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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by bipolarspectrum on February 13, 2004, at 14:55:21
Hello,
I am hoping many of the bright minds out there can provide possible answers to my little cunundrum (sp?)... I've been through multiple meds for major depression (bipolar III) and the only thing that ever works is 10 mg of Prozac (fluoxetine)... However, Prozac makes me experience:
1. Insomnia
2. Anxiety
3. Apathy
I would love a drug that could augment prozac and help deal with these issues.. However, this is the crux, I've already tried augmenting with anti-psychotics (cognitive problems) and klonopin/clonazepam (doesnt help at all)... Does anyone have any interesting augmenting strategies??
Thanx for any posts, much appreciatedPS. Anyone use propanol for anxiety?
Posted by PsychoSage on February 13, 2004, at 15:19:25
In reply to Difficult situation - what to augment PROZAC with?, posted by bipolarspectrum on February 13, 2004, at 14:55:21
> Hello,
> I am hoping many of the bright minds out there can provide possible answers to my little cunundrum (sp?)... I've been through multiple meds for major depression (bipolar III) and the only thing that ever works is 10 mg of Prozac (fluoxetine)... However, Prozac makes me experience:
> 1. Insomnia
> 2. Anxiety
> 3. Apathy
> I would love a drug that could augment prozac and help deal with these issues.. However, this is the crux, I've already tried augmenting with anti-psychotics (cognitive problems) and klonopin/clonazepam (doesnt help at all)... Does anyone have any interesting augmenting strategies??
> Thanx for any posts, much appreciated
>
> PS. Anyone use propanol for anxiety?
>
Apathy is the worse symptom. Are you irritable? You can't take most SSRIs or AD if you are bipolar 3? Many bipolars still take stabs at SSRIs or SNRIs even if they have been switched on to mania.Did you have any cooccuring disorders or stressful live events during your manic phases for bipolar 3?
Most manic depressives have more depressive episodes than manic. If you are really switched on by the drugs alone then do you really need them to begin with? Perhaps you need a new diagnosis. Major depression is the first one we generally get before we get the other ones.
If you start on an anti-convulsant then that can be for anxiety. You will just build a tolerance to benzos before bed and have to increase every few months. They also become a crutch too for those with mild or minor sleep problems. They also made me wake up and eat in the middle of the night.
Effexor may be a good option as a replacement as the manufacture called it prozac with a punch. Wellbutrin or Strattera may be good as augmenters.
Are you telling us that paxil and serzone switch you on?
See, if you don't respond to a whole class then i wonder if your diagnosis is correct or there is missing information unaddressed. There are many options just within the class of antidepressants. Perhaps you should list exactly what you liked or did not like and what you have tried including MAOis and non-SSRIs and all combos before we shoot in the dark.
I
Posted by bipolarspectrum on February 13, 2004, at 15:29:13
In reply to Re: Difficult situation - what to augment PROZAC with?, posted by PsychoSage on February 13, 2004, at 15:19:25
Hi psychosage,
Thanx for the post.. I'm 22 and have been through 28 different medications and 10 ECT treatments.. I only had a manic response to wellbutrin and this was pre-ECT.. Post-ECT, wellbutrin just made me very anxious, with tremors and an insomniac.. My great difficulty is side-effects, they are always hit me very hard.. I've tried all the SSRI's (including serzone), SNRI's, all the MAOIs (I'm a Canadian, therefore moclobemide too), most of the antipsychotics and even bloody SAM-e.. My reaction to all of them is the same, excessive side-effects...
Anywayz, thats my sad story in a nut shell, but at least I achieve partial remission of my depression (which is what i experience 99% of the time) with prozac... I just hope someone has an interesting suggestion(s) for augmentations
Thanx> Apathy is the worse symptom. Are you irritable? You can't take most SSRIs or AD if you are bipolar 3? Many bipolars still take stabs at SSRIs or SNRIs even if they have been switched on to mania.
