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Dr. Bob is Robert Hsiung, MD,
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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.
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> Simpler is better IMHO.
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> Linkadge
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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.
Posted by orbital on August 9, 2010, at 13:06:59
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by linkadge on August 9, 2010, at 7:33:44
Modafinil was a very good add-on medication for me a couple of year ago. This time around, though, it just caused anxiety and discomfort. It's like I've suddenly become sensitive to medication.
I'll ask my doc about methylphenidate, nothing to lose. Thanks for the suggestion.
> 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.
>
>
Posted by orbital on August 9, 2010, at 13:30:19
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by orbital on August 9, 2010, at 13:06:59
I reread my initial post and can't help but think it sounds pretty crazy, if not disturbing. I mean all of the drastic measures my doc and I took to combat what's probably SSRI-induced anhedonia / apathy.
I've been on one AD or another for a decade. I'm quite peeved that my doc has never bothered to do a re-evaluation to determine if maybe I don't need meds anymore. Maybe my initial condition has resolved or is in remission, thanks to pharma and regular therapy, and now my med regime offers little benefit and plenty of side effects.
That's why I've decided to stop my meds. I'll be seeing my doctor soon, hopefully she'll be supportive and offer a reasonable method to accomplish this. If my symptoms come back, I'll be back on meds in a heartbeat. Right now, though, I want out of this constant fog, lack of motivation and emotional numbness - I simply cannot keep going like this.
I appreciate your suggestions. Thank you!
Posted by ed_uk2010 on August 9, 2010, at 15:17:02
In reply to Re: Fluoxetine » ed_uk2010, posted by orbital on August 8, 2010, at 22:04:41
> 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.
Lilly do market fluoxetine as a once weekly med too, it's a 90mg capsule called 'Prozac Weekly'. It's available in the US but not in most countries. The weekly version is for maintenace treatment only, and cannot be used to initiate treatment.
>I've had enough, I think I'm going to give them all a miss for a while.
Best of luck. You might find that you feel much better without meds. That would be great.
Posted by Phillipa on August 9, 2010, at 20:00:38
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by orbital on August 8, 2010, at 22:31:28
Orbital well this get interesting as the next I took after quite a few years was paxil l0mg had to add lopressor 25mg pluse the benzos to tolerate. For three months was a zoombie and then was okay. Went back to working and took for two years then idiot doc took me off for celexa which did me in. Now I'm also sensitive or just nothing with meds. Strange isn't it? Phillipa
Posted by linkadge on August 9, 2010, at 20:08:57
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by orbital on August 9, 2010, at 13:06:59
If something works for your depression, you could treat the anxiety separately.
I.e. if something like modafanil, wellbutrin, desipramine etc, worked for depression, you could continue to take the clonazepam for anxiety.
Linkadge
Posted by morgan miller on August 9, 2010, at 21:56:51
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by orbital on August 9, 2010, at 13:06:59
I didn't do well with modanafil, it was pretty bad actually. Some people absolutely love it though.
I've considered methylphenidate. I actually think I might want to try dexmethylphenidate as it may have a "cleaner" or smoother effect and feel. I will be asking for some Focalin XR in a few months if my energy levels and brain function don't start to improve drastically.
Posted by violette on August 10, 2010, at 12:31:02
In reply to Off Lexapro? - apathy syndrome //Help!, posted by orbital on August 8, 2010, at 15:49:57
Hi Orbital,
Personally, I think apathy, amotivation, and 'post-SSRI syndrome' are more related to psychological issues that need addressed. Of course, if you don't believe in the psychodynamic concepts, you wouldn't agree. At the same time, I think people can do themselves a disservice by searching for the right med to dissolve such symptoms, which could prolong illness. I think it's positive that you are reassessing your medication search.
I just found this website, wish I found it soooner as it offers a quick reference summary of psychodynamic concepts. Hope it helps. If not, maybe it will help someone else....Good luck. :)
(Apathy can also be an indication of a neurological disorder.)
