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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by MB on January 25, 2002, at 21:11:46
Even with Klonopin (2mg/day) and LARGE doses of Neurontin (400mg 5 x day) I'm still getting breakthrough akathisia from the Prozac I'm on. I'm also taking 5 mg of Adderall, but that actually *helps* the akathisia. I think the akathisia is from the the way prozac stimulates 5-HT(sub)2 receptors, which in turn antagonizes dopamine action in the striatum. Do you think that if I switched to Serzone (which blocks 5-HT(sub)2 receptors and hence increases striatal dopamine) I would have less akathisia? I've suffered Restless Leg Syndrom all my life and this exacerbation is driving me loony-toons.
MB
Posted by Mr. Scott on January 25, 2002, at 21:35:21
In reply to Prozac akathisia driving me nuts, posted by MB on January 25, 2002, at 21:11:46
Damn.. I remember you posting about this a while ago. Consider adding trazodone to the Prozac, or better yet ditching the Prozac completely.
I was restless for a while at 20mg but it eventually went away, when it pooped i went to 30mg and the restlessness/akathesia never went away so I ditched it.
To have to take two ot three additional meds just to tolerate one sounds like a failure. There must be something else that won't exacerbate your condition so. Hmmm.. Have you tried Remeron or a tricyclic? Just thinking out loud.
Scott
Posted by JohnX2 on January 26, 2002, at 12:57:24
In reply to Prozac akathisia driving me nuts, posted by MB on January 25, 2002, at 21:11:46
A switch to Serzone or a Serzone add on would
probably help. Serzone has had a recent fda
warning, but I don't know the details.
You could also try Remeron standalone, or as
an add-on. Remeron is also a 5ht-2 antagonist.I believe your line of thinking regarding
the 5ht-2 receptor stimulation is correct.Zyprexa may even help, even though it is an
anti-psychotic. The benefits of its 5ht-2 antgonism
are guesstimate ~10x? fold over the dopamine antagonism/tweaking.Another med that may help a pinch is Buspar,
but I think the strong 5ht-2 antagonists are
what you are looking for.Regards,
John
> Even with Klonopin (2mg/day) and LARGE doses of Neurontin (400mg 5 x day) I'm still getting breakthrough akathisia from the Prozac I'm on. I'm also taking 5 mg of Adderall, but that actually *helps* the akathisia. I think the akathisia is from the the way prozac stimulates 5-HT(sub)2 receptors, which in turn antagonizes dopamine action in the striatum. Do you think that if I switched to Serzone (which blocks 5-HT(sub)2 receptors and hence increases striatal dopamine) I would have less akathisia? I've suffered Restless Leg Syndrom all my life and this exacerbation is driving me loony-toons.
>
> MB
Posted by MB on January 26, 2002, at 17:44:22
In reply to Re: Prozac akathisia driving me nuts » MB, posted by Mr. Scott on January 25, 2002, at 21:35:21
> Damn.. I remember you posting about this a while ago. Consider adding trazodone to the Prozac, or better yet ditching the Prozac completely.
For some reason, I can't tolorate Trazadone (too sedating, can't function the next day) but Serzone I can handle. I didn't find Serzone that sedating at all. My pdoc wants me on a serotonin drug because of some OCD components to my depression. His nurse mentioned that he wanted to switch ADs...I wonder which he will chose. It seems all SSRIs would do this. Anyway, and extra Klonopin always helps, but I'd like to keep my tolorance low for the times I really need them...and not waste them counteracting the side effects of the Prozac.
> I was restless for a while at 20mg but it eventually went away, when it pooped i went to 30mg and the restlessness/akathesia never went away so I ditched it.
I'm only on 10 mg. Sometimes the akathisia gets so bad it goes way beyond foot-wiggling...sometimes I just roll around on the ground in the fetal position moaning. I look like a junkie kicking heroin. It's SOOOO uncomfortable: feels like someone gave me an intervenous injection of itching powder.> To have to take two ot three additional meds just to tolerate one sounds like a failure. There must be something else that won't exacerbate your condition so. Hmmm.. Have you tried Remeron or a tricyclic? Just thinking out loud.