>
> Did you have any cooccuring disorders or stressful live events during your manic phases for bipolar 3?
>
> Most manic depressives have more depressive episodes than manic. If you are really switched on by the drugs alone then do you really need them to begin with? Perhaps you need a new diagnosis. Major depression is the first one we generally get before we get the other ones.
>
> If you start on an anti-convulsant then that can be for anxiety. You will just build a tolerance to benzos before bed and have to increase every few months. They also become a crutch too for those with mild or minor sleep problems. They also made me wake up and eat in the middle of the night.
>
> Effexor may be a good option as a replacement as the manufacture called it prozac with a punch. Wellbutrin or Strattera may be good as augmenters.
>
> Are you telling us that paxil and serzone switch you on?
>
> See, if you don't respond to a whole class then i wonder if your diagnosis is correct or there is missing information unaddressed. There are many options just within the class of antidepressants. Perhaps you should list exactly what you liked or did not like and what you have tried including MAOis and non-SSRIs and all combos before we shoot in the dark.
>
> I
Posted by PsychoSage on February 13, 2004, at 16:05:56
In reply to Re: Difficult situation - what to augment PROZAC with?, posted by bipolarspectrum on February 13, 2004, at 15:29:13
> Hi psychosage,
> Thanx for the post.. I'm 22 and have been through 28 different medications and 10 ECT treatments.. I only had a manic response to wellbutrin and this was pre-ECT.. Post-ECT, wellbutrin just made me very anxious, with tremors and an insomniac.. My great difficulty is side-effects, they are always hit me very hard.. I've tried all the SSRI's (including serzone), SNRI's, all the MAOIs (I'm a Canadian, therefore moclobemide too), most of the antipsychotics and even bloody SAM-e.. My reaction to all of them is the same, excessive side-effects...
> Anywayz, thats my sad story in a nut shell, but at least I achieve partial remission of my depression (which is what i experience 99% of the time) with prozac... I just hope someone has an interesting suggestion(s) for augmentations
> Thanx
Well, your apathy makes me feel you need to be perked up and stimulated, but your anxiety and insomnia make me think you are experiencing what is typical of prozac which is a caffeinated effect.Have you read "Electroboy" by Andy Behrman? It's not exactly as intelligent or intentionally profound, but by the end I knew there is another compulsive manic person with whom I can identify. Naturally, I judge manic memoirs against "Prozac Nation" and "An Unquiet Mind" by lizzie wurtzel and Dr. Kay Jamison {who wrote me a short note over postal mail once with a handout with URLS for lots of crazy people links}
There are other ways to combat apathy {structured activity, supervised exercise}, and to me the best is discontinuing SSRIs and antipsychotics.
Abilify is the only stimulating antipsychotic I have heard of. I have done two other ones not worth mentioning because of side effects. However, again, it sounds like stimulating is not necessarily the best thing unless you need to be evened out the way an ADD person needs to be.
I can list some individual drugs here that I have found to be decent in terms of their side effect profile, but if you are bipolar you need a mood stabilizer:
Antidepressants:
Celexa
Serzone
WellbutrinAnticonvulsants:
Trileptal- that's all i know from experience, but the rest gives rashes and makes you dead tired.Stimulants/Inattention:
Provigil
Strattera{supposed to be just like wellbutrin} and i have never tried it though I have asked, and my doctor thought there was no need to switch from wellbutrin.Antipsychotics:
Risperdal - was really unnoticeable, but it was when i needed a nueroleptic the most, so maybe that means it was working.
Abilify {sounds like the best one out there}
So obviously you should make a list of what you already like because what I have found is that doctors just go with what you like because it's just like ordering from a menu. Food is food.If you are treatment resistant then you gotta pray to something to pull things together for you. Thoughts and behaviors affectyour mind, so while treating the chemicals that affect them you can augment by going the other way around. They are really inextricable.
