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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 38. Go back in thread:
Posted by SLS on April 15, 2011, at 20:53:00
In reply to Prozac and Anafranil, posted by kolwolf on April 15, 2011, at 18:59:04
> Hi,
>
> This is my first post here. I went to a psychiatrist for the first time today, and he prescribed me Prozac (20mg), Anafranil (25mg), and Klonopin (0.5mg) for my OCD, anxiety, and depression.
>
> I have not started taking them yet, but I just read that it is potentially very dangerous to combine an SSRI with a TCA. The doses are all low, and I'd like to think my pdoc knows what he's doing, but the things I've read worry me greatly. Is this a safe combination at those doses? I have not yet had a chance to share my fears about it with him.
>
> I have read a few anecdotal experiences about success with the two, but in general there seems to be very little on the internet about the combination.
>
> Thanks...
Combinations of TCA and SSRI are generally safe. Your doctor seems to know what he is doing. What gave you the idea that there was a problem with combining these drugs?Good luck.
- Scott
Posted by Lou Pilder on April 15, 2011, at 21:33:14
In reply to Prozac and Anafranil, posted by kolwolf on April 15, 2011, at 18:59:04
> Hi,
>
> This is my first post here. I went to a psychiatrist for the first time today, and he prescribed me Prozac (20mg), Anafranil (25mg), and Klonopin (0.5mg) for my OCD, anxiety, and depression.
>
> I have not started taking them yet, but I just read that it is potentially very dangerous to combine an SSRI with a TCA. The doses are all low, and I'd like to think my pdoc knows what he's doing, but the things I've read worry me greatly. Is this a safe combination at those doses? I have not yet had a chance to share my fears about it with him.
>
> I have read a few anecdotal experiences about success with the two, but in general there seems to be very little on the internet about the combination.
>
> Thanks...kolwolf,
You wrote,[...it is potentially very dangerous to combine an SSRI with a TCA...]
There is a continual body of knowledge that goes to what you wrote...
Lou
http://www.drugs.com/drug-interactions/anafranil-with-prozac-702-355-1115-648.html
Posted by Phillipa on April 15, 2011, at 21:55:34
In reply to Prozac and Anafranil, posted by kolwolf on April 15, 2011, at 18:59:04
Anafranil at 25mg sounds like a safe dose to me. Phillipa
Posted by kolwolf on April 16, 2011, at 3:02:42
In reply to Re: Prozac and Anafranil » kolwolf, posted by SLS on April 15, 2011, at 20:53:00
I read on Wikipedia that they weren't safe to combine, and then I saw this:
http://www.drugs.com/drug-interactions/anafranil-with-prozac-702-355-1115-648.html
Needless to say, it freaked me out.
Posted by SLS on April 16, 2011, at 5:38:33
In reply to Re: Prozac and Anafranil, posted by kolwolf on April 16, 2011, at 3:02:42
> I read on Wikipedia that they weren't safe to combine, and then I saw this:
>
> http://www.drugs.com/drug-interactions/anafranil-with-prozac-702-355-1115-648.html
>
> Needless to say, it freaked me out.I really do apologize. I had forgotten about the enzymatic interaction. Paroxetine and fluvoxamine are the other drugs that increase levels of clomipramine, albeit by different mechanisms. When I combined paroxetine with desipramine, I simply reduced the dosage of desipramine by half. Blood tests can monitor the level of clomipramine, so you can evaluate different dosages of TCA. If you are caucasion, you might be an extensive-metabolizer, in which case you would need higher dosages of clomipramine.
Here is a study indicating greater efficacy of a combination clomipramine and SSRI than either drug alone:
http://www.ncbi.nlm.nih.gov/pubmed/9639080
Again, I apologize for my oversight. Just know that it can take significantly longer to respond to treatment for OCD than it does for depression. Higher dosages are often needed as well. Perhaps your doctor already took this into consideration.
