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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by orbital on January 2, 2010, at 17:20:18
Hi everyone, long time babble reader here :)
I'm currently on prozac 10mg/day for depression. It's working quite well, however, I've been struggling with poor sleep and insomnia since I started taking it.
I've tried the Z-drugs, Trazodone, low dose Seroquel with no success. Remeron worked great for a several months, but its hypnotic power wore off. It's staying on board, as it seems to boost the Prozac... along with my usual 2 mg Klonopin.
My pdoc wants me to try elavil next (10-25 mg, not to exceed 25mg/day). I've read up on the (seemingly dangerous) liver interactions between fluoxetine and Elavil, so this cocktail scares me. I've discussed my concerns with her, but she said I should be fine.
Has anyone tried this combo? Thanks in advance :)
Posted by Phillipa on January 2, 2010, at 21:59:55
In reply to Prozac + elavil - I need reassurance!, posted by orbital on January 2, 2010, at 17:20:18
No I haven't but found prozac quite activating years ago but was 20mg. The klonopin doesn't allow sleep? Phillipa
Posted by orbital on January 3, 2010, at 4:04:18
In reply to Re: Prozac + elavil - I need reassurance! » orbital, posted by Phillipa on January 2, 2010, at 21:59:55
> No I haven't but found prozac quite activating years ago but was 20mg. The klonopin doesn't allow sleep? Phillipa
Phillipa, I've been taking klonopin for several years now; it still controls my anxiety very well, but it no longer knocks me out (I can take my full daily dose in the middle of the day with no probs).
Actually, my pdoc had me raise the klono dosage for a while when I started Prozac - "just in case", she said. Well, I sure needed it!
Prozac made me feel very wired and jittery at first, but that eventually wore off; in fact, it actually seems to make me a bit sleepy and tired for a few hours after taking it (been on it for 4 months). BTW, I'm quite happy I decided to stick with the prozac and endure its startup effects... sleeping less sure beats the sluggish, foggy, messy state I was in before.
Thanks for your reply :)
Posted by SLS on January 3, 2010, at 7:07:06
In reply to Prozac + elavil - I need reassurance!, posted by orbital on January 2, 2010, at 17:20:18
You just need to be aware that the Prozac will cause blood levels of amitriptyline to rise by a factor of two. Other than that, the combination should be okay.
- Scott
Posted by orbital on January 3, 2010, at 9:59:52
In reply to Re: Prozac + elavil - I need reassurance! » orbital, posted by SLS on January 3, 2010, at 7:07:06
Thanks for the info, Scott. It's good to have actual numbers. I wish my pdoc had told me about this, as I've never taken a TCA before and I'm nervous about it.
Thanks again :)
Matt> You just need to be aware that the Prozac will cause blood levels of amitriptyline to rise by a factor of two. Other than that, the combination should be okay.
>
>
> - Scott
Posted by X-ray on January 3, 2010, at 10:13:32
In reply to Prozac + elavil - I need reassurance!, posted by orbital on January 2, 2010, at 17:20:18
Hi,
You can forget about Prozac and Elavil.
This is ugly polypharmacology.I was on this combo 15 years ago.
That was the worst time of my life.I fired my doc when I realized the truth.
Prozac and Elavil just dont mix.Your doctor is incompetent.
But Elavil is very good for sleep.Best regards,
X-ray
Posted by orbital on January 3, 2010, at 10:44:04
In reply to Re: Prozac + elavil - I need reassurance!, posted by X-ray on January 3, 2010, at 10:13:32
Thanks for the feedback, X Ray :)
I like my doc a lot, and I really don't blame her for cooking up this combination as a last resort, as I've been complaining about my insomnia for months. She's not a fan of unwarranted polypharmacy, for instance it took a lot of convincing to get her to prescribe Seroquel for sleep.
Maybe I should just put up with the insomnia, I'm not willing to give up Prozac - difficulty sleeping is the only side effect I'm experiencing, and it's a small price to pay for feeling stable and well.
