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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 82. This is the beginning of the thread.
Posted by orbital on August 8, 2010, at 15:49:57
Hi everyone,
It's been a while, I posted back in January I think (hi Phillipa *wave*).
I've been on Lexapro for 6 months now, and I can't stand the emotional detachment anymore. The Lexapro worked great for my anxiety, but didn't touch my unipolar depression, and three months into taking it I basically felt like a zombie.
I recently broke up with my BF, I'm isolating from friends and family, my job is like a pastime that I get over with (I wouldn't be surprised if I lost it sometime soon)... absolutely no joy, no pain, nothing. Even though I know, intellectually, that these situations are important, I couldn't care less. If I could have it my way, I'd lay on my couch all day long.
My doctor isn't helping much. She thinks that my Klonopin is to blame for my anhedonia. Two months ago, I dropped my dosage from 3mg to 0.5mg to prove her wrong. Her next -reasonable- suggestion was that my Lexapro dosage was too high, so we dropped it from 30mg to 20, then 10, now 5mg. The apathy remains.
Here's a long list of strategies I've tried these past couple of months:
Added:
* Provigil - revved me up, but no effect on emotions. Still okay, overall.
* Wellbutrin - couldn't tolerate it, unfortunately, I really wanted this combination to work.
* Remeron - made the sluggishness/apathy much much worse.
* Lamictal - no effect whatsoever as of yet, still taking it.
* Switched from Klonopin to Ativan - nothing.
* Gabapentin - lifted my mood, then pooped out. Ditto Lyrica.
* Seroquel - nothing.
* Added low dose of Prozac - best result, but doc isn't keen on this strategy.
I read Blueberry's experience with milnacipran, and I'd like to try that next. My doctor wants me to give Effexor another try. But, really, maybe enough is enough.
Also, I'm weary of SSRI apathy syndrome, and think that maybe I should just call it quits for a while and give my poor brain a rest. I've been on one med or another for several years now. I hate being so detached from life.
In the midst of this biochemical mess, I'm thinking that my original DX (GAD/social phobia and unipolar depression) is long gone, and the medication is just making matters worse. Maybe I should just rely on my Klonopin and Provigil, and quit the reuptake inhibitors for a while.
Any thoughts? I really appreciate your time, thank you!
Posted by ed_uk2010 on August 8, 2010, at 16:34:16
In reply to Off Lexapro? - apathy syndrome //Help!, posted by orbital on August 8, 2010, at 15:49:57
>Added low dose of Prozac - best result, but doc isn't keen on this strategy.
Perhaps you should stop Lexapro completely, and switch to a low dose of Prozac? Two different SSRIs are not commonly used in combination, which is probably why your doc is not keen on you adding Prozac to Lexapro.
What do you class as a low dose of Prozac? 5-10mg?
Posted by orbital on August 8, 2010, at 16:45:31
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by ed_uk2010 on August 8, 2010, at 16:34:16
Hi Ed.
Exactly, low dose of Prozac: 5-10mg. I'm aware of the potential danger of mixing SSRIs, but I never ran into problems while taking 10mg Prozac/day along with 20mg Lexapro. However I only did this for a week at a time, as I know that fluoxetine levels build up slowly but steadily, and I didn't want to end up in the ER. My doctor really discouraged me from doing this, and for good reason.
I can't take Prozac alone, as it causes terrible insomnia.
My plan was to take Prozac every few days, but maybe I should just back off for a while. I "feel" like a vegetable.
Thanks for your answer :)
> >Added low dose of Prozac - best result, but doc isn't keen on this strategy.
>
> Perhaps you should stop Lexapro completely, and switch to a low dose of Prozac? Two different SSRIs are not commonly used in combination, which is probably why your doc is not keen on you adding Prozac to Lexapro.
>
> What do you class as a low dose of Prozac? 5-10mg?