>
> Scott
Remeron, nortryptaline, and amiltryptaline (sp?) were waaay too sedating. I think they have antihistamine properties which can also exacerbate restless leg syndrome. I've heard of some people using mirapex (sp?) to help this problem of akathisia. Anyway, I will talk to my pdoc soon.
Posted by MB on January 26, 2002, at 17:54:23
In reply to Re: Prozac akathisia driving me nuts » MB, posted by JohnX2 on January 26, 2002, at 12:57:24
>
> A switch to Serzone or a Serzone add on would
> probably help. Serzone has had a recent fda
> warning, but I don't know the details.
> You could also try Remeron standalone, or as
> an add-on. Remeron is also a 5ht-2 antagonist.
I think there was a warning issued by the FDA that some people got liver failure from using Serzone. That's a real bummer because I found Serzone to be the easiest of all the serotonin meds to tolorate (plis no anorgasmia!! yea!!)
> I believe your line of thinking regarding
> the 5ht-2 receptor stimulation is correct.
>
> Zyprexa may even help, even though it is an
> anti-psychotic. The benefits of its 5ht-2 antgonism
> are guesstimate ~10x? fold over the dopamine antagonism/tweaking.
I tried Zyprexa years ago. I couldn't handle the sedation. Anything that interferes with the H-1 receptors seems to really disagree with my system.
I can't even take OTC antihistamines.
> Another med that may help a pinch is Buspar,
> but I think the strong 5ht-2 antagonists are
> what you are looking for.Buspar is a thought. However, I've heard rumors that it might actually lower dopamine levels to some degree which would not be good for the Restless Leg Syndrome.
Hmmm These are all good thoughts. I hope my pdoc has an answer.
MB
Posted by Mr. Scott on January 27, 2002, at 4:48:52
In reply to Re: Prozac akathisia driving me nuts » Mr. Scott, posted by MB on January 26, 2002, at 17:44:22
> > Damn.. I remember you posting about this a while ago. Consider adding trazodone to the Prozac, or better yet ditching the Prozac completely.
>
>
> For some reason, I can't tolorate Trazadone (too sedating, can't function the next day) but Serzone I can handle. I didn't find Serzone that sedating at all. My pdoc wants me on a serotonin drug because of some OCD components to my depression. His nurse mentioned that he wanted to switch ADs...I wonder which he will chose. It seems all SSRIs would do this. Anyway, and extra Klonopin always helps, but I'd like to keep my tolorance low for the times I really need them...and not waste them counteracting the side effects of the Prozac.
>
>
> > I was restless for a while at 20mg but it eventually went away, when it pooped i went to 30mg and the restlessness/akathesia never went away so I ditched it.
>
>
> I'm only on 10 mg. Sometimes the akathisia gets so bad it goes way beyond foot-wiggling...sometimes I just roll around on the ground in the fetal position moaning. I look like a junkie kicking heroin. It's SOOOO uncomfortable: feels like someone gave me an intervenous injection of itching powder.
>
> > To have to take two ot three additional meds just to tolerate one sounds like a failure. There must be something else that won't exacerbate your condition so. Hmmm.. Have you tried Remeron or a tricyclic? Just thinking out loud.
> >
> > Scott
>
>
> Remeron, nortryptaline, and amiltryptaline (sp?) were waaay too sedating. I think they have antihistamine properties which can also exacerbate restless leg syndrome. I've heard of some people using mirapex (sp?) to help this problem of akathisia. Anyway, I will talk to my pdoc soon.You might be surprised...all SSRI's are NOT created equally.. Just my experience.
Posted by MB on January 27, 2002, at 19:27:38
In reply to Re: Prozac akathisia driving me nuts » MB, posted by Mr. Scott on January 27, 2002, at 4:48:52
> You might be surprised...all SSRI's are NOT created equally.. Just my experience.
