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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by merpmerp on December 6, 2010, at 9:56:41
I met with the pdoc today and though she didn't seem happy about it, she said I could stay on the 2.5 mg of Lexapro. The thing is I'm not sure I want to; I can feel a daily change in my moods depending (I think) on how much is being metabolized. But we won't be making any changes now because I'm leaving the country in a week for the holidays.
I feel tired and weepy today and I did last night too, for the first time in a while. No real reason for it. Of course this has me concerned that the 2.5 mg isn't enough, despite the fact that I was getting nasty side effects at 5 mg.
Doc says that 2.5 mg of Lexapro is like 1 mg of Prozac. That sounds incredibly wrong to me.
Not sure if I want to ask her about trying Wellbutrin. It's been suggested to me by my counselor. The thing that concerns me is its potential to increase anxiety, which I already have enough, and also the fact that it doesn't seem to have very flexible dosing options, so I can't try an insanely low dose if I want to.
Posted by Phillipa on December 6, 2010, at 10:35:29
In reply to Pdoc meeting summary, posted by merpmerp on December 6, 2010, at 9:56:41
I don't know what to say you did consider going back to prozac I think you posted. But I guess that isn't an option now if you are making no changes. Hopefully the 2.5mg of lexapro will work for you. Can you post while gone? Phillipa
Posted by merpmerp on December 6, 2010, at 10:52:28
In reply to Re: Pdoc meeting summary » merpmerp, posted by Phillipa on December 6, 2010, at 10:35:29
Thanks for replying, Philipa :) I will almost certainly not be able to post while gone. I'm going to SE Asia for a wedding and then taking a tour to some rugged, historical sites and so I think I'll be jetlagged/off the beaten path most of the time.
I can wait till I get back - have another meeting with my pdoc set up in January. However I'm not sure she'll listen to me if I want to try something else to avoid the daily roller coaster Lex puts me on. I do still want to try low dose Prozac, very much so. But not right now, not before I'm about to leave and throw my schedule entirely out of whack.
I hope you are doing well!
> I don't know what to say you did consider going back to prozac I think you posted. But I guess that isn't an option now if you are making no changes. Hopefully the 2.5mg of lexapro will work for you. Can you post while gone? Phillipa
Posted by ed_uk2010 on December 6, 2010, at 13:34:03
In reply to Pdoc meeting summary, posted by merpmerp on December 6, 2010, at 9:56:41
>Doc says that 2.5 mg of Lexapro is like 1 mg of Prozac. That sounds incredibly wrong to me.
It is. I'd say that 2.5mg of Lexapro is more like 5mg of Prozac, but response will vary.
Posted by Christ_empowered on December 6, 2010, at 13:42:05
In reply to Re: Pdoc meeting summary » Phillipa, posted by merpmerp on December 6, 2010, at 10:52:28
I'm not a doc or anything, but do you think maybe you should/could try something besides (or in addition to) antidepressants for your issues?
Posted by merpmerp on December 6, 2010, at 13:53:12
In reply to Re: Pdoc meeting summary, posted by ed_uk2010 on December 6, 2010, at 13:34:03
Right, I don't know the exact conversion or if such a thing can even be done, but I sat there stunned for a minute because I was certain that 2.5 mg Lexapro does not equal an even smaller dose of Prozac!
I said to her (I'm not very assertive so I phrased it as a question), "But isn't Lexapro the most selective of the SSRIs so you could say it's 'stronger' than Prozac?" and she gave me a dodgy* answer about how you couldn't really make that claim or comparison, despite the fact that she had just made that comparison by telling me that 2.5 mg Lex = 1 mg Proz.
> It is. I'd say that 2.5mg of Lexapro is more like 5mg of Prozac, but response will vary.
*my interpretation
Posted by merpmerp on December 6, 2010, at 13:58:30
In reply to Re: Pdoc meeting summary, posted by Christ_empowered on December 6, 2010, at 13:42:05
Such as? (I mean that honestly; I'm soliciting suggestions.)
