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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by BobS, on April 9, 2004, at 19:53:03
Do you know what Pregabalin will help with, e.g. mild OCD and/or atypical depression? What might its indications be and then "off label" uses?
As to Zoloft, my pdoc is big on Zoloft for me. DX "harm avoidant OCD/atypical depression (mood reactivity and rejection sensitivity). Let's throw in some social phobia and panic when I was much younger. Any thoughts on Zoloft vs. the universe of meds?
Currently, on alprazolam, but due to a year of strong exogenous stressors had to go from 1.5 mg per day to 3.5 mg per day and still need help.
I am going to go to Zoloft, no choice, but hope Pregabalin (if it ever is approved) can replace the Zoloft. BTW, was on Paxil and Prozac earlier and had a horrible time with them.
Thanks,
BobS.
Posted by Keith Talent on April 9, 2004, at 22:31:20
In reply to Questions for Chemist - Pregabalin and Zoloft, posted by BobS, on April 9, 2004, at 19:53:03
Bob, wouldn't clonazepam (Klonopin), with its longer half-life, be more suitable than alprazolam (Xanax)? I found sertraline (Zoloft) more acceptable than paroxetine (Paxil) and fluoxetine (Prozac). You probably won't find the sertraline enough by itself though.
Posted by chemist on April 9, 2004, at 23:08:45
In reply to Questions for Chemist - Pregabalin and Zoloft, posted by BobS, on April 9, 2004, at 19:53:03
> Do you know what Pregabalin will help with, e.g. mild OCD and/or atypical depression? What might its indications be and then "off label" uses?
>
> As to Zoloft, my pdoc is big on Zoloft for me. DX "harm avoidant OCD/atypical depression (mood reactivity and rejection sensitivity). Let's throw in some social phobia and panic when I was much younger. Any thoughts on Zoloft vs. the universe of meds?
>
> Currently, on alprazolam, but due to a year of strong exogenous stressors had to go from 1.5 mg per day to 3.5 mg per day and still need help.
>
> I am going to go to Zoloft, no choice, but hope Pregabalin (if it ever is approved) can replace the Zoloft. BTW, was on Paxil and Prozac earlier and had a horrible time with them.
> Thanks,
> BobS.hi bob...pregabalin has a somewhat shaky history in terms of making it through phase II trials, yet there are literature that support the upside of this med, which will most likley be found to act on GABA_{A} and GABA_{B} receptors in addition to being indicated for calcium-dependent ion channel gating. pfizer is having a bit of a rough go at it and will refile an NDA (if not already) for approval next year. as for zoloft, it is one of the many early-generation SSRIs that can more or less ameleorate your symptoms. it is not nearly as activating as prozac or paxil, and i am concerned about you pushing the limit on alprazolam: 3.5 mg qd is going to present you with a challenge to taper, and the previous post - suggesting klonopin - is right on target. it sounds to me that you are in the mix of OCD/social phobia/and dysthemia, and i think that the anti-depressant activity of xanax is actually contributing to your overstimulation. bottom line: wait until the pros have given the green light on pregabalin - if ever - and in the meantime, taper xanax with a parallel titration of klonopin. xanax + zoloft is overstimulating, and 3.5 mg qd of xanax is going to *really* test your endurance in re: withdrawl. do keep in mind that for OCD - which is really real - there are alternatives such as celexa or, more appropriately, lexapro, but i am not dismissing zoloft for you if it does the trick. the problem is xanax and need to be remedied a.s.a.p. give me a shout.....best, chemist
Posted by BobS, on April 11, 2004, at 18:10:38
In reply to Re: Questions for Chemist - Pregabalin and Zoloft, posted by chemist on April 9, 2004, at 23:08:45
Keith/Chemist,
Thanks for your replies. My pdoc believes Xanax is better than Klonopin and prefers it to Klonopin. I should note also that is is only the last month or so that I exceeded 2 mg of Xanax. If and when the Zoloft kicks in, I will begin an immediate taper of Xanax.However, the real issue are my symptoms. Even though my dx is harm avoidant OCD and atypical depression, my symptoms are severe anxiety, the punishing kind. Xanax is the only thing that allows me to get out of bed at the moment. Multiple exogenous triggers have put me into a depression, which naturally is mostly anxiety. I tried Zoloft a couple of weeks ago, but had to stop as I felt worse. Now we are having a second trial with a slow titration and a Pindolol preceding the trial by a week. So my real question was/is what do you think of Zoloft, because my pdoc, a psycho pharmacologist, is very high on it? In other words, what could make it better than the others?
As to the combo of Xanax and Zoloft, could you please elaborate on your thoughts?
BTW, my OCD is not the kind most are familiar with, but rather constant reading of abstracts on Medline, etc., which by the way I only comprehend about 2% of, looking for hope (Pregabalin) to alleviate anxiety.
Thanks again,
BobS.