My knowledge of anatomy is horrid, but I believe that there is a part of the brain (does "striatum" sound right?) that is innervated by both serotonergic neurons and by dopaminergic neurons. From what I understand, some of the serotonergic neurons in this region synapse onto the dopaminergic neurons in this region and have an inhibitory effect on the action of these dopaminergic neurons (causing decreased dopaminergic activity in this area and consequent akathisia). I need to find an SSRI that exibits less modulation of the serotonin pathways in the striatum(?). But the $10,000 question is which SSRIs have this property. I do believe that the akathisia is due to underactivity of dopamine (at leat somewhere, if not in the striatum) because dopamine enhancing drugs like Adderall help the akathisia.
By the way, what the hell is a striatum anyway (LOL!!!)
MB
Posted by Mr. Scott on January 27, 2002, at 19:58:45
In reply to Re: Prozac akathisia driving me nuts » Mr. Scott, posted by MB on January 27, 2002, at 19:27:38
> > You might be surprised...all SSRI's are NOT created equally.. Just my experience.
>
> My knowledge of anatomy is horrid, but I believe that there is a part of the brain (does "striatum" sound right?) that is innervated by both serotonergic neurons and by dopaminergic neurons. From what I understand, some of the serotonergic neurons in this region synapse onto the dopaminergic neurons in this region and have an inhibitory effect on the action of these dopaminergic neurons (causing decreased dopaminergic activity in this area and consequent akathisia). I need to find an SSRI that exibits less modulation of the serotonin pathways in the striatum(?). But the $10,000 question is which SSRIs have this property. I do believe that the akathisia is due to underactivity of dopamine (at leat somewhere, if not in the striatum) because dopamine enhancing drugs like Adderall help the akathisia.
>
> By the way, what the hell is a striatum anyway (LOL!!!)
>
> MBIf I run for president my campaign slogan will be "Nigro-striatal pathways rich with dopamine for all!"
Yes I believe your right about, dopamine, and movement, and the like. However recently I understand it is less clear whether it is too much or too little dopaminergic activity at a given site that causes the symptoms we're talking about and are characteristic of several movement disorders. Unfortunately we haven't gotten so far as to have such wonderfully selective chemicals as you describe. However, I do know that Zoloft has the most dopaminergic enhancing properties and then theres always effexor. But theories aside, I noticed akathesia on Prozac but not celexa, which is purpoted to be the most selectively serotonergic??
Oye Vey...It gets complicated..
Scott
Posted by OldSchool on January 27, 2002, at 20:48:44
In reply to Prozac akathisia driving me nuts, posted by MB on January 25, 2002, at 21:11:46
> Even with Klonopin (2mg/day) and LARGE doses of Neurontin (400mg 5 x day) I'm still getting breakthrough akathisia from the Prozac I'm on. I'm also taking 5 mg of Adderall, but that actually *helps* the akathisia. I think the akathisia is from the the way prozac stimulates 5-HT(sub)2 receptors, which in turn antagonizes dopamine action in the striatum. Do you think that if I switched to Serzone (which blocks 5-HT(sub)2 receptors and hence increases striatal dopamine) I would have less akathisia? I've suffered Restless Leg Syndrom all my life and this exacerbation is driving me loony-toons.
>
> MB
Serzone and Remeron cause less akathesia definitely. You could also try adding OTC benadryl...that helps fight that sort of SSRI akathesia. Akathesia is believed to be from feeble dopamine activity. Anti-cholinergics like benadryl can help.Ask your doctor though about taking benadryl if you are already taking Adderall.
Old School
Posted by MB on January 27, 2002, at 22:08:05
In reply to Re: Prozac akathisia driving me nuts » MB, posted by Mr. Scott on January 27, 2002, at 19:58:45
Where are the doctors when we need them?
Anyway, I guess we just have to hang in there until we get it right.Peace,
MB> Oye Vey...It gets complicated..