Thanks again :)
> Hi,
>
> You can forget about Prozac and Elavil.
> This is ugly polypharmacology.
>
> I was on this combo 15 years ago.
> That was the worst time of my life.
>
> I fired my doc when I realized the truth.
> Prozac and Elavil just dont mix.
>
> Your doctor is incompetent.
> But Elavil is very good for sleep.
>
> Best regards,
> X-ray
>
Posted by Phillipa on January 3, 2010, at 18:53:34
In reply to Re: Prozac + elavil - I need reassurance! » Phillipa, posted by orbital on January 3, 2010, at 4:04:18
Do you take in am or pm? If am maybe switch to pm if it makes you sleepy? Phillipa
Posted by orbital on January 3, 2010, at 19:53:54
In reply to Re: Prozac + elavil - I need reassurance! » orbital, posted by Phillipa on January 3, 2010, at 18:53:34
Phillipa, I take it in the late afternoon - early am dosing makes me too tired to function, evening dosing disrupts my sleep.
Thanks for the suggestion, though, I'll try taking it at bedtime again, maybe I've adjusted to the sleep disruption thing by now.
> Do you take in am or pm? If am maybe switch to pm if it makes you sleepy? Phillipa
Posted by Phillipa on January 3, 2010, at 20:40:56
In reply to Re: Prozac + elavil - I need reassurance! » Phillipa, posted by orbital on January 3, 2010, at 19:53:54
That is a problem. Split the dose? But it's constant in blood so that wouldn't probably work either. Phillipa
Posted by orbital on January 3, 2010, at 22:11:54
In reply to Re: Prozac + elavil - I need reassurance! » orbital, posted by Phillipa on January 3, 2010, at 20:40:56
Well, I do notice a small spike a while after taking the Prozac... though I agree with you, it's probably negligible, as it should have reached a steady concentration by now.
Oh well, on the bright side, the insomnia is giving me a chance to catch up on my reading.
Thanks Phillipa :)
> That is a problem. Split the dose? But it's constant in blood so that wouldn't probably work either. Phillipa
Posted by SLS on January 4, 2010, at 6:21:28
In reply to Re: Prozac + elavil - I need reassurance! » SLS, posted by orbital on January 3, 2010, at 9:59:52
> Thanks for the info, Scott. It's good to have actual numbers. I wish my pdoc had told me about this, as I've never taken a TCA before and I'm nervous about it.
I would use blood tests to determine the level of the tricyclic just to be sure.
- Scott
Posted by mtdewcmu on January 4, 2010, at 9:17:59
In reply to Prozac + elavil - I need reassurance!, posted by orbital on January 2, 2010, at 17:20:18
Have you tried using over-the-counter antihistamines, such as diphenhydramine or doxylamine? They are sedating for the same reason as elavil, i.e. H1 blockade, however they are safer and have fewer side effects.
Posted by mtdewcmu on January 4, 2010, at 9:19:38
In reply to Re: Prozac + elavil - I need reassurance!, posted by mtdewcmu on January 4, 2010, at 9:17:59
By the way, elavil kept me awake. It did not help me sleep. So it depends on which effect of the drug wins out.
Posted by orbital on January 4, 2010, at 9:41:34
In reply to Re: Prozac + elavil - I need reassurance! » orbital, posted by SLS on January 4, 2010, at 6:21:28
Asking for blood tests does make sense, but I really don't think Elavil is worth the trouble.
I'll ask for something else instead - another trazodone trial at a higher dose, or maybe even agomelatine...I'm not willing to give Z-drugs another go, as they definitely worsen my depression (and IME they're not particularly effective sleep aids either).
Thanks, Scott :)
> I would use blood tests to determine the level of the tricyclic just to be sure.
