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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by krybrahaha on August 31, 2003, at 0:14:40
Im a little confused about something that has to do with SSRI's - actually a couple questions.
To start off with, I have had anxiety issues all my life and it wasnt until my girlfriend (now wife) got pregnant that my anxiety got worse. It started with me having a hard time with my breathing. I went to a doctor thinking there was something wrong with my lungs or something. He said I just had Generalized Anxiety Disorder and then prescribed Paxil - I couldnt stand the nausea, then tried Zoloft, didnt do nothing, then Celexa, Serzone, Buspar, then he prescribed me Effexor XR - that actually gave me generalized anxiety disorder even worse - even off it-the worsened anxiety did not go away. At this time the doctor got stumped and sent me to get therapy. My therapist set me up with an appointment with a Psychiatrist. He diagnosed me as having: Generalized Anxiety Disorder, Social Anxiety Disorder, OCD, and Tourettes Syndrome. First he prescribed me Fluoxetine (generic Prozac) and it actually did help with my generalized anxiety but gave me mad headaches. He took me off that and gave me Paxil CR (which didnt do anything) - then he tried me on Lexapro and that didnt do anything either. Then, we tried Klonopin which worked for my anxiety but at the same time made me very irritable. Then, he put me on Valium and it didnt do nothing then he tried Ativan which had the opposite effect on me (Paradoxical?) Then, Remeron which was awful and made me gain 6 pounds in five days - i had to get off that stuff. Then, he suggested I try Brand name Prozac instead of generic since it helped somewhat. This just made me feel crazy as hell. I had to get off it. He then prescribed me Tranxene. This makes my anxiety tolerable. It kind of made my OCD worse, so he tried Luvox - and it actually worked alot better than any other of the SSRI's.
My question(s) are: Doctors say try two SSRI's and if they dont work, move to a different class of drugs, well I have tried four of the SSRI's until I found the right one - What's up with that? I thought they were all the same on how they work. Is there anyone who has tried all the SSRI's and found only one to work?
Finally, People are always putting down SSRI's. For instance, Prozac caused this person to shoot people or Luvox for Columbine and on and on. What about Tricyclic antidepressants and MAOI's. I have never heard one story of a person being on a tricyclic or an maoi and go on a shooting spree or whatnot. These dont cause violence but ssri's do? Any feedback?
Sorry such a long post - just wanted some input
Posted by galkeepinon on August 31, 2003, at 1:51:40
In reply to Questions about SSRI's, any feedback?, posted by krybrahaha on August 31, 2003, at 0:14:40
Wow! Sounds like you have been through the mill of some meds here. I have to! As far as your questions go, I have tried every SSRI except for Zoloft, and now currently take Lexapro-the BEST yet!!! I know some doctors that put patients on 2 SSRI's at the same time-not sure if you mean that you have been on 2 at the SAME time or just at different times? Have you ever been on 2 SSRI's at the same time? That's worth looking into.
You say here: 'First he prescribed me Fluoxetine (generic Prozac) and it actually did help with my generalized anxiety but gave me mad headaches' If you are looking for a medicationn combo-how about continuing generic Prozac and adding Topamax (AED-helps with migraines also-which can counteract those headaches you get with the Prozac)??? I would then add Klonopin and Luvox-since you said that Luvox 'actually worked better than the other SSRI's' and the Luvox may counteract the irritability you experience with the Klonopin which you also said 'worked for my anxiety but at the same time made me very irritable' I would map out this plan for ya if I was a doctor-which I am not, but you asked for feedback:-)
As far as a correlation between 'Tricyclic antidepressants and MAOI's and stories of a person being on a tricyclic or an MAOI and go on a shooting spree or whatnot', I don't know. I have heard good, positive posts here about these type of medications, however, I personally have no experience with MAOI's or TCA's.
I think there's more cause to violence than mere medication, in my opinion.
Hope this helped ya and good luck!:-)
> Im a little confused about something that has to do with SSRI's - actually a couple questions.
>
> To start off with, I have had anxiety issues all my life and it wasnt until my girlfriend (now wife) got pregnant that my anxiety got worse. It started with me having a hard time with my breathing. I went to a doctor thinking there was something wrong with my lungs or something. He said I just had Generalized Anxiety Disorder and then prescribed Paxil - I couldnt stand the nausea, then tried Zoloft, didnt do nothing, then Celexa, Serzone, Buspar, then he prescribed me Effexor XR - that actually gave me generalized anxiety disorder even worse - even off it-the worsened anxiety did not go away. At this time the doctor got stumped and sent me to get therapy. My therapist set me up with an appointment with a Psychiatrist. He diagnosed me as having: Generalized Anxiety Disorder, Social Anxiety Disorder, OCD, and Tourettes Syndrome. First he prescribed me Fluoxetine (generic Prozac) and it actually did help with my generalized anxiety but gave me mad headaches. He took me off that and gave me Paxil CR (which didnt do anything) - then he tried me on Lexapro and that didnt do anything either. Then, we tried Klonopin which worked for my anxiety but at the same time made me very irritable. Then, he put me on Valium and it didnt do nothing then he tried Ativan which had the opposite effect on me (Paradoxical?) Then, Remeron which was awful and made me gain 6 pounds in five days - i had to get off that stuff. Then, he suggested I try Brand name Prozac instead of generic since it helped somewhat. This just made me feel crazy as hell. I had to get off it. He then prescribed me Tranxene. This makes my anxiety tolerable. It kind of made my OCD worse, so he tried Luvox - and it actually worked alot better than any other of the SSRI's.