At this point I think the problem is my doc wants to overmedicate me with too high of doses. (And I am thinking I may have to ditch SSRIs at some point.)
I don't have panic or severe anxiety except when having a bad med reaction, so I don't think benzos are the way to go. I don't have problems with motivation or attention except when Lexapro is turning me into an apathetic sleep zombie, so I don't think stimulants like Adderall are needed. There's no bipolar in my family, I've never had anything I would consider even hypomania, and I have specifically asked my pdoc if she thought I was bipolar and the answer was no, so I don't think I need a mood stabilizer. (I know that they do also have their place in refractory depression.)
What I'm trying to do here is find a low maintenance dose of something to prevent future relapses. Without a med, I seem to slowly relapse into depression every 2-3 years like clockwork, since I was 14 (now 25). My older siblings, who are unmedicated, also have this pattern. I want to prevent that with meds. But I'm wondering if that's even possible :\
Posted by Phillipa on December 6, 2010, at 19:50:59
In reply to Re: Pdoc meeting summary, posted by ed_uk2010 on December 6, 2010, at 13:34:03
Ed seriously 5mg of prozac the one that stimulated me the time I tried the 20mg. Wouldn't the prozac built up to higher levels than lexapro? PJ
Posted by shes_initforthemoney on December 6, 2010, at 20:23:28
In reply to Re: Pdoc meeting summary » ed_uk2010, posted by merpmerp on December 6, 2010, at 13:53:12
> Right, I don't know the exact conversion or if such a thing can even be done, but I sat there stunned for a minute because I was certain that 2.5 mg Lexapro does not equal an even smaller dose of Prozac!
>
> I said to her (I'm not very assertive so I phrased it as a question), "But isn't Lexapro the most selective of the SSRIs so you could say it's 'stronger' than Prozac?" and she gave me a dodgy* answer about how you couldn't really make that claim or comparison, despite the fact that she had just made that comparison by telling me that 2.5 mg Lex = 1 mg Proz.
>
> > It is. I'd say that 2.5mg of Lexapro is more like 5mg of Prozac, but response will vary.
>
> *my interpretationWhat my current doc has always said to me is that, basically, "..whatever works for you, works for you!". As the writer Andrew Sololman said in his excellent book on depression "Noonday Demon" , "Don't let them fool you just because they have a piece of paper on the wall." 10-20mg is starting dose for Prozac. 5-10mg starting dose for Lexapro. There is no logic in saying that 2.5mg of Lexapro would equal 1mg of Prozac. If you can, try to shop for a new pdoc, or even get your GP to take over your meds.
Best wishes,
Jay
Posted by merpmerp on December 6, 2010, at 20:27:12
In reply to Re: Pdoc meeting summary » merpmerp, posted by shes_initforthemoney on December 6, 2010, at 20:23:28
Thanks, Jay :)
Oddly enough I went with a pdoc this time because I thought "hey, they know what they're doing, got to be better than a GP right?" but I've had better luck with my old GP years ago than I have with this pdoc. My GP seemed more willing to listen to my ideas and wasn't as patronizing, didn't have as much ego wrapped up in it.
Would you recommend the book Noonday Demon? I was thinking about reading it, now that I'm in a more stable place. When I was in the depths of depression, ironically, I didn't feel that a book on depression would be good for me, I thought it would just trigger me and make me feel like rubbish so I steered clear of them.
Posted by emmanuel98 on December 6, 2010, at 20:52:46
In reply to Pdoc meeting summary, posted by merpmerp on December 6, 2010, at 9:56:41
I wouldn't try wellbutrin before going on a holiday. I started it about a week before going to the UK and it had a parodoxical effect on me of making me exhausted and depressed. My p-doc said, stop it immediately and go back to what you were taking (cymbalta) just to get through the vacation, then we would reevaluate.