>
>
> - Scott
Posted by orbital on January 4, 2010, at 9:52:52
In reply to Re: Prozac + elavil - I need reassurance!, posted by mtdewcmu on January 4, 2010, at 9:19:38
Yeah, I've tried OTC antihistamines - no luck, I think Remeron has desensitized me to them. This is yet another reason to give Elavil a miss... the potential risks seem to outweigh the benefits of a drug that will probably not work at all.
Thanks mtdewcmu :)
> Have you tried using over-the-counter antihistamines, such as diphenhydramine or doxylamine? They are sedating for the same reason as elavil, i.e. H1 blockade, however they are safer and have fewer side effects
Posted by Brainbeard on January 4, 2010, at 14:36:59
In reply to Prozac + elavil - I need reassurance!, posted by orbital on January 2, 2010, at 17:20:18
Lower dose Prozac with low dose Elavil (amitriptyline) is a fine combination.
Here's a handy study to give you an idea of Prozac's potentiation of amitriptyline: http://www.ncbi.nlm.nih.gov/pubmed/7751409
A regimen of 20mg of Prozac raises amitriptyline blood levels about twofold, but nortriptyline levels (the active metabolite) about ninefold.
I'm on 25mg of amitriptyline at the moment, and I've been taking small doses of Prozac (about 5mg a day) for a while.
Your doc has been perfectly cautious by setting the max at 25mg.
Posted by orbital on January 4, 2010, at 15:26:56
In reply to Re: Prozac + elavil - I need reassurance!, posted by Brainbeard on January 4, 2010, at 14:36:59
I really appreciate your input Brainbeard, thank you very much!
I trust my doc 100%, I know she would never prescribe something unless she is absolutely sure that there's no risk involved. I would even say that's she's overly cautious (if there's such a thing), she's not big on of polypharmacy.
Still, I was a bit weary when I searched Babble for info on this combo, and found very few first hand accounts.
I'll be seeing my doc later this week, I'll discuss my options thoroughly with her then.
Thanks again! :)
> Lower dose Prozac with low dose Elavil (amitriptyline) is a fine combination.
>
> Here's a handy study to give you an idea of Prozac's potentiation of amitriptyline: http://www.ncbi.nlm.nih.gov/pubmed/7751409
>
> A regimen of 20mg of Prozac raises amitriptyline blood levels about twofold, but nortriptyline levels (the active metabolite) about ninefold.
>
> I'm on 25mg of amitriptyline at the moment, and I've been taking small doses of Prozac (about 5mg a day) for a while.
>
> Your doc has been perfectly cautious by setting the max at 25mg.
Posted by Brainbeard on January 5, 2010, at 2:19:22
In reply to Re: Prozac + elavil - I need reassurance! » Brainbeard, posted by orbital on January 4, 2010, at 15:26:56
Trusting your doc is important. Keeping an eye on med interactions yourself is too. Unfortunately, not all docs are equally cautious. If you've found a doc that knows what she's doing, that's definitely a keeper.
Posted by orbital on January 8, 2010, at 12:03:24
In reply to Prozac + elavil - I need reassurance!, posted by orbital on January 2, 2010, at 17:20:18
Well, my pdoc and I discussed my concerns about this combo - she was actually pleased that I'd researched it on my own and had decided to bring it up. And yes, she was aware of the pharmacokinetics Scott and Brainbeard mentioned.
I wound up taking the Elavil and was pleasantly surprised, as it knocked me out cold for 8 hours straight - the quality of the sleep itself wasn't all that good, but I was in dire need of *any* sleep I could get. No side effects, except for cotton mouth (I'm definitely not complaining). More to the point, I'm still breathing ;)
Anyways, thanks for sharing your experience :) I really appreciate it.
Posted by Brainbeard on January 8, 2010, at 17:18:01
In reply to Re: Prozac + elavil - UPDATE, posted by orbital on January 8, 2010, at 12:03:24
> Well, my pdoc and I discussed my concerns about this combo - she was actually pleased that I'd researched it on my own and had decided to bring it up.
I can only be jealous of such a doc.
Good that you updated us lot.