Posted by ed_uk2010 on August 8, 2010, at 17:24:12
In reply to Re: Off Lexapro? - apathy syndrome //Help! » ed_uk2010, posted by orbital on August 8, 2010, at 16:45:31
Hi
>I can't take Prozac alone, as it causes terrible insomnia.
Even at 5mg (daily - in the morning)?
>maybe I should just back off for a while.
Perhaps you should. On the other hand, transferring to 5mg of Prozac might achieve two thing at once....
1. You would find out whether 5mg Prozac is beneficial for your mental health.
2. Even if it wasn't beneficial, Prozac is easier to discontinue than any of the other SSRIs or SNRIs, so you would be sparing yourself the risk of withdrawal symptoms.
Posted by morgan miller on August 8, 2010, at 17:54:50
In reply to Off Lexapro? - apathy syndrome //Help!, posted by orbital on August 8, 2010, at 15:49:57
Have you tried Zoloft? 100mg seems to be the sweet spot for many.
Posted by orbital on August 8, 2010, at 18:15:38
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by ed_uk2010 on August 8, 2010, at 17:24:12
Thanks for the suggestion, I might try taking 5mg or even less to see how it goes. I recall reading an unpublished paper in which the authors couldn't determine the appropriate dose range of Prozac; they tested something like 2mg/day, and went so far as to recommend one weekly 10mg dose. This was in 1987 I think.
Right now, though, I'm tempted to stop taking SSRIs to see how I feel without them. At the moment, it feels like I've had a lobotomy.
Thanks again, Ed.
> Hi
>
> >I can't take Prozac alone, as it causes terrible insomnia.
>
> Even at 5mg (daily - in the morning)?
>
> >maybe I should just back off for a while.
>
> Perhaps you should. On the other hand, transferring to 5mg of Prozac might achieve two thing at once....
>
> 1. You would find out whether 5mg Prozac is beneficial for your mental health.
>
> 2. Even if it wasn't beneficial, Prozac is easier to discontinue than any of the other SSRIs or SNRIs, so you would be sparing yourself the risk of withdrawal symptoms.
>
>
Posted by orbital on August 8, 2010, at 18:26:04
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 8, 2010, at 17:54:50
Yes, I had a great run with Zoloft about five years ago. Had to quit taking it due to extreme weight loss. Come to think of it, I've been on all the SSRIs at one point or another. They were all very helpful. However, it has only become clear to me -now that I'm practically zombified- that the brain fog just kept getting worse with each one (with Celexa being the worst offender).
As a disclaimer, I'm certainly not anti-med, I'm just wondering if I should take a break from them. I'm tired of not feeling like myself, if that makes any sense.
Thanks, Morgan.
> Have you tried Zoloft? 100mg seems to be the sweet spot for many.
>
>
Posted by morgan miller on August 8, 2010, at 19:21:49
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by orbital on August 8, 2010, at 18:26:04
> Yes, I had a great run with Zoloft about five years ago. Had to quit taking it due to extreme weight loss. Come to think of it, I've been on all the SSRIs at one point or another. They were all very helpful. However, it has only become clear to me -now that I'm practically zombified- that the brain fog just kept getting worse with each one (with Celexa being the worst offender).
> As a disclaimer, I'm certainly not anti-med, I'm just wondering if I should take a break from them. I'm tired of not feeling like myself, if that makes any sense.
>
> Thanks, Morgan.
>
Even if you were anti-med or anti-SSRi, it would be o.k. and make sense.If you're not feeling good on your current AD, maybe it would be a good idea to get off it.
I'm surprised you experienced weight loss on Zoloft. Was it suppressing your appetite?
Posted by morgan miller on August 8, 2010, at 19:23:47
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by orbital on August 8, 2010, at 18:26:04
Have you ever tried a good brand of St. John's Wort?
Do you take fish oil?
Have you ever tried any other natural alternatives or adjunct therapies for depression and anxiety?