- Scott
Posted by SLS on April 16, 2011, at 5:40:47
In reply to Lou's request-contnualbdyvknow » kolwolf, posted by Lou Pilder on April 15, 2011, at 21:33:14
Hi Lou.
Good catch!
- Scott
> > Hi,
> >
> > This is my first post here. I went to a psychiatrist for the first time today, and he prescribed me Prozac (20mg), Anafranil (25mg), and Klonopin (0.5mg) for my OCD, anxiety, and depression.
> >
> > I have not started taking them yet, but I just read that it is potentially very dangerous to combine an SSRI with a TCA. The doses are all low, and I'd like to think my pdoc knows what he's doing, but the things I've read worry me greatly. Is this a safe combination at those doses? I have not yet had a chance to share my fears about it with him.
> >
> > I have read a few anecdotal experiences about success with the two, but in general there seems to be very little on the internet about the combination.
> >
> > Thanks...
>
> kolwolf,
> You wrote,[...it is potentially very dangerous to combine an SSRI with a TCA...]
> There is a continual body of knowledge that goes to what you wrote...
> Lou
> http://www.drugs.com/drug-interactions/anafranil-with-prozac-702-355-1115-648.html
Posted by kolwolf on April 16, 2011, at 16:00:40
In reply to Re: Prozac and Anafranil » kolwolf, posted by SLS on April 16, 2011, at 5:38:33
Interesting. Perhaps the two together, at small doses, will be more effective sooner than one or the other at a higher dose?
Posted by Phillipa on April 16, 2011, at 20:12:37
In reply to Re: Prozac and Anafranil, posted by kolwolf on April 16, 2011, at 3:02:42
It also would me. Phillipa
Posted by SLS on April 17, 2011, at 5:24:10
In reply to Re: Prozac and Anafranil, posted by kolwolf on April 16, 2011, at 16:00:40
> Interesting. Perhaps the two together, at small doses, will be more effective sooner than one or the other at a higher dose?
That's a hard one. I tend to doubt it, at least according to my own observation. It seems to me that you would need full therapeutic dosages of both drugs. However, I would remind you that a therapeutic dosage of clomipramine is that which produces a blood level of about 150-300 ng/ml for depression and 200-400 ng/l for OCD. That could be as little as 50mg of clomipramine when combined with Prozac. Use blood tests. These values are consistent with most of the medical literature on the topic. I saw nothing that would lead me to believe that serotonin syndrome is a likely outcome. There are people on Psycho-Babble who believe that lower dosages are ideal. I would want to see evidence of this contention, though.
- Scott
Posted by Roslynn on April 17, 2011, at 12:33:28
In reply to Prozac and Anafranil, posted by kolwolf on April 15, 2011, at 18:59:04
Hi,
The combo of Prozac and anafranil is/was successful for me. I believe there is some risk of serotonin syndrome, so taking the lowest dose of each drug, if you are going to take them together, would be good.
Roslynn
> Hi,
>
> This is my first post here. I went to a psychiatrist for the first time today, and he prescribed me Prozac (20mg), Anafranil (25mg), and Klonopin (0.5mg) for my OCD, anxiety, and depression.
>
> I have not started taking them yet, but I just read that it is potentially very dangerous to combine an SSRI with a TCA. The doses are all low, and I'd like to think my pdoc knows what he's doing, but the things I've read worry me greatly. Is this a safe combination at those doses? I have not yet had a chance to share my fears about it with him.
>
> I have read a few anecdotal experiences about success with the two, but in general there seems to be very little on the internet about the combination.
>
> Thanks...
Posted by SLS on April 17, 2011, at 17:20:21
In reply to Re: Prozac and Anafranil, posted by Roslynn on April 17, 2011, at 12:33:28
Hi Roslynn.
> The combo of Prozac and anafranil is/was successful for me. I believe there is some risk of serotonin syndrome, so taking the lowest dose of each drug, if you are going to take them together, would be good.
What dosages did you use?
