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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 morganator on January 23, 2010, at 1:51:28
So I've been on 100 mg of Zoloft and Symbyax-25 mg of Prozac and 3 mg of Zyprexa for about 2 weeks now. I'm not quite sure what my doctor plans on doing in the next few weeks. God is my brain so burned that I can take combine SSRIs like this without a problem? Maybe this is just like doubling my dose of Zoloft or taking 60 mg of Prozac. So maybe combining 2 different SSRIs at moderate doses is no different than taking a high dose of one SSRI? Maybe it's even better in some cases since you get the benefits of the mechanisms of both SSRIs?
Anyone have any thoughts on this?
I don't think my doc intends to keep me on Zoloft, but, if I start feeling really good when Prozac really starts to do it's thing, and I'm still taking Zoloft, I might be hesitant to stop taking Zoloft.
Posted by herpills on January 23, 2010, at 11:35:14
In reply to I'm on Zoloft and Symbyax-questions/concerns, posted by morganator on January 23, 2010, at 1:51:28
I always thought you aren't supposed to mix ssri, but your doctor knows more about this stuff than I do. If Zoloft is working, could you just take Zyprexa with it instead of the Symbyax?
Not sure about these combo pills seems a little like a "patent extender" I'm waiting for GSK to come out with "Lamixil" (lamictal + paxil)
herpills
> So I've been on 100 mg of Zoloft and Symbyax-25 mg of Prozac and 3 mg of Zyprexa for about 2 weeks now. I'm not quite sure what my doctor plans on doing in the next few weeks. God is my brain so burned that I can take combine SSRIs like this without a problem? Maybe this is just like doubling my dose of Zoloft or taking 60 mg of Prozac. So maybe combining 2 different SSRIs at moderate doses is no different than taking a high dose of one SSRI? Maybe it's even better in some cases since you get the benefits of the mechanisms of both SSRIs?
>
> Anyone have any thoughts on this?
>
> I don't think my doc intends to keep me on Zoloft, but, if I start feeling really good when Prozac really starts to do it's thing, and I'm still taking Zoloft, I might be hesitant to stop taking Zoloft.
Posted by Phillipa on January 23, 2010, at 12:16:25
In reply to Re: I'm on Zoloft and Symbyax-questions/concerns, posted by herpills on January 23, 2010, at 11:35:14
I think it's common to combine two low doses of SSRI's. At one time I was on very low doses of paxil 2.5mg and luvox 12.5mg. Doc took me off the paxil though. I didn't realize the dose of zyprexa was so low in symbax does it cause weight gain in such low doses or that prozac was at that high a dose? So what class of meds does this put symbax in as both ssri and atypical antipsychotic. Phillipa
Posted by bleauberry on January 23, 2010, at 18:34:54
In reply to I'm on Zoloft and Symbyax-questions/concerns, posted by morganator on January 23, 2010, at 1:51:28
I found the combination of prozac and zyprexa to be quite good, keeping me pretty well for almost 8 years. Not quite remission, but close. Certainly no depression at all, just some mild to moderate ssri apathy stuff. The addition of one pill of adrafinil fixed a lot of that though nothing ever worked completely. If you don't get complete satisfaction with what you are doing, I would try adding modafinil. And if that didn't work, then ritalin. Ritalin and prozac go real well together, and zyprexa smooths out any rough edges.
Prozac and zoloft are different. Prozac has some serotonin receptor antagonism which stimulates increased dopamine and norepinephrine. Zoloft has unknown effects on the sigma-1 receptors, and very weak effect as a dopamine reuptake inhibitor. The mechanisms are basically the same, but with some unique differences.
The combination of prozac and zyprexa significantly increases dopamine and norepinephrine (up to 300%), while not increasing serotonin much more than prozac alone. It has been tested for treatment resistant depression. I am a fan of prozac+zyprexa and am stumped why it is not used more often than it is.
Serotonin syndrome toxicity is a risk even with ssri monotherapy, and of course more so when multiple serotonin agents of differing mechanisms are combined. In your case, the mechanisms of zoloft and prozac are not that much different, so I wouldn't suspect a high risk.
Whatever works. Eventually weaning off zoloft sounds like a reasonable plan.
If your continuing symptoms are in the apathy/motivation department, then addition of a noradrenergic agent would be a good choice...savella, nortriptyline, ritalin, maybe modafinil.
You mentioned 3 mg zyprexa. I think the pubmed studies that showed the NE/DA increases used 5mg and 10mg. I personally found 5mg to be right, anything less was not enough. Prozac 20mg.
I like the idea of taking prozac and zyprexa separately so you can have control over the doses of each. With symbyax you can't do that. The advantage of symbyax is that it forces your insurance company to give you brand name prozac, which is what is in symbyax. If you get prozac serparately, I've seen plenty of accounts, including myself, of generic prozac being crap, changing a response into deterioration. So no matter what you do...insist on brand prozac.
This is the end of the thread.
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