Wellbutrin Zoloft is one combo that covers a lot of bases.I have heard of effexor/Remeron.
Again, a mood stabilizer is an excellent way to go for anxiety.
Perhaps you should go with Symbyax{prozac/zyprexa}. Zyprexa can be bad if you like sweets. It has antidepressant effects and antianxiety, so I was told when I took it. I would go for the lowest dose. naturally, you may be dulled as I was.There is a whole bunch of anti parkinsonians and alzheimer's and dopamine agonists that can counter cognitive dulling.
Benzos will make you dumber even the next day.
Posted by PsychoSage on February 13, 2004, at 16:08:34
In reply to Re: Difficult situation - what to augment PROZAC with?, posted by PsychoSage on February 13, 2004, at 16:05:56
Have you read "Electroboy" by Andy Behrman?
sorry, somehow this question did not show up in my post
Posted by PsychoSage on February 13, 2004, at 16:10:16
In reply to Electroboy, posted by PsychoSage on February 13, 2004, at 16:08:34
>
> Have you read "Electroboy" by Andy Behrman?
>
>
> sorry, somehow this question did not show up in my postthe name of the book is
e-l-e-c-t-r-o-b-o-y
www.electroboy.comam i missing something here- i thought you post links to books with double quotes
Posted by shadows721 on February 13, 2004, at 17:22:09
In reply to Difficult situation - what to augment PROZAC with?, posted by bipolarspectrum on February 13, 2004, at 14:55:21
I had apathy with prozac. It seemed after 2.5 years it was pooping out on me. Some docs add buspar to help with ssri's. Trazodone or sequel (?) may help with the insomnia. These of course are taking before bed time. I have a friend that uses trazodone with her prozac. She loves it. She takes a very low dose. Since you have tried many meds, I wonder if it was the dosage that you could not tolerate. You may tolerate meds at a very low dosage.
Posted by bipolarspectrum on February 13, 2004, at 17:29:38
In reply to Re: Difficult situation - what to augment PROZAC with?, posted by shadows721 on February 13, 2004, at 17:22:09
Shadows and Psychosage,
Merci Beaucoup pour les messages, I really appreciate your help... Yeah, I've been through the myriad of anti-psychotics and essentially everything that you have mentioned.. Shadow, you bring up a great point, I usually hang at the 10 mg Prozac dose but I may kick it down to 5mg and see if I can retain the anti-depressant effects without some of those side-effects... But I've thought of a bit of curveball, what do people think about T3 with prozac?? It seems to be well-studied and supported by evidence-based medicine..
Posted by noa on February 13, 2004, at 19:40:13
In reply to Difficult situation - what to augment PROZAC with?, posted by bipolarspectrum on February 13, 2004, at 14:55:21
I think you are wise to think about an augmentatiaon strategy since you do get some response from the Prozac but just can't tolerate too much of it.
Have you tried Serzone? I take it with Effexor to counteract the insomnia/muscle activation, etc. of the Effexor.
Or what about a mood stabilizer as an augmentation agent?
Perhaps cytomel if your thyroid is in play here?
I'd say perhaps a stimulant as an augmentor to counteract apathy, but it could increase the insomnia and anxiety.
Good luck.
Posted by noa on February 13, 2004, at 19:41:19
In reply to what to augment PROZAC with? T3???????????, posted by bipolarspectrum on February 13, 2004, at 17:29:38
What ideas have you and your psychiatrist discussed in terms of augmentation strategies?
Posted by shadows721 on February 13, 2004, at 19:55:58
In reply to what to augment PROZAC with? T3???????????, posted by bipolarspectrum on February 13, 2004, at 17:29:38
Docs don't typically give T3. They give it if you have hyperthyroidism or have all of the symptoms without the lab findings. Thyroid medications are usually taking for the rest of one's life. The hormones are doing for the thyroid what it can't do for itself. So, it wouldn't be advised to add hormones in the system that aren't needed.
