![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by geno on April 16, 2002, at 15:07:14
3 beers, well i just upped my dose from 25mg after 7 days, using 25mg of zoloft/.5mg of klonopin in the am. Not bad. felt pretty sleepy,or just ok. Today, was the first increase of zoloft. Dont forget i dropped the xanax .5mg in the am due to my doc 3 days ago. So today, i stayed the same on klonopin .5mg and have only .25 mg of xanax for 5pm, when the klonopin usuually wears off. (note: took zoloft/klonopin at 7am. By 3pm, im jumping out of my skin. Im panicy, muscles are really tight!!! Luckily i have more klonopin. My mood is terrible also.
Question is, should i up the dose to 1mg of klonopin in the am. then take remaining xanax in the evening. I believe its the combonation of a few things. Zoloft is activating more at 50mg for me, kloponin dose is too low, and xanax withdrawls.
any comments?
I only have 1mg of klonopin a day, along with .25 xanax a day.
OH maybe its time to ditch the desipramine 25mg????
geno
Posted by rainbowlight on April 16, 2002, at 16:49:19
In reply to ZOLOFT Increase, more anxiety? 3 beers, posted by geno on April 16, 2002, at 15:07:14
Hi geno. I was wondering how your Zoloft trial was going, I am on week two. I think we started around the same time. I have just upped from 1 1/2 pills to 2 (50 mgs. total in the morning) per day. I noticed a decrease in my anxiety right away. As I have upped the dose I haven't noticed any more improvement than on the lower dose. I felt exactly as you describe when I tried Luvox. I only lasted a week because I couldn't handle the agitation and horrible cranky mood. Maybe you are experiencing the nervousness that is listed as a side effect? Have you asked your pdoc? I hope you start to feel better. I wish I had some advice for you, but I am in the same boat.
Posted by geno on April 16, 2002, at 17:07:05
In reply to Re: ZOLOFT Increase, more anxiety? 3 beers, posted by rainbowlight on April 16, 2002, at 16:49:19
Rainbow, i belive its benzo withdrawl, for instance i was taking .5mg of xanax in the am for a long time. My pdoc cut my dose to .25mg. he doesnt want me on benzos. He doesnt know i have 1mg of klonopin from my reg doc. Anyway, i dropped the am xanax and swithched to .5mg of klonopin. I feel xanax is 2x stronger, so .5mg of klonopin is like .25 of xanax, but last longer.
Tommorrow, im gonna try .5mg again. If my anxiety is still high, ill take 1mg in the am. I take 1mg at 7am with my zoloft. I feel it last 10-12 hrs. At 5pm, ill take my .25 xanax for the evening.
Im also feeling ache muscles. But i know 50mg of zoloft is not high, so im not dropping it. Im also on remeron for sleep at night. I may drop the desipramine, because i read the higher the zoloft, some dopamine gets reuptaked. Well see how it goes for another few days.geno
Posted by JohnX2 on April 16, 2002, at 19:00:05
In reply to ZOLOFT Increase, more anxiety? 3 beers, posted by geno on April 16, 2002, at 15:07:14
> 3 beers, well i just upped my dose from 25mg after 7 days, using 25mg of zoloft/.5mg of klonopin in the am. Not bad. felt pretty sleepy,or just ok. Today, was the first increase of zoloft. Dont forget i dropped the xanax .5mg in the am due to my doc 3 days ago. So today, i stayed the same on klonopin .5mg and have only .25 mg of xanax for 5pm, when the klonopin usuually wears off. (note: took zoloft/klonopin at 7am. By 3pm, im jumping out of my skin. Im panicy, muscles are really tight!!! Luckily i have more klonopin. My mood is terrible also.
>
> Question is, should i up the dose to 1mg of klonopin in the am. then take remaining xanax in the evening. I believe its the combonation of a few things. Zoloft is activating more at 50mg for me, kloponin dose is too low, and xanax withdrawls.
>
> any comments?
>
> I only have 1mg of klonopin a day, along with .25 xanax a day.