Posted by merpmerp on December 6, 2010, at 20:54:00
In reply to Re: Pdoc meeting summary, posted by emmanuel98 on December 6, 2010, at 20:52:46
Thanks for confirming what I was thinking - don't need to add start up effects to being severely jet lagged and in an entirely different culture! :)
Posted by whitmore on December 6, 2010, at 21:10:01
In reply to Re: Pdoc meeting summary » emmanuel98, posted by merpmerp on December 6, 2010, at 20:54:00
Interestingly my post above is saying basically what your are--that our GP's are more flexible and open-minded than our P-docs. I've known my GP for 18 years, so perhaps that's a contributing factor. Anyway, I found 2 mg of Prozac to be awesome in the same way as I found 2.5 mg of Paxil to be very effective. Both 'sub-clinical' doses according to the docs., but I always thought how lucky I was not to have to take such high doses in order to get the same effect. Until my current meltdown, which is uncharacteristic, I was stable for years on these low doses.
Posted by merpmerp on December 6, 2010, at 21:14:32
In reply to Re: Pdoc meeting summary, posted by whitmore on December 6, 2010, at 21:10:01
Thank you, whitmore, for sharing your experience of having success with "sub-therapeutic doses." I know the old caveat "anecdotal data doesn't mean much" but if the only question you're asking is "have these low doses ever worked for anyone, ever, in the history of the world" and the answer is YES, than that means that it is indeed within the realm of possibility that these doses can have a therapeutic effect. :)
I'm very sorry to hear about your current meltdown and I hope things get better for you. Having a setback like that is very distressing, I know from experience.
Posted by Hombre on December 8, 2010, at 0:37:09
In reply to Re: Pdoc meeting summary, posted by whitmore on December 6, 2010, at 21:10:01
Have you tried St. John's Wort? I'm just wondering if low doses of SSRIs are too strong or cause uncomfortable reactions, would SJW be able to exert a milder effect?
What sorts of symptoms do you get if you aren't on medication, and you start to feel the depression coming on? Any physical complaints? Fatigue?
Posted by merpmerp on December 8, 2010, at 10:43:03
In reply to Re: Pdoc meeting summary, posted by Hombre on December 8, 2010, at 0:37:09
Hi Hombre,
I too am wondering about SJW. Or talking with my (sometimes uncooperative) pdoc about switching to something that doesn't affect serotonin.
When depressed, I don't really feel fatigue. I can still get up and function, with extreme effort. I have insomnia (the classic "melancholic" type of not being able to get to sleep at first then becoming wide awake at 3 or 4 AM), psychomotor retardation (moving and thinking verrrrrryyyy slowwwwwwwwwly), inappropriate guilt and excessive rumination, and the dreaded *s* ideation which usually brings me in for treatment (because I'm too stubborn to go in before then, but I am making a concerted effort to change that).
Thoughts are appreciated :D
> Have you tried St. John's Wort? I'm just wondering if low doses of SSRIs are too strong or cause uncomfortable reactions, would SJW be able to exert a milder effect?
>
> What sorts of symptoms do you get if you aren't on medication, and you start to feel the depression coming on? Any physical complaints? Fatigue?
Posted by merpmerp on December 8, 2010, at 10:51:57
In reply to Pdoc meeting summary, posted by merpmerp on December 6, 2010, at 9:56:41
In the vein of the St. John's Wort, I am also considering trying my luck off antidepressants and just using supplements like tyrosine, SJW, or 5HTP (I know not to take SJW + 5HTP, I will choose one or the other.) I do take fish oil and a multivitamin every day. I tried Vitamn B capsules but they gave me flushing/a rash, so I had to stop that.
I'm just posting a lot because I'm frustrated, and I'm impatient but obviously don't want to make any changes now before I leave the country. Thanks everyone for responding to me and having patience :)
This is the end of the thread.
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