How long have you been on Prozac? I found that I developed apathy after 2.5 years of use. I simply could not cry or laugh at anything. I was emotionally numb. I simply got off of it. I got off of it gradually. I would have tried adding Buspar to it years ago, but I didn't know what I do now.
10 mg of Prozac is considered a very low dosage. Prozac is stimulating, so it may be responsible for the insomnia as well. Have you tried Lexapro? It seems helpful for mild anxiety. If you do start, start at 2.5 or 5 mg. I too am very sensitive to medications and I started at 5 mg. I still went thru several weeks of adjustment. It maybe helpful if you list the meds you tried, response and dosage. Maybe I or someone else can help solve this difficulty.
Posted by bipolarspectrum on February 13, 2004, at 20:07:09
In reply to Re: what to augment PROZAC with? T3???????????, posted by shadows721 on February 13, 2004, at 19:55:58
THanx for the posts Noa and Shadow,
I've tried Serzone and it caused grave insomnia, I believe due to the norepin effects... Well, my med history is surreal, 28 different ones I believe... All of the Canadian and American ones, plus a couple Euro's like tianeptine and reboxetine.. But my prob is going on these drugs and suffering severe side-effects such that I only last a couple days to a week on these drugs... But my pdoc is great and I have faith he'll have something to add to this conversation...
PS. My thyrotropin was tested at around 2.48 MIU/L
Thanx for ur attention and reads..
Posted by noa on February 13, 2004, at 21:36:50
In reply to Re: what to augment PROZAC with? T3???????????, posted by bipolarspectrum on February 13, 2004, at 20:07:09
Wow. For me, all the SSRIs and Effexor have been activating and cause insomnia, but Serzone has been Extremely Sedating for me.
Posted by PsychoSage on February 14, 2004, at 4:47:51
In reply to Re: what to augment PROZAC with? T3???????????, posted by bipolarspectrum on February 13, 2004, at 20:07:09
> THanx for the posts Noa and Shadow,
> I've tried Serzone and it caused grave insomnia, I believe due to the norepin effects... Well, my med history is surreal, 28 different ones I believe... All of the Canadian and American ones, plus a couple Euro's like tianeptine and reboxetine.. But my prob is going on these drugs and suffering severe side-effects such that I only last a couple days to a week on these drugs... But my pdoc is great and I have faith he'll have something to add to this conversation...
> PS. My thyrotropin was tested at around 2.48 MIU/L
> Thanx for ur attention and reads..Hey bipolarspectrum. Trazadone is an excellent idea. it is not habit forming, and it works for a while before you may have to increase it. I only took it in a psych ward at a hospital once, but I watched one of my best friends take it every night, and it worked like a charm, but she had munchies in the middle of the night. It is related to serzone which is nefazadone. Naturally, if serzone is sedating then this will be too.
I usually take the side effects and go with the drug for a few weeks. That is how ever single drug out there is like. Every drug will give you torture for at least a day. Perhaps you need to revisit your strategy and realize most of us stick it out for a few weeks to a month to see what happens.
This is psychiatry we are talking about right?
Think of this as stenuous exercise.
Keep tinkering around because you need to get that steady state, and you have to be on a drug for a while as you know. Sometimes you need to be on the same regimen or nearly the same one for a year or six onths to really get a robust effect.
They say things can work in a week or 2-4, but that is bull. They use that to sell drugs. YOu can improve quickly, but to benefit from a drug - antidepressant- you should stick with something. Naturally, you don't want to commit to sedating or overstimulating regimens. Do low doses and work through the easiest ones. Good luck! we know you are soooo frustrated. We all have been there and many still are.
Posted by PsychoSage on February 14, 2004, at 4:49:23
In reply to what to augment PROZAC with? T3???????????, posted by bipolarspectrum on February 13, 2004, at 17:29:38
oh by the way, electroboy was a person exactly like you who could not get a regimen to work.
This is the end of the thread.
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