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/apathy.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/annihilation.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/defensive_reactions_d.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/corrective_emotional_experience.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/isolation_.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/stress.html
Posted by violette on August 10, 2010, at 12:42:58
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by violette on August 10, 2010, at 12:31:02
Well, that website wasn't as inclusive as I had initially thought...
There are representations of apathy, lack of motivation in many case studies about patients in therapy which always seem to trace back to childhood experiences. It is an expression of inner state for many mental "disorders", while attributing the symptom with specific diagnoses doesn't fully explain the concept.
Posted by morgan miller on August 10, 2010, at 18:55:59
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by violette on August 10, 2010, at 12:31:02
Violette, I totally agree with your psychodynamic views. The problem is, most people to do not want to face their deep inner pain, sadness, and anger. Most people do not want to put in 2 or 3 years of hard work to get there. Most people, as soon as they feel better, decide they don't need therapy. Most people do not want to analyze and drudge up the past. And, most people have a difficult time finding a really good empathetic and compassionate therapist that they like and feel comfortable with.
I'm all for psychodynamic therapy, I think everyone, with an illness or without, should spent some time in therapy-hardly any of us got what we needed growing up.
Morgan
Posted by violette on August 10, 2010, at 19:23:31
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 10, 2010, at 18:55:59
Yes, I agree that may be true for some (I have no idea if it's most or some). And I also think some might possibly be better off leaving that stuff unadressed.
I just resent that various psychiatrists put me on med after med for years w/o even assessing my core issues-delaying and prolonging my recovery...and making me worse off in the long run.
And hope that at least someone here will take note of the possibility and not have to go through what I did. Especially those who are younger and have more opportunities. Some of the best years of my life were wasted..not totally wasted, but you know what I mean...
:)
(Hoping for > 1 person though)
Posted by morgan miller on August 10, 2010, at 19:44:14
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by violette on August 10, 2010, at 19:23:31
I feel the same way you do in regards to being diagnose with bipolar so late after it was pretty obvious I had already experienced a few mixed episodes in my life. I understand where you are coming from, it sucks, and you only have one youth.
Morgan
Posted by violette on August 10, 2010, at 19:54:36
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 10, 2010, at 19:44:14
Yes that's sucks too...Bipolar is difficult to diagnosis as certain symptoms and patterns have to appear first in order to evaluate them..and the ave. time frame to arrive at a correct dx for bipolar is something like 10 years (if I recall correctly-would have to look it up to be exact).
However, an innacurate dx is a bit different than not addressing psychological aspects of mental health...
Posted by morgan miller on August 10, 2010, at 20:06:50
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by violette on August 10, 2010, at 19:54:36
> Yes that's sucks too...Bipolar is difficult to diagnosis as certain symptoms and patterns have to appear first in order to evaluate them..and the ave. time frame to arrive at a correct dx for bipolar is something like 10 years (if I recall correctly-would have to look it up to be exact).
>
> However, an innacurate dx is a bit different than not addressing psychological aspects of mental health...
>
I actually have to disagree. Not getting diagnose earlier had a profound impact on my life, things that I did and did not do, and how the illness progressed.I also needed psychodynamic therapy, but I needed just as much an awareness and education on the genetic aspect of my struggles in life.
There are so many things one can do to prevent episodes and further progression of an illness. Knowing that you have an illness can empower you and can have equally as great an impact as psychodynamic therapy. I do think therapy and some hard work can also help treat a genetic illness as everything that went wrong in childhood likely contributed to the development and progression of the illness.
Morgan
Posted by violette on August 10, 2010, at 20:11:45
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 10, 2010, at 20:06:50
No, I agree with you Morgan-the effect of the situation is similar. I was emphasizing lack of addressing psychological issues-and just dispensing pills rather than correct/incorrect dx.
I think the issue I was pointing out is more of a systematic problem.
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