>
> Scott
Posted by MB on January 27, 2002, at 22:14:30
In reply to Re: Prozac akathisia driving me nuts, posted by OldSchool on January 27, 2002, at 20:48:44
> Serzone and Remeron cause less akathesia definitely. You could also try adding OTC benadryl...that helps fight that sort of SSRI akathesia. Akathesia is believed to be from feeble dopamine activity. Anti-cholinergics like benadryl can help.
>
> Ask your doctor though about taking benadryl if you are already taking Adderall.
>
> Old School
Unfortunately, benadryl is an antihistamine as well as an anticholinergic, and antihistamines seem to make RLS worse. This stuff is complex. I see my GP tomorrow and talk to my pdoc on the 13th of Feb. It's just a matter of hanging in there until I get the right combo. Thanks for all the suggestions.Peace and good luck to everyone,
MB(gosh, that sounded so final, but it wasn't meant to be...lol)
Posted by mr.scott on January 28, 2002, at 10:12:22
In reply to Prozac akathisia driving me nuts, posted by MB on January 25, 2002, at 21:11:46
Whatever happened to your trial with Trileptal?
Posted by MB on January 28, 2002, at 12:38:42
In reply to Your Trileptal trial? » MB, posted by mr.scott on January 28, 2002, at 10:12:22
> Whatever happened to your trial with Trileptal?
Just made me feel to icky. It was like I had the chills and some tremors. It was making my depression MUCH worse. And then when I added the Prozac to it I immediately went into a violent "mixed-state" episode which, by the way, I've never experienced on just Prozac alone. right now I'm on Neurontin (2000mg divided into 5 doses) but I don't know if it's strong enough.
Maybe Depakote is the next thing to try. I need a mood stabalizer I can take that will keep me from getting manic from the Adderall and antidepressant I need.
MB
Posted by mr.scott on January 28, 2002, at 12:48:12
In reply to Re: Your Trileptal trial? » mr.scott, posted by MB on January 28, 2002, at 12:38:42
> > Whatever happened to your trial with Trileptal?
>
> Just made me feel to icky. It was like I had the chills and some tremors. It was making my depression MUCH worse. And then when I added the Prozac to it I immediately went into a violent "mixed-state" episode which, by the way, I've never experienced on just Prozac alone. right now I'm on Neurontin (2000mg divided into 5 doses) but I don't know if it's strong enough.
>
> Maybe Depakote is the next thing to try. I need a mood stabalizer I can take that will keep me from getting manic from the Adderall and antidepressant I need.
>
> MB
I know the exact situation you are in..Cause I believe I'm in it too. Depakote is such a heinous substance to me though...It makes me feel gross. Aside from the akathesia, what other if any side effects are you getting from the Prozac?Scott
Posted by Noa on January 28, 2002, at 17:29:07
In reply to Prozac akathisia driving me nuts, posted by MB on January 25, 2002, at 21:11:46
What about adding serzone to the prozac instead of replacing the prozac with the serzone? Also, with serzone as an adjunct, there is the 2nd possible step of lowering the prozac dose. This is essentially what I did with effexor--restless legs, akathisia, myoclonus all problematic. Then, added serzone and lowered effexor dose, later raised serzone and lowered effexor again, til right balance found. I also take a tiny amount of ativan at night for the remaining restless legs. This seems to work.
Posted by MB on January 28, 2002, at 22:24:41
In reply to Re: Your Trileptal trial? » MB, posted by mr.scott on January 28, 2002, at 12:48:12
Aside from akathisia, Prozac gives me anorgasmia (and I'm only on 10 mg). At first, it made me nervous and gave me insomnia. Then it "switched" on me and is making me tired. When you say Depakote makes you feel gross, what do you mean? I like Neurontin...it does make me sleepy and a little bit "thick" or "insulated" but it isn't unpleasant.
> I know the exact situation you are in..Cause I believe I'm in it too. Depakote is such a heinous substance to me though...It makes me feel gross. Aside from the akathesia, what other if any side effects are you getting from the Prozac?
