some targeted questions that would prompt him to do some brainstorming of his own.
Good luck.
- Scott
This is the end of the thread.
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