Posted by orbital on August 8, 2010, at 20:09:35
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 8, 2010, at 19:21:49
I'm trying to remember... Zoloft caused really bad heartburn and GI problems, so I literally couldn't stomach anything. My doc had me on ranitidine and I was popping Tums like crazy; I held on for a good five months, as Zoloft was really helping my mood and anxiety. Side effects aside, it was probably the best of the bunch, as it balanced both my anxiety and my depression.
Although I'm not high risk (suicidal etc.) I'm hard to treat, as I suffer from high anxiety (various flavors) and a tendency towards flat affect (dysthimia?). So I'm either taking something activating like Prozac and popping benzos like crazy, or taking something soothing like Lexapro and slowly turning into a potato.
> > Yes, I had a great run with Zoloft about five years ago. Had to quit taking it due to extreme weight loss. Come to think of it, I've been on all the SSRIs at one point or another. They were all very helpful. However, it has only become clear to me -now that I'm practically zombified- that the brain fog just kept getting worse with each one (with Celexa being the worst offender).
>
> > As a disclaimer, I'm certainly not anti-med, I'm just wondering if I should take a break from them. I'm tired of not feeling like myself, if that makes any sense.
> >
> > Thanks, Morgan.
> >
> Even if you were anti-med or anti-SSRi, it would be o.k. and make sense.
>
> If you're not feeling good on your current AD, maybe it would be a good idea to get off it.
>
> I'm surprised you experienced weight loss on Zoloft. Was it suppressing your appetite?
>
>
>
Posted by orbital on August 8, 2010, at 20:18:10
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 8, 2010, at 19:23:47
I did take SJW for a while - it was Roche brand, I think, or maybe Bayer. I didn't notice much of anything. Herbs make me nervous.
I do take fish oil, but not regularly - I'll make a point to do that.
CBT and talk therapy have been very helpful, along with stuff like yoga and meditation. Thing is, when I'm in a haze, it's next to impossible to work up the motivation to practice. I do go to therapy regularly, and it makes a big difference.
But, again, my problem right now is feeling semi-comatose.. I think I'll just go ahead and quit taking Lexapro, it's getting ridiculous.
Thanks again, Morgan :)
> Have you ever tried a good brand of St. John's Wort?
>
> Do you take fish oil?
>
> Have you ever tried any other natural alternatives or adjunct therapies for depression and anxiety?
>
>
Posted by ed_uk2010 on August 8, 2010, at 20:31:25
In reply to Re: Off Lexapro? - apathy syndrome //Help! » ed_uk2010, posted by orbital on August 8, 2010, at 18:15:38
>I recall reading an unpublished paper in which the authors couldn't determine the appropriate dose range of Prozac; they tested something like 2mg/day, and went so far as to recommend one weekly 10mg dose. This was in 1987 I think.
The manufacturer's early clinical trials (of fluoxetine) used a variety of doses. One trial used 5mg per day and did demonstrate some efficacy. Most trials used 20mg. Higher doses were also tried but did not appear to be any more effective for depression than 20mg, although they were somewhat better for OCD and bulimia. The higher doses all tended to cause more side effects. I don't think any trial used less than 5mg per day.
>Right now, though, I'm tempted to stop taking SSRIs to see how I feel without them. At the moment, it feels like I've had a lobotomy.
I don't blame you. I suppose what I'm saying is that 5mg of fluoxetine might be a useful 'stepping stone' because it should reduce the risk of SSRI withdrawal symptoms, whilst at the same time allowing you to evaluate the efficacy of low-dose fluoxetine against your depression. You could then make a definite decision RE whether or not you want to stop all SSRIs completely.
Posted by linkadge on August 8, 2010, at 20:55:08
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by orbital on August 8, 2010, at 20:09:35
Yes, I would recomend a break from SSRIs.
I too hit a brick wall like you describe with SSRIs, and nothing seemed to work untill I discontinued them. To note though, I do get apathy from even small doses of clonazepam. Gabaergics can supress stem cell proliferation which may, over time, simply make the brain more stagnant / less alive.
