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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 cybercafe on June 8, 2003, at 4:39:07
hey dude, what do you know of going from one SSRI to another, do you have to wait another 6-8 weeks for the second to take effect?
:(
Posted by Ritch on June 8, 2003, at 10:36:34
In reply to Ritch -- SSRIs, posted by cybercafe on June 8, 2003, at 4:39:07
> hey dude, what do you know of going from one SSRI to another, do you have to wait another 6-8 weeks for the second to take effect?
>
> :(I had one pdoc that (when SSRI's were switched), would want me off the one I was switching from for one week. But, the main reason was to not confuse the effects of the old with the new one. I don't think you have to wait-because your receptors would already be down-regulated (changed), by the previous med (I would think anyhow). Let me guess.. You switched from Effexor to something else and the something else is not doing very well??
Posted by cybercafe on June 8, 2003, at 19:01:05
In reply to Re: Ritch -- SSRIs » cybercafe, posted by Ritch on June 8, 2003, at 10:36:34
> I had one pdoc that (when SSRI's were switched), would want me off the one I was switching from for one week. But, the main reason was to not confuse the effects of the old with the new one. I don't think you have to wait-because your receptors would already be down-regulated (changed), by the previous med (I would think anyhow). Let me guess.. You switched from Effexor to something else and the something else is not doing very well??
yep i switched to celexa 40 mg
not sure it's less effective than effexor, but i am sure that i'm still moderately depressed (and i would be much worse if not for the ritalin)i wonder if i should raise it to 60, or wait another week.. i've been at 20 mg for 4 days, 40 mg for about 11 days
dude this celexa is sweet, no tremors, no high blood pressure, and my libido is returning
Posted by Ritch on June 9, 2003, at 9:51:23
In reply to Re: Ritch -- SSRIs, posted by cybercafe on June 8, 2003, at 19:01:05
> > I had one pdoc that (when SSRI's were switched), would want me off the one I was switching from for one week. But, the main reason was to not confuse the effects of the old with the new one. I don't think you have to wait-because your receptors would already be down-regulated (changed), by the previous med (I would think anyhow). Let me guess.. You switched from Effexor to something else and the something else is not doing very well??
>
> yep i switched to celexa 40 mg
> not sure it's less effective than effexor, but i am sure that i'm still moderately depressed (and i would be much worse if not for the ritalin)
>
> i wonder if i should raise it to 60, or wait another week.. i've been at 20 mg for 4 days, 40 mg for about 11 days
>
> dude this celexa is sweet, no tremors, no high blood pressure, and my libido is returning
Instead of raising the dosage, what about asking your pdoc for a little buspar to pitch it with it? I had a significant boosting effect by doing that previously. Not much--- just 10mg/day and see what happens.
Posted by cybercafe on June 9, 2003, at 18:06:10
In reply to Re: Ritch -- SSRIs » cybercafe, posted by Ritch on June 9, 2003, at 9:51:23
> > > I had one pdoc that (when SSRI's were switched), would want me off the one I was switching from for one week. But, the main reason was to not confuse the effects of the old with the new one. I don't think you have to wait-because your receptors would already be down-regulated (changed), by the previous med (I would think anyhow). Let me guess.. You switched from Effexor to something else and the something else is not doing very well??
> >
> > yep i switched to celexa 40 mg
> > not sure it's less effective than effexor, but i am sure that i'm still moderately depressed (and i would be much worse if not for the ritalin)
> >
> > i wonder if i should raise it to 60, or wait another week.. i've been at 20 mg for 4 days, 40 mg for about 11 days
> >
> > dude this celexa is sweet, no tremors, no high blood pressure, and my libido is returning
>
>
> Instead of raising the dosage, what about asking your pdoc for a little buspar to pitch it with it? I had a significant boosting effect by doing that previously. Not much--- just 10mg/day and see what happens.hmmm... that sounds good. what is the benefit of using buspar rather than additional celexa?
i'm actually going to be raising my dose to 60 mg :)
dude ritalin celexa zyprexa ativan might actually work for me..... which means, i might become rich and be able to throw lavish parties for all my bipolar friends
oooh i can't wait
Posted by Ritch on June 9, 2003, at 21:41:52
In reply to Re: Ritch -- SSRIs, posted by cybercafe on June 9, 2003, at 18:06:10
> hmmm... that sounds good. what is the benefit of using buspar rather than additional celexa?SSRI's have a *very* flat dose-response curve. The only posts I've seen where additional SSRI dosage seems to yield considerable benefit is if OCD is involved. From personal experience with Celexa.... I started off with 10mg and felt a LOT better (during the start of a major depressive episode where it would be warranted), but as it deepened I complained that my depression was starting to come back... we increased the dose to 20mg. All that happened was more side effects with little additional benefit. The bottom line with my major depressive spells is that a purely serotonergic agent doesn't cut it. IOW, it really didn't matter whether I took Celexa at 5mg, 10mg, or 20mg, the effect wasn't much different. Buspar introduced a NE/DA effect that signficantly helped-that may be why Effexor "worked" for you. I've found that my bipolar depressions DON'T respond to serotonin agents exclusively, I have to bump the other neurotransmitters to get any relief.