>
> My question(s) are: Doctors say try two SSRI's and if they dont work, move to a different class of drugs, well I have tried four of the SSRI's until I found the right one - What's up with that? I thought they were all the same on how they work. Is there anyone who has tried all the SSRI's and found only one to work?
>
> Finally, People are always putting down SSRI's. For instance, Prozac caused this person to shoot people or Luvox for Columbine and on and on. What about Tricyclic antidepressants and MAOI's. I have never heard one story of a person being on a tricyclic or an maoi and go on a shooting spree or whatnot. These dont cause violence but ssri's do? Any feedback?
>
> Sorry such a long post - just wanted some input
>
>
>
Posted by Francesco on August 31, 2003, at 13:17:36
In reply to Re: Questions about SSRI's, any feedback? » krybrahaha, posted by galkeepinon on August 31, 2003, at 1:51:40
My personal insight about SSRIs and violence is that TCAs are quite sedating so, even if you would like to commit violence you'd probably not have the strenght. Onether reason could be that, according to my psychiatrist's opinion, TCAs kick in a more gradually way while SSRIs more suddenly. I think that SSRIs can sometimes disinhibit without improving mood (at least in the first weeks). Last but not least I think media are more interested in blaming SSRIs because they are perceveid by the public as THE antidepressants (few people knows about Anafranil but almost everyone has heard about Prozac). Anyway I found that both lessen my empathy and strenghen my assertiveness. I think that this could lead to violence in predisposed individual. When I was on Paxil my sexual fantasies were quite rude ... but if you put them in pratics or not, I think, depend strongly on your previuos moral code, education, and so on.
Posted by Viridis on August 31, 2003, at 18:13:06
In reply to Questions about SSRI's, any feedback?, posted by krybrahaha on August 31, 2003, at 0:14:40
Re: trying two SSRIs and then changing to a different class of meds: I think this just comes from a general observation that if you don't do well on two, then you're unlikely to do well on others. That doesn't make it an absolute rule, and in your case, you got lucky.
Although all the SSRIs are supposed to increase levels of serotonin in synapses (spaces between brain cells through which chemical signals are transferred), they do so differently, and besides, nobody really knows how these meds work. There are effects on other brain neurotransmitters as well, they may stimulate growth of new brain cells, and so on. So, it's not surprising that some people might benefit from one but not another. I certainly reacted differently to Zoloft than Prozac (although very negatively in each case). I suppose I could try all of the SSRIs for 6-8 weeks or so and see if any actually work for me, but I really don't want to go through that, so I found alternatives that work.
I think the time-lag issue has a lot to do with it -- given the long period it takes to establish whether a given SSRI is effective, most doctors don't want you to have to go through a couple of months on one, then a couple on another, and so on, until you get relief. They do want you to get better, and you could easily spend a year or more trying all of them.
Re: criticism of SSRIs: I seriously doubt that SSRIs are likely to make many people violent, suicidal etc. But they're prescribed so widely that there are bound to be weird reactions in a few people. Almost any med out there can cause problems for a small minority. For example, the antibiotic Cipro (which was used during the anthrax scare) can occasionally induce psychosis.
I do suspect that for someone who's been severely depressed and unable to do much of anything, a sudden change that allows them to function could trigger dangerous behavior if there's latent hostility, suicidal tendencies, etc. But I doubt this applies to more than a tiny proportion of SSRI users.
Another reason to bash SSRIs is that they have major side effects for many people, and many of these haven't been acknowledged until recently. When Prozac etc. came out, they got tremendous hype. Now it turns out that they're not just benign, feel-good drugs, and I think this has caused something of a backlash among those who were led to believe that they were essentially side effect-free. This doesn't mean that they shouldn't be used, just that people have to weigh the pros and cons. I did very badly with the SSRIs I've tried, but know others whose lives have been changed by them.
Overall, I suspect that the early publicity, combined with the wide prescribing, has led to emphasis on the really serious reactions. And, given the extensive use of these meds, it's also inevitable that people with dangerous personality disorders are going to get them too, even if other drugs are more appropriate. So, if a paranoid schizophrenic who's misdiagnosed by their GP is given Prozac and kills someone, was it the Prozac, or a bad diagnosis, or some combination?
I think this is a lot like the endless discussions here about the safety of benzodiazepines -- there's lots of evidence that they're excellent meds for many people with anxiety disorders, but given the way that Valium, Xanax etc. were handed out so freely, a few people were bound to have problems, and those get emphasized. So, suddenly, these are labelled "dangerous", "addictive" drugs. They're not for everyone, and neither are SSRIs, but each class of meds has its place.
This is the end of the thread.
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