- Scott
Posted by Phillipa on April 17, 2011, at 20:59:50
In reply to Re: Prozac and Anafranil » kolwolf, posted by SLS on April 17, 2011, at 5:24:10
Scott my pdoc now uses much lower doses of meds to start. Asked her why and she said that if you can lessen or prevent side effects more people are likely to keep taking a med. Phillipa
Posted by SLS on April 17, 2011, at 21:57:28
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 17, 2011, at 20:59:50
> Scott my pdoc now uses much lower doses of meds to start. Asked her why and she said that if you can lessen or prevent side effects more people are likely to keep taking a med. Phillipa
This is not a new concept.
Are there any differences in the final dosages arrived at? What are some examples?
- Scott
Posted by Roslynn on April 18, 2011, at 14:37:07
In reply to Re: Prozac and Anafranil » Roslynn, posted by SLS on April 17, 2011, at 17:20:21
Hi Scott,
I was on clomipramine 50mg and Prozac 60mg. But I also take lithobid, seroquel and ativan. The clomipramine was the last drug added to my cocktail and it was the one that finally had a positive result.
Right now I had a brief trial (unsuccessful) of Lexapro and am planning on going back to Prozac.
I hope all is well with you, Scott.Roslynn
> Hi Roslynn.
>
> > The combo of Prozac and anafranil is/was successful for me. I believe there is some risk of serotonin syndrome, so taking the lowest dose of each drug, if you are going to take them together, would be good.
>
>
> What dosages did you use?
>
>
> - Scott
Posted by SLS on April 18, 2011, at 15:22:33
In reply to Re: Prozac and Anafranil » SLS, posted by Roslynn on April 18, 2011, at 14:37:07
Hi Roslynn.
Did you ever get a blood level of clomipramine while you were taking 50mg?
> Hi Scott
>
> I hope all is well with you, Scott.
>
> Roslynn
Thanks for the well-wishes.Every day brings me closer to remission. I feel pretty good. I hit a plateau for about a week, but I am moving forward again. Improvement is very gradual. It might take another year before I recover 100%. This reflects the severity and length of my illness. I have observed that some people must wait four months before Nardil kicks in. I began to respond to it at the beginning of the fourth month. I am extremely fortunate.
Be well.
- Scott
Posted by Phillipa on April 18, 2011, at 19:41:45
In reply to Re: Prozac and Anafranil » Phillipa, posted by SLS on April 17, 2011, at 21:57:28
Scott depends on the person and their response. Mine doesn't feel coctails are What works just her opinion. For example fine to take what I do 50mg of luvox & 2.5 or 5mg of lexapro, and the lowe dose of benzos. Deplin is okay as a medicinal food and vitamins. I do remember when she would say give 50mg of luvox and raise it daily to maximum doseage. She has one patient still on an Maoi from years ago. I know she takes pristiq herself at the lowest dose and it works for her. You would have to ask her yourself what her maximum doses of a med are as can't speak for her. Just my own experiences with her. Back years ago prozac would have been a definite 20mg and now she presribes l0 or less of prozac to start. That's an example. Know cause one time she was going to give me some. Phillipa
Posted by SLS on April 18, 2011, at 20:12:32
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 18, 2011, at 19:41:45
> Scott depends on the person and their response.
Doesn't it always?
> Mine doesn't feel coctails are What works just her opinion.
My opinion of her opinion is that she is doing her patients a great disservice by denying them proven effective treatment alternatives.
> You would have to ask her yourself what her maximum doses of a med are as can't speak for her.
I don't think that would be appropriate. My question to you is whether or not it is your doctor's practice to use subtherapeutic dosages of the drugs she prescribes. Is this what you were trying to convey?
- Scott
Posted by Phillipa on April 18, 2011, at 21:33:21
In reply to Re: Prozac and Anafranil » Phillipa, posted by SLS on April 18, 2011, at 20:12:32
No as I wrote starting doses. She doesn't encourage me to raise a thing. Does that answer better not sure but best that I have. Not all docs feel meds are the whole answer as she utilizes a lot of therapists in her practice and also her sessions are over an hour if need be. Phillipa she feels it's my choice what dose or meds I take.