>
> OH maybe its time to ditch the desipramine 25mg????
>
> genoHi Geno,
3be is still in detention , I believe.
Zoloft for *many* is quite an activating drug. Some people call it the "black coffee" effect.
As far as the benzos go, I really feel that you ought to be on Klonopin dosing 2x a day. Otherwise you may just be a yo-yo.
I'm not sure what is behind making zoloft activating (it causes insomnia for many), maybe via some indirect mechanism the medicine increases norepinephrine conductance.. who knows. You never know. Just looking at the direct reuptake properties/binding of the medicine at hand doesn't always tell the whole story. All these SSRIs have such varied side effects, you know.
So maybe not a bad idea to ditch the desipramine.
Of course, you want to make the medicine maneuvers one step at a time. i.e. take it slow. (default advice).
Good Luck,
John
Posted by geno on April 16, 2002, at 19:14:12
In reply to Re: ZOLOFT Increase, more anxiety? 3 beers » geno, posted by JohnX2 on April 16, 2002, at 19:00:05
John, do you mean 1mg 2x a day. How many hours apart. I feel it last only 10 for me. The latter few i could feel the anxiety creeping up. How about this:
Remeron 30mg at bed
Ditch desipramine
50mg zoloft 8am
1mg klonopin 8am
1mg klonopin 4pmWhat do you think.
geno
Posted by JohnX2 on April 16, 2002, at 23:56:54
In reply to Re: ZOLOFT Increase, more anxiety? 3 beers, posted by geno on April 16, 2002, at 19:14:12
> John, do you mean 1mg 2x a day. How many hours apart. I feel it last only 10 for me. The latter few i could feel the anxiety creeping up. How about this:
> Remeron 30mg at bed
> Ditch desipramine
> 50mg zoloft 8am
> 1mg klonopin 8am
> 1mg klonopin 4pm
>
> What do you think.
> geno
Well, I guess that looks like a good plan.I think if you dose the Klonopin 2x a day, after a while it will build up in your system so that you don't feel the ups-and-downs. I know what you mean about the 10 hr affect for a 1x dosing...this is what I felt. But if I dose it 2x a day, it seems to build up to a more steady state (probably has to do with how the medicine's 1/2 life and how the repeated dosing is decaying in your body). I would just give it a go. You may need a 3x a day dosing. Maybe 0.5 mg morn, 0.5 mg afternoon, 1 mg night. Something should work out.
Is your pdoc reluctant to let you take the Klonopin 1 mg 2x a day?
I don't know much about Desipramine, so I wouldn't want to predict interactions there. I just know that Zoloft can be remarkedly stimulating. If you feel that Zoloft is stimulating, then ditching Desiramine might not be a bad idea (going by the less medicine is better approach than more medicines when possible)...
Take Care,
John
Posted by JohnX2 on April 17, 2002, at 0:14:48
In reply to Re: ZOLOFT Increase, more anxiety? 3 beers » geno, posted by JohnX2 on April 16, 2002, at 19:00:05
> > 3 beers, well i just upped my dose from 25mg after 7 days, using 25mg of zoloft/.5mg of klonopin in the am. Not bad. felt pretty sleepy,or just ok. Today, was the first increase of zoloft. Dont forget i dropped the xanax .5mg in the am due to my doc 3 days ago. So today, i stayed the same on klonopin .5mg and have only .25 mg of xanax for 5pm, when the klonopin usuually wears off. (note: took zoloft/klonopin at 7am. By 3pm, im jumping out of my skin. Im panicy, muscles are really tight!!! Luckily i have more klonopin. My mood is terrible also.
> >
> > Question is, should i up the dose to 1mg of klonopin in the am. then take remaining xanax in the evening. I believe its the combonation of a few things. Zoloft is activating more at 50mg for me, kloponin dose is too low, and xanax withdrawls.
> >
> > any comments?
> >
> > I only have 1mg of klonopin a day, along with .25 xanax a day.