Methylphenidate is working for me right now in monotherapy. I am happy.
Simpler is better IMHO.
Linkadge
Posted by morgan miller on August 8, 2010, at 20:59:13
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by orbital on August 8, 2010, at 20:09:35
Were you taking brand Zoloft or generic? I had GI issues when I switched to generic. I had to get back on brand and had no problems. I did have to eat yogurt on a regular basis, I do this with all medications.
Have you ever considered taking a good probiotic and other things that can help improve intestinal health and digestion?
Posted by morgan miller on August 8, 2010, at 21:03:04
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by orbital on August 8, 2010, at 20:18:10
What about a super low dose of Lexapro like 2.5 mg? Not sure if this would help.
Posted by morgan miller on August 8, 2010, at 21:09:41
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by linkadge on August 8, 2010, at 20:55:08
Good to hear Methylphenidate is working for you right now. Are you taking the extended release version?
>To note though, I do get apathy from even small doses of clonazepam. Gabaergics can supress stem cell proliferation which may, over time, simply make the brain more stagnant / less alive.
I agree that chronic klonopin use can be mind numbing. I had to stop using klonopin because it simply took the life out of me.
Posted by Phillipa on August 8, 2010, at 21:22:00
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by morgan miller on August 8, 2010, at 21:09:41
Hi Orbital just popped on here. Humm was also trying lexapro. Seems lower dose works better and also combining with low dose luvox 50mg. Been on it so many years. I do remember when prozac came out there was only 20mg available and although was working and felt very good on .25 of xanax first day on 20 of prozac lots of energy, day 2 anxiety, day three sheer panic and got rid of the prozac. Took three days for the anxiety to subside. At the time my pdoc was a good one and very amazed at my response to prozac and literally begged me to take it every three days and I refused. Reason I wrote all this is that I feel that if prozac truly helps discontinue other SSRI's then go for a very low dose and see what happens. And klonopin did depress me. And please let me know how it goes. Love Phillipa Waving!!!!!!
Posted by orbital on August 8, 2010, at 22:04:41
In reply to Fluoxetine, posted by ed_uk2010 on August 8, 2010, at 20:31:25
Ed, I'm kicking myself for not bookmarking the page I mentioned. That early study concluded that once weekly dosing was a feasible strategy, but Lilly clearly preferred marketing Prozac as a once-daily med. I'll keep on looking for it.
I know someone who uses this strategy very successfully:
http://www.ncbi.nlm.nih.gov/pubmed/10362436
In any case, and to state the obvious, fluoxetine is one weird drug. It can work wonders when used correctly, but reckless dosing can be dynamite for some people.
On another note, for whatever reason, I've never suffered from SSRI withdrawal, I've always been able to quit them cold turkey without a problem. Paxil, Luvox etc.. I've had enough, I think I'm going to give them all a miss for a while.
Really appreciate your answer, thanks :)
> >I recall reading an unpublished paper in which the authors couldn't determine the appropriate dose range of Prozac; they tested something like 2mg/day, and went so far as to recommend one weekly 10mg dose. This was in 1987 I think.
>
> The manufacturer's early clinical trials (of fluoxetine) used a variety of doses. One trial used 5mg per day and did demonstrate some efficacy. Most trials used 20mg. Higher doses were also tried but did not appear to be any more effective for depression than 20mg, although they were somewhat better for OCD and bulimia. The higher doses all tended to cause more side effects. I don't think any trial used less than 5mg per day.
>
> >Right now, though, I'm tempted to stop taking SSRIs to see how I feel without them. At the moment, it feels like I've had a lobotomy.
>
> I don't blame you. I suppose what I'm saying is that 5mg of fluoxetine might be a useful 'stepping stone' because it should reduce the risk of SSRI withdrawal symptoms, whilst at the same time allowing you to evaluate the efficacy of low-dose fluoxetine against your depression. You could then make a definite decision RE whether or not you want to stop all SSRIs completely.