Posted by SLS on April 19, 2011, at 9:11:10
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 18, 2011, at 21:33:21
> No as I wrote starting doses. She doesn't encourage me to raise a thing.
Great.
> Does that answer better
Not really. I wanted to know if she had become a believer in using substantially lower dosages of medication. If you don't know, you don't know.
> Not all docs feel meds are the whole answer
What does your doctor recommend for you besides medication?
> she feels it's my choice what dose or meds I take.
Great.
What do you think is keeping you from feeling the way you would like to feel?
- Scott
Posted by SLS on April 19, 2011, at 20:56:09
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 18, 2011, at 21:33:21
No response?
http://www.dr-bob.org/babble/20110418/msgs/983250.html
- Scott
Posted by Phillipa on April 19, 2011, at 21:00:17
In reply to Re: Prozac and Anafranil » Phillipa, posted by SLS on April 19, 2011, at 9:11:10
Physical pain the combo of osteoarthritis in back, bone spurs, spinal stenosis, curvature of spine, and osteoporosis the fear that doing something wrong will cause a bone to break. Also the fact that even though I have six bands positive for lymes disease the infection control doc just doesn't know what to do as antibiotics can cause a multitude of problems themselves. Lack of medical insurance, pain after any excercise and I was an athlete all my life. I refuse to give that up. And seems from the google seaches have done that since pain meds are not prescribed here as the docs feel they are abused that surgery isn't an option as no healing with osteoporosis to correct the discs. No good bone to bond with. See neuro spinal doc in a bit over a week. Have a look at his site if you like. Carolina Neurosurgery and Spine. Dr Hunter Dyer is who I will see trained in France. Recommended from the foot and ankle doc when I fell over a cement abuttment that shouldn't have been placed where it was in a parking lot. Sprained my ankle. The Abuttment was removed two days later. A Lady ran over when saw me with the managers and said remove that my Mother fell two years ago and broke her back on this. I'ts the only one in any parking lot around shopping cart holders. So too much stress and extenuating circumstances in my life have literally knocked me down. Phillipa
Posted by SLS on April 19, 2011, at 21:18:42
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 19, 2011, at 21:00:17
> So too much stress and extenuating circumstances in my life have literally knocked me down. Phillipa
Again, what prevents you from feeling the way you want to feel? Viewed another way, why has your doctor failed at making you feel better than you do right now? Have there been any treatment suggestions made by your doctor that you decided to forgo? Are you afraid of change?
"Change will come when the pain of staying the same is worse than the pain of change."
I hope you haven't given up.
- Scott
Posted by sigismund on April 19, 2011, at 21:36:30
In reply to Re: Prozac and Anafranil » Phillipa, posted by SLS on April 19, 2011, at 21:18:42
We're not quite as good as dead but we (PJ and I) are certainly over the hill. Some of it is just age and there is not such a lot you (we) can do about it. It's quite interesting, all the people I know who get cancer now, almost one a week (you might get something worth taking then, did wonders for my mother's depression). Dying takes a while too. So if you ever wondered why you are feeling bad........
Posted by Phillipa on April 19, 2011, at 21:44:29
In reply to Re: Prozac and Anafranil, posted by sigismund on April 19, 2011, at 21:36:30
Sigi and boy that hill is sure getting a lot taller would you say? PJ
Posted by sigismund on April 19, 2011, at 21:52:08
In reply to Re: Prozac and Anafranil » sigismund, posted by Phillipa on April 19, 2011, at 21:44:29
>boy that hill is sure getting a lot taller would you say?
Sure is. You don't feel that good, do you, and this is just the beginning. But what can you do?
I like the look of the world a lot more now that I know I will be leaving it soon.
Everything is soon now, and it wasn't once. Once it seemed like there was all the time in the world.
But things look (as opposed to feel) so much better. Young people, of course, but also colours and the sky and plants and clouds.
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