Posted by cybercafe on June 11, 2003, at 2:27:09
In reply to Re: Ritch -- SSRIs » cybercafe, posted by Ritch on June 9, 2003, at 21:41:52
> SSRI's have a *very* flat dose-response curve. The only posts I've seen where additional SSRI dosage seems to yield considerable benefit is if OCD is involved. From personal experience with
hmm... that is interesting... though i know i felt better on 40 mg paxil than 20 mg and 225 mg effexor than 150 mg (assuming it acts as an SSRI in this range) ... i think i am feeling better on celexa, it's strange... effexor made me feel worse + effected sleeping habits when i first went on it... celexa has NO noticeable effects of a doseage increase... and for the first time since being depressed my libido is back
>Celexa.... I started off with 10mg and felt a LOT better (during the start of a major depressive episode where it would be warranted), but as it deepened I complained that my depression was starting to come back... we increased the dose to 20mg. All that happened was more side effects with little additional benefit. The bottom line with my major depressive spells is that a purely serotonergic agent doesn't cut it. IOW, it really didn't matter whether I took Celexa at 5mg, 10mg, or 20mg, the effect wasn't much different. Buspar introduced a NE/DA effect that signficantly helped-that may be why Effexor "worked" for you.
hey that's cool, i thought buspar was just a post synaptic 5ht1a agonist or something...
ummm... i took effexor at a purely ssri range... more norepenephrine means more cycling right?
>I've found that my bipolar depressions DON'T respond to serotonin agents exclusively, I have to bump the other neurotransmitters to get any relief.
hmmmm! ... yeah ... this ritalin is really great... i just started a pseudo job so we'll see how things work out.... but i hope to be rich and lavish my bipolar friends with gifts of aripiprazole in the near future :)
Posted by Ritch on June 11, 2003, at 10:04:18
In reply to Re: Ritch -- SSRIs, posted by cybercafe on June 11, 2003, at 2:27:09
>... i think i am feeling better on celexa, it's strange... effexor made me feel worse + effected sleeping habits when i first went on it... celexa has NO noticeable effects of a doseage increase... and for the first time since being depressed my libido is back
The biggest problem I have with Effexor is the sleep disrupting potential it has. Prozac and Zoloft disrupted sleep worse. Celexa was easier on the sleep process for me too. The worst thing that would happen is having a little trouble *getting* to sleep, but once I fell asleep I snoozed pretty well. If I can just sleep decent-I'm set for the next day.
>.... i thought buspar was just a post synaptic 5ht1a agonist or something...The metabolite has noradrenergic activity-I think that is what is the real "booster" in it.
> >I've found that my bipolar depressions DON'T respond to serotonin agents exclusively, I have to bump the other neurotransmitters to get any relief.
>
> hmmmm! ... yeah ... this ritalin is really great... i just started a pseudo job so we'll see how things work out.... but i hope to be rich and lavish my bipolar friends with gifts of aripiprazole in the near future :)Stimulants have done the trick for BP depression for me in the past. Generic methylphenidate and dextroamphetamine are very cheap compared to Abilify!
Posted by colin wallace on June 11, 2003, at 10:47:19
In reply to Re: Ritch -- SSRIs » cybercafe, posted by Ritch on June 11, 2003, at 10:04:18
Dark-Lord Mitch,
Wanna pick your brains here for a moment.If I remember rightly,you were taking lithium and Prozac together with some success in the past?
I'm in the process of reducing my lamictal, and will likely need to augment the lower dose with something else(to keep the Prozac in check):I'm thinking a low dose of lithium.
I took a 200mg lith. pill last night, which I had left over from a previous trial-my psych. at the time was happy that I wouldn't need a blood test for such a low dose.
I had no adverse effects from it,(bonus),but little else either.
Was wondering how much lith. you took with your Prozac,and what effect it had,at what doses etc.Also, how long did it take to 'kick-in'??Cheers dude,
Col.
Posted by Ritch on June 11, 2003, at 12:39:42
In reply to Re: Ritch --Lithium/Prozac , posted by colin wallace on June 11, 2003, at 10:47:19
> Dark-Lord Mitch,
>
> Wanna pick your brains here for a moment.If I remember rightly,you were taking lithium and Prozac together with some success in the past?
> I'm in the process of reducing my lamictal, and will likely need to augment the lower dose with something else(to keep the Prozac in check):I'm thinking a low dose of lithium.
> I took a 200mg lith. pill last night, which I had left over from a previous trial-my psych. at the time was happy that I wouldn't need a blood test for such a low dose.
> I had no adverse effects from it,(bonus),but little else either.
> Was wondering how much lith. you took with your Prozac,and what effect it had,at what doses etc.Also, how long did it take to 'kick-in'??
>
> Cheers dude,
>
> Col.
"Dark Lord"! You crack me up! :)I took anywhere between 300-450mg/day of lithium with anywhere from 2.5-4.0mg/day of Prozac. The 450mg of Li was taken during my high times of the year (a few weeks total). The higher Prozac dose was taken during my major depressive spells in the winter and summer. I found by going up on lithium (in steps)to 1500mg/day, that it didn't help any more above 600mg/day. I found that 450mg wasn't *much* different than 600mg. Lithium was pretty good for sleep (all at once at bedtime). You got to give lithium a good solid week at least to get anything out of it. I had been off all meds for a couple of years once and was VERY depressed. I restarted 600mg of lithium and within about 9-10 days I noticed a substantial improvement, then I backed off to the 300-450mg range. My stomach just hates the stuff though. You could try 200mg every night for a solid two weeks and let the stuff reach a steady state and see how you tolerate it before you go up any more-just a tip......
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