Posted by chemist on April 11, 2004, at 22:47:50
In reply to Re: Questions for Chemist - Pregabalin and Zoloft, posted by BobS, on April 11, 2004, at 18:10:38
hi bob....given your debilitating panic/anxiety, xanax is the answer. zoloft is one of the first generation SSRIs, and your doctor is likely prescribing it becuase he/she has had the most success with it. it inhibits reuptake of serotonin and that is all. pregabalin is in - i believe - phase II or II trials - and is a mimic of GABA, which would indeed releive your panic/anxiety. my *opinion* about zoloft is that it is somewhat ``old-school'' and perhaps the activating features are attributable to it. the good folks at pfizer indicate that, in ocd, insomnia prevalence on zoloft vs. placebo is 28% vs. 12%. i, personally, would stick with xanax and perhaps investigate the xanax sr alternative, and dump zoloft for something like effexor or serzone. seems to me that it is the zoloft that is making your situation worse...pindolol is a beta-blocker, and will not address the biochemical imbalance, it simply works with calcium gating for your heart, for lack of a more accurate explanation.
...please let me know if i can be of any help, and all the best, chemist> Keith/Chemist,
> Thanks for your replies. My pdoc believes Xanax is better than Klonopin and prefers it to Klonopin. I should note also that is is only the last month or so that I exceeded 2 mg of Xanax. If and when the Zoloft kicks in, I will begin an immediate taper of Xanax.
>
> However, the real issue are my symptoms. Even though my dx is harm avoidant OCD and atypical depression, my symptoms are severe anxiety, the punishing kind. Xanax is the only thing that allows me to get out of bed at the moment. Multiple exogenous triggers have put me into a depression, which naturally is mostly anxiety. I tried Zoloft a couple of weeks ago, but had to stop as I felt worse. Now we are having a second trial with a slow titration and a Pindolol preceding the trial by a week. So my real question was/is what do you think of Zoloft, because my pdoc, a psycho pharmacologist, is very high on it? In other words, what could make it better than the others?
>
> As to the combo of Xanax and Zoloft, could you please elaborate on your thoughts?
>
> BTW, my OCD is not the kind most are familiar with, but rather constant reading of abstracts on Medline, etc., which by the way I only comprehend about 2% of, looking for hope (Pregabalin) to alleviate anxiety.
> Thanks again,
> BobS.
Posted by BobS, on April 12, 2004, at 19:49:22
In reply to Re: Questions for Chemist - Pregabalin and Zoloft » BobS,, posted by chemist on April 11, 2004, at 22:47:50
Chemist,
Thanks again. Pindolol is used as an augmentation strategy with SSRIs. I believe it is a mild 5HT1a antagonist and does "something" to autoreceptors. Various medline abstracts find efficacy and others don't. In my case, it is supposed to make it easier for me to get onto a therapeutic dose of Zoloft. That is why I wonder what is so special about Zoloft in my doctor's mind. We are in NJ the home of Pfizer, but I am pretty sure he is more interested in medicine and science than Pfizer's stock price. Never-the-less, I am still baffled. You are probably correct, he just had a lot of success with it. BTW, he does not like Paxil, something about anti-muscarinic(sp?) even though Preskorn.com says all those secondary features in SSRIs are meaningless. My pdoc talks alot about the secondary features...A friend of 40 years was on Xanax for 18 years at a 4 to 6 mg dose for panic and agoraphobia. She switched to Zoloft about a 1 and 1/2 years ago and felt great. It made me feel like I was jumping out of my skin. Go figure.
Regards,
BobS.
Posted by chemist on April 12, 2004, at 21:45:35
In reply to Re: Pindolol and Zoloft » chemist, posted by BobS, on April 12, 2004, at 19:49:22
hi bob....a few things...indeed pindolol is an antagonist of the serotonin 1A receptor subtype, and is indicated for additional therapy to boost serotonin levels. as for zoloft - or any SSRI - the pindolol ought to work by bringing you up-to-speed in a short time. paxil has a very little affinity for muscarinic receptors. this class of receptors is responsible for things like increased sweating, diarrhea, and increased production of mucus. as far as i know, the only difference between zoloft and paxil is that zoloft does not exhibit appreciable binding to muscarinic receptors: otherwise, both SSRIs hit more or less the same receptors in addition to 5-HT_{1A}. your doctor's anti-muscarinic arguement is not borne out by exstensive studies. further, he/she is probably wary of prescribing it in light of the U.K. and recent U.S. warnings for paxil and SSRis, respectively. HMOs/malpractice at work...in summary, pindolol is being used to ``jump start'' the zoloft effects. give it time, and investigate the second-generaton SSRIs such as effexor and serzone, where there is some antagonism of norepinephrine and dopamine receptors....please let me know if any of this helps, chemist
> Chemist,
> Thanks again. Pindolol is used as an augmentation strategy with SSRIs. I believe it is a mild 5HT1a antagonist and does "something" to autoreceptors. Various medline abstracts find efficacy and others don't. In my case, it is supposed to make it easier for me to get onto a therapeutic dose of Zoloft. That is why I wonder what is so special about Zoloft in my doctor's mind. We are in NJ the home of Pfizer, but I am pretty sure he is more interested in medicine and science than Pfizer's stock price. Never-the-less, I am still baffled. You are probably correct, he just had a lot of success with it. BTW, he does not like Paxil, something about anti-muscarinic(sp?) even though Preskorn.com says all those secondary features in SSRIs are meaningless. My pdoc talks alot about the secondary features...
>
> A friend of 40 years was on Xanax for 18 years at a 4 to 6 mg dose for panic and agoraphobia. She switched to Zoloft about a 1 and 1/2 years ago and felt great. It made me feel like I was jumping out of my skin. Go figure.
> Regards,
> BobS.
This is the end of the thread.
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