> >
> > OH maybe its time to ditch the desipramine 25mg????
> >
> > geno
>
> Hi Geno,
>
> 3be is still in detention , I believe.
>
> Zoloft for *many* is quite an activating drug. Some people call it the "black coffee" effect.
>
> As far as the benzos go, I really feel that you ought to be on Klonopin dosing 2x a day. Otherwise you may just be a yo-yo.
>
> I'm not sure what is behind making zoloft activating (it causes insomnia for many), maybe via some indirect mechanism the medicine increases norepinephrine conductance.. who knows. You never know. Just looking at the direct reuptake properties/binding of the medicine at hand doesn't always tell the whole story. All these SSRIs have such varied side effects, you know.
>
> So maybe not a bad idea to ditch the desipramine.
>
> Of course, you want to make the medicine maneuvers one step at a time. i.e. take it slow. (default advice).
>
> Good Luck,
> JohnHeres one study (probably could dig up more):
Sertraline, a selective serotonin reuptake inhibitor modulates extracellular noradrenaline in the rat frontal cortex.
Thomas DN, Nutt DJ, Holman RB.
University of Bristol, Psychopharmacology Unit School of Medical Sciences, UK.
The selective action of selective serotonergic reuptake inhibitors (SSRIs) on 5-hydroxytryptamine (5-HT) neurotransmission underlies the therapeutic effectiveness of this class of drugs. Yet there is increasing evidence that changes in extracellular 5-HT content may result in changes in the regulation of other neurotransmitter systems. The present study examines the effects of acute and chronic administration of the SSRI sertraline on release of endogenous noradrenaline (NA) in the frontal cortex and hippocampus of the rat using in vivo microdialysis. Acute administration of sertraline did not significantly alter NA release in either the cortex or the hippocampus. However, 24 h after chronic (14 days) administration of the drug (10 mg/kg i.p. once daily), NA release in the cortex but not hippocampus was significantly enhanced. The lack of an effect on NA release following a challenge with the alpha2-antagonist idazoxan suggests that chronic drug treatment has reduced the sensitivity of cortical pre-synaptic alpha2-adrenoceptors, activation of which would normally inhibit further NA release. The possible mechanisms underlying the regional specificity of the effect of chronic and not acute sertraline administration and the implications of these results for our understanding of depression are discussed.
PMID: 10065910 [PubMed - indexed for MEDLINE]
Posted by geno on April 17, 2002, at 15:18:25
In reply to Re: ZOLOFT and norepinephrine, posted by JohnX2 on April 17, 2002, at 0:14:48
Well, today was better. took 1mg of klonopin with 50mg of zoloft. I was in the even, not sedated, nor anxious. My mood was not great either. Not too social, just focused more. I guess i have to wait for a few weeks or raise the dose to feel the social and happy effects from this drug.geno
Posted by JohnX2 on April 17, 2002, at 16:43:10
In reply to Re: ZOLOFT and norepinephrine, posted by geno on April 17, 2002, at 15:18:25
>
> Well, today was better. took 1mg of klonopin with 50mg of zoloft. I was in the even, not sedated, nor anxious. My mood was not great either. Not too social, just focused more. I guess i have to wait for a few weeks or raise the dose to feel the social and happy effects from this drug.
>
> geno
Yeah, I noticed that Zoloft like Wellbutrin could immediately improve my focus in a manner similar to drinking coffee. The mood stuff comes later...Good Luck,
John
Posted by tinker on May 6, 2002, at 7:42:24
In reply to Re: ZOLOFT and norepinephrine, posted by JohnX2 on April 17, 2002, at 0:14:48
I am trying to understand the difference in action between zoloft and clomipramine. I have noticed that there appears to be a significant difference in the blockade levels of 5HT1, 5HT2, Acetylchonine, Histamine, D2. Can anyone comment on exactly what this means, and how significant is it. I am trying to understand why I developed tinnitus from zoloft, I was able to take clomipramine for years without that when the levels of seratonin reuptake are basically the same. Thanks to all.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.