>
> Scott
Posted by MB on January 28, 2002, at 22:26:12
In reply to Re: Prozac akathisia driving me nuts, posted by Noa on January 28, 2002, at 17:29:07
I'm already on such a low dose of Prozac (10 mg) that it wouldn't really work to lower it any further.
MB
Posted by Mr. Scott on January 29, 2002, at 19:01:22
In reply to Re: Your Trileptal trial? » mr.scott, posted by MB on January 28, 2002, at 22:24:41
I guess the Depakote makes me hold water, because for some reason I feel fat hours after Itake it, and I notice my face is kind of puffy. It also constipates me, further adding to the bloating sensation. And finally knowing that I am going to put on weight from it doesn't help matters any.
Remind me if you've tried Klonopin?
Scott
Aside from akathisia, Prozac gives me anorgasmia (and I'm only on 10 mg). At first, it made me nervous and gave me insomnia. Then it "switched" on me and is making me tired. When you say Depakote makes you feel gross, what do you mean? I like Neurontin...it does make me sleepy and a little bit "thick" or "insulated" but it isn't unpleasant.
>
> > I know the exact situation you are in..Cause I believe I'm in it too. Depakote is such a heinous substance to me though...It makes me feel gross. Aside from the akathesia, what other if any side effects are you getting from the Prozac?
> >
> > Scott
Posted by MB on January 30, 2002, at 3:35:48
In reply to Re: Your Trileptal trial? » MB, posted by Mr. Scott on January 29, 2002, at 19:01:22
> Remind me if you've tried Klonopin?
>
> Scott
Yes, I'm on Klonopin. 2.5 mg a day (3.5 mg on a bad day). Also, I've switched from Prozac to Serzone hoping there would be less akathisia (it blocks 5-HT2 receptors which is supposed to alleviate the antidopaminergic effects responsible for SSRI akathisia)...sounds good on paper, at least. At some point I'm supposed to add Adderall for ADD. Last time I took 5 mg of Adderall I had a full blown manic episode. I must need a stronger MS on board. Gabitril made me feel like I drank a bottle of dextromethorphan and trileptal gave me chills, malaise and upper-right quadrant pain (liver?). No thanks!! I might be willing to try a small add-on dose of Depakote to my Neurontin and Klonopin.Hey, by the way, is the brand name Klonopin supposed to be that much better than the generic clonozapam?
MB
I guess bipolar disorder with add is proably hard to treat given the mania-inducing properties of the pstims...
Posted by therese desqueroux on January 30, 2002, at 18:46:36
In reply to Re: Prozac akathisia driving me nuts » Noa, posted by MB on January 28, 2002, at 22:26:12
Isn't liquid Prozac available in smaller doses (I understand it's more expensive)?
Unless the Prozac is helping you tremendously, I would vote to ditch the Prozac. Prozac is the only other drug I've taken in 12 years that worked
but ultimately I had to quit it (I think I had reached a 60 mg dosage) because the akathisia was unbearable. I kept wondering if this was like having St. Vitus' Dance (which I've never actually seen), or I would compare myself to the little girl in Hans Christian Andersen's "The Red Shoes." A woodcutter has to chop off her feet to put the poor girl out of her misery and the feet still go dancing off into the wood. By the time I stopped, I was seriously considering whether I should tie one of my legs to my bedstead at bedtime because, in addition to jumpiness, it made me keep visualizing jumping out of a window, and I was rehearsing it repeatedly in my mind . . . one . . . two . . . three. . . .I'm taking a small dose of Prozac in a cocktail now and fortunately have not experienced similar problems.
> I'm already on such a low dose of Prozac (10 mg) that it wouldn't really work to lower it any further.
>
> MB
Posted by Mr. Scott on January 30, 2002, at 19:24:09
In reply to Re: Your Trileptal trial? » Mr. Scott, posted by MB on January 30, 2002, at 3:35:48
>
> > Remind me if you've tried Klonopin?