>
>
Posted by orbital on August 8, 2010, at 22:13:32
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by linkadge on August 8, 2010, at 20:55:08
Linkadge, have you taken modafinil? How does it compare to Ritalin? I'm just wondering, there's no way my doc would prescribe that for me.
A wall, that's a really accurate description of what I'm feeling. It's not benzo robotic coldness, but more like "I don't give a dime" blahs. It's downright scary.
Time for a break, I think. Thanks for your feedback, I appreciate it :)
> Yes, I would recomend a break from SSRIs.
>
> I too hit a brick wall like you describe with SSRIs, and nothing seemed to work untill I discontinued them. To note though, I do get apathy from even small doses of clonazepam. Gabaergics can supress stem cell proliferation which may, over time, simply make the brain more stagnant / less alive.
>
> Methylphenidate is working for me right now in monotherapy. I am happy.
>
> Simpler is better IMHO.
>
> Linkadge
>
>
>
>
>
>
>
>
>
>
>
>
>
>
Posted by orbital on August 8, 2010, at 22:19:29
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by morgan miller on August 8, 2010, at 20:59:13
It was brand name. I vividly recall my stomach "unclenching" a few days after stopping the Zoloft, I just sighed in relief. Maybe it was anxiety? Yes, I do take probiotics regularly..
> Were you taking brand Zoloft or generic? I had GI issues when I switched to generic. I had to get back on brand and had no problems. I did have to eat yogurt on a regular basis, I do this with all medications.
>
> Have you ever considered taking a good probiotic and other things that can help improve intestinal health and digestion?
Posted by orbital on August 8, 2010, at 22:23:42
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by morgan miller on August 8, 2010, at 21:03:04
I'm quite certain that 2.5mg of escitalopram is a relatively significant dose; I'm on 5mg right now and can definitely "feel" it (how I managed to take 30mg a couple of months ago is beyond me!).
Thanks, I really appreciate all of your insights, it's good to have options :)
> What about a super low dose of Lexapro like 2.5 mg? Not sure if this would help.
Posted by morgan miller on August 8, 2010, at 22:27:46
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by orbital on August 8, 2010, at 22:23:42
Whatever you do, good luck!
Morgan
Posted by orbital on August 8, 2010, at 22:31:28
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by Phillipa on August 8, 2010, at 21:22:00
Hey Phillipa :)
Similar experience here, about 10 years ago my GP prescribed 20mg Prozac. A week later I was in the ER with uncontrollable panic. After that experience, it took me years to work up the nerve to try another med (Paxil).
Anyway, thanks for your advice, I think I'll do just that, stop everything for a while, then reassess, based on how I'm feeling. Thank you!
> Hi Orbital just popped on here. Humm was also trying lexapro. Seems lower dose works better and also combining with low dose luvox 50mg. Been on it so many years. I do remember when prozac came out there was only 20mg available and although was working and felt very good on .25 of xanax first day on 20 of prozac lots of energy, day 2 anxiety, day three sheer panic and got rid of the prozac. Took three days for the anxiety to subside. At the time my pdoc was a good one and very amazed at my response to prozac and literally begged me to take it every three days and I refused. Reason I wrote all this is that I feel that if prozac truly helps discontinue other SSRI's then go for a very low dose and see what happens. And klonopin did depress me. And please let me know how it goes. Love Phillipa Waving!!!!!!
Posted by orbital on August 8, 2010, at 22:33:35
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 8, 2010, at 22:27:46
Thanks, Morgan.. I think I'd like to try milnacipran after my SSRI break, I'll search the archives for more info. Thank you so much!
Matt.
> Whatever you do, good luck!
>
> Morgan
Posted by linkadge on August 9, 2010, at 7:33:44
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by orbital on August 8, 2010, at 22:13:32
No, I havn't taken modafinil, but I recently read a study which suggests it has occupancy at the dopamine transporter (like ritalin).
I know some people use it for refractory depression, like stimulants, with sucess.
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