I have the impression that for many people sleep quality (not just quantity) improves with longer Elavil use. Prozac does have sleep disturbing qualities though.
(Elavil - I've never liked the brand name. Only two letters short of 'evil'. 'Amitriptyline' sounds so much more fun!)
Posted by g_g_g_unit on February 5, 2010, at 20:55:37
In reply to Re: Prozac + elavil - UPDATE, posted by Brainbeard on January 8, 2010, at 17:18:01
> > Well, my pdoc and I discussed my concerns about this combo - she was actually pleased that I'd researched it on my own and had decided to bring it up.
>
> I can only be jealous of such a doc.
>
> Good that you updated us lot.
>
> I have the impression that for many people sleep quality (not just quantity) improves with longer Elavil use. Prozac does have sleep disturbing qualities though.
>
> (Elavil - I've never liked the brand name. Only two letters short of 'evil'. 'Amitriptyline' sounds so much more fun!)my doctor currently has me on this combination as well.
Brainbeard, i was just curious, do you find that the sleep-disrupting properties of Prozac persist through treatment? i've been taking 10mg for 5 days now and it makes my insomnia (which i've battled with chronically since becoming depressed) worse. i've tried it once in the past, but was taken off it pretty quickly due to the insomnia. i find all the other SSRI's pretty intolerable though which is why we decided to try Prozac again.
the Elavil helps me sleep, but i feel a little groggy and apathetic on the combo. i also have the WORST case of the munchies. it would nice if i could sleep on my own eventually.
i was also wondering about dosages. is there much qualitative difference between 10 and 20mg? i've seen mention of all sorts of doses used therapeutically here (including lower ones) but my doctor is adamant that 20mg is the minimum effective dose for OCD and depression.
thanks for your time
Posted by Brainbeard on February 6, 2010, at 6:34:39
In reply to Re: Prozac + elavil - UPDATE » Brainbeard, posted by g_g_g_unit on February 5, 2010, at 20:55:37
In fact, I don't have any experience with normal doses of Prozac, only with baby doses.
It is possible that the sleep disrupting properties of Prozac dissipate or disappear in the long term, but I would only expect the latter to happen after one or two years.
Luvox (fluvoxamine) is the SSRI that's most friendly for sleep, I think.
Your doc is right about OCD, not about depression. Depression could be lifted by low dose Prozac. OCD though usually needs high dose SRI. OCD is hard to beat with meds anyway.
Posted by g_g_g_unit on February 6, 2010, at 7:29:00
In reply to Re: Prozac + elavil - UPDATE, posted by Brainbeard on February 6, 2010, at 6:34:39
> It is possible that the sleep disrupting properties of Prozac dissipate or disappear in the long term, but I would only expect the latter to happen after one or two years.
thanks. i try not concern myself too much with sleep architecture and whatnot (though it's hard), so when i say sleep-disruption, i mean the ability to fall asleep on my own, which i'm hoping will come about eventually.
man this hunger is intense, though. is it more likely a sf of the prozac or elavil or the combination of the two? i'm a pretty lean guy, but i worry because i have a problem with a compressed artery in my stomach, and any excessive eating (i.e. anything outside of really small, regular meals) causes a lot of pain.
Posted by Brainbeard on February 6, 2010, at 7:56:34
In reply to Re: Prozac + elavil - UPDATE » Brainbeard, posted by g_g_g_unit on February 6, 2010, at 7:29:00
> man this hunger is intense, though. is it more likely a sf of the prozac or elavil or the combination of the two?
They can both cause binge eating. Both have a reputation for that. Prozac, even in low doses, made me gain weight fast. Weight that was hard to lose after I quit. My personal experience with low dose Elavil is that the increased appetite dissipates after a while.
Weight gain is usually a problem with any SSRI in the long term, although some people experience weight loss at first. Paxil is the worst offender.
With a lot of meds, effectiveness seems to come with weight gain and you can't have one without the other. Although you can keep an eye on your diet and exercise, for sure.
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