> >
> > Scott
>
>
> Yes, I'm on Klonopin. 2.5 mg a day (3.5 mg on a bad day). Also, I've switched from Prozac to Serzone hoping there would be less akathisia (it blocks 5-HT2 receptors which is supposed to alleviate the antidopaminergic effects responsible for SSRI akathisia)...sounds good on paper, at least. At some point I'm supposed to add Adderall for ADD. Last time I took 5 mg of Adderall I had a full blown manic episode. I must need a stronger MS on board. Gabitril made me feel like I drank a bottle of dextromethorphan and trileptal gave me chills, malaise and upper-right quadrant pain (liver?). No thanks!! I might be willing to try a small add-on dose of Depakote to my Neurontin and Klonopin.
>
> Hey, by the way, is the brand name Klonopin supposed to be that much better than the generic clonozapam?
>
> MB
>
> I guess bipolar disorder with add is proably hard to treat given the mania-inducing properties of the pstims...I liked the brand named because it had a K in the middle and I thought that was cool. My insurance company didn't I guess, and I was switched to generic. I never noticed any difference that I can recall. If anything the the generic was stronger or more sedating, but I cant say for sure. I may give Lamictal another trial, otherwise I'll have to wait for Pagoclone and Pregabalin should they ever see the light of day. Both in phase III clinical trials for GAD, Panic, and Bipolar Disorder. Made by Pfizer.
Your idea to take tiny bits of this and that may be the way for me to go. I like Neurontin except for the sedation, but I swear it makes me ADD or worsens it, but is very soothing and calming in many ways. Klonopin is also good stuff, but I'm looking in other directions right now.
Scott
Posted by Mr. Scott on January 30, 2002, at 19:27:46
In reply to Re: Your Trileptal trial? » Mr. Scott, posted by MB on January 30, 2002, at 3:35:48
>
> > Remind me if you've tried Klonopin?
> >
> > Scott
>
>
> Yes, I'm on Klonopin. 2.5 mg a day (3.5 mg on a bad day). Also, I've switched from Prozac to Serzone hoping there would be less akathisia (it blocks 5-HT2 receptors which is supposed to alleviate the antidopaminergic effects responsible for SSRI akathisia)...sounds good on paper, at least. At some point I'm supposed to add Adderall for ADD. Last time I took 5 mg of Adderall I had a full blown manic episode. I must need a stronger MS on board. Gabitril made me feel like I drank a bottle of dextromethorphan and trileptal gave me chills, malaise and upper-right quadrant pain (liver?). No thanks!! I might be willing to try a small add-on dose of Depakote to my Neurontin and Klonopin.
>
> Hey, by the way, is the brand name Klonopin supposed to be that much better than the generic clonozapam?
>
> MB
>
> I guess bipolar disorder with add is proably hard to treat given the mania-inducing properties of the pstims...Careful when switching from Prozac to Serzone. I could not make the change successfully. Apparently a metabolite of Serzone is blocked by Prozac and may accumulate and intensify anxiety until it has a chance to get out. Not everyone gets it, and I am particularly sensitive too. I had to switch to Zoloft and then off of that before actually getting on Serzone.
Scott
Posted by MB on January 31, 2002, at 1:39:35
In reply to Oh and also.. » MB, posted by Mr. Scott on January 30, 2002, at 19:27:46
My pdoc warned me about the switch from Paxil to Serzone (which I did years ago), but he didn't seem worried about switching from fluoxetine to Serzone. So far Serzone just helps me sleep (only at 100mg and bedtime).
MB
> Careful when switching from Prozac to Serzone. I could not make the change successfully. Apparently a metabolite of Serzone is blocked by Prozac and may accumulate and intensify anxiety until it has a chance to get out. Not everyone gets it, and I am particularly sensitive too. I had to switch to Zoloft and then off of that before actually getting on Serzone.
>
> Scott
This is the end of the thread.
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